CONSERVATIVE SURGICAL APPROACH VERSUS NONSURGICAL MANAGEMENT FOR DIABETIC NEUROPATHIC FOOT ULCERS - A RANDOMIZED TRIAL

To test the efficacy of surgical treatment of non-infected neuropathic foot ulcers compared to conventional non-surgical management, a group of diabetic outpatients attending our diabetic foot clinic were studi ed. All patients who came to the clinic for the first time from Januar y to December 1995 inclusive with an uncomplicated neuropathic ulcer w ere randomized into two groups. Group A received conservative treatmen t, consisting of relief of weight-bearing, regular dressings; group B underwent surgical excision, eventual debridement or removal of bone s egments underlying the lesion and surgical closure. Healing rate, heal ing time, prevalence of infection, relapse during a 6-month period fol lowing intervention and subjective discomfort were assessed. Twenty-fo ur ulcers in 21 patients were treated in group A (17 Type 2 DM/3 Type 1 DM, age 63.24 +/- 13.46 yr, duration of diabetes 18.2 +/- 8.41 yr, H bA(1c) 9.5 +/- 3.8%) and 22 ulcers in 21 patients in group B (19 Type 2 DM/2 Type 1 DM, age 65.53+/-9.87 yr, duration of diabetes 16.84 +/- 10.61 yr; HbA(1c) 8.9 +/- 2.2%). Healing rate was lower (79.2% = 19/24 ulcers) in group A than in group B (95.5% = 21/22 ulcers; p < 0.05), and healing time was longer (128.9 +/- 86.60 days vs 46.73 +/- 38.94 d ays; p < 0.001). Infective complications occurred significantly more o ften in group A patients (3/24, 12.5% vs 1/22, 4.5%; p < 0.05), as did relapses of ulcerations (8 vs 3; p < 0.01). There were only two minor perioperative complications in group B patients. Patients reported a higher degree of satisfaction in group B (p < 0.01) as well as lower d iscomfort (p < 0.05) and restrictions (p < 0.05). Thus surgical treatm ent of neuropathic foot ulcers in diabetic patients proved to be an ef fective approach compared to conventional treatment in terms of healin g time, complications, and relapses, and can be safely performed in an outpatient setting. (C) 1998 John Wiley & Sons, Ltd.