DIFFERENCE IN TREATMENT OF FOOT ULCERATIONS IN BOSTON, USA AND PISA, ITALY

Primary care of the diabetic patient with foot ulcer can be provided b y medically or surgically trained practitioners. We have prospectively followed 90 sequential patients with newly developed foot ulcers from two major centers, one in the USA where the primary doctor was a podi atrist and one in Europe with a diabetologist. Thirty-four patients fr om Boston and 56 from Pisa (mean age, 55.6; range, 26-75 years; vs. 66 .5; range, 35-94; P < 0.001), matched for sex, weight, type, duration of diabetes, renal impairment and retinopathy took part. Boston patien ts had more severe neuropathy, assessed with clinical examination util izing a neuropathy disability score (NDS) (16 +/- 6 vs. 6 +/- 3 (mean +/- S.D.) P < 0.001) and vibration perception threshold (46 +/- 8 vs. 35 +/- 12 V; P < 0.001) while no difference existed in the number of p atients with clinical infection, a history of lower extremity by-pass operation (6 (18%) vs. 3 (5%); P = NS) and in the size and the severit y of the ulcer, according to the Wagner classification. Initial treatm ent was similar in both centers with emphasis on outpatient ulcer debr idement, pressure relieving foot-wear and topical wound care. Hospital ization was needed in five (15%) Boston and 12 (21%) Pisa patients (P = NS) while surgery was performed on five (15%) Boston and 16 (29%) Pi sa patients (P = NS). The in-hospital stay was similar in both centers (1.4 +/- 4.4 vs. 2.1 +/- 5.9 days; P = NS). The most common operation s in both centers were incision, drainage and bone debridement. Ulcers healed in all patients but the amount of healing time was shorter in Boston patients (6.7 +/- 4.2 vs. 10.5 +/- 6.5 weeks; P < 0.02). We con clude that despite the differences in the two systems similar success rates were achieved in the two centers while a more surgically oriente d strategy may have resulted in a slightly shorter healing time. (C) 1 997 Elsevier Science Ireland Ltd.