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Diabetic foot ulcer

Diabetic foot ulcers are the most common cause of lower extremity amputation in the diabetic population. More than one million people with diabetes lose a leg every year as a consequence of their condition. Of all amputations, 85% are preceded by a foot ulcer.

Today, 20-40% of the healthcare resources spent on diabetes are related to diabetic feet.1 To prevent amputations and other complications, as well as to control costs, it is important to diagnose and treat the wound as early as possible.

One of the most important factors relating to the outcome of a diabetic foot ulcer is Peripheral Arterial Disease (PAD), so ischemia must be excluded.2 This is very important, as 50% of all patients with diabetes suffer from PAD. In addition, the diabetic patients show an impaired collateral formation and therefore a more aggressive form of PAD. The presence of PAD also implies an increased risk for cardiovascular disease.3-5

Diagnosing Peripheral Arterial Disease in diabetic patients is challenging. Two thirds of all patients do not show typical symptoms such as walking pain and rest pain. Neuropathy reduces the pain perception and may even result in relatively warm feet (atypical for ischemic feet), due to the increased arteriovenous shunt blood flow. Many patients with PAD are sedentary, and therefore do not experience typical symptoms of claudication. Palpable pedal pulses tend to overestimate PAD. Furthermore, diabetic patients often have incompressible arteries, resulting in falsely elevated Ankle Brachial Index (ABI) values. Therefore, alternative objective noninvasive vascular tests, such as toe pressure and transcutaneous oxygen (tcpO2) measurements, are warranted.1-4

Learn more about toe pressure
Learn more about tcpO2

Diabetic foot ulcers can be classified as:
•    Neuropathic
•    Ischemic
•    Neuroischemic

The prevalence of the neuroischemic ulcers is rising and today 50% of all diabetic foot ulcers are neuroischemic compared to 20-25% in the 1990s.5

Once diagnosis of peripheral arterial disease has been established, an estimate of the wound healing potential will help to identify the correct management strategy for each diabetic foot ulcer. No specific symptom or signs of PAD will reliably predict healing of the ulcer. Several societies recommend objective vascular tests for this purpose. The International Working Group on the Diabetic Foot,for example, indicate that, a toe pressure > 30 mmHg, a tcpO2 > 25 mmHg or a a skin perfusion pressure > 40 mmHg increases the likelihood for healing.3-5  

Learn more about guidelines and recommendations for PAD

The severity of Peripheral Arterial Disease is not the only factor affecting the healing outcome. Other factors will also influence each individual diabetic foot ulcer; the presence of infection, amount of tissue loss, mechanical load on the ulcer, and co-morbidities, such as heart failure, and end stage renal disease. Consequently, various degrees of ischemia may prove "critical” depending on the overall status of the limb. As an example, a diabetic patient with mild PAD but a foot ulcer complicated with infection, might benefit from revascularization to speed up healing of smaller wounds or be essential to heal an extensive wound.3-5

PeriFlux 6000 - intelligence combined

Assessing diabetic foot ulcers is challenging. PeriFlux 6000 offers a unique combination of simultaneous vascular tests to ensure accurate diagnosis of peripheral arterial disease and wound healing assessment also in the diabetic population.

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Improving quality of life since 1981

Perimed AB, established in 1981, provides instruments, software and expertise to enable assessment of the microcirculation. We utilize laser Doppler, laser speckle (LASCA) and transcutaneous oxygen (tcpO2 or TCOM), to accurately monitor and quantify blood perfusion and tissue oxygenation in real-time. Our modular PeriFlux System 5000 and PeriFlux 6000, the latest generation of our PeriFlux System, are excellent choices for diagnosing Peripheral Arterial Disease (PAD) and Critical Limb Ischemia (CLI) or for assessing wound healing potential in your vascular patients. Our blood perfusion imager PeriCam PSI System allows you to investigate spatial distribution, for example during cortical spreading depression.