Cardiovascular Report

Before Johns Hopkins established its Multidisciplinary Diabetic Foot and Wound Clinic, says director and vascular surgeon Christopher Abularrage, patients with diabetes and complex foot or wound care needs weren’t making the appointments they needed with specialists, including endocrinologists and podiatrists.

“They might have seen me but didn’t get to the endocrinologist,” says Abularrage, “so once we got their foot healed, they would come back with the same problem because their blood sugar was out of control.” Getting to appointments required major effort for these patients, many of whom were already scheduled for dialysis three times a week or relied on others for transportation.

The clinic recently celebrated its fifth anniversary; within that time, it has expanded from a service offered one half day every other week to one full day a week, with vascular surgeons, surgical podiatrists, and endocrinologists available to see about 40 patients in one stop. The clinic, which also features physician assistants and a wound care nurse, manages patients with issues such as peripheral arterial disease, foot ulcers or foot infections. If surgery is needed, the team includes an orthopaedic and plastic surgeon, physical therapists, and orthotics and prosthetics specialists.

Building on the Johns Hopkins Medicine model, the office also boasts a robust research database. The first time patients arrive, a clinic staff member enters basic information about their medical history, comorbidities and any previous surgeries. Patients are then tracked over time.

“What we recently found is that, stage for stage, in the types of wounds and the types of ischemia and infections patients have, our amputation rates are some of the lowest in the country, especially for stage IV wounds requiring major amputation,” Abularrage says. In the U.S., he adds, about 20 percent to 64 percent of stage IV wounds require major amputation; at Johns Hopkins, it’s around 7 percent. The work was published in the Journal of Vascular Surgery.

Rates of recurrent ulcers have also dropped — 60 percent of new wounds that occur after patients have been seen initially are less serious, resulting in fewer surgeries and lower health care costs. Overall, Abularrage says, multidisciplinary care has equalized treatment outcomes for patients regardless of socioeconomic status, whereas in many settings, patients who are disadvantaged have much worse outcomes.

Learn more or refer a patient: 410-955-5165 or visit the Johns Hopkins Heart and Vascular Institute's Multidisciplinary Diabetic Foot and Wound Clinic.