Clinical and morphological characteristics of wound healing in diabetic foot syndrome

Abstract

Aim. To assess the clinical and morphological characteristics of neuropathic diabetic foot ulcers (DFUn) Materials and Methods. Forty-three specimens of DFUn were analysed. Depending on the outcome, samples were divided into 2 groups: group 1—healed ulcers (30 samples), group 2—unhealed ulcers (13 samples). The following characteristics were analysed: age, sex, glycated haemoglobin (HbA1c), ulcer duration, time of admission to the specialised clinic, severity of neuropathy, presence of late complications, plantar localisation, percentage of necrotic tissue, granulation and fibrotic tissue and, Ki-67expression. Results. Patients were similar in age, HbA1c, severity of late complications and plantar localisation. There was a significant difference in the time of admission to the specialised clinic [50 vs 132 days, p = 0.03], percentage of granulation [61 ± 25 vs 32 ± 21 %, р = 0.001] and fibrotic tissue [24 ± 24 vs 49 ± 22 %, р = 0.002], the granulation/fibrosis coefficient [7.5 ± 8.1 vs 1.9 ± 4.6 (%), р = 0,02] and expression of Ki-67 [15 ± 8 vs ± 21 (%), р = 0.001] between groups. A multidimensional model revealed granulation tissue as the main parameter influencing healing. The probability of healing was 1.0 if the percentage of granulation tissue was <50%. If the percentage of granulation tissue was <50%, the prognosis of healing was determined by the expression of Ki-67. When Ki-67 levels were >7%, the probability of healing was 0.75. For Ki-67 levels ≤7%, the probability of healing was 0.17 and the probability of not healing was 0.83. Conclusion. The time at which a patient was admitted to the specialised clinic and the percentage of granulation tissue were key factors affecting the prognosis of wound healing in DFUn.

Keywords

• diabetes mellitus
• diabetic foot syndrom
• predictors of neuropathic diabetic foot ulcers healing
• granulation tissue
• fibrosis
• ki67