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Original Articles

Chronology and Determinants of Tissue Repair in Diabetic Lower-Extremity Ulcers

  1. Roger E Pecoraro,
  2. Jessie H Ahroni,
  3. Edward J Boyko and
  4. Victoria L Stensel
  1. Medical Service, Seattle Veterans Affairs Medical Center, and the Division of General Internal Medicine and the Department of Medicine, University of Washington School of Medicine Seattle, Washington
  1. Address correspondence and reprint requests to Roger E. Pecoraro, MD, Seattle Veterans Affairs Medical Center, GIMC (111M), 1660 South Columbian Way, Seattle, WA 98108.
Diabetes 1991 Oct; 40(10): 1305-1313. https://doi.org/10.2337/diab.40.10.1305
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Abstract

The natural history of tissue repair and the critical determinants of faulty healing of diabetic ulcers remain obscure despite recent advances in our knowledge of the cellular physiology of normal cutaneous healing. To characterize the chronology and identify important factors affecting healing, we applied an objective method to quantify the rate of wound healing of full-thickness lower-extremity ulcers in 46 diabetic outpatients who received local wound care under a standardized clinical protocol. The initial ulcer healing rate, eventual status of tissue repair, and definitive clinical outcome were not significantly associated with age; diabetes type, duration, or treatment; level or change in glycosylated hemoglobin; current smoking; presence of sensory neuropathy; ulcer location or class; initial infection; or frequency of recurrent infections. However, direct measures of local cutaneous perfusion, estimated by periwound measurements of transcutaneous O2 tension (TcPo2) and transcutaneous CO2 tension (TcPco2), were significantly associated with the initial rate of tissue repair (P = 0.003 and 0.005, respectively). The strong prediction of early healing by these parameters of local skin perfusion was independent from the effects of segmental Doppler arterial blood pressure at the dorsalis pedis, although eventual ulcer reepithelialization was significantly related to foot blood pressure and periwound TcPo2 and TcPco2. We conclude that periwound cutaneous perfusion is the critical physiological determinant of diabetic ulcer healing, indicating a 39-fold increased risk of early healing failure when the average periwound TcPo2 is <20 mmHg.

  • Received January 4, 1991.
  • Revision received April 4, 1991.
  • Accepted April 4, 1991.
  • Copyright © 1991 by the American Diabetes Association

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October 1991, 40(10)
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Chronology and Determinants of Tissue Repair in Diabetic Lower-Extremity Ulcers
Roger E Pecoraro, Jessie H Ahroni, Edward J Boyko, Victoria L Stensel
Diabetes Oct 1991, 40 (10) 1305-1313; DOI: 10.2337/diab.40.10.1305

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Chronology and Determinants of Tissue Repair in Diabetic Lower-Extremity Ulcers
Roger E Pecoraro, Jessie H Ahroni, Edward J Boyko, Victoria L Stensel
Diabetes Oct 1991, 40 (10) 1305-1313; DOI: 10.2337/diab.40.10.1305
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