Few studies suggested that frailty may increase inflammation, which in turn may negatively impact tissue repair in people with significant tissue loss. This study aims to shed light on potential impact of frailty on outcomes of skin-substitute placement in patients with chronic diabetic foot ulcers (DFU).
Methods: Patients with chronic diabetic wounds ≥ Grade 2 Wagner class who underwent skin-substitute placement (i.e., acellular dermal matrix, bilayer cross-linked bovine matrix) were recruited. Using a validated trauma-specific frailty index questionnaire, patients with a score of >0.27 were classified as frail; all others as non-frail. Wounds were biweekly monitored for a 4-month period or until successfully closed. Primary outcome was successful granulation (defined as 100% of granulated tissue at the DFU site), and secondary outcome was wound tissue oxygen saturation (SatO2) at the study endpoint.
Results: Thirty-four patients with chronic DFUs (age: 58.2±11.6 years, 70.6% male, 55.9% Frail) were recruited. At the study endpoint, the successful granulation was significantly higher among non-frail than frail (53.8% vs. 8.3%, p=0.015) patients. The non-frail patients showed a trend for increased SatO2 (Baseline: 70.2 ± 13.6% vs Endpoint: 76.5 ±12.4%, p=0.17), as opposed to the frail patients (Baseline: 69.2 ± 11.4% vs Endpoint: 65.3 ± 21.9%, p=0.28). In addition, the magnitude of change in SatO2 at Endpoint compared to baseline showed a trend (p=0.13) for increased values in the non-frail patients (22% higher), in contrast to the frail patients (45% lower).
Conclusions: These findings support the hypothesis that frailty affects tissue granulation in patients with DFUs treated with skin-substitutes. The results are in agreement with prior studies suggesting that frailty may lead to increased inflammation and decreased tissue regeneration. This observation should be validated in a larger sample size.
Source: Zulbaran A, Park C, Ross J, Lepow B, Najafi B. The Impact of Frailty on Wound Healing in People with Chronic Diabetic Foot Ulcers Treated with Skin Substitutes. Available at https://www.dfcon.com/posters/.