DOI: http://dx.doi.org/10.18203/2349-2902.isj20213977

Efficacy of diabetic ulcer severity score in patients with diabetic foot ulcer in predicting prognosis

Robinson George, Joe Mathew, Vishnu M. L., Jacob P. Thomas

Abstract


Background: Diabetic foot ulcer (DFU) is a full-thickness wound, skin necrosis or gangrene below the ankle induced by peripheral neuropathy or peripheral arterial disease in patients with diabetes. There are well-accepted classification systems for DFUs, namely Wagner’s scoring system, university of Texas scoring system etc. However, only few are scientifically validated. Diabetic ulcer severity score (DUSS) introduced by Beckert et al consists of easily accessible clinical parameters which categorizes wounds into specific subgroups for comparison of outcomes.

Methods: A prospective study was conducted on 250 diabetic ulcer patients, attending the out-patient department (OPD) of surgery, Pushpagiri institute of medical sciences, Tiruvalla.

Results: Most common age group affected with diabetic foot was between 51-60 years (mean 58.9±10.2 years). Males accounted for 54% of patients. Most common ulcers were of score of 2 followed by score 3. Overall, 105 (42%) of 250 people had amputations in our study with majority undergoing minor amputation (30%) than the major amputation (12%). None of the patients with scores 0, 1 and 2 had major amputation. Probability of healing among the various scores were-100% for score 0, 97.9% for score 1, 83.4% for score 2, 17.7% for score 3 and 4.8% for score 4. Lower score is strongly associated with primary healing and higher score with amputations.

Conclusions: DUSS system is an easy wound based diagnostic tool for anticipating probability of healing or amputation and need for surgery by assessing the four clinical parameters and combining them which is safe and easily reproducible.


Keywords


DUSS, DFU, Amputation, OPD, SSG, Diabetes mellitus

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References


Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005;293:217-28.

Greer N, Foman NA, MacDonald R, et al. Advanced wound care therapies for non-healing diabetic, venous, and arterial ulcers: a systematic review. Ann Intern Med. 2013;159:532-42.

Armstrong DG, Lavery LA, Harkless LB. Validation of a diabetic wound classification system. The contribution of depth, infection, and ischemia to risk of amputation. Diabetes Care. 1998;21:855-9.

Lavery LA, Armstrong DG, Harkless LB. Classification of diabetic foot wounds. J Foot Ankle Surg. 1996;35:528-31.

Schaper NC. Diabetic foot ulcer classification system for research purposes: a progress report on criteria for including patients in research studies. Diabetes Metab Res Rev. 2004;20(1):S90-5.

Jeffcoate WJ, Macfarlane RM, Fletcher EM. The description and classification of diabetic foot lesions. Diabetes Med. 1993;10:676-9.

Jones EW, Peacock I, McLain S, Fletcher E, Edwards R, Finch RG et al. A clinic pathological study of diabetic foot Ulcers. Diabetes Med. 1987;4:475-9.

Sanders LJ. From Thebes to Toronto and the 21st Century: An Incredible Journey. Diabetes Spectrum. 2002;15(1):56-60.

International Diabetes Federation Regional Fact Sheet 6th edition 2014. Available at: http://www.idf.org/sites/default/files/DA-regional-factsheets-2014_FINAL.pdf. Accessed on 25 April 2020.

Huysman F, Mathieu C. Diabetes and Peripheral Vascular Disease. Acta Chirurgica Belgica. 2009;109(5):587-94.

Most RS, Sinnock P. The epidemiology of lower extremity amputations in diabetic individuals. Diabetes Care. 1983;6:87-91.

Delbridge L, Ctercteko G, Fowler C, Reeve TS, Le Quesne LP. The etiology of diabetic neuropathic ulceration of the foot. Br J Surg. 1985;72(1):1-6.

LoGerfo FW, Coffman JD. Vascular and micro vascular disease of the footin diabetes. N Engl J Med. 1984;311:1615-9.

Hamlin CR, Kohn RR, Luschin JH. Apparent accelerated ageing of human collagen in diabetes mellitus. Diabetes. 1975;24:902.

Ctercteko GC, Dhanendran M, Hutton WC, Le Quesne LP. Vertical forces acting on the feet of diabetic patients. Br J Surg. 1981;68(9):608-14.

Oyibo SO, Jude EB, Tarawneh I, Nguyen HC, Lawrence B, Harkless et al. A comparison of Two DiabeticFoot Ulcer Classification Systems - The Wagner and the University of Texas wound classification systems. Diabetes Care. 2001;24:84-8.

Beckert S, Witte M, Wicke C, Konigsrainer A, Coerper S. A new wound-based severity score for diabetic foot ulcers. Diabetes Care 2006;29:988-92.

Grunert BK, Wertsch JJ, Matloub HS, McCallum-Burke S. Reliability of sensory threshold measurement using a digital vibrogram. J Occup Med.1990;32(2):100-2.

Kumar S, Fernando D, Veves A, Knowles E, Young M, Boulton A. Semmes-Weinstein monofilaments: a simple, effective and inexpensive screening device for identifying diabetic patients at risk of foot ulceration. Diabetes Res Clin Pract. 1991;13:63-8.

Shaw JE, Boulton AJ. The Pathogenesis of Diabetic Foot Problems: An Overview. Diabetes. 1997;46(2):S58-61.

Boulton A. Diabetic foot: a global view. J Tissue Viability. 2005;15(1):22-3.

Jeffcoate W, Lima J, Nobrega L. The Charcot foots. Diabetic Med. 2000;17(4):253-8.

Brash PD, Foster J, Vennar W. Magnetic resonance imaging techniques demonstrate soft tissue damage in the diabetic foot. Diabetic Med. 1999;16:55-61.

Piaggesi A. Semi-quantitative analysis of the histopathological features of the neuropathic foot. Diabetes care. 2003;26:3123.

Mc Callon SK, Knight CA, Valiulus JP, Cunningham MW, McCulloch JM, Farinas LP. Vacuum-assisted closure versus saline moistened gauze in the healing of postoperative diabetic foot wounds. Ostomy Wound Manage. 2000;46(8):28-32.

Thomas S, Andrews A, Jones M. Maggots are useful in treating infected or necrotic wounds. BMJ. 1999;318:807-8.

Falanga V, Margolis D, Alvarez O, Auletta M, Maggiacomo F, Altman M et al. The human skin equivalent investigators group: Rapid healing of venous ulcers and lack of clinical rejection with an allogeneic cultured human skin equivalent. Arch Dermatol. 1998;134:293-300.

Eaglstein WH. A composite skin substitute (Graft skin) for surgical wounds: a clinical experience. Dermatol Surg. 1995;21:839-43.

Cohen IK. Wound care and wound healing. In Schwartz SI, Shires GT, Spencer FC, et al (Eds). Principles of Surgery (7th ed) New York, NY: McGraw Hill. 1999;263-95.

Galiano. A review of becaplermin gel in the treatment of diabetic neuropathic foot ulcers. Biologics: Targets and amp; Therapy. 2008;1.

D LoGerfo FW, Gibbons GW, Pomposelli FB. Evolving trends in the management of the diabetic foot. Arch Surg. 1992;127:617-21.

Burgess EM, Romano RL, Zettl JH. Amputations of the leg for peripheral vascular insufficiency. J Bone Joint Surg. 1971;53;874-89.

Gough A, Clapperton M, Ronaldo N. Granulocyte-colony-stimulating factor in diabetic foot infection. Lancet. 1997;35:855-9.

Fletcher ER, MacFarlane, Jeffcoate W. Can foot ulcers be prevented by education? Diabetic Med. 1992;9(2):41.

Ince P, Abbas ZG, Lutale JK, Basit A, Ali SM, Chohan F et al. Use of SINBAD classification System and score in comparing outcome of foot ulcer management on three continents. Diabetes Care. 2008;31;964-7.

Leese G, Schofield C, McMurray B, Libby G, Golden J, MacAlpine R et al. Scottish foot ulcer risk score predicts foot ulcer healing in a regional specialist foot clinic. Diabetes care. 2007;30(8):2064-9.

Reed JF. An audit of lower extremity complication in patients with diabetes mellitus. International Journal Lower Extremity Wounds. 2004;3:161-4.

Parisi MC, Zantut-Wittmann DE, Pavin EJ, Machado H, Nery M, Jeffcoate WJ. Comparison of three systems of classification in predicting the out-come of diabetic foot ulcers in a Brazilian population. Eur J Endocrinol. 2008;159(4):417-22.

Prompers L, Schaper N, Apelqvist J. Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease. Eurodiale study Diabetologia. 2008;51:747-55.

Oyibo SO, Jude EB, Tarawneh I. The effects of ulcer size and site, patient’s age, sex and type and duration of diabetes on the outcome of diabetic foot ulcers. Diabet Med. 2001;18:133-8.