Improvement of wound healing after diabetic foot debridement by a novel high ankle block: a randomized controlled...

To evaluate the effect of ultrasound-guided high ankle block (HAB) on postoperative wound healing and foot perfusion after diabetic foot debridement.

This prospective, assessor-blinded randomized controlled trial (NCT06395961) enrolled 70 patients with Wagner II-IV diabetic foot ulcers undergoing debridement. Thirty-five patients received HAB with 35 mL of 0.375% ropivacaine, and 35 received general anesthesia (GA). The primary outcome was ulcer area on postoperative day 7, measured using ImageJ boundary delineation. Ulcer area was also assessed on days 1, 7, 14, 28, and 60. Secondary outcomes included: anterior and posterior tibial artery hemodynamics assessed by Doppler ultrasound on days 1, 7, and 14; foot skin temperature measured by infrared thermography on days 2, 4, 6, 8, 10, 12, and 14 (to avoid interference with ultrasound measurement); and visual analog scale (VAS) pain scores, opioid consumption, and adverse events assessed at various time points.

The HAB group showed significantly higher ulcer healing rates on day 7 (42.2% vs. 29.4%, P=0.04), day 14 (67.9% vs. 53.2%, P=0.02), day 28 (85.7% vs. 75.2%, P=0.02), and day 60 (96.8% vs. 91.2%, P=0.01). Arterial flow volume, peak systolic velocity, end diastolic velocity, time-averaged mean velocity, and time-averaged maximum velocity were significantly improved in the HAB group on days 1 and 7 (all P<0.001). The HAB group also had significantly higher foot skin temperatures (P<0.05), lower VAS scores (P<0.001), and lower opioid consumption (P<0.001). Pneumonia occurred less frequently with HAB (2.9% vs. 20.0%, P=0.055). No significant differences were observed in reoperation or amputation rates.

HAB enhances foot perfusion, accelerates early ulcer healing, and provides superior analgesia with fewer complications compared with GA.