The international journal of lower extremity wounds最新文献

The current study aimed to evaluate characteristics and outcomes of patients admitted for a diabetic foot attack (DFA). It is a retrospective observational study including a population of patients admitted for diabetic foot ulcers (DFU) in a specialized diabetic foot service. Based on the type of hospital admission (emergency or elective), patients were divided into two groups: those with DFA and those without DFA (chronic diabetic foot, CDF). The DFA was considered in case of ischemia, infection and Charcot foot requiring urgent hospitalization. The following in-hospital outcomes were evaluated: minor and major amputation, number of surgical procedures, length of stay (LOS), mortality. Overall, 150 patients were included. The mean age was 70.3 ± 12.2 years, most patients were male (76.0%) and had type 2 diabetes (92.7%) with a mean duration of 22.1 ± 13.2 years; 88 (58.7%) patients presented DFA while 62 (41.3%) presented CDF. The DFA group reported a greater rate of foot infection (81.8 vs 50.0%, p = 0.002), higher HbA1c values (67.9 ± 22 vs 56.6 ± 14.3 mmol/mol, p = 0.0005) and more cases of first assessment for DFUs (43.2 vs 12.9%, p = 0.005) compared with the CDF group. Outcomes for DFA and CDF were minor amputation (36.4 vs 21%, p = 0.04), major amputation (2.3 vs 1.6%, p = 0.7), need for surgical procedures (>1) (27.3 vs 11.3%, p = 0.0001), LOS (17 ± 9.6 vs 12 ± 6.3 days, p = 0.0004), mortality (1.1 vs 0%, p = 0.6). In addition, foot infection and poor glycometabolic control were independently related to the DFA presentation. The DFA increases the risk of minor amputations, more surgical procedures and longer hospitalization. Foot infection and poor metabolic control resulted closely related to the DFA.

Charcot osteoarthropathy (CO) is an unusual and frequently misdiagnosed complication of diabetes mellitus. The delayed diagnosis can have severe consequences for patients' limb and life. Its diagnosis is based firstly in its clinical suspicion, is mainly clinical and is confirmed by imaging tests, like magnetic resorance imaging. Specific biomarkers for its early detection and therapy have not been found yet. The understanding of CO pathogenesis and measurement of molecules involved in this can head to this direction. The purpose of this review is to summarize/describe the most current studies measuring biomarkers in people with CO. Confocal corneal microscopy (CCM), inflammatory markers including IL-1, IL-6 and TNF-a, bone metabolism markers like RANK, RANKL, OPG, advanced glycation end products (AGEs) and bone mineral density (BMD) were among the most popular ones included in a large number of studies of the last 20 years and people with CO have significant different levels of the above comparing to non-Charcot groups. Future and larger studies can lead to the discovery of novel biomarkers of the prompt detection of this special entity at an early stage.

AimTo clarify the clinical characteristics of autoimmune disease (AID)-related ulcers to improve treatment outcomes.Materials and MethodsThe medical records of 189 patients treated for AID-related ulcers at two tertiary hospitals in Nanjing, China, from January 1, 2018 to December 31, 2022 were retrospectively reviewed. The relevant clinical data included diagnosis, type and severity of wounds, and prescribed medications.ResultsOf the 189 patients with AID-related ulcers, 146 (77.25%) were female and 43 (22.75%) were male. The top four immunological diagnoses were rheumatoid arthritis, systemic lupus erythematosus, Sjogren's syndrome, and vasculitis. The four most common wound sites were the lower limb, foot, hand, and upper limb. Regarding the number of wounds, 81 (42.86%) patients had one ulcer, 43 (22.75%) had two, 30 (15.87%) had three, and 35 (18.52%) had four or more. More than half of the patients (54%, 102/189) were previously treated for AID-related ulcers. Of these 102 patients, 27 (26.47%) had one previous diagnosis, 49 (40.83%) had two, and 26 (25.49%) had three or more. Among all 189 patients, 142 (75%) had clinical symptoms of local infection. Of these 142 patients, bacteria cultures were conducted for 70 (49.30%), of which 63 (90.00%) were positive. The most commonly detected bacteria were Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae. The median (interquartile range) duration of AID-related ulcers was 55 (39, 90) days. Most patients (87.3%, 165/189) received systemic therapy with immunosuppressants and hormones.ConclusionsThe most common clinical characteristics of AID-associated ulcers were spontaneous rupture, long duration, multiple wounds, bacterial infection, and recurrence. Clarification of the clinical characteristics of AID-associated ulcers can improve treatment outcomes.

BackgroundFoot ulcers represent a major complication in patients with diabetes and are often challenging for clinicians. Distinguishing between infected and non-infected diabetes foot ulcers (DFUs) can prevent many irreversible injuries such as inappropriate antibiotic therapy, amputation, and even death. Procalcitonin (PCT) has been proposed in the diagnosis of infection and osteomyelitis in diabetes foot ulcers. The present study aimed to compare PCT levels between patients with and without infected diabetes foot ulcer (IDFU).MethodThis review searched three databases including PubMed, Web of Science, and Scopus to identify all articles reporting PCT levels in two groups of infected diabetes foot ulcer (IDFU) and non-infected diabetes foot ulcer (NIDFU). Quality has been assessed using the NIH tool. The pooled mean difference (MD) of PCT level between groups was estimated by random effect meta-analysis. In addition, The PRISMA 2020 statement has been used to update guidelines for reporting present systematic reviews.ResultTwenty-three studies were eligible for meta-analysis, of which data from 2412 people was extracted. Pooled estimation of PCT level was significantly higher in IDFU patients compared with NIDFU patients (MD = 0.25 ng/l, 95% CI: 0.14-0.37). According to the meta-analysis results, PCT level was not significantly higher in patients with Osteomyelitis compared with those without Osteomyelitis (MD = 0.59 ng/l, 95% CI: -0.19, 1.38, I²= 98.5%).ConclusionSince the results of the present study showed higher PCT levels in patients with IDFU compared to those without, it can be suggested that procalcitonin might be applied as an additional biomarker for the differentiation of NIDFU from IDFU. It needs more evidence to conclude about the role of PCT in terms of osteomyelitis and amputation.

The wound healing process is really interesting, dynamic, and complex, captivating researchers for a long time. With the growing worldwide concern regarding the prevalence of wounds and the associated healthcare challenges, efforts to expedite this natural process have intensified. Fortunately, with a particular focus on improving wound dressings, significant advancements have been made in wound care management including using of nanoparticle-based delivery systems. These nanoparticles, similar to molecular messengers, purchase vast promise for revolutionizing wound treatment. Among them, chitosan nanoparticles stand out as remarkable candidates. Their safety profile, biocompatibility, and bioactivity make them particularly appealing for wound care. In this article, we will delve into the intricacies of wound healing and then discuss the wound-healing properties of chitosan nanoparticles, supported by comprehensive study results. Current evidence highlights the wound-healing effects of chitosan nanoparticles, which can be considered independent agents for wound management. In conclusion, the utilization of chitosan nanoparticles for wound healing presents significant opportunities and potential.Graphical abstract [Formula: see text].

IntroductionThis study is to examine the reduction in wound size between the LTAPP and the control group and also investigate the wound healing effect factor.MethodsA randomized controlled trial was conducted at five study centers. Participated patients were between 18-80 years old who had pressure ulcer wound(s) and excluded patients with high risk or receiving other treatment such as previous radiation therapy in the affected area, pregnancy, sepsis, and immunocompromised host. The study divided participant into LTAPP group and standard of care (SOC) group, the LTAPP group would received a dressing of non-Ag materials and administer LTAPP for 1 min per 1 cm² (maximum of 20 min). The SOC group would received standard dressing wound protocol. Both groups would be followed until the end of study (ninth visit) or until the wound healed.ResultsWhen considering patients who attended follow-up ≥4 visits, only 45 ulcers were eligible, of which consisted of 21 ulcers in the LTAPP group and 24 ulcers in the SOC group. The results showed significant healing rate of the LTAPP group, whether to be the wound size: wound area and wound volume, wound healing: exudate reduction, granulation and lesser necrotic tissue or Pressure Ulcer Scale for Healing (PUSH) score. The LTAPP group had better bacterial load reduction without the use of tropical antibiotic, this also signified the quality in bacterial eradication of LTAPP.ConclusionLTAPP showed outstanding performance in treating pressure ulcer wounds. The LTAPP gave greater outcome in wound size, wound healing indicators, microbiological analyses and cost-effective comparison. Although, the absence of statistical significance, it did not affect the outcome trends. This study suggested further investigation of the potential role of LTAPP therapy in different wound types in near future.

The aim of study was to confirm the hypothesis that advanced medial arterial calcification (MAC)/ small artery disease (SAD), much like the progression of peripheral arterial disease (PAD) stages can adversely impact the outcomes in DFU patients, even after successful endovascular procedures. In retrospective study, we enrolled 54 patients with DFUs who underwent percutaneous transluminal angioplasty (PTA). MAC was quantified using a three-level scoring system based on radiographs. Patients were categorized based on their MAC score into three groups. Study groups were compared in terms of primary DFU outcomes (healing, amputations) and secondary DFU outcomes (mortality, changes in transcutaneous oxygen pressure (TcPO2)) three and six months after PTA. The MAC/SAD score increased significantly with age (p = 0.014). The MAC/SAD score was't associated with the risk of amputation or the healing of DFUs up to three months after revascularization. However, a significant association was observed after six months (p = 0.043). The MAC/SAD score correlated significantly with severity of PAD, as classified by the Global Limb Anatomic Staging System (p = 0.042) and the Graziani system (p = 0.019). We found a negative correlation between the MAC/SAD score and absolute levels of TcPO2 after PTA. MAC/SAD score was significantly associated with long-term unhealed DFUs and the risk of lower limb amputations.

Venous leg ulcers (VLUs) cause a significant health care burden due to high health care costs, prolonged treatment, and high recurrence. Our study aims to compare between retrograde venous perfusion (RVP) combined with conventional therapy versus conventional therapy for treatment of chronic VLUs with regard to safety and efficacy. Drugs used for RVP were prostaglandin E1 (alprostadil), calcium heparin, hydrocortisone, pheniramine maleate, and lidocaine. This was a randomized controlled study conducted on 60 patients with chronic VLUs from June 2023 to June 2024. Patients were divided into two groups: RVP with conventional therapy versus conventional therapy only. Outcomes included the rate of complete ulcer closure and the percentage of healing at 6 months, ulcer-related complications, and recurrence rates. At 6 months, the RVP with conventional therapy group had a significantly higher ulcer surface area reduction, 83.7% versus 61%, p = 0.001, and a higher percentage of complete healing, 86.2% versus 44.8%, p = 0.005, as compared to the conventional therapy alone group. Similarly, time to complete healing was shorter in the RVP group at 7.8 ± 2.61 weeks versus 10.7 ± 4.31 weeks, p < 0.001. There was no significant difference in rates of wound infection between the two groups. Lower, though statistically non-significant, recurrence rates were seen within the RVP group: 8% versus 15.4%. RVP should be considered one of the adjunctive treatments for chronic VLUs. It offered positive results with regard to improved healing outcomes and reduced ulcer size. More researches are needed to confirm these conclusions.

BackgroundDiabetic foot ulcer (DFU) is a severe complication of diabetes. Nutritional deficiencies, including poor nutritional status reflected by a high CONUT score and low serum zinc have been implicated in the severity and wound healing failure of DFU. However, the association between these factors and DFU remains unclear.MethodsA retrospective cohort study was performed in 319 patients categorized into three groups: healthy controls (HC, n = 213), patients with diabetes without foot ulcer (DM, n = 67), and patients with diabetes with foot ulcer (DFU, n = 39). Demographic, clinical, nutritional, and biochemical data were collected, including age, sex, body mass index, the presence of chronic limb-threatening ischemia (CLTI), the presence of maintenance dialysis, CONUT score, hemoglobin A1c, hemoglobin (Hb), total protein (TP), and zinc levels. The severity of DFU was assessed using the PEDIS score, while wound healing failure was defined based on specific clinical criteria. Statistical analyses were conducted to identify factors associated with DFU severity and wound healing failure.ResultsDFU cases had significantly lower Hb, TP, and zinc levels and higher CONUT score compared to the HC and DM cases. Within the DFU group, high PEDIS score (>8) was associated with significantly higher CONUT score, lower TP levels, and the presence of CLTI. Patients with wound healing failure had significantly lower zinc and Hb levels and a higher prevalence of CLTI. Multivariable logistic regression identified CONUT score and the prevalence of CLTI as independent factors associated with DFU severity, while serum zinc levels and the prevalence of CLTI were independently associated with wound healing failure.ConclusionsThis study highlighted the critical role of poor nutritional status, as indicated by high CONUT score, and zinc deficiency in the severity and poor healing outcomes of DFU. These findings underscore the critical role of nutritional management in comprehensive treatment of DFU.

Diabetic foot ulcer (DFU) is a common complication of diabetes. It is often accompanied by infection and, in severe cases, necessitates amputation. Early diagnosis and monitoring are crucial for improving prognosis. Novel inflammatory biomarkers, such as the systemic inflammatory response index (SIRI), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) are useful for the diagnosis and predicting prognosis of some diseases. This study aimed to clarify the association between SIRI, NLR, PLR and DFU and assess their utility for early diagnosis and monitoring of DFU. Cross-sectional data were extracted on individuals with diabetes who participated in the National Health and Nutrition Examination Survey (NHANES) between 1999 to 2004. DFU was diagnosed based on the presence of foot ulcers that had not healed within 4 weeks. Weighted multivariable regression, subgroup analysis, and smooth curve fitting were used to evaluate the relationships between the SIRI, NLR, and PLR with DFU.A total of 1204 participants were included in the analysis, of whom 112 had DFUs. Participants with DFUs had higher NLR, PLR, and SIRI values than those without DFUs. For each unit increase in SIRI, the prevalence of DFU increased by 27% . Subgroup analyses showed a consistent association between an elevated SIRI and the prevalence of DFUs.SIRI is a low-cost, readily accessible biomarker that can be used in conjunction with NLR and PLR to assess the severity and predict the prognosis of DFU. Continuous monitoring of these indicators could assist with early diagnosis and management of DFU.