Pub Date : 2023-09-01DOI: 10.1177/15347346211023041
Gianmario Balduzzi, Roberto De Giglio, Benedetta Masserini, Ilaria Formenti, Sara Lodigiani, Teresa Mondello, Nicola Mumoli, Basilio Pintaudi, Giacoma Di Vieste
Chopart amputation is the consequence of severe diabetes-related foot complications. A new interim orthosis allowing the patient a greater degree of mobility after Chopart surgery than currently used systems is now available. The aim of this study was to evaluate the effectiveness of the new orthosis compared with traditional treatment. Safety and level of patient acceptance of the device were also investigated. We performed a retrospective case-control observational study involving people with diabetes who underwent Chopart amputation between January 2016 and January 2018. The sample of subjects treated with the innovative orthosis was compared with consecutive patients, who were treated with traditional management. The main study outcomes include major amputation occurrence, ulcer recurrence, healing time, and patient acceptance of the orthosis. Patient satisfaction was evaluated using the Italian validated version of the Orthotic Prosthetic User's Survey (OPUS) questionnaire. Overall, 27 subjects were enrolled using the new device (mean age 68.7 ± 8.4 years, 70.4% males, mean diabetes duration 22.7 ± 15 years). Clinical baseline characteristics were comparable between the cases and the controls. There was no difference between the groups in the healed wound rate (81.5% vs 80.0% for cases and the control group, respectively, P = .53). The ulcer recurrence rate was higher in the control group compared with subjects using the new orthosis (62.5% vs 24.0%, respectively, P = .04). The use of the innovative orthosis was associated with an 81% lower probability to have ulcer recurrence (odds ratio 0.19, 95% confidence interval 0.04-1.04). No between groups difference was detected for a major amputation rate. The wound healing time was faster for cases compared with controls (160.4 ± 114.1 vs 256.5 ± 112.9 days, P = .05). No adverse events related to the use of the new orthosis were recorded. Patient acceptance of the new orthosis was high. This orthosis can be recommended as an efficient, safe, and well-accepted device after Chopart amputation.
Chopart截肢是严重的糖尿病相关足部并发症的后果。一种新的临时矫形器允许患者在Chopart手术后比目前使用的系统有更大程度的活动。本研究的目的是评估新型矫形器与传统矫形器的效果。安全性和患者对该装置的接受程度也进行了调查。我们进行了一项回顾性病例对照观察性研究,涉及2016年1月至2018年1月期间接受Chopart截肢的糖尿病患者。采用创新矫形器治疗的患者样本与连续采用传统矫形器治疗的患者样本进行比较。主要研究结果包括大截肢发生率、溃疡复发、愈合时间和患者对矫形器的接受程度。使用意大利验证版的矫形义肢用户调查(OPUS)问卷评估患者满意度。总体而言,27名受试者使用新设备入组(平均年龄68.7±8.4岁,70.4%为男性,平均糖尿病病程22.7±15年)。病例和对照组的临床基线特征具有可比性。两组创面愈合率差异无统计学意义(病例81.5% vs对照组80.0%,P = 0.53)。对照组溃疡复发率高于使用新型矫形器组(62.5% vs 24.0%, P = 0.04)。使用创新矫形器可使溃疡复发的概率降低81%(优势比0.19,95%可信区间0.04-1.04)。两组间主要截肢率无差异。治疗组创面愈合时间较对照组快(160.4±114.1 vs 256.5±112.9,P = 0.05)。没有记录与使用新矫形器相关的不良事件。患者对新矫形器的接受度很高。该矫形器是Chopart截肢后一种有效、安全且被广泛接受的矫形器。
{"title":"Effectiveness, Safety, and Acceptance of an Interim Orthosis in Patients with Diabetes in the Immediate Postoperative Chopart Surgery.","authors":"Gianmario Balduzzi, Roberto De Giglio, Benedetta Masserini, Ilaria Formenti, Sara Lodigiani, Teresa Mondello, Nicola Mumoli, Basilio Pintaudi, Giacoma Di Vieste","doi":"10.1177/15347346211023041","DOIUrl":"https://doi.org/10.1177/15347346211023041","url":null,"abstract":"<p><p>Chopart amputation is the consequence of severe diabetes-related foot complications. A new interim orthosis allowing the patient a greater degree of mobility after Chopart surgery than currently used systems is now available. The aim of this study was to evaluate the effectiveness of the new orthosis compared with traditional treatment. Safety and level of patient acceptance of the device were also investigated. We performed a retrospective case-control observational study involving people with diabetes who underwent Chopart amputation between January 2016 and January 2018. The sample of subjects treated with the innovative orthosis was compared with consecutive patients, who were treated with traditional management. The main study outcomes include major amputation occurrence, ulcer recurrence, healing time, and patient acceptance of the orthosis. Patient satisfaction was evaluated using the Italian validated version of the Orthotic Prosthetic User's Survey (OPUS) questionnaire. Overall, 27 subjects were enrolled using the new device (mean age 68.7 ± 8.4 years, 70.4% males, mean diabetes duration 22.7 ± 15 years). Clinical baseline characteristics were comparable between the cases and the controls. There was no difference between the groups in the healed wound rate (81.5% vs 80.0% for cases and the control group, respectively, <i>P</i> = .53). The ulcer recurrence rate was higher in the control group compared with subjects using the new orthosis (62.5% vs 24.0%, respectively, <i>P</i> = .04). The use of the innovative orthosis was associated with an 81% lower probability to have ulcer recurrence (odds ratio 0.19, 95% confidence interval 0.04-1.04). No between groups difference was detected for a major amputation rate. The wound healing time was faster for cases compared with controls (160.4 ± 114.1 vs 256.5 ± 112.9 days, <i>P</i> = .05). No adverse events related to the use of the new orthosis were recorded. Patient acceptance of the new orthosis was high. This orthosis can be recommended as an efficient, safe, and well-accepted device after Chopart amputation.</p>","PeriodicalId":49181,"journal":{"name":"International Journal of Lower Extremity Wounds","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/15347346211023041","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9966727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1177/15347346211032555
Sanjay Rai, Tej Pratap Gupta, Omna Shaki, Amit Kale
Background: Hydrogen peroxide (H2O2) is used as a topical antiseptic in contaminated wounds caused by road traffic accidents. It kills bacteria by producing oxidation through local, nascent, free oxygen radicals. It also removes dirt from the wound due to its frothing action. H2O2 is synthesized by various cells as an active biochemical agent that affects cell biological behavior through complex chemical reactions. H2O2 has also been used as a wound cleaning agent, removing debris, preventing infection, and causing hemostasis due to its exothermic reaction with blood. Despite its widespread use, there is scanty literature on its use to promote granulation tissue formation. Objective: In the orthopaedics literature, studies on H2O2 use are very limited and its potential is underestimated. In the present study, we would like to report our protocol of use of H2O2 for its tremendous potential for stimulating granulation and early wound healing. Material and Methods: A total of 53 patients with large acute extensive lower limb contaminated wounds reported to the emergency department have been included with and without lower limb fracture. In group A (43 patients) wound management was done using 7% H2O2 and group B (10 patients) was treated by only saline dressing as a control group. Results: In the present study, daily dressing by 7% H2O2 solution and provide solution gives excellent results compared to the Saline group. Granulation tissue appeared much earlier with a mean SD 6.3 ± 6.8 days in the hydrogen peroxide group as compared to the Saline group where granulation tissue appeared in 9.3 ± 8.4 days. Conclusion: Spontaneous wound healing is a controlled balance between destructive and healing processes. It is mandatory to remove damaged tissue to promote healing by secondary intention and minimize infection. The dynamic effect of H2O2 promotes faster healing, stimulates granulation, and minimizes infection by oxidative stress.
{"title":"Hydrogen Peroxide: Its Use in an Extensive Acute Wound to Promote Wound Granulation and Infection Control - Is it Better Than Normal Saline?","authors":"Sanjay Rai, Tej Pratap Gupta, Omna Shaki, Amit Kale","doi":"10.1177/15347346211032555","DOIUrl":"https://doi.org/10.1177/15347346211032555","url":null,"abstract":"<p><p><i>Background</i>: Hydrogen peroxide (H<sub>2</sub>O<sub>2</sub>) is used as a topical antiseptic in contaminated wounds caused by road traffic accidents. It kills bacteria by producing oxidation through local, nascent, free oxygen radicals. It also removes dirt from the wound due to its frothing action. H<sub>2</sub>O<sub>2</sub> is synthesized by various cells as an active biochemical agent that affects cell biological behavior through complex chemical reactions. H<sub>2</sub>O<sub>2</sub> has also been used as a wound cleaning agent, removing debris, preventing infection, and causing hemostasis due to its exothermic reaction with blood. Despite its widespread use, there is scanty literature on its use to promote granulation tissue formation. <i>Objective</i>: In the orthopaedics literature, studies on H<sub>2</sub>O<sub>2</sub> use are very limited and its potential is underestimated. In the present study, we would like to report our protocol of use of H<sub>2</sub>O<sub>2</sub> for its tremendous potential for stimulating granulation and early wound healing. <i>Material and Methods</i>: A total of 53 patients with large acute extensive lower limb contaminated wounds reported to the emergency department have been included with and without lower limb fracture. In group A (43 patients) wound management was done using 7% H<sub>2</sub>O<sub>2</sub> and group B (10 patients) was treated by only saline dressing as a control group. <i>Results</i>: In the present study, daily dressing by 7% H<sub>2</sub>O<sub>2</sub> solution and provide solution gives excellent results compared to the Saline group. Granulation tissue appeared much earlier with a mean SD 6.3 ± 6.8 days in the hydrogen peroxide group as compared to the Saline group where granulation tissue appeared in 9.3 ± 8.4 days. <i>Conclusion</i>: Spontaneous wound healing is a controlled balance between destructive and healing processes. It is mandatory to remove damaged tissue to promote healing by secondary intention and minimize infection. The dynamic effect of H<sub>2</sub>O<sub>2</sub> promotes faster healing, stimulates granulation, and minimizes infection by oxidative stress.</p>","PeriodicalId":49181,"journal":{"name":"International Journal of Lower Extremity Wounds","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/15347346211032555","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9912664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1177/15347346211022587
Marta Carmena-Pantoja, Francisco Javier Álvaro-Afonso, Esther García-Morales, Yolanda García-Álvarez, Aroa Tardáguila-García, José Luis Lázaro-Martínez
The aim of our study was to analyze the influence of radiographic arterial calcification (RAC) on clinical outcomes and wound healing in patients with diabetic foot ulcers complicated by osteomyelitis treated by surgery. We analyzed retrospectively the clinical records of 102 patients with diabetic foot osteomyelitis who underwent surgery at a specialized diabetic foot unit between January 2014 and December 2016. The clinical data of evolution until its complete epithelialization and a follow-up 1 year were reviewed, and after reviewing the radiological images, patients were classified into 2 groups: those with RAC and those without RAC. We analyzed several clinical features in both groups. The presence of RAC was associated with a greater time of healing (10.68 ± 7.24 vs 8.11 ± 4.50 weeks; P = .029) and shorter time to recurrence and reulceration (13.30 ± 9.25 vs 18.81 ± 11.63 weeks; P = .036). However, this association was not found for patients with mild and moderate peripheral artery disease (PAD), whose time of healing was 8.97 ± 4.51 weeks compared to 9.16 ± 6.39 weeks for patients without PAD; P = .864. The time of healing of diabetic foot ulcers complicated by osteomyelitis treated by surgery can be negatively affected by the presence of RAC even more than by the presence of mild and moderate ischemia. The presence of RAC may offer clinical guidance at the level of primary care though this would need thorough validation in future studies.
我们的研究目的是分析放射动脉钙化(RAC)对手术治疗的糖尿病足溃疡合并骨髓炎患者的临床结局和伤口愈合的影响。我们回顾性分析了2014年1月至2016年12月在一家糖尿病足专科医院接受手术治疗的102例糖尿病足骨髓炎患者的临床记录。回顾其进化至上皮化完全的临床资料及随访1年,回顾影像学影像后将患者分为RAC组和非RAC组。我们分析了两组患者的一些临床特征。RAC的存在与较长的愈合时间相关(10.68±7.24 vs 8.11±4.50周;P = 0.029),复发和再溃时间较短(13.30±9.25 vs 18.81±11.63周;p = .036)。然而,在轻度和中度外周动脉疾病(PAD)患者中没有发现这种关联,其愈合时间为8.97±4.51周,而非PAD患者的愈合时间为9.16±6.39周;p = .864。手术治疗的糖尿病足溃疡合并骨髓炎的愈合时间,RAC的存在比轻度和中度缺血的存在更有负面影响。RAC的存在可能在初级保健水平上提供临床指导,尽管这需要在未来的研究中进行彻底的验证。
{"title":"The Influence of Arterial Calcification on Clinical Outcomes in Patients with Diabetic Foot Ulcer Complicated by Osteomyelitis Treated by Surgery.","authors":"Marta Carmena-Pantoja, Francisco Javier Álvaro-Afonso, Esther García-Morales, Yolanda García-Álvarez, Aroa Tardáguila-García, José Luis Lázaro-Martínez","doi":"10.1177/15347346211022587","DOIUrl":"https://doi.org/10.1177/15347346211022587","url":null,"abstract":"<p><p>The aim of our study was to analyze the influence of radiographic arterial calcification (RAC) on clinical outcomes and wound healing in patients with diabetic foot ulcers complicated by osteomyelitis treated by surgery. We analyzed retrospectively the clinical records of 102 patients with diabetic foot osteomyelitis who underwent surgery at a specialized diabetic foot unit between January 2014 and December 2016. The clinical data of evolution until its complete epithelialization and a follow-up 1 year were reviewed, and after reviewing the radiological images, patients were classified into 2 groups: those with RAC and those without RAC. We analyzed several clinical features in both groups. The presence of RAC was associated with a greater time of healing (10.68 ± 7.24 vs 8.11 ± 4.50 weeks; <i>P</i> = .029) and shorter time to recurrence and reulceration (13.30 ± 9.25 vs 18.81 ± 11.63 weeks; <i>P</i> = .036). However, this association was not found for patients with mild and moderate peripheral artery disease (PAD), whose time of healing was 8.97 ± 4.51 weeks compared to 9.16 ± 6.39 weeks for patients without PAD; <i>P</i> = .864. The time of healing of diabetic foot ulcers complicated by osteomyelitis treated by surgery can be negatively affected by the presence of RAC even more than by the presence of mild and moderate ischemia. The presence of RAC may offer clinical guidance at the level of primary care though this would need thorough validation in future studies.</p>","PeriodicalId":49181,"journal":{"name":"International Journal of Lower Extremity Wounds","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/15347346211022587","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10270026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1177/15347346211031085
Marta García-Madrid, Irene Sanz-Corbalán, Aroa Tardáguila-García, Raúl J Molines-Barroso, Mateo López-Moral, José Luis Lázaro-Martínez
Punch grafting is an alternative treatment to enhance wound healing which has been associated with promising clinical outcomes in various leg and foot wound types. We aimed to evaluate the clinical outcomes of punch grafting as a treatment for hard-to-heal diabetic foot ulcers (DFUs). Six patients with chronic neuropathic or neuroischemic DFUs with more than 6 months of evolution not responding to conventional treatment were included in a prospective case series between May 2017 and December 2020. All patients were previously debrided using an ultrasound-assisted wound debridement and then, grafted with 4 to 6 mm punch from the donor site that was in all cases the anterolateral aspect of the thigh. All patients were followed up weekly until wound healing. Four (66.7%) DFUs were located in the heel, 1 (16.7%) in the dorsal aspect of the foot and 1 (16.7%) in the Achilles tendon. The median evolution time was 172 (interquartile range [IQR], 25th-75th; 44-276) weeks with a median area of 5.9 (IQR; 1.87-37.12) cm2 before grafting. Complete epithelization was achieved in 3 (50%) patients at 12 weeks follow-up period with a mean time of 5.67 ± 2.88 weeks. Two of the remaining patients achieved wound healing at 32 and 24 weeks, respectively, and 1 patient showed punch graft unsuccessful in adhering. The median time of wound healing of all patients included in the study was 9.00 (IQR; 4.00-28.00) weeks. The wound area reduction (WAR) at 4 weeks was 38.66% and WAR at 12 weeks was 88.56%. No adverse effects related to the ulcer were registered through the follow-up period. Autologous punch graft is an easy procedure that promotes healing, achieving wound closure in chronic DFUs representing an alternative of treatment for hard-to-heal DFUs in which conservative treatment has been unsuccessful.
{"title":"Punch Grafting for the Management of Hard-to-Heal Diabetic Foot Ulcers: A Prospective Case Series.","authors":"Marta García-Madrid, Irene Sanz-Corbalán, Aroa Tardáguila-García, Raúl J Molines-Barroso, Mateo López-Moral, José Luis Lázaro-Martínez","doi":"10.1177/15347346211031085","DOIUrl":"https://doi.org/10.1177/15347346211031085","url":null,"abstract":"<p><p>Punch grafting is an alternative treatment to enhance wound healing which has been associated with promising clinical outcomes in various leg and foot wound types. We aimed to evaluate the clinical outcomes of punch grafting as a treatment for hard-to-heal diabetic foot ulcers (DFUs). Six patients with chronic neuropathic or neuroischemic DFUs with more than 6 months of evolution not responding to conventional treatment were included in a prospective case series between May 2017 and December 2020. All patients were previously debrided using an ultrasound-assisted wound debridement and then, grafted with 4 to 6 mm punch from the donor site that was in all cases the anterolateral aspect of the thigh. All patients were followed up weekly until wound healing. Four (66.7%) DFUs were located in the heel, 1 (16.7%) in the dorsal aspect of the foot and 1 (16.7%) in the Achilles tendon. The median evolution time was 172 (interquartile range [IQR], 25th-75th; 44-276) weeks with a median area of 5.9 (IQR; 1.87-37.12) cm<sup>2</sup> before grafting. Complete epithelization was achieved in 3 (50%) patients at 12 weeks follow-up period with a mean time of 5.67 ± 2.88 weeks. Two of the remaining patients achieved wound healing at 32 and 24 weeks, respectively, and 1 patient showed punch graft unsuccessful in adhering. The median time of wound healing of all patients included in the study was 9.00 (IQR; 4.00-28.00) weeks. The wound area reduction (WAR) at 4 weeks was 38.66% and WAR at 12 weeks was 88.56%. No adverse effects related to the ulcer were registered through the follow-up period. Autologous punch graft is an easy procedure that promotes healing, achieving wound closure in chronic DFUs representing an alternative of treatment for hard-to-heal DFUs in which conservative treatment has been unsuccessful.</p>","PeriodicalId":49181,"journal":{"name":"International Journal of Lower Extremity Wounds","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/15347346211031085","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9903570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1177/15347346211020269
Nicola Troisi, Stefano Michelagnoli, Simone Panci, Sara Bacchi, Daniela Incerti, Luigi Lo Vecchio, Giovanni L Dedola, Emiliano Chisci
The aim of this study was to demonstrate the association between 2-dimensional (2D) perfusion angiography and wound healing rate in patients with combined femoro-popliteal and below-the-knee lesions in critical limb-threatening ischemia (CLTI) and foot wounds undergoing isolated femoro-popliteal endovascular revascularization. Between January and June 2019, 24 patients with multilevel CLTI and foot wounds underwent isolated femoro-popliteal endovascular revascularization. In all of them, an assessment of foot perfusion by 2D perfusion angiography was performed. To evaluate the foot perfusion, a region of interest was identified, and time-density curves were calculated. Changes of the overall time-density curves were evaluated together with transcutaneous oximetry (TcPO2) using bivariate correlation (Pearson correlation coefficient) and associated with 6-month wound healing. The mean increase of time-density curves was 212.2% (range from +9.8% to +1984.9%) and the mean increase of TcPO2 was 116.4% (range from -4.7% to 485.7%). No significant association between time-density curves and TcPO2 values (Pearson correlation coefficient: -0.24) was observed (P = .3). At 6 months, wound healing occurred in 15 of 24 (62.5%) patients. In conclusion, this preliminary experience confirmed that 2D perfusion angiography associates with wound healing rate in CLTI patients with ischemic foot wounds and combined femoro-popliteal and below-the-knee lesions who are undergoing isolated femoro-popliteal endovascular revascularization. No association between time-density curves and TcPO2 values was observed.
{"title":"Association of 2D Perfusion Angiography and Wound Healing Rate in Combined Femoro-popliteal and Below-the-Knee Lesions in Ischemic Patients Undergoing Isolated Femoro-popliteal Endovascular Revascularization.","authors":"Nicola Troisi, Stefano Michelagnoli, Simone Panci, Sara Bacchi, Daniela Incerti, Luigi Lo Vecchio, Giovanni L Dedola, Emiliano Chisci","doi":"10.1177/15347346211020269","DOIUrl":"https://doi.org/10.1177/15347346211020269","url":null,"abstract":"<p><p>The aim of this study was to demonstrate the association between 2-dimensional (2D) perfusion angiography and wound healing rate in patients with combined femoro-popliteal and below-the-knee lesions in critical limb-threatening ischemia (CLTI) and foot wounds undergoing isolated femoro-popliteal endovascular revascularization. Between January and June 2019, 24 patients with multilevel CLTI and foot wounds underwent isolated femoro-popliteal endovascular revascularization. In all of them, an assessment of foot perfusion by 2D perfusion angiography was performed. To evaluate the foot perfusion, a region of interest was identified, and time-density curves were calculated. Changes of the overall time-density curves were evaluated together with transcutaneous oximetry (TcPO<sub>2</sub>) using bivariate correlation (Pearson correlation coefficient) and associated with 6-month wound healing. The mean increase of time-density curves was 212.2% (range from +9.8% to +1984.9%) and the mean increase of TcPO<sub>2</sub> was 116.4% (range from -4.7% to 485.7%). No significant association between time-density curves and TcPO<sub>2</sub> values (Pearson correlation coefficient: -0.24) was observed (<i>P</i> = .3). At 6 months, wound healing occurred in 15 of 24 (62.5%) patients. In conclusion, this preliminary experience confirmed that 2D perfusion angiography associates with wound healing rate in CLTI patients with ischemic foot wounds and combined femoro-popliteal and below-the-knee lesions who are undergoing isolated femoro-popliteal endovascular revascularization. No association between time-density curves and TcPO<sub>2</sub> values was observed.</p>","PeriodicalId":49181,"journal":{"name":"International Journal of Lower Extremity Wounds","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/15347346211020269","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10033363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1177/15347346211028687
Aakansha G Goswami, Somprakas Basu, Vijay K Shukla
Marjolin's ulcer (MU) with rapid progression and multiple distant metastases is rare. We report a case of an MU of the thigh developing in a postburn scar, which after successful R0 resection developed multiple bony and visceral metastasis to femur, vertebra, skull, lung, and liver within 3 months of excision. We highlight the "hurricane-like" recurrence in an MU, which is unusual for the metachronous disease. We stress that MUs, unlike conventional wisdom, need a thorough metastatic workup at presentation, and prognostication of a possible rapidly progressive course after surgery which may lead to grave prognosis and mortality.
{"title":"\"Hurricane-like\" Presentation of a Recurrent Marjolin's Ulcer in a Young Female.","authors":"Aakansha G Goswami, Somprakas Basu, Vijay K Shukla","doi":"10.1177/15347346211028687","DOIUrl":"https://doi.org/10.1177/15347346211028687","url":null,"abstract":"<p><p>Marjolin's ulcer (MU) with rapid progression and multiple distant metastases is rare. We report a case of an MU of the thigh developing in a postburn scar, which after successful R0 resection developed multiple bony and visceral metastasis to femur, vertebra, skull, lung, and liver within 3 months of excision. We highlight the \"hurricane-like\" recurrence in an MU, which is unusual for the metachronous disease. We stress that MUs, unlike conventional wisdom, need a thorough metastatic workup at presentation, and prognostication of a possible rapidly progressive course after surgery which may lead to grave prognosis and mortality.</p>","PeriodicalId":49181,"journal":{"name":"International Journal of Lower Extremity Wounds","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/15347346211028687","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9946410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
High plantar pressure is a risk factor for diabetic foot ulcers, and it is known that restriction of ankle dorsiflexion range of motion (ROM) causes high plantar pressure. Stretching is a non-invasive and general means to improve ROM; however, the effect of stretching on the ROM and plantar pressure has not been clarified in patients with diabetes mellitus. We aimed to study the effects of intermittent weight-bearing stretching on ankle dorsiflexion ROM and plantar pressure during gait in patients with diabetes mellitus. Seven patients with diabetes mellitus participated, and their triceps surae was stretched using weight-bearing stretching with a stretch board. Five minutes of stretching was performed 4 times with a rest interval of 30 s. Ankle dorsiflexion ROM was measured with the knee flexed and extended. Peak pressure and pressure-time integral during gait were measured and calculated for the rearfoot, midfoot, forefoot, and total plantar surface before and after stretching. Ankle dorsiflexion ROM with the knee extended or bent increased significantly after stretching (P < .05). Peak pressure and the pressure-time integral decreased significantly, especially in the forefoot (P < .01), and these also decreased significantly in the total plantar surface (P < .05). The duration of foot-flat decreased after stretching (P < .05). Weight-bearing stretching improved ankle dorsiflexion ROM and reduced plantar pressure during gait. These results suggest that weight-bearing calf stretching may be an effective means to prevent and treat diabetic foot ulcers.
{"title":"Immediate Effects of Weight-Bearing Calf Stretching on Ankle Dorsiflexion Range of Motion and Plantar Pressure During Gait in Patients with Diabetes Mellitus.","authors":"Noriaki Maeshige, Mikiko Uemura, Yoshikazu Hirasawa, Yoshiyuki Yoshikawa, Maiki Moriguchi, Nobuhide Kawabe, Miki Fujii, Hiroto Terashi, Hidemi Fujino","doi":"10.1177/15347346211031318","DOIUrl":"https://doi.org/10.1177/15347346211031318","url":null,"abstract":"<p><p>High plantar pressure is a risk factor for diabetic foot ulcers, and it is known that restriction of ankle dorsiflexion range of motion (ROM) causes high plantar pressure. Stretching is a non-invasive and general means to improve ROM; however, the effect of stretching on the ROM and plantar pressure has not been clarified in patients with diabetes mellitus. We aimed to study the effects of intermittent weight-bearing stretching on ankle dorsiflexion ROM and plantar pressure during gait in patients with diabetes mellitus. Seven patients with diabetes mellitus participated, and their triceps surae was stretched using weight-bearing stretching with a stretch board. Five minutes of stretching was performed 4 times with a rest interval of 30 s. Ankle dorsiflexion ROM was measured with the knee flexed and extended. Peak pressure and pressure-time integral during gait were measured and calculated for the rearfoot, midfoot, forefoot, and total plantar surface before and after stretching. Ankle dorsiflexion ROM with the knee extended or bent increased significantly after stretching (<i>P < </i>.05). Peak pressure and the pressure-time integral decreased significantly, especially in the forefoot (<i>P < </i>.01), and these also decreased significantly in the total plantar surface (<i>P < </i>.05). The duration of foot-flat decreased after stretching (<i>P < </i>.05). Weight-bearing stretching improved ankle dorsiflexion ROM and reduced plantar pressure during gait. These results suggest that weight-bearing calf stretching may be an effective means to prevent and treat diabetic foot ulcers.</p>","PeriodicalId":49181,"journal":{"name":"International Journal of Lower Extremity Wounds","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/15347346211031318","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9955647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1177/15347346211024493
Sung Y Jung, Myoung J Lee, Sang Y Lee
This study aimed to determine how the muscle mass of the lower leg affects the preservation of the lower extremities in patients with diabetic foot ulcer. This study analyzed patients with diabetic foot ulcer between January 2014 and June 2018 with a follow-up of at least 2 years. Of these 181 patients whose ulcer is located distal to the metatarsophalangeal joint, which was categorized as grade ≤2 by the Wagner classification were classified into 4 grades: grade 0 (treated without amputation), grade 1 (amputation distal to the metatarsophalangeal joint), grade 2 (Ray, transmetatarsal, Lisfranc, and Chopart amputation), and grade 3 (Syme, below-knee, and above-knee amputation) according to the final amputation degree. The muscles of the lower leg were classified into 4 compartments: anterior, lateral, deep posterior, and superficial posterior. The cross-sectional area and attenuation to estimate the muscle volume and density were measured at the axial image of computed tomography (CT) angiography. No significant differences were observed in the sex ratio and mean age among the grades (P = .966 and .962). The cross-sectional area of the anterior, lateral, and posterior compartments demonstrated no significant differences, but that of the superficial posterior compartment exhibited significant differences among the grades (P < .001). Moreover, the attenuation of the anterior, lateral, and deep posterior compartments showed no significant differences, but that of the posterior compartment showed significant differences among the grades (P = .003). The muscle mass of the superficial posterior compartment of the lower leg could be a good indicator of the preservation of the lower extremity in patients with diabetic foot ulcer. Therefore, a strengthening exercise for the triceps surae and plantaris muscles in the early stage could help preserve as much of the lower extremities as possible.
本研究旨在确定下肢肌肉质量如何影响糖尿病足溃疡患者下肢的保存。本研究分析了2014年1月至2018年6月期间患有糖尿病足溃疡的患者,随访时间至少为2年。181例溃疡位于跖趾关节远端,Wagner分类为≤2级的患者,根据最终截肢程度分为0级(不截肢)、1级(跖趾关节远端截肢)、2级(Ray、经跖骨、Lisfranc、Chopart截肢)、3级(Syme、膝下、膝上截肢)4个级别。下肢肌肉分为4个肌室:前肌室、外侧肌室、后深肌室和后浅肌室。在计算机断层扫描(CT)血管造影的轴向图像上测量横截面积和衰减来估计肌肉体积和密度。年级间性别比例和平均年龄差异无统计学意义(P =。966和。962)。前、外侧和后腔室的横截面积在不同级别间无显著差异,但后浅腔室的横截面积在不同级别间有显著差异(P P = 0.003)。下肢后浅腔室的肌肉质量可以作为糖尿病足溃疡患者下肢保存的一个很好的指标。因此,在早期加强肱三头肌和足底肌的锻炼可以帮助尽可能多地保护下肢。
{"title":"Analysis of the Relationship Between Lower leg Muscle Mass and Preservation of Lower Extremity in Patients with Diabetic Foot Ulcer.","authors":"Sung Y Jung, Myoung J Lee, Sang Y Lee","doi":"10.1177/15347346211024493","DOIUrl":"https://doi.org/10.1177/15347346211024493","url":null,"abstract":"<p><p>This study aimed to determine how the muscle mass of the lower leg affects the preservation of the lower extremities in patients with diabetic foot ulcer. This study analyzed patients with diabetic foot ulcer between January 2014 and June 2018 with a follow-up of at least 2 years. Of these 181 patients whose ulcer is located distal to the metatarsophalangeal joint, which was categorized as grade ≤2 by the Wagner classification were classified into 4 grades: grade 0 (treated without amputation), grade 1 (amputation distal to the metatarsophalangeal joint), grade 2 (Ray, transmetatarsal, Lisfranc, and Chopart amputation), and grade 3 (Syme, below-knee, and above-knee amputation) according to the final amputation degree. The muscles of the lower leg were classified into 4 compartments: anterior, lateral, deep posterior, and superficial posterior. The cross-sectional area and attenuation to estimate the muscle volume and density were measured at the axial image of computed tomography (CT) angiography. No significant differences were observed in the sex ratio and mean age among the grades (<i>P</i> = .966 and .962). The cross-sectional area of the anterior, lateral, and posterior compartments demonstrated no significant differences, but that of the superficial posterior compartment exhibited significant differences among the grades (<i>P</i> < .001). Moreover, the attenuation of the anterior, lateral, and deep posterior compartments showed no significant differences, but that of the posterior compartment showed significant differences among the grades (<i>P</i> = .003). The muscle mass of the superficial posterior compartment of the lower leg could be a good indicator of the preservation of the lower extremity in patients with diabetic foot ulcer. Therefore, a strengthening exercise for the triceps surae and plantaris muscles in the early stage could help preserve as much of the lower extremities as possible.</p>","PeriodicalId":49181,"journal":{"name":"International Journal of Lower Extremity Wounds","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/15347346211024493","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9958073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1177/15347346211020985
Vijay Viswanathan, Sukanya Nachimuthu
People with diabetes have a higher risk of lower-limb amputations than people without diabetes. The risk of avoidable lower-limb amputations has increased in the coronavirus disease 2019 (COVID-19) lockdown period. Hence, we conducted a retrospective, single-centered study on major amputations during the prepandemic period (March 25, 2019-December 31, 2019) and pandemic period (March 25, 2020-December 31, 2020). During the prepandemic period, 24 major amputations (below-knee and above-knee amputations) were performed and during the pandemic period, 37 major amputations were performed. There was a 54.1% increase in major amputations noted in the pandemic period more than the prepandemic period. This increase may also be due to irregular/missed hospital visits, improper diet, nonadherence to the medications, and physical inactivity. This study shows the indirect effect of the COVID-19 pandemic on people with diabetes, resulting in the increased incidence of lower-extremity amputations (below-knee and above-knee amputations) which might cause a drastic impact on their quality of life. This study also emphasizes the importance of easy and routine access to foot-care specialists to prevent avoidable amputations.
{"title":"Major Lower-Limb Amputation During the COVID Pandemic in South India.","authors":"Vijay Viswanathan, Sukanya Nachimuthu","doi":"10.1177/15347346211020985","DOIUrl":"https://doi.org/10.1177/15347346211020985","url":null,"abstract":"<p><p>People with diabetes have a higher risk of lower-limb amputations than people without diabetes. The risk of avoidable lower-limb amputations has increased in the coronavirus disease 2019 (COVID-19) lockdown period. Hence, we conducted a retrospective, single-centered study on major amputations during the prepandemic period (March 25, 2019-December 31, 2019) and pandemic period (March 25, 2020-December 31, 2020). During the prepandemic period, 24 major amputations (below-knee and above-knee amputations) were performed and during the pandemic period, 37 major amputations were performed. There was a 54.1% increase in major amputations noted in the pandemic period more than the prepandemic period. This increase may also be due to irregular/missed hospital visits, improper diet, nonadherence to the medications, and physical inactivity. This study shows the indirect effect of the COVID-19 pandemic on people with diabetes, resulting in the increased incidence of lower-extremity amputations (below-knee and above-knee amputations) which might cause a drastic impact on their quality of life. This study also emphasizes the importance of easy and routine access to foot-care specialists to prevent avoidable amputations.</p>","PeriodicalId":49181,"journal":{"name":"International Journal of Lower Extremity Wounds","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/15347346211020985","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10270027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Management of complex wounds with large skin defects presents a real challenge for orthopedic or reconstructive surgeons. We developed a simple skin stretching system associated with vacuum sealing drainage to examine the efficiency and complication. A total of 34 patients with different types of complex wounds were retrospectively included from January 2015 to March 2021. All patients in the study were underwent the treatment by 2 stages. The method was used to the wounds from 4.71 to 169.65 cm2 with a median defect size of 25.13 cm2. The median time for wound closure was 11.5 days (range: 5-32 days), although the median absolute reduction was 2.08 cm2/day (range: 0.15-25.66 cm2/day). Depending on the site of the wounds, the cause of the wound, and the rate of max-width/max-length (W/L), these complex wounds could be separately divided into several groups. There were statistically significant differences in the median value of the above variables (P < .05 Kruskal-Wallis test). The results showed that different anatomical sites had different viscoelastic properties, the complex wounds caused by trauma were easier to close than caused by diabetic foot and the complex wounds in group A (W/L > 0.5) were more difficult to close than in group B (W/L ≤ 0.5). No major complications were encountered in this study. In summary, the results of our study showed that the simple skin stretching system associated with vacuum sealing drainage was a safe approach for closure of complex wounds. Nevertheless, more attention should be paid to the viscoelasticity of the wounds to ensure closure and avoid undue complications when applying the method.
{"title":"Closure of Complex Wounds by a Simple Skin Stretching System Associated With Vacuum Sealing Drainage-Clinical Outcome of 34 Patients.","authors":"Yaojun Wu, Liang Chen, Xinliang Mao, Zhengliang Ru, Liying Yu, Mimi Chen, Jingnan Wang, Jiejie Chen, Qingjiang Pang","doi":"10.1177/15347346211032046","DOIUrl":"https://doi.org/10.1177/15347346211032046","url":null,"abstract":"<p><p>Management of complex wounds with large skin defects presents a real challenge for orthopedic or reconstructive surgeons. We developed a simple skin stretching system associated with vacuum sealing drainage to examine the efficiency and complication. A total of 34 patients with different types of complex wounds were retrospectively included from January 2015 to March 2021. All patients in the study were underwent the treatment by 2 stages. The method was used to the wounds from 4.71 to 169.65 cm<sup>2</sup> with a median defect size of 25.13 cm<sup>2</sup>. The median time for wound closure was 11.5 days (range: 5-32 days), although the median absolute reduction was 2.08 cm<sup>2</sup>/day (range: 0.15-25.66 cm<sup>2</sup>/day). Depending on the site of the wounds, the cause of the wound, and the rate of max-width/max-length (<i>W</i>/<i>L</i>), these complex wounds could be separately divided into several groups. There were statistically significant differences in the median value of the above variables (<i>P</i> < .05 Kruskal-Wallis test). The results showed that different anatomical sites had different viscoelastic properties, the complex wounds caused by trauma were easier to close than caused by diabetic foot and the complex wounds in group A (<i>W</i>/<i>L</i> > 0.5) were more difficult to close than in group B (<i>W</i>/<i>L</i> ≤ 0.5). No major complications were encountered in this study. In summary, the results of our study showed that the simple skin stretching system associated with vacuum sealing drainage was a safe approach for closure of complex wounds. Nevertheless, more attention should be paid to the viscoelasticity of the wounds to ensure closure and avoid undue complications when applying the method.</p>","PeriodicalId":49181,"journal":{"name":"International Journal of Lower Extremity Wounds","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/15347346211032046","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10287995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}