International Journal of Lower Extremity Wounds最新文献

Diabetic foot ulcer (DFU) is globally a major health burden predisposing to limb amputation. Among the various treatment modalities, platelet-rich plasma (PRP) is emerging as a promising agent. It stimulates wound healing by providing a higher concentration of essential growth factors locally. Though the role of PRP in DFU healing is established, still the route of administration with maximal efficacy is yet to be defined. Our study aims to evaluate the efficacy of autologous PRP in the treatment of diabetic ulcers and compare the effect of topical and perilesional injections of PRP in DFU healing. We conducted a single-centre, prospective, interventional study on 60 patients with DFU, in 2 groups of 30 patients each. They were treated with freshly prepared autologous PRP injection perilesionally and topically respectively, once a week for 4 weeks. Ulcer size was assessed, using "imito-measure" software at presentation and 2, 4, 8, and 12 weeks post-therapy. Serum MMP-9 levels were assessed in both groups, pretreatment and post-treatment. For statistical analysis, SPSS software V-23 was used. On assessment, both groups had comparable baseline characteristics, Wagner's grading, and glycemic indices. The percentage reduction in the size of the wound at 2 weeks, 1 month, 2 months, and 3 months was greater in the perilesional group as compared to the topical PRP group.

There is accumulating evidence that magnesium, an important mineral having a pivotal role in many physiological functions, may be important in development and healing of diabetic foot ulcers (DFUs). In this non-systematic mini review, we discuss the role of magnesium in DFUs, as well as the effects of magnesium administration in DFUs. Reduced Mg levels appear to be associated with DFUs. Moreover, Mg administration may be beneficial for the outcome of DFUs. Further investigation is imperative in order to shed more light on these findings.

Diabetic neuropathy is one of the commonest diabetic complications. It affects 30-50% of people with diabetes mellitus (DM) and may cause severe pain and foot ulcers. Distal symmetric polyneuropathy and diabetic autonomic neuropathy are the main manifestations of diabetic neuropathy. The American Diabetes Association's (ADA) 82nd Scientific Sessions took place in June 2022 in New Orleans, Louisiana, and the 58th European Association for the Study of Diabetes (EASD) Annual Meeting was held in September 2022 in Stockholm, Sweden. Herein, we describe interesting studies in the field of diabetic neuropathy presented in these two meetings.

Charcot neuro-osteoarthropathy (CNO), or Charcot foot, is a disabling complication of diabetes, which is poorly understood and frequently overlooked. We describe an atypical presentation of an active Charcot foot in a woman with a long-standing type 1 diabetes who did not exhibit loss of protective sensation (sensate to a 10-gram monofilament) or loss of vibration sensation. These standard measures of large nerve fibre function ruled out "classical" neuropathy. However, additional testing showed reduced sweat gland function most likely related to degeneration of c-fibres (small fibre neuropathy). This case raises the awareness that in addition to the "textbook" description, in diabetes, Charcot foot can develop in individuals with "minimal" or "no signs" of clinical neuropathy. The onset of active Charcot foot should be suspected in every person with diabetes and history of trauma even when foot and ankle x-rays are normal. Offloading should be initiated until the diagnosis is proven otherwise.

The number of studies on the diabetes health literacy of patients with diabetic foot is very limited. The aim of this study was to determine the diabetes health literacy levels of patients with diabetic foot. The data in this cross-sectional, descriptive study were collected using a sociodemographic data collection form and the Health Literacy Scale (HLS). Data were analyzed using SPSS for Windows Version 25.0 software. The HLS total score was 35.96 ± 10.70, and the Functional, Interactive and Critical subscale scores were 11.90 ± 5.04, 13.10 ± 4.80, and 10.96 ± 4.19, respectively. The diabetic health literacy level of the patients was seen to be affected by general education level, the status of having received education about diabetes, and family history of diabetes (P < .05). The diabetes health literacy level of patients with diabetic foot can be said to be low. This demonstrates the necessity of determining and increasing the health literacy levels of patients diagnosed with diabetes before the development of diabetic foot.

In this study, we investigated the literature's publication trends related to the Charcot foot deformity. Using bibliometric analysis to examine the data of origin, this analysis was carried out by conducting an electronic search of the Web of Science database for research articles between 1970 and March 2023. We used the following search term in the search bar: TI  =  (Charcot foot OR Charcot foot deformity OR Charcot's foot OR Charcot Osteopathic Arthropathy) with English language and article-format filtering for documents. The bibliometric analysis was carried out using R's "Bibliometrix" package program. A total of 437 articles were found in the electronic search. A total number of 1513 authors from around the world contributed to the Charcot foot literature, with the most articles published (42.1%) originating in the United States. The United States had the highest proportion of citations (3332 citations). The highest number of articles (n = 245) on Charcot foot deformity was in the last decade. 2021 was the year with the most articles (n = 34). The authors from the United States and the United Kingdom had the highest number of international collaborations. The study offers researchers a current overview of essential data and may help direct future research by summarizing the main points and research trends on the topic of Charcot foot deformity.

Background: Off-the-shelf supply of viable engineered tissue is critical for effective and fast treatment of life-threatening injuries such as deep burns. An expanded keratinocyte sheet on the human amniotic membrane (KC sheet-HAM) is a beneficial tissue-engineering product for wound healing. To access an on-hand supply for the widespread application and overcome the time-consuming process, it is necessary to develop a cryopreservation protocol that guarantees the higher recovery of viable keratinocyte sheets after freeze-thawing. This research aimed to compare the recovery rate of KC sheet-HAM after cryopreservation by dimethyl-sulfoxide (DMSO) and glycerol. Methods: Amniotic membrane was decellularized with trypsin, and keratinocytes were cultured on it to form a multilayer, flexible, easy-to-handle KC sheet-HAM. The effects of 2 different cryoprotectants were investigated by histological analysis, live-dead staining, and proliferative capacity assessments before and after cryopreservation. Results: KCs well adhered and proliferated on the decellularized amniotic membrane and successfully represented 3 to 4 stratified layers of epithelialization after 2 to 3 weeks culture period; making it easy to cut, transfer, and cryopreserve. However, viability and proliferation assay indicated that both DMSO and glycerol cryosolutions have detrimental effects on KCs, and KCs-sheet HAM could not recover to the control level after 8 days of culture post-cryo. The KC sheet lost its stratified multilayer nature on AM, and sheet layers were reduced in both cryo-groups compared to the control. Conclusion: Expanding keratinocytes on the decellularized amniotic membrane as a multilayer sheet made a viable easy-to-handle sheet, nonetheless cryopreservation reduced viability and affected histological structure after thawing. Although some viable cells were detectable, our research highlighted the need for a better cryoprotectant protocol other than DMSO and glycerol, specific for the successful banking of viable tissue constructs.

Diabetic foot is a serious complication of diabetes which has significant medical and socioeconomic impacts. Turmeric is a popular Indian spice that has been used for centuries in herbal medicines for the treatment of a variety of ailments such as rheumatism, diabetic ulcers, anorexia, cough and sinusitis. Curcumin is the main ingredient presents in turmeric and responsible for its yellow color. We report here a randomized, placebo-controlled investigation into the effectiveness of topical turmeric ointment in the treatment of diabetic foot ulcers. Seventy-six patients enrolled in the study. They were randomly divided into two groups, one of which received topical turmeric ointment and the other received placebo. Preparations were applied twice daily after irrigation of the wound by normal saline and dressed. Image analysis software was used to evaluate photographs of the ulcers and quantify the difference between treatment and placebo groups. Topical turmeric ointment demonstrated statistically significant reduction (p < .001) in the size of diabetic ulcers at five weeks compared to placebo, independently of fasting blood sugar and HbA1C levels. Turmeric ointment may be an effective treatment for diabetic foot ulcers.

Background/objectiveFetal wound repair seems a relatively efficient process when compared to wound repair during adulthood, which may be explained by the effects of the fetal environment. This study examined the effects of an amnion cell culture medium (ACCM) on skin wound healing in a rat experimental model.MethodsSixteen adult female Wistar albino rats were used in this experimental animal study (treatment group, n  =  8; control group, n  =  8). Surgical wounds were formed on the dorsal skin of each rat. A commercially available ACCM was administered daily over each of the wound in the treatment group for 14 days and the control group did not receive any treatment. Wounds were evaluated for tissue perfusion with laser doppler, tissue superoxide dismutase (SOD), glutathione peroxidase (GPX), and malondialdehyde (MDA) levels as well as histopathological examination.ResultsControls had significantly higher tissue SOD levels when compared to the treatment group (10.0  ±  3.2 vs 6.7  ±  1.2, P  =  .005); however, the 2 groups did not differ in terms of tissue GPX and MDA levels. For open wounds, inflammation and neovascularization were more prominent in the ACCM group at day 14. However, at day 21 neovascularization and granulation were more prominent in controls. For closed wounds, neovascularization was more prominent in controls at days 14 and 21. The 2 groups did not differ in terms of tissue perfusion.ConclusionAlthough marginal difference was found between controls and ACCM group for several parameters, findings of this study do not support beneficial effect of ACCM on wound healing.

ObjectiveAs diabetic patients live longer and there are more effective treatments available, the incidence of diabetes and its complications is increasing. The effects of oxidative stress and antioxidant processes on diabetes behavior, especially diabetic foot, are really direct. The goal of this research is to investigate the effects of oxidative stress and antioxidant mechanism on the outcome of amputation by examining the levels of 8-hydroxy-2'-deoxyguanosine (8-OHdG) and thiol/disulfide in the blood of patients diagnosed with diabetic foot.MethodsThe research consisted of 76 patients with type 2 diabetes with associated diabetic foot, ages 40-65 (51 men, 25 women). Patients with diabetic foot wounds and accompanying peripheral artery disease were not included in the study. After a mean follow-up of 9.6 months, 28 patients resulted in amputation. Between patients who required amputation and those who did not, the levels of 8-OHdG, native thiol, total thiol, disulfide, native thiol/total thiol ratio, disulfide/native thiol ratio, and disulfide/total thiol ratio were compared. Additionally, the age, sex, Wagner stage, and amputation outcome of these 2 patient groups were compared.ResultsThe outcomes of amputation in diabetic foot patients were not related to the levels of native thiol, total thiol, disulfide, native thiol/total thiol ratio, disulfide/native thiol ratio, total thiol/disulfide ratio, or 8-OHdG (P > .05). However, patients with diabetic foot who were male, older, and at a more advanced Wagner stage had a higher rate of amputations (P < .05).ConclusionOxidative stress and antioxidant mechanism are effective on diabetes complications. However, since there are many factors affecting the outcome of amputation, they are not directly effective in terms of resulting amputation in patients with diabetic foot ulcer.