الفهرس 
AcknowledgmentOnly 14 pages are availabe for public view
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Abstract
Introduction: Diabetes Mellitus (DM) is a chronic disease which is considered a global public health problem. Diabetic foot ulcer (DFU) is the most costly and devastating complication of diabetes mellitus affecting 15% of diabetic patients during their lifetime. Assessment of foot perfusion is a critical step in the management of patients with diabetic foot ulcers. The ankle-brachial pressure index is a simple, quick, non-invasive. Vacuum-assisted closure is one of adjuvant therapies that have been studied to decrease DFU healing times and amputation rates. It is a non-invasive therapy system which uses controlled negative pressureto help encourage wound healing by removing fluid from wounds, preparing the wound bed for closure, reducing edema, and promoting formation and perfusion of granulation tissue. Aim of study: To verify cutoff value of ABPI at which diabetic foot ulcers get benefit from VAC application and follow up of ABPI before and after VAC application to assess its impact on improving the blood flow in the presence of PAD. Patient and Methods: An observational descriptive prospective analytic study that had been performed at Vascular Surgery Department at Mansoura University Hospital between March 2020 and May 2021. 56 patients were enrolled in the study. The inclusion criteria consisted of the following: the patient ≥40 years with unhealed diabetic foot ulcers belonged to grade 1 or grade 2 (in wound category of WIFI classification). Patients with immunocompromised status, varicose veins, CVI, foot with severe infection or extensive tissue loss were excluded from the study. Results: The ROC curve plotted for the different cutoff values of the ABPI giving the sensitivity against different values for 1 − specificity. The area under the curve (AUC) was 0.762 (95% CI: 0.476–1). The AUC was significantly above and away from the diagonal reference line (P= 0.028) with cutoff point 0.615. However, when comparing the change in ABPI before and after VAC application, the current results showed non-significant improvement (1.3%, P=0.285). Discussion : The present work demonstrated that ABPI could significantly predict the improvement in the dimensions of diabetic foot ulcer after VAC application. The area under the curve (AUC) was significantly above and away from the diagonal reference line (P=0.028), as well at a cutoff point 0.615, ABPI showed 71.4% sensitivity and 100.0% specificity (AUC= 0.762), verifying the ability of ABPI to detect diabetic foot ulcers get benefit from VAC application. However, when comparing the change in ABPI before and after VAC application, the current results showed non-significant improvement (1.3%, P=0.285). In agreement with the current results, VAC system has been shown to increase blood flow by up to 4 times the basal level. Conclusion : By measurement of ABPI, we can predict diabetic foot ulcers which can get benefit after VAC application. However, VAC application shows non-significant improvement in ABPI.