Functional limb salvage in the diabetic patient: the use of a collagen bilayer matrix and risk factors for amputation.

BACKGROUND: The diabetic foot ulcer presents a therapeutic challenge with a high rate of limb infection and extremity amputation. Adequate debridement and stable coverage of exposed structures are paramount to preserving limb length. The authors reviewed their use of a collagen bilayer matrix in the diabetic population for the preservation of functional limb length. Salvage rates were stratified with patient comorbidities of severe peripheral arterial disease and/or persistent infection.
METHODS: A retrospective review was performed of all consecutive patients who underwent application of Integra by the senior authors (J.S.S., C.E.A.) for lower extremity salvage between January of 2004 and December of 2008.
RESULTS: A total of 105 patients with 121 separate wounds were analyzed. Patient age ranged from 22 to 80 years (mean, 58 years). The average wound size was 25.9 cm2 in the diabetic population. Average follow-up was 325 days, and average number of operations before closure was 1.28. In the diabetic population, of the 59 patients identified as low risk for amputation, 10 (17 percent) progressed to amputation. Of the 28 patients identified as high risk for amputation, 15 (54 percent) progressed to amputation. In the nondiabetics, 31 patients were classified as low risk for amputation, and one (3 percent) went on to an amputation.
CONCLUSIONS: Use of a collagen bilayer matrix appears to be a viable option for reconstruction and stable closure in the diabetic patient at low risk for amputation, with risk based on available blood supply and evidence of infection. In the diabetic patient at high risk for amputation, however, the rate of salvage may not be improved with the use of Integra.