Wound healing in diabetes. Outcome and costs.

Healing of foot ulcers is limited by multiple factors that necessitate a multifactorial and multidiciplinary approach. Patients with diabetes with previous foot ulcers have a high risk for new ulcerations and further amputations and have increased mortality rates. These findings stress the need for lifelong observation of the diabetic foot. The diabetic foot is a large economic problem, and management of ulcers has not always been performed in a most cost-effective way. Cost for amputation is high to society because of prolonged hospitalization, rehabilitation, and need for home care and social service for disabled patients. A cost-effective management plan should focus not only on short-term cost until healing but also on long-term costs, because foot ulcer and especially amputation are related to increased high reulceration rate and lifelong disability. The most important action to reduce cost in management of the diabetic foot is to avoid amputations.