(WHS-L4.04) Evaluating TEWL as a Predicitve Marker for Reulceration in Healed Chronic Diabetic Foot Ulcers
Thursday, May 16, 2024
10:30 AM – 11:30 AM East Coast USA Time
Background: Chronic diabetic foot ulcers (DFUs) present a significant healthcare challenge due to their high recurrence rate and associated morbidity. Identifying reliable predictive markers for ulcer re-ulceration is critical for improving patient outcomes. This study investigates the role of transepidermal water loss (TEWL) as such a marker. TEWL's potential relevance stems from its reflection of skin barrier function, which is crucial in wound healing and prevention of complications.
Methods: Nineteen patients, averaging 69 years of age (±6.4 years), including 50% with a smoking history, were enrolled. These individuals had an average Charlson comorbidity index of 5.7 (±1.5) and a mean diabetes duration of 21 years (±6.7 years). Wound chronicity varied from 8 to 53 weeks with a mean of 20.8 weeks. TEWL was measured using a Vapometer™ device at the healed wound site, 5.0 cm from the wound site, the identical site on the contralateral leg, and 5.0 cm from the contralateral site at three to four monthly visits. Reulceration occurred at a mean of 78.7 weeks (±60.6 weeks) after initial healing, and the time from the last TEWL reading to reulceration ranged from 4 to 146 weeks.
Results: A significant difference was observed in TEWL values at the healed ulcer site between patients whose ulcers remained healed and those who re-ulcerated within 3 months to 3 years post-study. Patients who did not re-ulcerate had a mean TEWL at the healed wound site of 22.85, compared to 27.04 in patients who subsequently re-ulcerated (p < 0.001). The difference in TEWL between the wound and contralateral sites was 4.46 in patients who did not re-ulcerate and 7.61 in those who re-ulcerated (p=0.005). Significance and analysis were determined by T-tests and generalized linear modeling.
Conclusions: The results indicate that TEWL, especially the previously unrecognized variance between the wound and contralateral sites, may serve as a reliable indicator for predicting the risk of re-ulceration in patients with healed DFUs. However, the generalizability of these findings is limited due to the small sample size, suggesting a need for further research with larger cohorts. Future studies should aim to establish TEWL norms in healthy individuals for better comparative analysis and the development of effective preventative strategies for diabetic patients, considering the high 5-year mortality rate associated with DFUs.