A novel approach to diabetes-related foot ulcers/disease: First report of bipolar pulsed RF lumbar sympathetic block

BackgroundDiabetes-related foot ulcers (DFUs), often complicated by peripheral arterial disease (PAD), remain a major therapeutic challenge. In patients unsuitable for revascularization, alternative treatments are essential. This study is the first to evaluate bipolar radiofrequency (RF) ablation as part of lumbar sympathetic block (LSB) for enhancing wound healing in DFU patients with critical limb ischemia.MethodsThis retrospective cohort study included 31 DFU patients with severe PAD who were not candidates for revascularization. Group 1 (n = 18) received LSB with bipolar RF plus medical care; Group 2 (n = 13) received medical care alone. Wound healing, amputation rates, pain scores (NRS, DN4), and complications were analyzed.ResultsComplete wound healing was significantly higher in Group 1 (55.5%) than in Group 2 (15.3%) (<i>p</i> = 0.031). Amputation was required in 23.1% of Group 2 patients, while none occurred in Group 1 (<i>p</i> = 0.063). Group 1 showed significant reductions in DN4 (<i>p</i> = 0.0057) and NRS (<i>p</i> = 0.0013) at 6 months. No complications related to LSB were observed.ConclusionsLSB with bipolar RF ablation is a safe, potentially effective option for DFU patients with PAD not eligible for revascularization. It significantly improves wound healing and pain outcomes. Larger prospective studies are needed to confirm these results.