J Korean Foot Ankle Soc.  2022 Jun;26(2):66-70. 10.14193/jkfas.2022.26.2.66.

The Application of Vacuum-Assisted Closures According to the Texas Staging System in the Treatment of Infective Diabetic Foot Ulcers

• Lim SA
• Choi YS
• Jang YJ
• Baek SN
• Bae AN

• KMID: 2530485
• DOI: http://doi.org/10.14193/jkfas.2022.26.2.66

Abstract

Purpose
A group of patients who were hospitalized for diabetic foot ulcers was classified according to the University of Texas Staging System for Diabetic Foot Ulcers, and we attempted to evaluate whether this staging system could be a criterion for treatment success using vacuum-assisted closure (VAC) technique.
Materials and Methods
A total of 32 patients were diagnosed with diabetic foot ulcers according to the University of Texas Staging System for Diabetic Foot Ulcers. Of these, 24 patients who were evaluated as stage B according to the staging system were classified as Group 1, and 8 patients in stage D were classified as Group 2. After applying VAC, the treatment success rate was compared by evaluating the size and severity of ulcers between the two groups.
Results
The grade of granulation after VAC was on average 3.75±0.53 in Group 1 and 2.25±0.71 in Group 2. There was better granulation after VAC application in Group 1 (p<0.01). The success rate of the treatment was 22 cases (91.67%) in Group 1 and one case (12.5%) in Group 2. Thus there were statistically significant differences in the success rate of treatment between groups 1 and 2 (Pearson’s chisquare test, p=0.01; odd ratio 77.00, 95% confidence interval [CI] 1.26~14.66; relative risk 4.30, 95% CI 1.26~14.66).
Conclusion
These results suggest that there was a higher success rate of treatment with VAC in stage B patients. The University of Texas Staging System for Diabetic Foot Ulcers can thus be an index for applying VAC to patients with infective diabetic foot ulcers.

Keyword

Foot; Diabetic foot ulcer; The University of Texas Staging System for Diabetic Foot Ulcers; Vacuum-assisted closure

Figure

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  Figure. 1 (A) Infective diabetic foot ulcer classified as Texas grade B-stage 3 wound undergoing surgical debridement. (B) Granulation tissue was formed after surgical treatment and vacuum-assisted closure application for 6 weeks. Achilles tendon and marginal infective tissue were seen. (C) Second surgical management was done; Direct closure was done for distal longitudinal wound and debridement was done around Achilles tendon, intractable wound. (D) Full-thickness skin graft which was harvested at ipsilateral inguinal area was done. (E) No significant steno-occlusive lesion.

• 

  Figure. 2 (A) Infective diabetic foot ulcer classified as Texas grade D-stage 3 ulcer penetrating to proximal interphalangeal joint. (B) Arterial computed tomography angiography; red arrows indicate both anterior tibial artery (ATA) occlusion. (C) Osteolysis proceeded despite surgical treatment and vacuum-assisted closure application for 6 weeks. (D) Second toe amputation was done.

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