The impact of frailty on wound healing in people with chronic diabetic foot ulcers treated with skin substitutes

Objective: Frailty associated with adverse health outcomes has not been investigated on management of diabetic foot ulcers (DFUs). This study aims to shed light on potential impact of frailty in patients with chronic diabetic foot ulcers (DFU) treated with skin substitutes.Methods: Patients with chronic diabetic wounds ≥ Grade 2 Wagner class who underwent skin-substitute placement (i.e., *human-, †bovine-derived 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 wound area measured with a 3D camera. Secondary outcome was tissue oxygen saturation (SatO2) measured with near infrared spectroscopy. Outcome changes were assessed at the endpoint (EP) compared to baseline (BL) and between groups using general linear mixed model.Results: Thirty-four patients with DFUs (age: 58.2±11.6 yrs, 70.6% male, HbA1c: 9.17±2.9 %mmol/mol, previous revascularization: 58.8%, wound area: 20.5±16.4cm2, wound SatO2: 70.3±12.1%) were recruited (frail, n=19; Non-frail, n=15). At EP, wound area reduction was significantly higher among non-frails compared to frails (53.5% vs. 28.1%, P=0.001). The magnitude of change in SatO2 at EP compared to BL showed a trend (P=0.12) for increased values in the non-frail (22% higher), in contrast to the frail (45% lower) group.Conclusion: These findings support the hypothesis that frailty may affect wound healing in patients with DFUs treated with skin-substitutes.This observation should be validated in a larger sample size.