Recurrent diabetic foot ulcers: Results of a maximal multidisciplinary approach including reconstructive foot/ankle surgery.

The diabetic foot ulcer (DFU) and Charcot Neuroarthropathy (CN) are serious complications of diabetes mellitus in which wound closure is complex to achieve. Treating recurrent DFU in patients with a combination of infection, ischemia, and deformities is extremely challenging and this group of patients has a very poor outcome. This case series describes the outcomes of patients with a recurrent DFU and CN, with a mean SINBAD score of 4 and of which 40% had a TCS of D3, using a multidisciplinary protocol that includes reconstructive foot and ankle surgery. In 24/35 (69%) of patients, wound closure was achieved after a mean of 75 days postoperatively. The mean ulcer-free period was 358 days. The mean number of interventions was 6.7 (range 3-9). Post treatment 27/35 (77%) of patients was mobile, without additional amputation or ulcer recurrence. This study shows that wound closure and a long ulcer-free period can be achieved in patients with a DFU and CN and its multifactorial underlying diseases when treated in a multidisciplinary team, including reconstructive foot and ankle surgery.

Quality of Care and Cost-effectiveness: Optimizing Wound Care in the Netherlands.

OBJECTIVE: Previously, the authors implemented a "fast-track protocol" in the Netherlands to shorten the time to referral for patients when diagnostic testing was deemed necessary given suspicion of underlying pathology preventing wound healing. This subanalysis of the cross-sectional study presents the cost reduction of using that fast-track protocol. METHODS: The cross-sectional study data were collected at the Alrijne Wound Centre between January 2017 and January 2018 and included patients from two general practitioner practices and a large home-care organization who had a new occurrence of wounds. The cost-effectiveness analysis consisted of an analysis of the mean reduction in care, wound dressing materials, and reduction in unnecessary hospital referrals. RESULTS: In 2017, a total of 415 patients received wound care of the general practitioners or home-care organization. By using the "fast-track" protocol, costs were reduced in all areas. After extrapolation, the minimum mean cost reduction in wound care was €129,949,638; on wound dressings, it was €2,623,920, and on the reduction of unnecessary hospital referrals, the average recovery was €2,436,000. CONCLUSIONS: Prompt triage, analyses, and treatment of underlying causes by specialized doctors in a multidisciplinary setting offer enormous potential for cost savings. The conservative estimate is that approximately €135,000,000 to €293,000,000 can be saved in annual healthcare costs in the Netherlands using this protocol.