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ORIGINAL RESEARCH article

Front. Endocrinol.
Sec. Clinical Diabetes
Volume 15 - 2024 | doi: 10.3389/fendo.2024.1420232

The association of the perioperative neutrophil-to-lymphocyte ratio with wound healing in patients with Wagner grade 3 and 4 diabetic foot ulcers after tibial cortex transverse transport surgery: A prospective observational cohort study

Provisionally accepted
Sichun Zhao Sichun Zhao 1,2Fudie Guo Fudie Guo 1,2*Yonghui zang Yonghui zang 1,2*Rong Hu Rong Hu 1,2*Xianjun Yu Xianjun Yu 1,2*Hongmei Zhang Hongmei Zhang 1,2*Tingting Xie Tingting Xie 1,2*Xiaoya Li Xiaoya Li 1,2*Chunxia Bai Chunxia Bai 1,2*Haoran Shi Haoran Shi 1,2*Dingwei Zhang Dingwei Zhang 1,2*
  • 1 Mianyang Central Hospital, Mianyang, China
  • 2 University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China

The final, formatted version of the article will be published soon.

    Background: Diabetic foot ulcers (DFUs) are severe complications of diabetes, involving multiple etiological factors including neuropathy, vascular insufficiency, and impaired wound healing. The global burden of DFUs is substantial, with significant morbidity and high management costs. Recent advancements have introduced the Tibial Cortex Transverse Transport (TTT) technique, which has shown promising results in the management of severe DFUs by promoting angiogenesis and immunomodulation. Methods: This prospective cohort study enrolled patients with Wagner grade 3 and 4 DFUs, treated using the TTT technique from May 2022 to September 2023 at MianYang Central Hospital. The study assessed the influence of TTT on the perioperative neutrophil-tolymphocyte ratio (NLR), an established biomarker of systemic inflammation, and its correlation with wound healing outcomes. Results: A total of 82 patients were enrolled, with 66 completing the study. The survival analysis revealed that patients with a lower preoperative NLR experienced significantly faster wound healing compared with a high NLR (log rank test P < 0.05; hazard ratio (HR)=0.46; 95% CI: 0.26-0.83). The optimal NLR cut-off values (4.25) were established for predicting wound healing times for DFUs. The median NLR was significantly different before TTT surgery, 3-days after TTT surgery and 1 month after TTT surgery (P＜0.05). Conclusion: TTT technique significantly influences the perioperative NLR and is associated with improved wound healing in DFU patients. The perioperative NLR serves as an effective predictive biomarker for wound healing outcomes, highlighting the significance of interventions targeting NLR values in perioperative management strategies and postoperative monitoring protocols for the treatment of diabetic foot ulcers (DFUs) in clinical practice.

    Keywords: diabetic foot ulcer, Wagner grade 3 and 4, tibial cortex transverse transport technique, neutrophil-to-lymphocyte ratio (NLR), Wound Healing

    Received: 19 Apr 2024; Accepted: 29 Sep 2024.

    Copyright: © 2024 Zhao, Guo, zang, Hu, Yu, Zhang, Xie, Li, Bai, Shi and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Fudie Guo, Mianyang Central Hospital, Mianyang, China
    Yonghui zang, Mianyang Central Hospital, Mianyang, China
    Rong Hu, Mianyang Central Hospital, Mianyang, China
    Xianjun Yu, Mianyang Central Hospital, Mianyang, China
    Hongmei Zhang, Mianyang Central Hospital, Mianyang, China
    Tingting Xie, Mianyang Central Hospital, Mianyang, China
    Xiaoya Li, Mianyang Central Hospital, Mianyang, China
    Chunxia Bai, Mianyang Central Hospital, Mianyang, China
    Haoran Shi, Mianyang Central Hospital, Mianyang, China
    Dingwei Zhang, Mianyang Central Hospital, Mianyang, China

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