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The Superiority of Removable Contact Splints in the Healing of Diabetic Foot during Postoperative Care
OBJECTIVE: Off-loading is one of the crucial components of diabetic foot (DF) therapy. However, there remains a paucity of studies on the most suitable off-loading for DF patients under postoperative care. The aim of our study was to evaluate the effect of different protective off-loading devices on...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Hindawi
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6766149/ https://www.ncbi.nlm.nih.gov/pubmed/31637262 http://dx.doi.org/10.1155/2019/5945839 |
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author | Fejfarová, Vladimíra Pavlů, Jaroslav Bém, Robert Wosková, Veronika Dubský, Michal Němcová, Andrea Jirkovská, Alexandra Sixta, Bedřich Sutoris, Karol Thieme, Filip Armstrong, David G. Vrátná, Eliška Hazdrová, Jitka Lánská, Věra |
author_facet | Fejfarová, Vladimíra Pavlů, Jaroslav Bém, Robert Wosková, Veronika Dubský, Michal Němcová, Andrea Jirkovská, Alexandra Sixta, Bedřich Sutoris, Karol Thieme, Filip Armstrong, David G. Vrátná, Eliška Hazdrová, Jitka Lánská, Věra |
author_sort | Fejfarová, Vladimíra |
collection | PubMed |
description | OBJECTIVE: Off-loading is one of the crucial components of diabetic foot (DF) therapy. However, there remains a paucity of studies on the most suitable off-loading for DF patients under postoperative care. The aim of our study was to evaluate the effect of different protective off-loading devices on healing and postoperative complications in DF patients following limb preservation surgery. METHODS: This observational study comprised 127 DF patients. All enrolled patients had undergone foot surgery and were off-loaded empirically as follows: wheelchair+removable contact splint (RCS) (group R: 29.2%), wheelchair only (group W: 48%), and wheelchair+removable prefabricated device (group WP: 22.8%). We compared the primary (e.g., the number of healed patients, healing time, and duration of antibiotic (ATB) therapy) and secondary outcomes (e.g., number of reamputations and number and duration of rehospitalizations) with regard to the operation regions across all study groups. RESULTS: The lowest number of postoperative complications (number of reamputations: p = 0.028; rehospitalizations: p = 0.0085; and major amputations: p = 0.02) was in group R compared to groups W and WP. There was a strong trend toward a higher percentage of healed patients (78.4% vs. 55.7% and 65.5%; p = 0.068) over a shorter duration (13.7 vs. 16.5 and 20.3 weeks; p = 0.055) in the R group, as well. Furthermore, our subanalysis revealed better primary outcomes in patients operated in the midfoot and better secondary outcomes in patients after forefoot surgery—odds ratios favouring the R group included healing at 2.5 (95% CI, 1.04-6.15; p = 0.037), reamputations at 0.32 (95% CI, 0.12-0.84; p = 0.018), and rehospitalizations at 0.22 (95% CI, 0.08-0.58; p = 0.0013). CONCLUSIONS: This observational study suggests that removable contact splint combined with a wheelchair is better than a wheelchair with or without removable off-loading device for accelerating wound healing after surgical procedures; it also minimises overall postoperative complications, reducing the number of reamputations by up to 77% and the number of rehospitalizations by up to 66%. |
format | Online Article Text |
id | pubmed-6766149 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Hindawi |
record_format | MEDLINE/PubMed |
spelling | pubmed-67661492019-10-21 The Superiority of Removable Contact Splints in the Healing of Diabetic Foot during Postoperative Care Fejfarová, Vladimíra Pavlů, Jaroslav Bém, Robert Wosková, Veronika Dubský, Michal Němcová, Andrea Jirkovská, Alexandra Sixta, Bedřich Sutoris, Karol Thieme, Filip Armstrong, David G. Vrátná, Eliška Hazdrová, Jitka Lánská, Věra J Diabetes Res Research Article OBJECTIVE: Off-loading is one of the crucial components of diabetic foot (DF) therapy. However, there remains a paucity of studies on the most suitable off-loading for DF patients under postoperative care. The aim of our study was to evaluate the effect of different protective off-loading devices on healing and postoperative complications in DF patients following limb preservation surgery. METHODS: This observational study comprised 127 DF patients. All enrolled patients had undergone foot surgery and were off-loaded empirically as follows: wheelchair+removable contact splint (RCS) (group R: 29.2%), wheelchair only (group W: 48%), and wheelchair+removable prefabricated device (group WP: 22.8%). We compared the primary (e.g., the number of healed patients, healing time, and duration of antibiotic (ATB) therapy) and secondary outcomes (e.g., number of reamputations and number and duration of rehospitalizations) with regard to the operation regions across all study groups. RESULTS: The lowest number of postoperative complications (number of reamputations: p = 0.028; rehospitalizations: p = 0.0085; and major amputations: p = 0.02) was in group R compared to groups W and WP. There was a strong trend toward a higher percentage of healed patients (78.4% vs. 55.7% and 65.5%; p = 0.068) over a shorter duration (13.7 vs. 16.5 and 20.3 weeks; p = 0.055) in the R group, as well. Furthermore, our subanalysis revealed better primary outcomes in patients operated in the midfoot and better secondary outcomes in patients after forefoot surgery—odds ratios favouring the R group included healing at 2.5 (95% CI, 1.04-6.15; p = 0.037), reamputations at 0.32 (95% CI, 0.12-0.84; p = 0.018), and rehospitalizations at 0.22 (95% CI, 0.08-0.58; p = 0.0013). CONCLUSIONS: This observational study suggests that removable contact splint combined with a wheelchair is better than a wheelchair with or without removable off-loading device for accelerating wound healing after surgical procedures; it also minimises overall postoperative complications, reducing the number of reamputations by up to 77% and the number of rehospitalizations by up to 66%. Hindawi 2019-09-15 /pmc/articles/PMC6766149/ /pubmed/31637262 http://dx.doi.org/10.1155/2019/5945839 Text en Copyright © 2019 Vladimíra Fejfarová et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Article Fejfarová, Vladimíra Pavlů, Jaroslav Bém, Robert Wosková, Veronika Dubský, Michal Němcová, Andrea Jirkovská, Alexandra Sixta, Bedřich Sutoris, Karol Thieme, Filip Armstrong, David G. Vrátná, Eliška Hazdrová, Jitka Lánská, Věra The Superiority of Removable Contact Splints in the Healing of Diabetic Foot during Postoperative Care |
title | The Superiority of Removable Contact Splints in the Healing of Diabetic Foot during Postoperative Care |
title_full | The Superiority of Removable Contact Splints in the Healing of Diabetic Foot during Postoperative Care |
title_fullStr | The Superiority of Removable Contact Splints in the Healing of Diabetic Foot during Postoperative Care |
title_full_unstemmed | The Superiority of Removable Contact Splints in the Healing of Diabetic Foot during Postoperative Care |
title_short | The Superiority of Removable Contact Splints in the Healing of Diabetic Foot during Postoperative Care |
title_sort | superiority of removable contact splints in the healing of diabetic foot during postoperative care |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6766149/ https://www.ncbi.nlm.nih.gov/pubmed/31637262 http://dx.doi.org/10.1155/2019/5945839 |
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