The international journal of lower extremity wounds最新文献

The study aimed to assess the outcomes of patients with diabetic foot osteomyelitis (DFO) and concomitant soft tissue infection (STI). It is a retrospective observational study including consecutive patients affected by DFO located in the forefoot (toes and/or rays) who referred to a specialized diabetic foot service from 2019 to 2022. Patients were categorized in two groups: those with DFO and STI and those with DFO without STI. All patients were managed by a conservative surgical approach aiming to remove only the infected bone in association with antibiotic therapy. After 1-year of follow-up, the following outcomes were evaluated and compared between groups: healing, healing time, minor amputation, major amputation, and hospitalization. Overall, 166 patients were included. The mean age was 68.5 ± 13.2 years, 94.9% of them were affected by type 2 diabetes with a mean duration of 19.3 ± 7.1 years. One hundred fourteen patients (68.7%) had DFO complicated by STI, while 52 (31.3%) had DFO without STI. The outcomes for DFO with and without STI were: healing (52.3 vs 94.2%, p = 0.005), healing time (7.8 ± 5.8 vs 4.6 ± 2.7 weeks, p = 0.0002), minor amputation (13.1 vs 3.8%, p = 0.04), major amputation (0 vs 0%, ns), and hospitalization (66.7 vs 48.1%, p < 0.002) respectively. In addition, STI resulted an independent predictor of non-healing [OR 3.1, CI 95% (1.7-9.3), p = 0.002]. Patients with DFO complicated by STI showed higher rate of non-healing, delayed healing time, and more case of minor amputation and hospitalization in comparison to those without STI. STI was independently associated to the risk of non-healing, while any association was found for amputation and hospitalization.

PurposeDiabetic foot ulcer (DFU) and diabetic retinopathy (DR) are severe complications of diabetes mellitus reflecting advanced vascular injury. While DR has been extensively studied as a predictor of DFU, data on the burden and determinants of DR among individuals with DFUs remain limited. This study aimed to evaluate the prevalence, severity, and clinical correlates of DR in individuals with DFUs.MethodsThis observational study included 85 individuals with DFUs and 81 individuals with type 2 diabetes mellitus without DFUs. All participants underwent comprehensive ophthalmologic examination for DR classification. Demographic characteristics, comorbidities, and laboratory parameters were recorded. Unadjusted and adjusted odds ratios (UORs and AORs) with 95% confidence intervals were calculated.ResultsDR was significantly more prevalent in individuals with DFUs than in controls (85.9% vs 51.9%; UOR 5.65, 95% CI 2.67-11.96; p < .001). Proliferative DR was approximately threefold more frequent in the DFU group (33.0% vs 11.1%; UOR 3.93, 95% CI 1.72-8.99; p = .002). Higher Wagner ulcer grades were associated with increased DR prevalence (p = .005). In multivariate analysis, longer duration of diabetes and proteinuria remained independently associated with DR, while HbA1c showed a modest independent association. Among DFU patients, DR was also associated with hypertension, proteinuria, and coronary artery disease.ConclusionIndividuals with DFUs carry a markedly increased burden of DR, particularly proliferative disease, indicating advanced systemic microvascular involvement. DFU should be regarded as a clinical red flag for severe retinopathy, warranting prompt and comprehensive ophthalmologic screening alongside integrated renal and cardiovascular assessment.

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.