ORIGINAL ARTICLE   

Minerva Chirurgica 2017 June;72(3):200-5

DOI: 10.23736/S0026-4733.16.07157-1

Copyright © 2016 EDIZIONI MINERVA MEDICA

language: English

The influence of different debridement methods on the prognosis of elderly patients with diabetic foot ulcers and sepsis

Qintong YANG ¹, Yemin CAO ¹, Yudong FANG ¹, Bin LI ¹, Puqing ZHAO ², Weiling WANG ³, Lingfeng YIN ¹, Hongtao XU ¹, Gaowu HU ⁴ ✉

¹ Angiopathy Department, Shanghai University of TCM, Shanghai TCM-Integrated Hospital, Shanghai, China; ² Endocrine Department, Shanghai University of TCM, Shanghai TCM-Integrated Hospital, Shanghai, China; ³ Clinical Laboratory, Shanghai University of TCM, Shanghai TCM-Integrated Hospital, Shanghai, China; ⁴ Surgical Department, Shanghai University of TCM, Shanghai TCM-Integrated Hospital, Shanghai, China

BACKGROUND: We evaluated the influence of different debridement methods on the prognosis of elderly patients with diabetic foot ulcers complicated with sepsis.
METHODS: Retrospective study was adopted to study 65 hospitalized elderly patients with Wagner Grade-4 diabetic foot ulcer and sepsis in Vascular Disease Department of Shanghai TCM-Integrated Hospital. Thirty-two cases were included in the thorough debridement group and the other 33 were included in the minor debridement group. We compared the mortality rates on the 7th day and 14th day after debridement, and monitored changes of sepsis-related organ failure assessment (SOFA) Score as well as C-reactive protein (CRP), procalcitonin (PCT) and D-Dimer (D-D) levels. Cox regression analysis and Kaplan-Meier analysis were used to analyze the mortality rates. Binary logistic regression analysis was employed to screen relevant prognostic factors to see the prognostic value of SOFA Score, PCT and D-D.
RESULTS: Fatality rates of the thorough debridement group on the 7th day and 14th day of the debridement were higher than those in the minor debridement group and such a difference has statistical significance. The CRP, PCT, and D-D of patients within seven days after thorough debridement were obviously higher than those of patients after minor debridement.
CONCLUSIONS: Damage control should be provided for elderly patients with diabetic foot ulcers and sepsis when debridement is being performed. Palliative debridement methods such as small-scale incision and drainage are less likely to affect systematic inflammatory response and coagulation function, and thus can buy time for further treatment to improve clinical effect.

KEY WORDS: Diabetic foot - Debridement - Sepsis - Mortality