Hierarchical Management of Chronic Infectious Diabetic Foot Wounds During the COVID-19 Pandemic: A Single-Center...

Coronavirus disease 2019 (COVID-19) has placed considerable pressure on healthcare systems worldwide and has disrupted the routine management of chronic diseases. Patients with diabetic foot often require repeated outpatient visits, hospitalization, and surgical intervention, making continuous wound care particularly challenging during the pandemic. This study aimed to describe the clinical characteristics of patients with diabetic foot treated during the COVID-19 pandemic and to summarize the hierarchical management strategy adopted at our institution. This single-center retrospective observational study included all consecutive patients with diabetic foot treated at our hospital between January 23 and March 27, 2020. Patient attendance during the study period was compared with that during the corresponding period in 2019. Demographic characteristics, comorbidities, Wagner classification, treatment strategies, and clinical outcomes were collected from electronic medical records and analyzed retrospectively. A total of 12 patients were treated during the study period, representing a marked reduction in hospital attendance compared with the corresponding period in 2019 (P < 0.0001). Most patients were older adults with multiple comorbidities, and 58% had Wagner grade 4-5 lesions. Surgical treatment was performed in eight patients, and the mean hospital stay was 27.5 days ± 20.2 days. No patient developed laboratory-confirmed COVID-19 during hospitalization or follow-up. One patient died of infectious shock secondary to diabetic foot infection, and the death was unrelated to COVID-19. Patients with diabetic foot often have advanced age, diabetes, multiple comorbidities, and chronic wounds that require ongoing medical care, which may increase their vulnerability during infectious disease outbreaks. The hierarchical management strategy described in this study allowed essential diabetic foot care to be maintained throughout the COVID-19 pandemic and was associated with no observed COVID-19 cases in this small retrospective cohort. Further studies involving larger populations are needed to evaluate its effectiveness and generalizability.