- ICH GCP
- US Clinical Trials Registry
- Klinisk utprøving NCT01762085
Nerve Decompression for Ulcer Recurrence Avoidance (DURA) (DURA)
A Prospective Study of Recurrence Risk in Diabetic Foot Ulceration After Nerve Decompression
Studieoversikt
Status
Forhold
Intervensjon / Behandling
Detaljert beskrivelse
Diabetes patients with a recently healed, non-ischemic plantar diabetic foot ulcer will be randomized to "best care" standard post-ulcer treatment or to best care plus bilateral nerve decompression by external neurolysis at 4 fibro-osseous tunnel sites in the leg and foot. Comparison of the control group with standard care to the surgical intervention group will be made for subsequent appearance of a plantar foot ulcer and ulcer recurrence risks will be calculated. Additional subjective and objective secondary outcomes will be monitored. Null hypothesis: nerve decompression will not decrease diabetic foot ulcer recurrence risk.
If protection against ulcer occurrence were to be confirmed, a change in the treatment paradigm for diabetic neuropathy and foot ulcer could be appropriate.
Studietype
Registrering (Forventet)
Fase
- Ikke aktuelt
Kontakter og plasseringer
Studiekontakt
- Navn: Stephen Barrett, DPM
- Telefonnummer: 623 572-3456
- E-post: slbarrettpod@me.com
Studer Kontakt Backup
- Navn: D. Scott Nickerson, MD
- Telefonnummer: 307 752-9875
- E-post: thenix@fiberpipe.net
Studiesteder
-
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Arizona
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Phoenix, Arizona, Forente stater, 85024
- Rekruttering
- Barrett Foot & Ankle Institute
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Ta kontakt med:
- Steven L Barrett, DPM
- Telefonnummer: 480-478-0780
- E-post: slbarrettpod@me.com
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Ta kontakt med:
- John C Tassone, DPM
- Telefonnummer: (602) 938-6960
- E-post: jctassone@cox.net
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Hovedetterforsker:
- Stephen L Barrett, DPM
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Scottsdale, Arizona, Forente stater, 85251
- Rekruttering
- Richard P. Jacoby
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Ta kontakt med:
- Richard P Jacoby, DPM
- Telefonnummer: 480-994-5977
- E-post: jacobydpm@gmail.com
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Hovedetterforsker:
- Richard P Jacoby, DPM
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Tucson, Arizona, Forente stater, 85724-5072
- Rekruttering
- Southern Arizona Limb Salvage Alliance,
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Ta kontakt med:
- Manish Bharara, PhD
- Telefonnummer: 520-626-1349
- E-post: manish.bharara@gmail.com
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Ta kontakt med:
- David Armstrong, DPM
- Telefonnummer: (520) 626-1349
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Hovedetterforsker:
- Manish Bharara, PhD
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Indiana
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Jasper, Indiana, Forente stater, 47546
- Rekruttering
- Andrew Rader, DPM
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Ta kontakt med:
- Andrew P Rader, DPM
- Telefonnummer: 812-634-2778
- E-post: pvppc@psci.net
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Hovedetterforsker:
- Andrew P Rader, DPM
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Texas
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Denton, Texas, Forente stater, 76210
- Rekruttering
- Damien Dauphinee
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Ta kontakt med:
- Damien Dauphinee, DPM
- Telefonnummer: 940-300-3054
- E-post: dauphinee@completefootandanklecare.com
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Hovedetterforsker:
- Damien Dauphinee, DPM
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Houston, Texas, Forente stater, 77092
- Rekruttering
- Maria Buitrago, DPM
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Ta kontakt med:
- Maria Buitrago, DPM
- Telefonnummer: 713-680-3668
- E-post: mobui@hotmail.com
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Hovedetterforsker:
- Maria Buitrago, DPM
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Deltakelseskriterier
Kvalifikasjonskriterier
Alder som er kvalifisert for studier
Tar imot friske frivillige
Kjønn som er kvalifisert for studier
Beskrivelse
Inclusion Criteria:
- Type 1 or Type 2 Diabetes Mellitus
- Diabetic sensorimotor peripheral neuropathy
- Recently healed plantar neuropathic Diabetic Foot Ulcer (< 18 months)
- At least one palpable foot or ankle pulse or ABI>0.8 bilaterally.
- Recent Hgb A1c < 9.0%
- Ankle edema absent or mild
Exclusion Criteria:
- Ischemic peripheral vascular disease or ankle-brachial index (ABI)<0.8
- History of peripheral vascular arterial surgery
- History of peripheral nerve or lumbar disc surgery
- alcohol abuse(more than 2 drinks/day)
- untreated thyroid disorders
- B12 or Folate deficiency
- spondyloarthropathies
- hepatic disease
- advanced renal disease
- current lumbosacral radiculopathy or nerve compression
- toxin exposure including chemotherapeutic agents
Studieplan
Hvordan er studiet utformet?
Designdetaljer
- Primært formål: Forebygging
- Tildeling: Randomisert
- Intervensjonsmodell: Enkeltgruppeoppdrag
- Masking: Ingen (Open Label)
Våpen og intervensjoner
Deltakergruppe / Arm |
Intervensjon / Behandling |
---|---|
Placebo komparator: healed DFU control arm
clinic-specific usual "best care"
|
|
Eksperimentell: healed DFU surgical intervention
clinic-specific "best care" plus nerve decompression at 4 known sites of lower leg fibro-osseous entrapment
|
surgical decompression involves surgical division or incision of perineural fibrous or fibro-osseous tunnel tissues which pinch, choke, compress or sharply deviate nerve trunks.
Andre navn:
|
Hva måler studien?
Primære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
---|---|---|
occurrence of plantar foot ulceration wound
Tidsramme: 2 years post-enrollment or post-op
|
Non- traumatic pressure wound or ulcer appearance during the study.
|
2 years post-enrollment or post-op
|
Sekundære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
---|---|---|
occurrence of delayed wound healing
Tidsramme: 3 months post nerve decompression
|
failure of surgical wound to heal primarily, without local infection signs of swelling, heat, redness, and pain
|
3 months post nerve decompression
|
Visual Analog Pain Score
Tidsramme: 2 years
|
Patient report of pain level
|
2 years
|
Andre resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
---|---|---|
any amputation
Tidsramme: 24 months, 2 years
|
surgical removal of any part of the lower extremity, including toe
|
24 months, 2 years
|
surgical wound infection
Tidsramme: 3 months
|
swelling, redness, or heat, with pain after surgery
|
3 months
|
non-surgical foot infection
Tidsramme: 24 months
|
foot swelling, redness, pain, and heat not subsequent to operation; or occurring in an operated leg >90 days post-op
|
24 months
|
measures of diabetic peripheral neuropathy (DPN)
Tidsramme: 2 years
|
Michigan Neuropathy Symptom Index; Pain visual analog pain scale (VAPS); sensibility to vibration, light touch, 2-point discrimination; deep tendon reflex
|
2 years
|
analgesic usage
Tidsramme: 2 years
|
patients will log use of analgesic medications and changes in use.
|
2 years
|
SPY Indocyanine green circulation evaluation
Tidsramme: pre-opo, post-op, study end
|
This intravenous injection and non-invasive scan evaluation may indicate whether relief of nerve entrapment will alter macro or microcirculation
|
pre-opo, post-op, study end
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Incidence of falls during the study
Tidsramme: 2 years
|
Prior history of falls will be defined and changes in risk of new falls in control and intervention groups.
Balance has been reported to improve after nerve decompression.
|
2 years
|
Samarbeidspartnere og etterforskere
Etterforskere
- Studieleder: D. Scott Nickerson, MD, NE Wyoming Wound Care Center, consultant
- Hovedetterforsker: Stephen L. Barrett, DPM, Barrett Foot & Ankle Institute
Publikasjoner og nyttige lenker
Generelle publikasjoner
- Aszmann O, Tassler PL, Dellon AL. Changing the natural history of diabetic neuropathy: incidence of ulcer/amputation in the contralateral limb of patients with a unilateral nerve decompression procedure. Ann Plast Surg. 2004 Dec;53(6):517-22. doi: 10.1097/01.sap.0000143605.60384.4e.
- Dellon AL. Preventing foot ulceration and amputation by decompressing peripheral nerves in patients with diabetic neuropathy. Ostomy Wound Manage. 2002 Sep;48(9):36-45.
- Dellon AL. Neurosurgical prevention of ulceration and amputation by decompression of lower extremity peripheral nerves in diabetic neuropathy: update 2006. Acta Neurochir Suppl. 2007;100:149-51. doi: 10.1007/978-3-211-72958-8_32.
- Nickerson DS. Low recurrence rate of diabetic foot ulcer after nerve decompression. J Am Podiatr Med Assoc. 2010 Mar-Apr;100(2):111-5. doi: 10.7547/1000111.
- Dellon AL, Muse VL, Nickerson DS, Akre T, Anderson SR, Barrett SL, Biddinger KR, Bregman PJ, Bullard BP, Dauphinee DM, DeJesus JM, DeJesus RA, Ducic I, Dunkerly J, Galina MR, Hung V, Ichtertz DR, Kutka MF, Jacoby RP, Johnson JB, Mader DW, Maloney CT Jr, Mancuso PJ, Martin RC, Martin RF, McDowel BA, Rizzo VJ, Rose M, Rosson GD, Shafiroff BB, Steck JK, Stolarski RG, Swier P, Wellens-Bruschayt TA, Wilke B, Williams EH, Wood MA, Wood WA, Younes MP, Yuksel F. Prevention of ulceration, amputation, and reduction of hospitalization: outcomes of a prospective multicenter trial of tibial neurolysis in patients with diabetic neuropathy. J Reconstr Microsurg. 2012 May;28(4):241-6. doi: 10.1055/s-0032-1306372. Epub 2012 Mar 12.
- Dellon AL. A cause for optimism in diabetic neuropathy. Ann Plast Surg. 1988 Feb;20(2):103-5. doi: 10.1097/00000637-198802000-00001. No abstract available.
- Dellon AL. Treatment of symptomatic diabetic neuropathy by surgical decompression of multiple peripheral nerves. Plast Reconstr Surg. 1992 Apr;89(4):689-97; discussion 698-9.
- Rankin TM, Miller JD, Gruessner AC, Nickerson DS. Illustration of Cost Saving Implications of Lower Extremity Nerve Decompression to Prevent Recurrence of Diabetic Foot Ulceration. J Diabetes Sci Technol. 2015 Jul;9(4):873-80. doi: 10.1177/1932296815584796. Epub 2015 Jun 8.
Studierekorddatoer
Studer hoveddatoer
Studiestart
Primær fullføring (Forventet)
Studiet fullført (Forventet)
Datoer for studieregistrering
Først innsendt
Først innsendt som oppfylte QC-kriteriene
Først lagt ut (Anslag)
Oppdateringer av studieposter
Sist oppdatering lagt ut (Anslag)
Siste oppdatering sendt inn som oppfylte QC-kriteriene
Sist bekreftet
Mer informasjon
Begreper knyttet til denne studien
Ytterligere relevante MeSH-vilkår
Andre studie-ID-numre
- WIRB 20122035
- Nerve DURA (Annet stipend/finansieringsnummer: AENS/ENRF)
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