Complex wounds tend to develop more rapidly in patients receiving hemodialysis because of diabetes mellitus.

The number of patients requiring dialysis because of diabetes mellitus is increasing and such patients often have complex chronic wounds, which are difficult to heal. However, there are few retrospective studies of wounds requiring surgical treatment. We evaluated 14 patients receiving hemodialysis (HD) (8 because of diabetes and 6 because of other diseases) who had extremity wounds and underwent surgical treatment in our unit from 2004 through 2007. We investigated differences in the cause of wounds, and in the interval between the start of HD and wound development. Wounds in patients undergoing HD because of diabetes originated due to ischemia in 2 cases (25%), trauma in 2 cases (25%), and infection in 4 cases (50%). Seven of 8 wounds developed infection with methicillin-resistant Staphylococcus aureus (MRSA). Wounds in patients undergoing HD because of other diseases developed due to ischemia in 2 cases (33%) and trauma in 4 cases (67%). Three of 6 wounds developed infection and MRSA were isolated from 2 wounds. The interval between the start of HD and wound development was significantly shorter in patients with diabetes than in patients without diabetes. All patients with infectious wounds required immediate debridement. We conclude that patients receiving HD because of diabetes are likely to have more severe and rapidly developing wounds due to infections. Thus, they usually require immediate debridement before blood access shunt infection occurs.