Here - EWMA 2013

Key Session: What is Good Evidence in Wound Care and How do We Generate it?
159
Free Paper Session: Diabetic Foot II
158
Helping to raise the quality of research evidence in wound
management: lessons we have learnt
Treatment Results of Septic Complications and Mixed Forms of
Neuropathic Diabetic Foot
Patricia Price 1
Tamara Tamm 1 , M.S. Popov 1 , O.V. Danilova 1 , A.V. Pasechnik 1
1 Cardiff University (Cardiff, United Kingdom).
1 Ukrainian Wound Treatment Organisation (Ukraine).
In 2010 the EWMA Patient Outcome Group (POG) published recommendations to
improve the quality of evidence in wound management (www.ewma.org/english/
publications/ewma-pog- evidence-doc.html). As a companion piece of work, the EWMA
POG is working to provide a user-friendly document to assist those new to (or
inexperienced in) research in starting on the path to plan, conduct, interpret and
disseminate findings from a study that will improve our understanding of clinical wound
healing and raise the evidence level of the work undertaken in this important area. The
documents will relate to venous leg ulcers, in the first instance. The target audience for
this publication is hospital and community clinicians/researchers working collaboratively
with other professions or industry; the text will take the format of a ‘step by step’
instruction manual to highlight activities to consider and outline frequent mistakes that
many of us have made along the way – with the aim of helping novice researchers avoid
making them and improve the quality of studies that are undertaken. The emphasis will
focus on Randomised Controlled Trials (RCTs) and Cohort Studies that are prospective
(i.e., retrospective studies are not included): see Nice/UK: Guideline Manual 2009,
Appendix M for an outline of different study designs (www.nice.org.uk/guidelinesmanual.
As a European association, the focus will be on European regulations and directives.
Relevance: In contrast to medicamentous treatment, surgery problem of foot destructive
processes is not fixed, as connected with lack of consensus among surgeons as to
surgery choice for such patients, who do not consider the form of foot lesions.
Target: To improve patients treatment with purulent complications of Diabetic Foot
Syndrome (DFS) results by increasing number of patients with preserved leg support
function.
Materials and Methods: Where analyzed results of surgical treatment of 379 patients
with purulent DFS complications: 55 (14.5%) had ischemic form, 120 (31.7%) had
neuropathic and 204 (53.8%) – mixed. Volume of observation included clinical
examination, laboratory and instrumental methods.
Results: It was found that neuropathic form primarily affects bone and joint structure.
Suppurative arthritis and osteomyelitis were diagnosed in 294 (93.4%) patients with
neuropathic and mixed forms. Separate injury of interphalangeal and
metatarsophalangeal joints was performed resection of latter. Prevention of vascular
lesions compression after joints resection was performed by orthopedic correction. It
was found that around resected area formed pseudo articularis, which gives sufficient
support and protection to vascular structures. It was done 34 (70.1%) arthrotomies and
removals of bone structures. Were performed 111 (93%) closings of wounds defects with
free splits or skin grafts. Foot support function was stored in 341 (93%) patients.
Conclusions:
1. Neuropathic and mixed forms of DFS with suppurative processes, often affect foot
bone and joint structure.
2. Foot surgery has to help to maintain support, which is achieved by surgery and
orthopedic correction.
KEY SESSION: WHAT IS GOOD EVIDENCE IN WOUND CARE AND HOW DO WE GENERATE IT?
EWMA 2013
COPENHAGEN
15-17 May · 2013
Danish Wound
Healing Society
99