Leg ulcers in patients with diabetes: an underestimated problem?

Diabetic foot ulcer (DFU) is not only type of ulcers which can affect lower extremities of patients with diabetes mellitus (DM). The second common type is leg ulcer (LU). These ulcers may appear not only as classic ones – a result of venous diseases, but also result of some degree of leg ischemia in combination with several additional factors. Some diabetic foot outpatient clinics (DFOC) have experience with treatment of such ulcers.

Aim of our study was to analyze main characteristics of patients with diabetes and LU treated in DFOC, results of their treatment and possible reasons for treatment of this group in the DFOCs.

Object and methods

All patients with diabetes and LU of any etiology (venous, posttraumatic, mixed) treated in our DFOC from July 2007 to June 2012 were included in our study (n = 101, main group). All patients with DFU treated in the same DFOC in this time frame (n = 721) formed the control group. Follow-up data was observed from medical records or by phone calls. Follow-up time was between 6 mo and 2.5 yrs. 

Results

Most of patients with LU were females (71%) and had type 2 DM. More frequent wound infection, higher median wound surface, lower depth and very rare involvement of deep tissues (phlegmone and osteomyelitis) were characteristic for LU group. There were not significant difference (p > 0.05) between groups in terms of diabetes duration, type 2 DM treatment methods, rate of DM complications and concomitant diseases and HbA1c level. At follow-up contact time ulcers healed in 64% in LU group and 65% of DFU group (р > 0.05). More LUs stayed unhealed at this time than DFUs (13% vs 5%, р = 0.013). Minor amputations were made in 0% in LU group and in 5% in DFU group (p = 0.039), but major amputations rate was not significantly different between groups (4% vs 6%, p > 0.05). Mortality was not also significantly different between groups (p > 0.05).

Conclusions

1. Leg ulcer population of the DFOC is mainly female and has type 2 DM;
2. LUs healed during follow-up in 64% patients but stayed unhealed in 13% and leaded to major amputation in 4%;
3. Amputation prevention programs in patients with diabetes should take into account that at least 10% of major amputations in these patients are a result of LU;
4. Epidemiological studies are necessary to assess prevalence of LU and LU-related amputations in whole diabetic population;
5. Treatment of LU in patients with diabetes should be as careful as of DFU and DFOC is optimal setting for it.

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