High Trans-Epidermal Water Loss at the Site of Wound Closure is Associated with Increased Recurrence of Diabetic Foot Ulcers: The NIDDK Diabetic Foot Consortium TEWL Study

Objective: The NIDDK Diabetic Foot Consortium tested the hypothesis that compromised restoration of skin barrier function of closed diabetic foot ulcers (DFU), as measured by high trans-epidermal water loss (TEWL), is associated with an increased risk of DFU recurrence.

Research Design and Methods. This is a multi-center, non-interventional study measuring TEWL in 418 adult participants with diabetes and a recently healed DFU. TEWL was measured at the center of the closed wound and at an anatomically similar reference area on the contralateral foot within 2 weeks of wound closure (visit 1) and were repeated at a wound closure confirmation visit 2 weeks later (visit 2). Participants were followed for up to 16 weeks to assess for wound recurrence. Participant self-reported and clinician assessment of DFU wound recurrence were recorded.

Results. DFU recurrence by week 16 occurred in 21.5% of participants. Mean TEWL at the center of the healed DFU at visit 1 was higher for those with recurrence compared to those without (p=0.006). Among participants with high TEWL (>30.05 g.m-2.h-1), 35% reported wound recurrence by 16 weeks versus 17% (low TEWL). The odds ratio for recurrence for participants with high TEWL was 2.66 (p<0.001). Self-reported wound recurrence was highly concordant with clinician assessment of wound recurrence.

Conclusion. Compromised wound healing mechanisms culminating in wound closure associated with defective skin barrier function is associated with increased risk of DFU recurrence. Measurement of TEWL has value as a predictor of functional wound healing and may impact clinical practice, leading to better outcomes.