Ensuring sustained closure of diabetic foot ulcers using the STRIDE pathway - Initial results from a single center

Introduction: Diabetic foot ulcers have a high recurrence rate, with 42% of patients experiencing relapse within two years due to factors such as neuropathy, arteriopathy, and poor offloading and metabolic control. Ulceration recurrence leads to decreased physical, emotional, and social function, increased healthcare costs, and higher mortality risks. We recently developed a novel aggressive surgical approach aimed at sustained wound closure called STRIDE (Surgical Treatments for Reconstruction & Innovative Deformity Elimination). STRIDE focuses on infection management, biomechanical issues through offloading, and long-term solutions for sustained wound closure. Here, we present our initial outcomes with this approach.Methods:A retrospective chart review of the patients who underwent the STRIDE pathway in our center during the last year was conducted. Outcomes include the rate of amputations, the rate of wound closure by 20 weeks, and the rate of ulceration recurrence at six months.Results:A total of 100 patients were included. All of them underwent surgical fixation of foot and ankle deformities and underwent treatment of osteomyelitis using antibiotic-loaded flowable bone cement and synthetic CAMPs for treating their wounds. This approach led to a 50% reduction in our historical amputation rate, over 90% rate of wound closure of Wagner 3/4 ulcers by 20 weeks, and less than 5% recurrence rate, typically not at the same site.Discussion: The STRIDE pathway represents a novel surgical approach that heals wounds faster and reduces recurrence rates. It also significantly lowers amputation rates and promotes limb salvage, thereby improving patient quality of life and lowering healthcare system costs.References: