International Journal of Lower Extremity Wounds最新文献

Background. Diabetic foot osteomyelitis may precede major limb amputations and lengthy hospital admission. These complications impact patients' morbidity and mortality. Healthcare institutions with dedicated limb-preservation teams realize reduced amputation rates and improved quality of care. This study evaluates the outcomes following the implementation of a rigorous diabetic limb-preservation program at an academic institution. Methods. Patients with diabetes admitted for osteomyelitis occurring below the knee were identified by ICD-10 codes and included for retrospective review. The number and type of amputations, bone biopsies, revascularizations, and hospital length of stay (LOS) were evaluated. Outcomes were compared using the high-low (Hi-Lo) amputation ratio for the 24 months preceding and the 24 months after the integration of a diabetic limb-preservation service. Results. The authors identified and included 337 patients admitted for diabetic foot osteomyelitis. In the 24-month period prior to program implementation, 140 patients were evaluated. In the 24-month period after program implementation, 197 patients were evaluated. The overall amputation rate decreased from 67.1% (n = 94) to 59.9% (n = 118) (P = .214). Major limb amputation rates significantly decreased from 32.9% (n = 46) to 12.7% (n = 25) (P = .001). Minor amputation rates significantly increased from 34.2% (n = 48) to 47.2% (n = 93) (P = .024). The Hi-Lo amputation ratio decreased from 0.96 to 0.27 (P < .001). The rate of obtaining bone biopsies increased from 32.1% (n = 45) to 72.1% (P < .001). The rate of revascularization increased from 10.7% (n = 15) to 15.2% (n = 30) (P = .299). Average hospital LOS decreased significantly from 11.6 days to 9.8 days (P = .044). Conclusion. After the implementation of a limb-preservation team, there was a precipitous drop in major limb amputations in favor of minor amputations. The average hospital LOS decreased. These findings demonstrated improved clinical care and outcomes in patients with lower extremity osteomyelitis and reinforce the importance of a diabetic foot-preservation service within healthcare institutions.

The treatment of pressure ulcer is of an extreme clinical and social concern. Effective and thorough debridement lays the foundation for favorable wound healing. Recently, a case report confirmed the efficacy of a combined application of methylene blue staining and ultrasonic debridement for pressure ulcer debridement. A 91-year-old male who suffered from severe pressure ulcers for over 6 years eventually obtained a favorable restoration after receiving surgical debridement optimized with methylene blue staining and ultrasonic debridement. We write to learn more about the details of the case. In this letter, we raised some questions involving the identification capability of methylene blue staining among different tissues, the application of methylene blue staining for various wounds, the arrangement of the debridement liquid, and the management strategy after wound closure. We thank the authors for creating a successful paradigm and hope the discussion can make sense for guiding subsequent clinical practice.

Objective: Through clinical trials, this study observes the therapeutic effect of platelet-rich plasma (platelet-rich plasma, PRP) on diabetic foot ulcers and explored the relationship between the relationship between PRP and autophagy. Methods: Thirty patients with diabetic foot ulcer who met the relevant criteria were randomly divided into PRP treatment group and control group. In the PRP treatment group, the formed PRP gel was coated and bandaged on the diabetic foot ulcer wound, and the PRP treatment was repeated on the seventh day. The control group was covered with normal saline sterile gauze. Observe the healing rate of the wound in 7 days, 14 days and 21 days, the pain in 5 consecutive days and the healing time of the wound after treatment, collect wound granulation tissues before and twenty-first days after treatment then detect the expression of autophagy-related proteins (LC-3, P62) and inflammatory factors (IL-6, IL-10) in diabetic foot ulcer wound to investigate the potential relationship between PRP treatment of diabetic foot ulcers and autophagy and inflammatory responses. Results: The wound healing rate of diabetic foot ulcer patients in the PRP treatment group was higher than that in the control group on the seventh, 14th and 21st days, the healing time (31.40 ± 4.47) was better than that in the control group (43.20 ± 5.03) days, and the pain improvement was better than that in the control group (P < .05). The results of Western blot analysis and quantitative PCR of autophagy-related proteins (LC-3 and p62) in granulation tissue showed that the values of LC3 and LC3-II/LC3-I and the expression of LC3 gene in wound granulation tissue of PRP group were significantly higher than those before treatment (P < .05). The value and gene expression of P62 protein were lower than those before treatment (P < .05). In the control group, there was no significant difference in LC3 and P62 protein gray level and gene expression before and after treatment (P > .05). The level of autophagy in the wound of PRP group increased after treatment, while there was no statistical significance in the control group. The results of ELISA showed that the concentration of IL-6 in granulation tissue of the PRP treatment group was lower than that before treatment (P < .05), while there was no significant difference in IL-6 in the control group after treatment. The concentration of IL-10 increased in both groups after treatment, but the concentration in PRP group was higher than that in control group (P < .05). Conclusions: This study shows that PRP gel has advantages in accelerating wound healing, relieving pain, shortening healing time and reducing inflammatory response in treating diabetic foot ulcers wound, which may be related to autophagy, and provides new ideas for the treatment of diabetic foot ulcers.

The systemic immune-inflammation index (SII) was significantly higher in patients with severe infections, those with necrosis, and in those requiring admission, postoperative antibiotics, and any amputation. However, SII was significantly lower in patients with osteomyelitis compared to those with soft tissue infections. The correlation coefficients (rho) between SII and other inflammatory markers were as follows: WBC (Moderate correlation, 0.64, P < .001), ESR (Weak correlation, 0.34, P < .001), and CRP (Moderate correlation, 0.56, P < .001). The correlation coefficient (rho) between SII and the number of days admitted was moderate, 0.42 (P < .001). Based on a previous experience, SII may be an additional marker to diagnose osteomyelitis in the feet of patients with diabetes. Now, we need further research including SII, a low-cost and easy-to-measure index, in well-designed controlled studies to definitively clarify its role.

According to the World Health Organization (WHO), ∼180,000 casualties are recorded every year due to burns, majorly from low- and middle-income countries that require medical attention. For the last 5 decades, silver sulfadiazine (SSD) 1% cream has been the most widely used topical antimicrobial agent for managing burn wound infections. Although SSD is considered the gold standard therapy in burn wound management, however in the last 10 years, several studies have reported the negative impact of SSD on the wound healing process. The therapeutic potential of SSD is restricted by its poor solubility, and antimicrobial action appears only after the dissociation of SSD into silver ions (Ag⁺) and sulfadiazine (SD). Pharmaceutical researchers and industries are looking for alternative strategies to overcome the challenges and limitations of the available SSD formulation due to rising costs, extensive time commitment, and the high risk of failure associated with the de novo development of new antimicrobial drugs. Recent advances in drug delivery systems nanotechnology-based strategies have had a colossal impact on them, particularly in burn wound management. Nanoparticulate systems and nanotools could be considered as potential drug delivery approaches for burn management. This contemporary review provides an abridgment of the literature on advanced SSD nanotherapeutics and their importance in managing burns.

High plantar flexor moment and limited ankle mobility are known to cause high plantar pressure under the forefoot. Stretching is an effective physical therapy for the limited ankle range of motion (ROM), and electrical stimulation is used to regulate the activity of antagonistic muscle via the action of reciprocal inhibition. Additionally, stretching paired with electrical stimulation has been reported to improve the limited ROM significantly. This study aims to investigate the influences of stretching on triceps surae (STR), electrical stimulation to tibialis anterior (ES), and the combination (ES+STR) on the ROM, kinematic parameters, and plantar pressure distribution during gait in patients with diabetes mellitus. Planter pressure and other parameters were measured before and after the intervention of ES, STR, ES+STR, or the rest sitting on the bed (CON) for 10 min. Pressure time integral under the medial forefoot decreased in the ES+STR compared to CON (P< .05). Interestingly, ES+STR increased passive and dynamic ROM on ankle dorsiflexion during gait and increased the lateral center of pressure excursion (P < .05). Furthermore, these changes were followed by decreased contact duration under the medial forefoot (P < .05). The combined therapy improves ankle mobility during gait and reduces the contact duration and the plantar pressure under the medial forefoot in patients with diabetes mellitus.

Objective: The aim was to describe the effects of the use of citric acid in the healing process of chronic leprosy wounds. Approach: This is a case series, carried out with 5 people with chronic leprosy wounds, under continuous care in an outpatient center wound care in the center-south region of Brazil. The intervention protocol consisted of topical application of 3% citric acid (ointment), on the wound bed, in a thin layer of approximately 2 mm, on alternate days, and followed up for a total period of 8 weeks and secondary coverage rayon and gauze. The cases were analyzed regarding wound dimensions, histology and clinical observation. Results: It was observed in all cases better aspect of the wound bed, presence of granulation tissue and decrease of the inflammatory process with predominance of lymphocytes, reduction of bacterial colonies, increase and verticalization of type I collagen fibers, reduction of type III collagen and increased areas of epithelialization. Innovation: There was also a reduction in the level of pain and exudation after the treatment protocol. Conclusions: Therefore, the use of citric acid in leprosy neuropathic wounds is promising and may be a treatment option, considering its cost, clinical management and possible effect on the chronic inflammatory process.

Exercise therapy helps improve glycaemic control and insulin sensitivity and may be relevant in treating patients with diabetic foot ulcers (DFUs). This study describes the development of a 12-week exercise therapy program for patients with DFUs and the preliminary feasibility of the program focusing on the program's inclusion, adherence, and safety. The development process is built on knowledge from a published systematic review on exercise for people with DFUs and a grounded theory study on the main concerns of people with DFUs regarding physical activity. The development involved doctors, wound care nurses, podiatrists, and feedback from patients and physical therapists using semi-structured interviews. The program was designed as a combination of aerobic and resistance training exercises. The aerobic exercise phase on the stationary bike of 30-minute duration was aimed at a moderate intensity. Resistance exercises were conducted with a 15-repetition maximum approach (four to five sets per trial) throughout the 12-week period. Three patients were included and received the exercise intervention. Except for recruitment and retention rates, acceptance levels were met for all other research progression criteria. Patients found the intervention relevant, wanted further guidance on continuing exercising, and would have liked the intervention closer to their home for example, a municipality setting. Although the exercise therapy program for patients with DFUs was developed in a thorough process with the inclusion of available evidence and the involvement of patients and other stakeholders conclusions on feasibility are limited due to the low recruitment rate. A reconsideration of the setting is needed in future exercise intervention studies.

Pyoderma gangrenosum (PG) is a neutrophilic inflammatory dermatosis, whose management still represents a clinical challenge due to frequent unresponsive cases. The aim of our study was to evaluate the efficacy of a novel, combined approach including local wound management, based on the principle of PG-TIME and a systemic therapy with an anti interleukin (IL)-17A monoclonal antibody (mAb). We presented a case of a 37-year-old female patient, affected by multi-refractory PG. The patient was treated with a combined approach of both local and systemic therapy. Wound clinical improvement was assessed by Wound Bed Score (WBS), wound size was evaluated through 3D camera laser scanner, and pain was evaluated with visual analog scale (VAS). After 52 weeks of therapy, the association of local wound management with ixekizumab 80 mg [160 mg at time (T) 0; 80 mg every 2 weeks until week 12; 80 mg every 4 weeks] allowed us to perform skin grafting and obtain complete wound healing. Our clinical case demonstrated the efficacy of a novel combination therapy for the treatment of recalcitrant PG based on IL-17 mAbs and local wound management built on the main features of PG-TIME.

AimTo monitor wound pH and surface temperature as predictors of wound healing in diabetic foot ulcers (DFU).MethodsProspective, observational, time-bound study of 18 months, enrolling patients aged 18 to 60 years with uninfected DFU. The wound was assessed at baseline and after that, every week for 4 weeks according to the leg ulcer measurement tool (LUMT). Concurrently, wound surface pH and temperature were measured. The data were analyzed using descriptive statistics, and a P-value < .05 was considered statistically significant.ResultsFifty-four patients with DFU were included in the study with a mean age of 55 years and a male to female ratio of 1.57. The wound showed progressive improvement, a maximum mean LUMT score of 48.89 (± 2.81) at the initial evaluation and decreased progressively to the mean of 19.80 at week 4 (± 3.43), both of which were statistically significant (P-value < .001). Similarly, the median wound pH progressively reduced from 7.7 at baseline to 7.20 in the fourth week, and median wound temperature decreased from 90°F (32.22 °C) at baseline to 85°F (29.44 °C) in the fourth week, both of which were statistically significant (P-value < .001).ConclusionProgressive and significant change in wound pH to acidic and drop in wound surface temperature, both corresponding to improvement in the status of DFU, maximum at 4 weeks, make them valuable predictors of wound healing. However, further, more extensive studies are required to establish a concrete relationship.