Letter to the Editor
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Mar 15, 2025; 16(3): 102899
Published online Mar 15, 2025. doi: 10.4239/wjd.v16.i3.102899
Optimizing risk management for post-amputation wound complications in diabetic patients: Focus on glycemic and immunosuppressive control
Zhi-Peng Li, Jin-Ke Sun, Wei-Ping Fu, Chang-Jiang Zhang
Zhi-Peng Li, Wei-Ping Fu, Chang-Jiang Zhang, Second Department of Orthopedics, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
Zhi-Peng Li, Tianjian Advanced Biomedical Laboratory, Zhengzhou University, Zhengzhou 450001, Henan Province, China
Jin-Ke Sun, Third Department of Orthopedics, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
Co-corresponding authors: Wei-Ping Fu and Chang-Jiang Zhang.
Author contributions: Li ZP contributed to conceptualization, methodology, software, and writing of the original draft; Sun JK contributed to formal analysis and methodology; Fu WP and Zhang CJ contributed to visualization, formal analysis, and manuscript reviewing and editing. All authors participated in drafting the manuscript and all have read, contributed to, and approved the final version of the manuscript. Fu WP and Zhang CJ contributed equally to this work as co-corresponding authors. Each corresponding author made significant contributions to distinct and critical aspects of the study, including collaborative writing and final review of the manuscript. As the authors of this manuscript, we believe that the designation of two co-corresponding authors, Fu WP and Zhang CJ, is fully justified. Both made equal and critical contributions to the study. Fu WP played a leading role in formal analysis, data visualization, and methodological refinement, while Zhang CJ provided supervision, project direction, and critical revisions, ensuring the accuracy and clarity of the manuscript. Furthermore, both co-corresponding authors were instrumental in securing the funding that supported this research. They contributed significantly to drafting and managing applications for key grants, including the Henan Province Key Research and Development Program and the Henan Province Medical Science and Technology Key Project. Their leadership and collaboration were indispensable in shaping the study and ensuring its completion.
Supported by Henan Province Key Research and Development Program, No. 231111311000; Henan Provincial Science and Technology Research Project, No. 232102310411; Henan Province Medical Science and Technology Key Project, No. LHGJ20220566 and No. LHGJ20240365; Henan Province Medical Education Research Project, No. WJLX2023079; and Zhengzhou Medical and Health Technology Innovation Guidance Program, No. 2024YLZDJH022.
Conflict-of-interest statement: Every author has stated that there is no commercial, professional, or personal conflict of interest relevant to the study, proving that it complies with the principles of publishing ethics.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chang-Jiang Zhang, Chief Physician, MD, Professor, Second Department of Orthopedics, The Fifth Affiliated Hospital of Zhengzhou University, No. 3 Kangfu Qianjie, Erqi District, Zhengzhou 450052, Henan Province, China. changjiangzhang1968@outlook.com
Received: November 1, 2024
Revised: December 19, 2024
Accepted: December 27, 2024
Published online: March 15, 2025
Processing time: 81 Days and 8.3 Hours
Abstract

This study highlights the importance of identifying and addressing risk factors associated with wound complications following transtibial amputation in diabetic patients. These amputations, often necessitated by severe diabetic foot ulcers, carry significant risks of postoperative complications such as infection and delayed wound healing. Elevated hemoglobin A1c levels, indicative of poor glycemic control, and a history of kidney transplantation, due to required immunosuppressive therapy, are key factors influencing these outcomes. This paper emphasizes the need for enhanced glycemic management and personalized postoperative care, particularly for immunocompromised individuals, to minimize complications and improve patient prognosis. Future research should focus on prospective studies to validate targeted interventions and optimize care strategies, ultimately aiming to reduce the healthcare burden associated with diabetic foot complications.

Keywords: Transtibial amputation; Diabetic foot; Wound complications; Risk factors; Glycemic control; Hemoglobin A1c; Immunosuppressive therapy; Kidney transplantation; Personalized care; Postoperative outcomes

Core Tip: Effective management of wound complications following transtibial amputation in diabetic patients relies on targeted risk factor mitigation. Maintaining optimal glycemic control, particularly by managing preoperative elevated hemoglobin A1c levels, can significantly reduce complications. Additionally, personalized postoperative care, especially for immunocompromised patients such as those with a history of kidney transplantation, is crucial. A multidisciplinary approach involving endocrinologists, surgeons, and wound care specialists is recommended to optimize patient outcomes and minimize healthcare burdens. Future research should focus on validating these strategies through prospective studies to enhance clinical practice in diabetic foot care.