Pub Date : 2023-10-17DOI: 10.1177/15347346231207747
Marco Meloni, Aikaterini Andreadi, Valeria Ruotolo, Maria Romano, Ermanno Bellizzi, Laura Giurato, Alfonso Bellia, Luigi Uccioli, Davide Lauro
The aim of the current study was to evaluate the rate of readmission in patients affected by diabetes and foot ulcers (DFUs), and causes and outcomes of patients requiring a new hospitalization. The current study is a retrospective observational study including patients who have required hospitalization since January 2019 to September 2022 due to a DFU. Once patients were discharged, they were regularly followed as outpatients. Within 6 months of follow-up, the rate of hospital readmission for a diabetic foot problem was recorded. According to the readmission or not, patients were divided into 2 groups, readmitted and not readmitted patients, respectively. Hence, all patients were followed for 6 months more and outcomes of the 2 groups were analyzed and compared. Overall, 310 patients were included. The mean age was 68 ± 12 years, the majority of patients reported type 2 diabetes (>90%), and the mean diabetes duration was approximately 20 years. Sixty-eight (21.9%) patients were readmitted. The main reason for hospital readmission was the presence of critical limb ischemia (CLI) in the contralateral limb (6.1%), the recurrence of CLI in the previous treated limb (4.5%), and the onset of new infected DFU in the contralateral foot (4.5%). Readmitted patients reported lower rate of healing (51.5% vs 89.2%, P < .0001) and higher rate of major amputation (10.3% vs 4.5%, P = .2) in comparison to not readmitted patients. Critical limb ischemia resulted in the only independent predictor of hospital readmission. Hospital readmission is a frequent issue among patients with DFUs, and readmitted patients showed a lower chance of wound healing. Critical limb ischemia resulted in the main cause of new hospitalization.
本研究的目的是评估糖尿病和足部溃疡(DFU)患者的再入院率,以及需要新住院治疗的患者的原因和结果。目前的研究是一项回顾性观察性研究,包括自2019年1月至2022年9月因DFU需要住院治疗的患者。一旦病人出院,他们就作为门诊病人定期接受随访。在随访的6个月内,记录糖尿病足问题的再次入院率。根据是否再次入院,将患者分为两组,分别为再次入院和未再次入院患者。因此,所有患者都接受了6个月以上的随访,并对两组的结果进行了分析和比较。总共纳入310名患者。平均年龄68岁 ± 12年后,大多数患者报告2型糖尿病(>90%),平均糖尿病持续时间约为20年。68名(21.9%)患者再次入院。再次入院的主要原因是对侧肢体存在严重肢体缺血(CLI)(6.1%),先前治疗的肢体出现严重肢体缺血复发(4.5%),对侧足部出现新感染的DFU(4.5%) P = .2) 与未再次入院的患者相比。严重的肢体缺血是再次入院的唯一独立预测因素。在DFU患者中,再次入院是一个常见的问题,再次入院的患者伤口愈合的几率较低。严重的肢体缺血是新住院的主要原因。
{"title":"Hospital Readmission in Patients With Diabetic Foot Ulcers: Prevalence, Causes, and Outcomes.","authors":"Marco Meloni, Aikaterini Andreadi, Valeria Ruotolo, Maria Romano, Ermanno Bellizzi, Laura Giurato, Alfonso Bellia, Luigi Uccioli, Davide Lauro","doi":"10.1177/15347346231207747","DOIUrl":"https://doi.org/10.1177/15347346231207747","url":null,"abstract":"<p><p>The aim of the current study was to evaluate the rate of readmission in patients affected by diabetes and foot ulcers (DFUs), and causes and outcomes of patients requiring a new hospitalization. The current study is a retrospective observational study including patients who have required hospitalization since January 2019 to September 2022 due to a DFU. Once patients were discharged, they were regularly followed as outpatients. Within 6 months of follow-up, the rate of hospital readmission for a diabetic foot problem was recorded. According to the readmission or not, patients were divided into 2 groups, readmitted and not readmitted patients, respectively. Hence, all patients were followed for 6 months more and outcomes of the 2 groups were analyzed and compared. Overall, 310 patients were included. The mean age was 68 ± 12 years, the majority of patients reported type 2 diabetes (>90%), and the mean diabetes duration was approximately 20 years. Sixty-eight (21.9%) patients were readmitted. The main reason for hospital readmission was the presence of critical limb ischemia (CLI) in the contralateral limb (6.1%), the recurrence of CLI in the previous treated limb (4.5%), and the onset of new infected DFU in the contralateral foot (4.5%). Readmitted patients reported lower rate of healing (51.5% vs 89.2%, <i>P</i> < .0001) and higher rate of major amputation (10.3% vs 4.5%, <i>P</i> = .2) in comparison to not readmitted patients. Critical limb ischemia resulted in the only independent predictor of hospital readmission. Hospital readmission is a frequent issue among patients with DFUs, and readmitted patients showed a lower chance of wound healing. Critical limb ischemia resulted in the main cause of new hospitalization.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41242712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bacterial proliferation plays a well-known role in delayed tissue healing. To date, the presence of microorganisms on the wound bed can be detected by skin swabs or skin biopsies. A novel noninvasive fluorescence imaging device has recently allowed real-time detection of bacteria in different types of wounds through endogenous autofluorescence. The fluorescence signals detected by the device provide health workers with a visual indication of the presence, load, and distribution of bacteria. The aim of our study was to evaluate the level of bacterial colonization in perilesional skin of patients affected by venous leg ulcers treated with 2 different types of bandages: short stretch bandage and zinc oxide bandage. We conducted a monocentric prospective study, enrolling 30 patients with venous leg ulcers, divided into 2 groups: group A was treated with short stretch bandage and group B with zinc oxide bandage. A complete patient's assessment was performed once a week for 3 weeks. Levels of potentially harmful bacteria in perilesional skin were detected using a fluorescent device by 2 experienced operators on the frames taken at individual injuries, while pain was evaluated with the Numerical Rating Scale. After 3 weeks, we observed a reduction in the bacterial colonization levels of the perilesional skin by 68.67% for group A and 85.54% for group B. All the patients had a statistically significant reduction in bacterial load (P < .001), and a statistically significant difference was identified between the 2 groups (P = .043). No statistically significant differences were found between the 2 groups in terms of pain relief (P = .114). Our study demonstrated that the application of zinc oxide bandage provides a higher reduction in bacterial load perilesional skin. On the other hand, we found no difference between the 2 bandages in terms of pain symptom reduction.
{"title":"Fluorescence-Based Evaluation of Bacterial Load in Perilesional Skin: A Comparison Between Short Stretch Bandage and Zinc Oxide Bandage.","authors":"Alessandra Michelucci, Giorgia Salvia, Agata Janowska, Giammarco Granieri, Riccardo Morganti, Valentina Dini, Marco Romanelli","doi":"10.1177/15347346231206449","DOIUrl":"https://doi.org/10.1177/15347346231206449","url":null,"abstract":"<p><p>Bacterial proliferation plays a well-known role in delayed tissue healing. To date, the presence of microorganisms on the wound bed can be detected by skin swabs or skin biopsies. A novel noninvasive fluorescence imaging device has recently allowed real-time detection of bacteria in different types of wounds through endogenous autofluorescence. The fluorescence signals detected by the device provide health workers with a visual indication of the presence, load, and distribution of bacteria. The aim of our study was to evaluate the level of bacterial colonization in perilesional skin of patients affected by venous leg ulcers treated with 2 different types of bandages: short stretch bandage and zinc oxide bandage. We conducted a monocentric prospective study, enrolling 30 patients with venous leg ulcers, divided into 2 groups: group A was treated with short stretch bandage and group B with zinc oxide bandage. A complete patient's assessment was performed once a week for 3 weeks. Levels of potentially harmful bacteria in perilesional skin were detected using a fluorescent device by 2 experienced operators on the frames taken at individual injuries, while pain was evaluated with the Numerical Rating Scale. After 3 weeks, we observed a reduction in the bacterial colonization levels of the perilesional skin by 68.67% for group A and 85.54% for group B. All the patients had a statistically significant reduction in bacterial load (<i>P</i> < .001), and a statistically significant difference was identified between the 2 groups (<i>P</i> = .043). No statistically significant differences were found between the 2 groups in terms of pain relief (<i>P</i> = .114). Our study demonstrated that the application of zinc oxide bandage provides a higher reduction in bacterial load perilesional skin. On the other hand, we found no difference between the 2 bandages in terms of pain symptom reduction.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41242711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Diabetic foot ulcers (DFUs) are classified as hard-to-heal wounds, which occur in approximately 15% of diabetic patients. Several interventions have shown efficacy in reducing the risk of amputation among patients with DFU, including timely diagnosis and management of infection and ischemia, debridement of necrotic tissues, reducing mechanical pressure on ulcers, and patient education. One major challenge in the management of DFUs is optimizing wound care to improve healing outcomes. Recently, interdisciplinary approaches proposed a new generation of wound dressing which increased efficacy and significantly decreased the healing time. The current study assessed the healing characteristics of chronic DFUs treated with lyophilized amniotic membrane gel (LAMG) in combination with standard care, versus a placebo hydrogel with standard care. In total, 18 patients (8 male, 10 female) were randomly assigned to the control group, which received standard care and a gelatin scaffold (placebo), or the intervention group, which received standard care along with LAMG. We evaluated the reduction in wound size and assessed the patient's health-related quality of life over 9 weeks. In the LAMG group (n = 9) and the Placebo group (n = 9), the wounds were reduced in size by a mean of 73.4% ± 15.3% and 13.1% ± 10.1%, respectively (P = .008). Patients treated with LAMG demonstrated significant improvements in the scores related to physical function, physical limitation, physical pain, general health, social function, emotional problems, and energy levels compared to the control group. The findings of this study indicate that using the LAMG with standard care significantly enhances wound healing.
{"title":"The Therapeutic Efficacy of Freeze-Dried Human Amniotic Membrane Allograft Gel for Diabetic Foot Ulcers: A Phase-1 Clinical Trial.","authors":"Aida Rezaei-Nejad, Mohammad-Amir Amirkhani, Alireza Ebrahimi, Seyyed-Mojtaba Ghorani, Emad Alamoutifard, Mohammad-Ali Nilforoushzadeh, Mahsa Mollapour-Sisakht","doi":"10.1177/15347346231204246","DOIUrl":"10.1177/15347346231204246","url":null,"abstract":"<p><p>Diabetic foot ulcers (DFUs) are classified as hard-to-heal wounds, which occur in approximately 15% of diabetic patients. Several interventions have shown efficacy in reducing the risk of amputation among patients with DFU, including timely diagnosis and management of infection and ischemia, debridement of necrotic tissues, reducing mechanical pressure on ulcers, and patient education. One major challenge in the management of DFUs is optimizing wound care to improve healing outcomes. Recently, interdisciplinary approaches proposed a new generation of wound dressing which increased efficacy and significantly decreased the healing time. The current study assessed the healing characteristics of chronic DFUs treated with lyophilized amniotic membrane gel (LAMG) in combination with standard care, versus a placebo hydrogel with standard care. In total, 18 patients (8 male, 10 female) were randomly assigned to the control group, which received standard care and a gelatin scaffold (placebo), or the intervention group, which received standard care along with LAMG. We evaluated the reduction in wound size and assessed the patient's health-related quality of life over 9 weeks. In the LAMG group (n = 9) and the Placebo group (n = 9), the wounds were reduced in size by a mean of 73.4% ± 15.3% and 13.1% ± 10.1%, respectively (<i>P</i> = .008). Patients treated with LAMG demonstrated significant improvements in the scores related to physical function, physical limitation, physical pain, general health, social function, emotional problems, and energy levels compared to the control group. The findings of this study indicate that using the LAMG with standard care significantly enhances wound healing.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41224493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-12DOI: 10.1177/15347346231207437
Gerardo Víquez-Molina, Javier Aragón-Sánchez, María Eugenia López-Valverde, Javier Aragón-Hernández, Cristina Aragón-Hernández, José María Rojas-Bonilla
We hypothesized that foot infections secondary to a puncture wounds (PWs) have a worse prognosis concerning infection-related mortality, recurrence of the infection, and healing than those secondary to a chronic ulcer. We conducted a prospective study consisting of 200 patients with moderate-to-severe diabetic foot infections. The cohort consisted of 155 men (77.5%) and 45 women (22.5%). The mean age of the patients was 59 years (standard deviation 12.2). Puncture wounds were the cause of the infection in 107 patients (53.5%) and a chronic ulcer was the cause in 93 patients (46.5%). One hundred and eleven patients (55.5%) had moderate and 89 (44.5%) had severe infections. Osteomyelitis was more frequently found in chronic ulcers (71%) than in PWs (44.9%), P < .001. Cox's survival analysis using PWs as an explanatory variable showed no association with infection-related mortality (hazard ratio [HR] 1.06, 95% confidence interval [CI] 0.32-3.46, P = .92), time to recurrence of infection (HR 0.64, 95% CI 0.27-1.51, P = .30), and time to healing (HR 0.81, 95% CI 0.60-1.08, P = .15). More than half of our patients had PWs as the mechanism by which the infection occurred. These patients usually had a lower rate of osteomyelitis but required hospitalization and antibiotic therapy more frequently than patients with infected chronic ulcers. We found no difference in outcomes between the 2 groups.
{"title":"Differences in Foot Infections Secondary to Puncture Wounds or Chronic Ulcers in Diabetes.","authors":"Gerardo Víquez-Molina, Javier Aragón-Sánchez, María Eugenia López-Valverde, Javier Aragón-Hernández, Cristina Aragón-Hernández, José María Rojas-Bonilla","doi":"10.1177/15347346231207437","DOIUrl":"https://doi.org/10.1177/15347346231207437","url":null,"abstract":"<p><p>We hypothesized that foot infections secondary to a puncture wounds (PWs) have a worse prognosis concerning infection-related mortality, recurrence of the infection, and healing than those secondary to a chronic ulcer. We conducted a prospective study consisting of 200 patients with moderate-to-severe diabetic foot infections. The cohort consisted of 155 men (77.5%) and 45 women (22.5%). The mean age of the patients was 59 years (standard deviation 12.2). Puncture wounds were the cause of the infection in 107 patients (53.5%) and a chronic ulcer was the cause in 93 patients (46.5%). One hundred and eleven patients (55.5%) had moderate and 89 (44.5%) had severe infections. Osteomyelitis was more frequently found in chronic ulcers (71%) than in PWs (44.9%), <i>P</i> < .001. Cox's survival analysis using PWs as an explanatory variable showed no association with infection-related mortality (hazard ratio [HR] 1.06, 95% confidence interval [CI] 0.32-3.46, <i>P</i> = .92), time to recurrence of infection (HR 0.64, 95% CI 0.27-1.51, <i>P</i> = .30), and time to healing (HR 0.81, 95% CI 0.60-1.08, <i>P</i> = .15). More than half of our patients had PWs as the mechanism by which the infection occurred. These patients usually had a lower rate of osteomyelitis but required hospitalization and antibiotic therapy more frequently than patients with infected chronic ulcers. We found no difference in outcomes between the 2 groups.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41224492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-09DOI: 10.1177/15347346231206448
Shaima Kmari-El-Ghazouany, Aroa Tardáguila-García, Mateo López-Moral, Marta García-Madrid, Yolanda García-Álvarez, José Luis Lázaro-Martínez
This study aims to describe the healing times of patients who underwent bone resection compared to bone curettage for managing diabetic foot osteomyelitis and to compare short- and long-term complications. This analytical retrospective observational cohort study collected clinical records of patients from a specialized diabetic foot clinic who underwent resection or bone curettage between January 2017 and January 2022. After surgery, a 1-year follow-up was conducted to record healing times and short- and long-term complications. The study included thirty-one patients, with 19 (61.29%) undergoing resections and 11 (38.71%) undergoing bone curettages. The resection cohort had a mean healing time of 5.70 ± 6.05 weeks, whereas the curettage cohort had a mean healing time of 14.45 ± 11.78 weeks, showing a statistically significant difference (P = 0.011). No significant differences were observed in terms of short- and long-term complications. In the resection cohort, 12 (63.20%) experienced short-term complications, compared to eight (66.70%) in the curettage cohort (P = 0.842, χ2 = 0.40, OR = 1.16). In the resection cohort, n = 6 (31.60%) had long-term complications, while n = 3 (25.00%) in the curettage cohort experienced long-term complications (P = 0.694, χ2 = 0.155, OR = 0.72). Although there were no significant differences in short- and long-term complications between resection and curettage, the resection group showed shorter healing times.
{"title":"Comparative Analysis of Bone Resection Versus Bone Curettage in Diabetic Foot Osteomyelitis.","authors":"Shaima Kmari-El-Ghazouany, Aroa Tardáguila-García, Mateo López-Moral, Marta García-Madrid, Yolanda García-Álvarez, José Luis Lázaro-Martínez","doi":"10.1177/15347346231206448","DOIUrl":"https://doi.org/10.1177/15347346231206448","url":null,"abstract":"<p><p>This study aims to describe the healing times of patients who underwent bone resection compared to bone curettage for managing diabetic foot osteomyelitis and to compare short- and long-term complications. This analytical retrospective observational cohort study collected clinical records of patients from a specialized diabetic foot clinic who underwent resection or bone curettage between January 2017 and January 2022. After surgery, a 1-year follow-up was conducted to record healing times and short- and long-term complications. The study included thirty-one patients, with 19 (61.29%) undergoing resections and 11 (38.71%) undergoing bone curettages. The resection cohort had a mean healing time of 5.70 ± 6.05 weeks, whereas the curettage cohort had a mean healing time of 14.45 ± 11.78 weeks, showing a statistically significant difference (<i>P</i> = 0.011). No significant differences were observed in terms of short- and long-term complications. In the resection cohort, 12 (63.20%) experienced short-term complications, compared to eight (66.70%) in the curettage cohort (<i>P</i> = 0.842, χ<sup>2</sup> = 0.40, OR = 1.16). In the resection cohort, n = 6 (31.60%) had long-term complications, while n = 3 (25.00%) in the curettage cohort experienced long-term complications (<i>P</i> = 0.694, χ<sup>2</sup> = 0.155, OR = 0.72). Although there were no significant differences in short- and long-term complications between resection and curettage, the resection group showed shorter healing times.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41184692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-04DOI: 10.1177/15347346231205641
Manar Fayiz Atoum, Amjad Al Shdaifat, Huda Al Hourani, Muwafag Al Hyari, Reema Zahran, Hanan Abu Shaikh
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.
{"title":"Relationship of Serum Vitamin D Levels With Diabetic Foot in Patients With Type 2 Diabetes Mellitus: A Cross-Sectional Study.","authors":"Manar Fayiz Atoum, Amjad Al Shdaifat, Huda Al Hourani, Muwafag Al Hyari, Reema Zahran, Hanan Abu Shaikh","doi":"10.1177/15347346231205641","DOIUrl":"https://doi.org/10.1177/15347346231205641","url":null,"abstract":"<p><p><b>Background and aims:</b> 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. <b>Methods:</b> 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. <b>Results:</b> 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; <i>P</i> = .011). Serum 25-OH-vitamin D and B12 were found to have a significant positive correlation (<i>r</i> = 0.410, <i>P</i> = <.01). The 25-OH-vitamin D level and body mass index were independently associated with diabetic foot (<i>P</i> = .043, OR = 1.21; <i>P</i> = .009, OR = 1.47), respectively. <b>Conclusions:</b> 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.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41175788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-27DOI: 10.1177/15347346231198940
Sang Yoon Lee, Myoung Jin Lee, Sung Bin Byun
Diabetes mellitus has a global impact, necessitating surgical intervention when conservative methods fail. Transtibial amputation (TTA) is commonly performed on diabetic patients, yet surgical site complications can lead to more procedures. This study aimed to identify factors linked to wound healing issues post-TTA in diabetics.A total of 181 patients who underwent TTA between 2004 and 2021 at a single hospital were included in the study. Exclusion criteria comprised trauma, non-diabetic mellitus, follow-up duration of less than 1 year, incomplete medical records, and surgeries performed by different surgeons. The comparison focused on underlying diseases other than diabetes between the group with wound problems and the group without. Additionally, factors impacting blood flow, such as presurgery hemoglobin levels, intraoperative blood transfusion, the use of antithrombotic or anticoagulant drugs, and the presence of procedures like percutaneous transluminal angioplasty (PTA) and bypass surgery, were analyzed.Among the 181 cases, 22.1% experienced problems at the surgical site while 77.9% did not. Statistical analysis revealed that age was a significant variable affecting wound healing problems after TTA in diabetic patients (p = .007). However, there were no significant differences in wound problems based on comorbidities other than diabetes (p = .209), gender (p = .677), preoperative anemia (p = .102), intraoperative blood transfusion (p = .633), the use of antithrombotic or anticoagulant medications (p = .556), and the performance of PTA or bypass surgery (p = .6).In conclusion, this study found that age was a significant variable affecting wound healing problems after TTA in diabetic patients. Although no association was observed between underlying diseases and wound healing problems, further investigation and cautious management of factors such as preoperative anemia, intraoperative blood transfusion, the use of antithrombotic or anticoagulant drugs, and the performance of PTA or bypass surgery are warranted to prevent complications and optimize wound healing outcomes in diabetic patients undergoing TTA.
{"title":"Analysis of the Factors of Wound Healing Problems After Transtibial Amputation in Diabetic Patients.","authors":"Sang Yoon Lee, Myoung Jin Lee, Sung Bin Byun","doi":"10.1177/15347346231198940","DOIUrl":"https://doi.org/10.1177/15347346231198940","url":null,"abstract":"<p><p>Diabetes mellitus has a global impact, necessitating surgical intervention when conservative methods fail. Transtibial amputation (TTA) is commonly performed on diabetic patients, yet surgical site complications can lead to more procedures. This study aimed to identify factors linked to wound healing issues post-TTA in diabetics.A total of 181 patients who underwent TTA between 2004 and 2021 at a single hospital were included in the study. Exclusion criteria comprised trauma, non-diabetic mellitus, follow-up duration of less than 1 year, incomplete medical records, and surgeries performed by different surgeons. The comparison focused on underlying diseases other than diabetes between the group with wound problems and the group without. Additionally, factors impacting blood flow, such as presurgery hemoglobin levels, intraoperative blood transfusion, the use of antithrombotic or anticoagulant drugs, and the presence of procedures like percutaneous transluminal angioplasty (PTA) and bypass surgery, were analyzed.Among the 181 cases, 22.1% experienced problems at the surgical site while 77.9% did not. Statistical analysis revealed that age was a significant variable affecting wound healing problems after TTA in diabetic patients (<i>p</i> = .007). However, there were no significant differences in wound problems based on comorbidities other than diabetes (<i>p</i> = .209), gender (<i>p</i> = .677), preoperative anemia (<i>p</i> = .102), intraoperative blood transfusion (<i>p</i> = .633), the use of antithrombotic or anticoagulant medications (<i>p</i> = .556), and the performance of PTA or bypass surgery (<i>p</i> = .6).In conclusion, this study found that age was a significant variable affecting wound healing problems after TTA in diabetic patients. Although no association was observed between underlying diseases and wound healing problems, further investigation and cautious management of factors such as preoperative anemia, intraoperative blood transfusion, the use of antithrombotic or anticoagulant drugs, and the performance of PTA or bypass surgery are warranted to prevent complications and optimize wound healing outcomes in diabetic patients undergoing TTA.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41163953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-26DOI: 10.1177/15347346231203279
Despoina D Kakagia, Efthimios J Karadimas, Ioannis A Stouras, Nikolaos Papanas
Feet suffer significant stress throughout a lifetime and undergo ageing-associated problems due to gradual tissue degeneration affecting the skin, connective tissue, and nerves. Oxygen supply to the tissues may be diminished. The skin gets dry and calluses, ulcers and fungal infections of the skin and nails are not uncommon. Ligaments and tendons degenerate and, without proper prevention, deformities including claw toes, hammer toes, tendonitis, and bursitis may occur. Skeletal toe deformities such as bunions, bony spurs, and hallux valgus may increase discomfort, while stress fractures may have an adverse impact on the patients' quality of life. The ageing foot pathology may add up to common age-related problems, such as crystal deposition arthropathies, diabetes mellitus, peripheral circulatory disorders, and peripheral edema, increasing morbidity. This review summarizes ageing-related feet problems, focusing on prevention and treatment. Foot health has a paramount role in overall wellbeing, therefore prevention, proper foot care, and prompt diagnosis and management of ageing-related changes are vital for maintaining a healthy, active status.
{"title":"The Ageing Foot.","authors":"Despoina D Kakagia, Efthimios J Karadimas, Ioannis A Stouras, Nikolaos Papanas","doi":"10.1177/15347346231203279","DOIUrl":"https://doi.org/10.1177/15347346231203279","url":null,"abstract":"<p><p>Feet suffer significant stress throughout a lifetime and undergo ageing-associated problems due to gradual tissue degeneration affecting the skin, connective tissue, and nerves. Oxygen supply to the tissues may be diminished. The skin gets dry and calluses, ulcers and fungal infections of the skin and nails are not uncommon. Ligaments and tendons degenerate and, without proper prevention, deformities including claw toes, hammer toes, tendonitis, and bursitis may occur. Skeletal toe deformities such as bunions, bony spurs, and hallux valgus may increase discomfort, while stress fractures may have an adverse impact on the patients' quality of life. The ageing foot pathology may add up to common age-related problems, such as crystal deposition arthropathies, diabetes mellitus, peripheral circulatory disorders, and peripheral edema, increasing morbidity. This review summarizes ageing-related feet problems, focusing on prevention and treatment. Foot health has a paramount role in overall wellbeing, therefore prevention, proper foot care, and prompt diagnosis and management of ageing-related changes are vital for maintaining a healthy, active status.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41166894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-21DOI: 10.1177/15347346231158858
M. Mahjoubi, B. Rezgui, M. Maatouk, Nada Essid, Yasser Karoui, H. Kandara, M. Moussa
Because of its rarity compared to dry and wet gangrene of the lower limb, the gaseous form has often been considered as the most severe form of gangrenous disease. We aimed to report clinical, paraclinical, and therapeutic features, and to identify mortality risk factors of gas gangrene of the lower limb. We conducted a one-center case series retrospective study over a period of 13 years from January 2006 to December 2018. A total of 19 patients were included: 12 men, 7 women. Mean age was 59.3 ± 11.3 years. There were 17 diabetic patients and one patient was on radio-chemotherapy for lower rectal cancer. Septic shock was initially present in 4 cases. Hyperleukocytosis was noted in 17 patients. C-reactive protein was elevated in 11 patients. All patients were put on antibiotics then operated on. A total of 8 patients died postoperatively (42%) in an average time of 9.6 days after surgery. On univariate analysis, factors associated with mortality were: Septic shock on admission (p = 0.02); local signs limited to foot (p = 0.05) or extended above the knee (p = 0.02); leukocytosis (p = 0.005); glycemia level (p = 0.02); antibiotic therapy duration (p = 0.04); antibiotic association of Penicillin G, metronidazole, and gentamicin (p = 0.02); amputation procedure solely (p = 0.04) or debridement procedure without amputation (p = 0.05); intraoperative transfusion (p = 0.006); and hospital stay (p = 0.01). Identifying gas gangrene mortality factors is fundamental to standardize management. Our study was able to build on the small size of our series, but further prospective and large-scale studies are required.
{"title":"Tracking a Fatal Disease: Lower Limb Gas Gangrene's Mortality-Related Factors","authors":"M. Mahjoubi, B. Rezgui, M. Maatouk, Nada Essid, Yasser Karoui, H. Kandara, M. Moussa","doi":"10.1177/15347346231158858","DOIUrl":"https://doi.org/10.1177/15347346231158858","url":null,"abstract":"Because of its rarity compared to dry and wet gangrene of the lower limb, the gaseous form has often been considered as the most severe form of gangrenous disease. We aimed to report clinical, paraclinical, and therapeutic features, and to identify mortality risk factors of gas gangrene of the lower limb. We conducted a one-center case series retrospective study over a period of 13 years from January 2006 to December 2018. A total of 19 patients were included: 12 men, 7 women. Mean age was 59.3 ± 11.3 years. There were 17 diabetic patients and one patient was on radio-chemotherapy for lower rectal cancer. Septic shock was initially present in 4 cases. Hyperleukocytosis was noted in 17 patients. C-reactive protein was elevated in 11 patients. All patients were put on antibiotics then operated on. A total of 8 patients died postoperatively (42%) in an average time of 9.6 days after surgery. On univariate analysis, factors associated with mortality were: Septic shock on admission (p = 0.02); local signs limited to foot (p = 0.05) or extended above the knee (p = 0.02); leukocytosis (p = 0.005); glycemia level (p = 0.02); antibiotic therapy duration (p = 0.04); antibiotic association of Penicillin G, metronidazole, and gentamicin (p = 0.02); amputation procedure solely (p = 0.04) or debridement procedure without amputation (p = 0.05); intraoperative transfusion (p = 0.006); and hospital stay (p = 0.01). Identifying gas gangrene mortality factors is fundamental to standardize management. Our study was able to build on the small size of our series, but further prospective and large-scale studies are required.","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83201539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-16DOI: 10.1177/15347346221109047
Elif Yıldırım Ayaz, Berna Dincer, A. Oguz
This systematic review and meta-analysis aimed to synthesize randomized controlled trials on the impact of foot care education on knowledge, self-efficacy and behavior in patients with diabetes. A search was made using PubMed, Web of Science, Science Direct, Google Scholar, YOK National Thesis Center and Google Scholar electronic databases for studies published between March 2003-January 2022. The search medical subject headings (MeSH) terms were diabetic foot, knowledge, self-efficacy, and behavior. Studies suitable for the systematic review and the meta-analysis met the following criteria (PICOS): target participants would be diagnosed with diabetes (population), diabetic foot education (intervention), comparison of the group receiving diabetic foot care education and routine care education, and the control group receiving only routine care education (comparison), studies evaluating the levels of knowledge, self-efficacy and behavior (outcome), randomized controlled trials (study design). Twenty-six studies were included in systematic review. Three studies for knowledge, 5 studies for behavior, 8 studies for self-efficacy were included in the meta-analysis (total sample: 2534, experiment: 1464, control: 1071). All of the studies had low reporting bias. The mean duration of educations for knowledge was 5.2 months. This duration was 4.8 months for behavior and 4.5 months for self-efficacy. In the random effect (since the homogeneity test: P < .001, this model was used), there were significantly difference in terms of knowledge (standardized mean difference (SMD): 1.656, 95% [CI]: 1.014-2.299, P < .001), and behavior (SMD: 1.045, 95% CI: 0.849-1.242, P < .001). But no difference was observed in terms of self-efficacy (SMD: 0.557, 95%CI: −0.402-1.517, P > .05). The results of a systematic review of twenty-six studies and a meta-analysis of 9 studies showed that diabetic foot education improved the level of knowledge and behavior of patients with diabetes, while not affecting their self-efficacy. Educational interventions with long-term follow-up are needed to address the growing health care needs of patients with diabetes.
本研究旨在对足部护理教育对糖尿病患者知识、自我效能和行为影响的随机对照试验进行系统综述和meta分析。利用PubMed、Web of Science、Science Direct、b谷歌Scholar、YOK国家论文中心和谷歌Scholar电子数据库检索2003年3月至2022年1月间发表的研究。搜索医学主题标题(MeSH)术语为糖尿病足、知识、自我效能和行为。适合系统评价和荟萃分析的研究符合以下标准(PICOS):目标受试者将被诊断为糖尿病(人群),糖尿病足教育(干预),接受糖尿病足护理教育组与常规护理教育组的比较,仅接受常规护理教育的对照组(比较),评估知识水平,自我效能和行为水平的研究(结果),随机对照试验(研究设计)。系统评价纳入26项研究。meta分析共纳入3项知识研究、5项行为研究、8项自我效能研究(总样本2534份,实验1464份,对照1071份)。所有的研究报告偏倚都很低。接受知识教育的平均时间为5.2个月。行为的持续时间是4.8个月自我效能感的持续时间是4.5个月。在随机效应(自同质性检验:P .05)。对26项研究的系统回顾和对9项研究的荟萃分析结果表明,糖尿病足教育提高了糖尿病患者的知识和行为水平,但不影响他们的自我效能感。需要长期随访的教育干预措施来解决糖尿病患者日益增长的保健需求。
{"title":"The Effect of Foot Care Education for Patients with Diabetes on Knowledge, Self-Efficacy and Behavior: Systematic Review and Meta-Analysis","authors":"Elif Yıldırım Ayaz, Berna Dincer, A. Oguz","doi":"10.1177/15347346221109047","DOIUrl":"https://doi.org/10.1177/15347346221109047","url":null,"abstract":"This systematic review and meta-analysis aimed to synthesize randomized controlled trials on the impact of foot care education on knowledge, self-efficacy and behavior in patients with diabetes. A search was made using PubMed, Web of Science, Science Direct, Google Scholar, YOK National Thesis Center and Google Scholar electronic databases for studies published between March 2003-January 2022. The search medical subject headings (MeSH) terms were diabetic foot, knowledge, self-efficacy, and behavior. Studies suitable for the systematic review and the meta-analysis met the following criteria (PICOS): target participants would be diagnosed with diabetes (population), diabetic foot education (intervention), comparison of the group receiving diabetic foot care education and routine care education, and the control group receiving only routine care education (comparison), studies evaluating the levels of knowledge, self-efficacy and behavior (outcome), randomized controlled trials (study design). Twenty-six studies were included in systematic review. Three studies for knowledge, 5 studies for behavior, 8 studies for self-efficacy were included in the meta-analysis (total sample: 2534, experiment: 1464, control: 1071). All of the studies had low reporting bias. The mean duration of educations for knowledge was 5.2 months. This duration was 4.8 months for behavior and 4.5 months for self-efficacy. In the random effect (since the homogeneity test: P < .001, this model was used), there were significantly difference in terms of knowledge (standardized mean difference (SMD): 1.656, 95% [CI]: 1.014-2.299, P < .001), and behavior (SMD: 1.045, 95% CI: 0.849-1.242, P < .001). But no difference was observed in terms of self-efficacy (SMD: 0.557, 95%CI: −0.402-1.517, P > .05). The results of a systematic review of twenty-six studies and a meta-analysis of 9 studies showed that diabetic foot education improved the level of knowledge and behavior of patients with diabetes, while not affecting their self-efficacy. Educational interventions with long-term follow-up are needed to address the growing health care needs of patients with diabetes.","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75131290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}