The international journal of lower extremity wounds最新文献

AimsTo evaluate impact of Social Determinants of Health (SDOH) on clinical evolution of Charcot neuro-osteoarthropathy (CNO) in people with diabetes.MethodsWe retrospectively collected SDOH for patients with acute CNO from 2022 to 2023: distance from hospital, education, employment status, family (number of cohabitants) and residential environment (urban, suburban and rural). We focused on SDOH impact on clinical outcomes: clinical and radiological stabilization time.We assessed association between these and SDOH using multiple linear regression and Kaplan-Meier analysis.ResultsWe analyzed 62 patients with an acute episode of CNO. 64.5% were women, 27.4% had type 1 diabetes mellitus, at CNO-diagnosis mean age was 65.8 years and diabetes duration 18.7 years.Average distance from the clinic was 80.4 km; 25% of patients lived in urban and 46.2% in rural areas. 46.2% were still working at diagnosis; 15.4% lived alone, 38.4% with one and 46.2% with more cohabitants.Stabilization times were significantly associated with urban residence while number of cohabitants predicted radiological stabilization only.Kaplan-Meier analysis showed that stabilization times were shorter for patients living in urban areas and with more cohabitant.ConclusionsSDOH impact clinical outcome in people with diabetes with CNO. Healthcare professionals should consider these factors to customize treatment.

Diabetic foot ulcers (DFUs) are a serious and common complication of diabetes mellitus (DM), contributing substantially to patient morbidity, reduced quality of life, and healthcare costs. Accumulating evidence suggests that both low and high blood glucose may delay wound healing and increase mortality. Continuous glucose monitoring (CGM) in people with DM is known to improve glycaemic control compared with self-monitoring of blood glucose. This narrative review summarises current evidence on the role of CGM and CGM-derived metrics, such as time in range (TIR), in DFU management. Emerging evidence suggests that optimising glycaemic control with CGM sensors in patients with DFUs may be essential to promote wound healing and, ultimately, reduce the risk of amputations. Accordingly, CGM emerges as a promising tool to improve DFUs outcomes. Well-designed clinical trials are now needed to confirm these findings and to provide guidelines for everyday clinicians.

Automated leprosy chronic wound analysis from smartphone-acquired images remains hindered by uneven illumination, indistinct lesion margins, and poor spatial-textural integration. The CO-WinF framework introduces three specialized modules: AINCE, which performs tile-adaptive contrast remapping guided by local intensity distributions and edge-preserving smoothing to restore fine lesion textures; MEPS, which executes simultaneous multi-resolution encoding within a U-Net backbone enhanced by gradient-driven attention to emphasize boundary transitions and ensure accurate segmentation of irregular wound contours; and HSTFC, which leverages attention-weighted fusion of deep spatial embeddings and handcrafted LBP and HOG texture histograms, followed by classification via a gradient-boosted ensemble optimized for class imbalance. Validation on the CO2Wounds-V2 dataset yields 94.98% precision, 95.78% recall, 93.10% F1-score, and 87.09% IoU, surpassing existing state-of-the-art approaches. By integrating localized enhancement, edge-aware segmentation, and hybrid feature fusion in a computationally efficient pipeline, CO-WinF delivers robust, interpretable diagnostic support in resource-constrained clinical environments. Key novelties include the tile-adaptive remapping within AINCE, the gradient-driven attention integrated at scales in MEPS, and the attention-weighted fusion of spatial and textural features in HSTFC. By addressing pre-processing and feature-level integration challenges, CO-WinF establishes a benchmark for smartphone wound analysis.

Diabetic foot ulcers (DFUs) are a serious complication of diabetes, associated with high risks of infection, amputation, and reduced quality of life. Silver nanoparticle dressings, known for their broad-spectrum antimicrobial and anti-inflammatory properties, offer a promising advanced treatment option. This prospective, randomized, single-blind controlled trial evaluated the efficacy of tetra silver tetroxide dressings compared to conventional dressings in managing DFUs, with limb salvage as the primary endpoint and wound healing parameters as secondary endpoints. Fifty-nine patients were randomly assigned to Group A (tetra silver tetroxide spray and gel, n = 30) or Group B (conventional dressings, n = 29). While no statistically significant difference in limb salvage rates was observed (Group A: 100% vs 86.21%; P = .052), the silver nanoparticle dressing demonstrated superior outcomes in all secondary endpoints: a higher rate of complete healing (100% vs 82.76%, P = .024), reduced mean healing time (9.77 vs 18.79 weeks, P < .001), lower incidence of post-treatment infection (0% vs 20.69%, P = .011), and fewer median dressing days (62.5 vs 122.5 days, P < .001). These findings indicate that tetra silver tetroxide nanoparticle dressings significantly accelerate wound healing, reduce infection, and lessen treatment burden, supporting their use as an effective DFU treatment option.

The aim of this study was to evaluate the efficacy and safety of a mixed probiotics formulation (MPF) combined with standard care for treating diabetic foot (DF), specifically targeting infection control, ulcer healing, and wound recovery. Seventy DF patients were randomly assigned to receive standard therapy alone or in combination with MPF. Following the treatment, ankle-brachial index (ABI), wound characteristics, inflammatory markers, ultrasound measurements, vascular endothelial markers, blood glucose levels, and recurrence rates were evaluated at 8-week and 12-week timepoints. Significant improvements were observed in the MPF-treated group after 12 weeks compared to the control group, including reductions in body mass index (BMI) and waist circumference (p < 0.05), as well as improvements in wound healing outcomes, ABI scores (p < 0.05), ultrasound parameters, and vascular endothelial markers (p < 0.05). While blood glucose levels decreased similarly in both groups (p > 0.05), the MPF group exhibited a lower recurrence rate (11.43%) compared to the control group (25.71%). Importantly, MPF was well-tolerated with no adverse events reported. In conclusion, MPF, when used alongside standard care, significantly improves BMI, waist circumference, ABI scores, wound healing, and vascular parameters in DF patients. These findings indicated the potential of MPF for clinical application in the management and prevention of diabetic foot complications.

BackgroundDiabetic foot ulcers (DFUs) are a serious complication of diabetes, often leading to amputations and high healthcare costs. Dipeptidyl peptidase-4 (DPP-4) inhibitors may help wound healing by enhancing angiogenesis. This study aimed to evaluate the efficacy of DPP-4 inhibitors in DFUs healing.MethodsThis systematic review and meta-analysis followed PRISMA 2020 guidelines. Randomized controlled trials (RCTs) comparing DPP-4 inhibitors with standard care or placebo were searched in PubMed, Scopus, Web of Science, and Cochrane Library up to October 1, 2025. Relative risk (RR) and mean difference (MD) were pooled using a random-effect model.ResultsFour RCTs with 285 patients were included. DPP-4 inhibitors significantly increased complete ulcer healing (RR = 1.63, 95% CI 1.30-2.06, P < .0001) and shortened healing time (MD = -10.72 days, 95% CI -14.61 to -6.84, P < .00001). Ulcer size was also reduced (MD = -2.36 cm², 95% CI -2.95 to -1.77, P < .00001). Side effects were rare and similar between groups.ConclusionTreatment with DPP-4 inhibitors improves DFU healing outcomes compared to the control group. This finding is limited to the number of included studies and the small sample size. Future randomized clinical trials are warranted to provide more robust results.

The study aimed to evaluate the incidence and impact of small artery disease (SAD) in persons with ischaemic diabetic foot ulcers (DFUs). The current study is a retrospective research including patients with ischaemic DFUs treated by lower limb revascularization and managed in a specialized diabetic foot service between January 2021 and September 2023. Based on final angiograms, subjects were divided in 2 groups, those with SAD and those without. SAD was defined by the absence or poverty of the plantar arch and the arteries originating from it including tarsal, metatarsal, and digital arteries, and the calcaneal branches of the plantar arteries. At 1 year of follow-up, the following outcomes were evaluated and compared between groups: healing, minor and major amputation, survival. Overall, 128 patients were included, 80 (62.5%) with SAD and 48 (37.5%) without. Patients presenting SAD were older (72.4 vs 66.1 yrs, p = .03), had higher rate of dialysis (30 vs 20.8%, p = .02), and ischaemic heart disease (80 vs 40%, p = .0002) when compared to patients without SAD. They reported also more cases of gangrene (80 vs 56.2%, p = .001) and lower TcPO2 values both at the assessment (16 vs 27 mmHg, p = .03) and after the revascularization procedure (34 vs 48 mmHg, P = .02). Subjects with SAD in comparison to those without reported lower rate of healing (57.1 vs 90.0%, p < .0001), higher rate of minor amputation (80 vs 45.4, p < .0001), major amputation (10 vs 4.1%, p = .02), and mortality (15 vs 0%, p = .03). In addition, SAD resulted an independent predictor of non-healing (in association with dialysis), and major amputation (in association with the revascularization failure). SAD is a frequent pattern of peripheral arterial disease in subjects with DFUs and independently impacts on healing and amputation.

ObjectiveTo examine the association between skeletal muscle mass index (SMI) and lower extremity ulcer (LEU) risk, and to develop and externally validate a prediction model incorporating SMI.MethodsWe analyzed NHANES 1999-2004 data and validated findings in a hospital-based cohort. LEUs included diabetic foot, venous, arterial, and pressure ulcers. SMI was calculated from DXA-derived appendicular lean mass. Logistic regression assessed SMI-LEU associations; restricted cubic splines tested non-linearity. LASSO identified predictors for a nomogram, evaluated using AUC, calibration, and decision curve analysis (DCA).ResultsAmong 7194 participants, lower SMI quartiles were associated with higher LEU odds (Q1: OR = 1.74, 95% CI 1.06-2.86; Q2: OR = 1.76, 95% CI 1.03-3.03 vs Q4). No non-linear association was observed. The final model (SMI group, marital status, smoking, diabetes, CKD, RBC) showed acceptable discrimination (AUC: 0.618 training; 0.682 validation) and acceptable calibration, although its clinical applicability remains limited.ConclusionLower SMI showed an independent association with increased LEU risk, and the exploratory model incorporating SMI and clinical factors provides preliminary evidence for its potential use in future risk assessment research.