Comparison of angiosome based incision with conventional aggressive debridement for the treatment of diabetic foot ulcers.

Abstract

Objectives: To compare the efficacy of angiosome based incisions versus aggressive debridement for the treatment of diabetic foot ulcer. Study Design: Randomized Controlled Trial. Setting: Surgical Unit 1 Nishtar Medical University/ Hospital Multan. Period: 9 months duration, from 1^st January 2017 to 30^th September 2017. Material & Methods: Sample Size: Total 210 patients, 105 in each group. Sampling Technique: Non-probability, consecutive sampling. 210 patients of both genders with history of diabetes mellitus having Grade II diabetic foot ulcer below the ankle. Before the procedure, foot ulcers were measured and ulcer dimensions equal or greater than 4 cm² were included in the study. 105 patients were in angiosome based incision group (Group A), while105 patients were in aggressive debridement group (Group B). Patients were called for follow up after every 5 days. Regular dressings were done to allow more regular wound inspection and cleansing to avoid infection. Efficacy of treatment was finally determined after 30 days by measuring the ulcer dimension by similar procedure as done before the start of procedure. Data was noted on especially designed proforma. Results: Age range in this study was from 30 to 60 years with mean age of 45.971± 4.89 years in Group A while 46.457± 6.22 years in Group B. Mean duration of diabetes was 10.171±4.09 years in Group A and 10.561±5.58 years in Group B. Mean duration of foot ulcer was 3.895±2.72 months in Group A and 3.790±2.03 months in Group B. Mean size of foot ulcer was 5.047±1.52 cm² in Group A and 4.895±1.67 cm² in Group B. Mean weight of the patients was 68.238±10.44 kg in Group A and 67.742±9.53 Kg in Group B. Majority of the patients were of 46-60 years in  group A (63.8%) and in group B  (66.7%). Male gender was dominant in both group (73.3% and 55.25). In group A efficacy was seen in 96 (91.4%) patients as compare to 47 (44.8%) patients in group B, (P=0.000). Conclusion: Angiosome based incision in the treatment of diabetic foot ulcer has shown outstanding outcome with respect to wound healing compared with aggressive debridement.