The international journal of lower extremity wounds最新文献

Total contact casting (TCC) is a well-established offloading strategy for the management of Charcot neuroarthropathy and plantar ulcer healing; however, its use after resolution of the acute phase of diabetic foot attack (DFA) remains limited in routine clinical practice, particularly in complex presentations associated with severe infection, edema, compartment syndrome, or necrotizing fasciitis. This study evaluated the role of the San Elian Total Contact Cast (TCC-SE1) as an adjunctive intervention to enhance wound healing during the post-acute phase following clinical remission of DFA. A pilot prospective, comparative, non-randomized observational study was conducted between April 2021 and December 2024, including 67 patients who achieved clinical stabilization after a DFA. Patients received adjunctive treatment with TCC-SE1 or conventional post-acute management. Baseline demographic and clinical characteristics, including the San Elian Wound Severity Score (SEWSS) and DFA type, were comparable between groups (p > 0.05). All patients fulfilled SEWSS criteria for mild-to-severe diabetic foot infection according to IDSA. Mixed DFA-characterized by infection, edema, and/or Charcot neuroarthropathy-were the most frequent type DFA (87%). Severe acute complications, including compartment syndrome and necrotizing fasciitis, required prior surgical control in 97% of cases. Patients with severe unsolved ischemia or high risk of major amputation were excluded. Complete ulcer remission was achieved in 82.3% of patients treated with TCC-SE1 compared with 63.6% in the control group (p = 0.04). Mean healing time was significantly shorter in the TCC-SE1 group, with a reduction of 7.4 weeks (p = 0.03), and final wound area was significantly smaller (mean difference 11.3 cm², p = 0.04). Kaplan-Meier survival analysis demonstrated a significantly higher probability of earlier wound closure in the TCC-SE1 group compared with conventional management (log-rank p < 0.001). Adjunctive use of TCC-SE1 after remission of complex DFA was associated with improved post-acute wound outcomes; these findings warrant confirmation in larger prospective studies.

BackgroundDiabetic foot ulcer (DFU) is a major cause of infection-related hospitalization and amputation. Negative-pressure wound therapy with instillation and dwell time (NPWTi-d) is used for complex DFU, and beraprost sodium (BS), an oral prostacyclin analogue, may improve microcirculation; evidence for their combination is limited.ObjectiveTo assess the safety and effectiveness of NPWTi-d plus BS versus NPWTi-d alone and BS with standard wound care in DFU.MethodsWe retrospectively reviewed hospitalized DFU patients treated from February 2019 to April 2024. Of 667 screened patients, 590 met inclusion criteria and were grouped by therapy: NPWTi-d (n = 190), BS plus standard care (n = 200), and NPWTi-d plus BS (n = 200). Primary outcomes were 12-week healing rate, time to healing, and ulcer area reduction (ImageJ). Secondary outcomes included reinfection and DFU-related readmission at 12 weeks, 6 months, and 12 months, and quality of life (DFU-SF).ResultsAt 12 weeks, NPWTi-d plus BS achieved faster healing than NPWTi-d alone (mean difference 2.6 days; 95% CI 0.1-5.3; P = 0.042) and greater area reduction at weeks 8-12 (P < 0.05). DFU-SF improved in all groups, with consistently higher scores in the combination group (P < 0.001). Reinfection and readmission increased over time in all groups; between-group differences were small and may reflect residual confounding. No treatment-related serious adverse events were documented. No major bleeding, symptomatic hypotension, or treatment discontinuation due to intolerance was documented during the 12-week treatment period; minor adverse events may be underreported due to the retrospective design.ConclusionsIn this retrospective cohort, adding oral BS to NPWTi-d was associated with faster wound closure and better DFU-related quality of life. Prospective controlled studies are needed to confirm these findings.

BackgroundTriglyceride glucose (TyG) related indices are cost-effective and reliable markers for the assessment of insulin resistance. Diabetic foot ulcer (DFU) is a serious complication of diabetes mellitus, causing a huge social burden worldwide. However, research on the relationship between TyG-related indices and DFU remains limited. In this study, we aimed to assess the associations between TyG-related indices with DFU prevalence and all-cause mortality, with a focus on DFU-specific mortality.MethodsThis cross-sectional study included 1118 participants from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2004. Three TyG-related indices were identified in the subjects: TyG-waist circumference (TyG-WC), TyG-waist height ratio (TyG-WHtR), and TyG-body mass index (TyG-BMI). Weighted multivariable logistic regression was applied to assess the relationship between TyG-related indices and DFU. We employed Cox proportional hazards models and Kaplan-Meier survival analysis to evaluate the association between TyG-related indices and all-cause mortality over a median follow-up of 14.8 years. Additionally, restricted cubic splines (RCS) modeling, subgroup analyses, and receiver operating characteristic (ROC) curves were conducted to enhance the accuracy and interpretability of the results.ResultsIn the study, a total of 1118 U.S. participants (age≥18) with diabetes were included, among whom 91 (8.14%) had DFU. A significant positive correlation was found between TyG-related indices and DFU in fully adjusted model [odds ratios (ORs) for Q3 versus Q1; TyG-WC: 5.85(95%CI: 2.45,13.97); TyG-WHtR: 4.16(95%CI: 1.45,11.95); TyG-BMI: 6.94(95%CI: 2.56,18.78), p for trend <0.05]. Similar trends were observed for all-cause mortality [HRs for Q3 versus Q1; TyG-WC: 1.29 (95%CI: 1.08,1.56); TyG-WHtR: 1.64 (95%CI: 1.17,2.31); TyG-BMI: 1.40 (95%CI: 1.02,1.91), p for trend <0.05]. Additionally, TyG-WHtR and TyG-BMI showed a non-linear relationship with DFU after adjusting all three models and the ROC curve indicated that TyG-WC had the highest predictive accuracy (AUC=0.656). In DFU participants, higher TyG-WC and TyG-WHtR (per 1-SD) were independently associated with all-cause mortality, whereas TyG-BMI was not; no significant TyG-related index × DFU interaction was observed in the overall cohort (all p for interaction > 0.05).ConclusionsElevated TyG-related indices, particularly TyG-WC, are independently associated with increased risk of DFU and all-cause mortality, suggesting that they can be cost-effective and reliable markers for identifying high-risk DFU in diabetic individuals.LimitationsDiabetes and DFU were self-reported, and detailed DFU wound characteristics and DFU-related comorbidities were unavailable in NHANES.

Growing evidence has supported the potential method of umbilical cord mesenchymal stem cell (UCMSC) therapy for diabetic foot and lower extremity peripheral artery disease (PAD), but their results are not consistent. Thus, the authors conducted the first meta-analysis concerning the safety and efficacy of UCMSC treatment in diabetic foot patients. 8 English and Chinese databases were searched to identify randomized controlled trials regarding UCMSC therapy in diabetic foot patients. Two independent investigators carried out literature inclusion, data extraction, and quality assessment. Meta-analysis was performed using ReviewManager 5.4.1., 6 RCT studies involving 380 patients were included. Primary endpoints included ulcer healing, transcutaneous oxygen pressure (TcPO₂), ankle-brachial index (ABI), and intermittent claudication. Compared with conventional treatment, patients who accepted UCMSC therapy had a better ulcer healing rate (Odds Ratio (OR) = 2.88 [1.20-6.91]), TcPO₂ (standardized mean difference (SMD) = 1.39, [0.01-2.77]), and ABI improvement (SMD=1.22 [0.30-2.13]). Moreover, they also experienced significantly better improvements in pain amelioration, skin temperature, and ulcer area reduction. Whereas, intermittent claudication cannot be ameliorated by UCMSC therapy (SMD=0.83 [-0.45-2.10]). Additionally, neovascularization, examined by angiography, was significantly promoted after UCMSC administration. Moreover, two studies recorded adverse events during follow-up, which were considered to be transient, minor, and regional. The present meta-analysis validated that UCMSC treatment enhances diabetic foot ulcer healing and circulation recovery, and has a promising safety profile, though limited by incomplete reporting. Larger-sample multicenter randomized controlled trials and longer-term follow-up are urgently needed to further explore the safety and efficacy of UCMSC treatment in diabetic foot patients. The meta-analysis was prospectively registered on PROSPERO.

This study aims to evaluate the performance of an innovative in-shoe sensing device against the FScan system. Across five trials, the novel device demonstrated consistently strong correlations with FScan peak pressure readings (r = 0.801, r = 0.978, r = 0.813, r = 0.887, r = 0.944). Superimposed peak-pressure plots revealed highly similar waveform patterns between the two systems. Error-based metrics also supported this equivalence. Root Mean Squared Logarithmic Error values similarly suggested consistent predictive agreement. Temperature-sensing performance was assessed by comparing in-shoe sensor readings by the novel device with thermal-camera measurements. The thermal camera detected an average temperature change of 3.7°C, whereas the in-shoe sensor recorded an average change of 0.67°C. There was substantial variability in both systems, with higher variation observed in the in-shoe sensor than in the thermal camera. Despite variability, temperature and pressure measurements from the novel device were strongly correlated (r = 0.87). In conclusion, the new device provides pressure measurements comparable to the FScan system and appears promising for monitoring foot health.

Background and aims: Diabetic foot is one of the most severe complications in patients with diabetes mellitus and has been linked to 25-OH-vitamin D status. This study aims to determine the prevalence of 25-OH-vitamin D deficiency and its association with diabetic foot. Methods: Patients with type 2 diabetes mellitus were enrolled in this study. The patients were divided into the diabetic foot group (n = 95) and the non-diabetic foot group (n = 388). Weight, height, and waist circumference were measured. The 25-OH-vitamin D and the other biochemical tests were extracted from the electronic medical records. The difference in clinical parameters between the diabetic foot group and the non-diabetic foot group was analyzed, and the risk factors of the diabetic foot group were analyzed using logistic regression. Results: The prevalence of 25-OH-vitamin D deficiency was 44.6%, accounting for 57.9% of all the diabetic foot group patients and only 41.0% of the non-diabetic foot group patients. The mean serum 25-OH-vitamin D level was significantly different between the diabetic foot group and the non-diabetic foot group (19.8 ± 9.5 vs 24.1 ± 11.8; P = .011). Serum 25-OH-vitamin D and B12 were found to have a significant positive correlation (r = 0.410, P = <.01). The 25-OH-vitamin D level and body mass index were independently associated with diabetic foot (P = .043, OR = 1.21; P = .009, OR =  1.47), respectively. Conclusions: The 25-OH-vitamin D deficiency was higher in the diabetic foot group. More research is needed to understand the role of 25-OH-vitamin D in the development of diabetic foot.

Aims: To evaluate the reliability of the methodological quality and outcome measures of systematic reviews (SRs)/metaanalyses (MAs) of the acellular dermal matrix (ADM) for diabetic foot ulcer (DFU). Methods: We searched and retrieved SRs and MAs on the application of ADM for DFU from PubMed, Web of Science, The Cochrane Library, EMBASE, CNKI, CBM, WanFang, and VIP databases. We employed AMSTAR 2 to assess methodological quality, Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system to grade, and the strength of evidence of included SRs/MAs. We excluded the overlapping randomized controlled trials (RCTs) and conducted a re-MA of the primary RCTs. Results: A total of 7 SRs/MAs were included. Results from the AMSTAR 2 evaluation revealed a low overall quality; the GRADE system showed that the evidence was of moderate to very low quality. Our re-MA showed that ADM was superior to standard of care (SOC), with regards to complete wound healing rate at 12 weeks (RR = 1.74, 95% CI:1.34-2.25, P < .0001), complete wound healing rate at 16 weeks (RR = 1.50, 95% CI: 1.26-1.77, P ＜ .00001); healing time (MD = -2.06, 95% CI: -2.57 to -1.54, P < .00001) and adverse events (RR = 0.62, 95% CI: 0.49-0.80, P = .0002). However, a consensus has not yet been reached between ADM and SOC groups with regard to outcome indicators of the reduction of ulcer area and quality of life; and subgroup analyses showed no statistically significant differences between the xenograft ADM and SOC groups (RR = 1.36, 95% CI: 0.95-1.93, P = .09) at 12 weeks. Conclusion: Current evidence suggests that ADM is more effective than the standard of care in the treatment of DFU, particularly for full-thickness, noninfected, and nonischemic foot ulcers, but with low evidence quality. Therefore, the results of this overview should be interpreted dialectically and prudently, and the role of ADM in DFU needs further exploration.

Patients with diabetic foot ulcer (DFU) are prone to major complications including amputations. Traditional remedies (TR) have been used to treat DFU around the world. This study aims to identify the prevalence of TR among patients with DFU in our local cohort and its effect on DFU. 1408 patients were included in the analysis. Data were collected retrospectively from patients' medical records. DFU characteristics include grading ulcers using the Wagner scale (WG) and infections (cellulitis and osteomyelitis). Ulcer management (UM) includes medical treatment, self-medical treatment, traditional treatment, and medical-traditional treatment. The mean age of the cohort was 60 years (SD = 12.4). The mean duration of diabetes was 18.6 years (SD = 9.3) and the mean duration of open wounds was 206.9 days (SD = 545.6). The majority were males (71%) and had type 2 diabetes (96%, SD = .204). Forty-three percent of patients were treated with TR (29% were self-prescribed and 14% prescribed by a physician) while 48% had medical treatment and 10% were self-treated using medical treatment. More than two-thirds of the cohort had cellulitis and/or osteomyelitis at the time of presentation. The use of traditional treatment was significantly associated with higher WG (WG 4 OR =  1.936, 95% CI: 1.338-2.800; WG 5 OR =  2.937, 95% CI:1.614-5.346; P < 0.05). Moreover, osteomyelitis was associated with medical-traditional treatment (OR = 1.608, 95% CI: 1.006-2.572; P < 0.05) and increased wound depth (WG 3 OR =  1.969, 95% CI: 1.193-3.250; WG 4 OR =  1.874, 95% CI: 1.115-3.15; P < 0.05). There is high use of TR for the treatment of DFU in our cohort. High Wagner-grade of foot ulcers and the presence of osteomyelitis were highly associated with DFU. This study showed for the first time the use of traditional potions by medical physicians. Both physicians and patients need to be made aware of the detrimental effects of using traditional methods on DFU.

Diabetic foot (DF) is one of the most devastating complications of diabetes mellitus (DM). Infrared thermography has been studied for its potential in early diagnosis and preventive measures against DF ulcers, although its role in the management and prevention of DF complications remains uncertain. The objective of this study was to determine the average temperatures of different points of the plantar foot using infrared thermography in patients with DM and history of DF (DFa group, at the highest risk of developing foot ulcers) and compare them to people without DM (NoDM group). One hundred and twenty-three feet were included, 63 of them belonged to DFa Group and the other 60 to NoDM Group. The average temperature in the NoDM Group was 27.4 (26.3-28.5) versus 28.6 (26.8-30.3) in the DFa Group (p = .002). There were differences between both groups in temperatures at the metatarsal heads and heels, but not in the arch. Average foot temperatures did not relate to sex, ankle-brachial index, and age, and had a mild correlation with daily temperature (Spearman 0.51, p < .001). Data provided in our study could be useful in establishing a parameter of normal temperatures for high-risk patients. This could serve as a foundational framework for future research and provide reference values, not only for preventative purposes, as commonly addressed in most studies, but also to assess the applicability of thermography in clinical scenarios particularly when one foot cannot serve as a reference, suspected osteomyelitis of the remaining bone, or instances of increased temperature in specific areas which may necessitate adjustments to the insoles in secondary prevention.

Diabetic foot infections (DFIs) are a common and costly complication of diabetes. Soft tissue and bone infections in DFIs frequently lead to amputation and/or sepsis which can be costly for both the patient and the healthcare system. Staphylococcus aureus is the most commonly identified causative agent in DFIs, and people with diabetes may have an increased risk of infection with methicillin-resistant Staphylococcus aureus (MRSA). In addition to increased susceptibility to severe infection, MRSA in DFIs is associated with high rates of treatment failure, morbidity, and hospitalization costs meaning appropriate treatment is a high priority. While hospitalized patients are usually treated with intravenous (IV) vancomycin, this can be costly in terms of inpatient stays, staffing costs, and adverse events. For example, vancomycin-associated acute kidney injury not only delays hospital discharge and increases costs but is also a particular concern for patients with diabetes who already have an increased risk of kidney problems. Vancomycin-resistant strains of S. aureus have also been identified, which means that alternative treatment options may need to be explored. Treatment alternatives to IV vancomycin, including oral antibiotics, have been shown to provide similar efficacy, with reduced costs, outpatient or home-based administration, and with fewer serious adverse effects. Although infectious disease specialists often use IV vancomycin alone, or in combination, as a first-line therapeutic option, they are increasingly seeing the value of outpatient or at-home oral antibiotics as an alternative. This manuscript reviews the evidence for true costs of vancomycin therapy for MRSA-associated DFIs and examines the alternatives.