What are the IWGDF guidelines on the restoration of tissue perfusion in the treatment of diabetic foot ulcers?

Updated: Oct 15, 2020
  • Author: Tanzim Khan, DPM; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

With regard to restoration of tissue perfusion, the practical guidelines state the following [35] :

  • When ankle pressure is below 50 mmHg or the ankle brachial index (ABI) is less than 0.5, urgent vascular imaging and, in the presence of appropriate findings, revascularization, should be considered; revascularization should also be considered if the toe pressure is below 30 mmHg or the transcutaneous pressure of oxygen (TcpO 2) is less than 25 mmHg; however, revascularization may be considered at higher pressures should extensive tissue loss or infection occur
  • If optimal treatment does not result in ulcerative healing signs within 6 weeks, revascularization should be considered, regardless of the outcomes of the above-mentioned vascular tests
  • If an above-the-ankle amputation is being contemplated, revascularization should first be considered as an option
  • Revascularization should be avoided in patients with an unfavorable risk-benefit ratio
  • Individual factors (eg, morphologic distribution of peripheral artery disease, autogenous vein availability, patient comorbidities) and local operator expertise should be considered when selecting a revascularization technique
  • Following revascularization, perfusion should be objectively measured to assess the procedure’s effectiveness
  • Pharmacologic treatments have not been proven to benefit perfusion
  • Smoking cessation, hypertension and dyslipidemia control, and antiplatelet drug use, as the means to reduce cardiovascular risk, should be emphasized

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