The international journal of lower extremity wounds最新文献

AimsDiabetes-related foot disease (DFD) is a prevalent and costly complication of diabetes in Latin America (LATAM). Our bibliometric study aims to identify emerging research output from LATAM countries, knowledge gaps, and future opportunities in research.MethodsA bibliometric analysis between 2000 and 2025 was done using PubMed and Scopus databases. English-language articles with corresponding authors affiliated with LATAM institutions were included. A total of 1423 records were screened, with 435 meeting inclusion criteria. Data on authorship, country, study type, citations, journal impact, and collaboration type were extracted and analyzed.ResultsOverall, Brazil contributed to 51.5% publications, followed by Mexico (18.6%) and Cuba (7.8%). Citation analysis revealed a total of 9397 citations, with a median of seven citations per publication. Venezuela and Barbados had the highest median citations per article, despite low output. Collaboration analyses showed that only 1.6% involved intra-LATAM collaborations. International collaborations outside the region were associated with higher median citations. Observational studies (n = 198) were most prevalent, with experimental, trial, and review studies showing significant growth over time.ConclusionDespite the recent growth of DFD research in Latin America, structural barriers such as research equity, international visibility, and regional collaboration persist. Addressing these by strengthening intra-regional collaboration, improving funding equity, and investing in research infrastructure may enhance scientific visibility and improve healthcare outcomes for DFD in the region.

BackgroundA variety of dressings are used for burn patients in the clinic, and the difference in efficacy between different dressings is controversial Therefore, we used Bayesian net meta-analysis to evaluate the clinical efficacy of 14 dressings in patients with second-degree burns.MethodsPubMed, Cochrane Library, Web of Science, Embase, and China Knowledge Network databases were searched to collect randomised controlled trials on different dressings used in the treatment of second-degree burns that met the inclusion criteria from 2010-01 to 2024-12 in each database. Literature was screened by 2 investigators, who independently collected and organised the data for extraction, assessed the quality of the included studies using the Cochrane Risk of Bias tool and Review Manager 5.4, and scored the evidence using GRADEPro. Network meta-analysis (NMA) was performed using R Studio, and SUCRA was used to rank the included dressings for each outcome indicator.ResultsA total of 28 studies containing 2072 patients with second-degree burns and 14 different interventions were included, and the results of the network meta-analysis showed that:1) the top 3 results of the ranked probability of wound healing rate within 2 weeks were: human amniotic membrane (85.3%)>Recombinant human granulocyte macrophage colony stimulating factor(81.7%)>Recombinant Human Erythropoietin(78.1%); ②The top three results in terms of wound healing time were: Recombinant Human Erythropoietin(1.6%)ConclusionBased on the SUCRA values and NMA results, we found that Human amniotic membrane can significantly increase the wound healing rate of patients with second-degree burns, Recombinant Human Erythropoietin can significantly shorten the wound healing time, and Heparin has a better effect on reducing the pain of burn patients.However, limited by the quality of the included literature, further high-quality clinical studies are needed to confirm this.

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.

This study aimed to evaluate the effectiveness of prevention strategies and detect the risk level of recurrence. A randomized controlled trial (RCT) was conducted. Sixty participants were split into two groups: an intervention group consisting of 30 individuals and a control group also with 30 participants. For the intervention group, education and guidance on foot examination, foot care, dietary habits, exercise, and stress management were provided for 1 to 1.5 h each month. However, the control group only received standard care and education through a pamphlet at baseline. The both groups, the baseline risk level of ulcer recurrence score was assessed using INDIFURUTO (Indonesian Diabetic Foot Ulcer Recurrence Assessment Tool). The follow-up period was three months. A General Linear Model (GLM) repeated measures (ANCOVA) analysis was employed to compare the quality of life and risk level between the two groups at baseline and third follow-up. Risk factors for recurrence score in the intervention group significantly decreased after 3 months. These included improvements in mobility (P = .04), anxiety/depression (P < .001), EuroQol Visual Analogue Scale score (P = .004), and INDIFURUTO score (P = .004). The combination of preventive strategies could reduce the risk of recurrence ulcer and improve the quality of life.Trial registration numberClinicalTrials.gov Identifies: NCT06434922.

Randomized controlled trials represent the cornerstone for the regulatory approval of drugs and evidence-based medicine and policy. Compared with observational studies random assignment of participants to each study arm guarantees an equal distribution of potential confounders thus achieving impartiality in the evaluation of between group differences and allowing for causal inferences to be drawn. These complex and costly medical experiments are tightly regulated and require substantial planning with great attention to several methodological aspects ranging from allocation concealment and blinding to sample size estimation, statistical analysis, and handling of protocol deviations. This brief guide offers useful insights into the design, conduct, and interpretation of clinical trial findings for beginners.

The present descriptive study investigates the general and foot-care self-efficacy and the level of foot-care knowledge of 151 participants who presented to the internal medicine ward and diabetes nursing unit of a training and research hospital in Türkiye. The mean Diabetes Management Self-Efficacy Scale score of the participants was 69.0 ± 15.0 (min: 20, max: 100), the mean Diabetic Foot Care Self-Efficacy Scale score was 56.2 ± 23.1 (min: 9, max: 90) and the mean Diabetes Foot Self-Care Behavior Scale score was 51.5 ± 13.6 (min: 15, max: 75). The total Diabetes Management Self-Efficacy Scale, Diabetic Foot Care Self-Efficacy Scale and Diabetes Foot Self-Care Behavior Scale scores were noted to be higher in the participants who underwent regular health check-ups and used their medication regularly than in those who did not (p < 0.05). People with diabetes should be provided with counseling on the benefits of developing positive behaviors related to self-efficacy and foot self-care, and the prevention of wound development through education, support and the effective self-management of their condition.

Diabetic foot (DF) is a significant complication with high morbidity and mortality, often resulting from neuropathy and ischemia. In our study, we aimed to evaluate the relationship between serum Gremlin-1 levels and disease severity based on the Wagner classification in DF patients, and to determine its prognostic value in predicting the need for amputation.Eighty-five patients with DF ulcers or considered at high risk for DF were included in the study. The patients' complications were evaluated, and laboratory results were obtained from their records. The Wagner classification was applied, and serum Gremlin-1 levels were analyzed using the ELISA method.It was found that as the Wagner stage of the DF increased, Gremlin-1 levels decreased significantly at the statistical borderline (p = 0.05). In the group of patients who underwent amputation, Gremlin-1 levels decreased significantly (p < 0.05). The sensitivity of Gremlin-1 in predicting amputation, with a cut-off value of 2.47 ng/ml, was 67%, and its specificity was 46%. Additionally, a positive correlation was found between total cholesterol, LDL, fasting glucose, and Gremlin-1 (p < 0.05). In the group of patients with an HbA1c value >7.5%, Gremlin-1 levels increased significantly (p < 0.05). In patients with albuminuria, serum Gremlin-1 levels decreased significantly (p < 0.05).It was determined that Gremlin-1 plays a role through an unknown mechanism in DF patients, and its levels decrease as the Wagner stage increases. Gremlin-1 levels were significantly decreased in the amputation group (p < 0.05). It was shown that Gremlin-1 could be a prognostic marker for predicting amputation.

The current study aimed to evaluate the clinical outcomes of patients admitted for diabetic foot ulcers (DFUs) located in the heel. The study is a retrospective observational study including a population of patients admitted for DFUs from April 2024 to September 2024. According to the wound location, patients were divided in two groups: those with heel ulcers and those with forefoot/midfoot ulcers without calcaneal involvement. All patients have been managed through a limb salvage protocol in the respect of international guidelines. The following hospital outcomes were evaluated: minor and major amputation, mortality, length of stay, need for regenerative surgery by using dermal-epidermal graft. Overall, 150 patients were included. The mean age was 70.2 ± 12.2 years, most patients were male (76.0%), had type 2 diabetes (92.7%) with a mean duration of 22.1±13.2 years; 27 (18%) patients had heel ulcers, while 123 (82%) had forefoot/midfoot lesions. Outcomes for patients with heel location and without were: minor amputation (18.5 vs 32.5%, p = 0.1), major amputation (7.4 vs 0.8%, p = 0.02), mortality (0 vs 0.8%, p = 0.5), length of hospital stay (17.5 ± 8.5 vs 14.4 ± 8.7 days, p = 0.08), need for regenerative therapy using dermal-epidermal substitutes (48.1 vs 19.5%, p = 0.003) respectively. In addition, heel ulcer was found to be an independent predictor for major amputation [OR 5.06, CI95% (3.1-11.4), p = 0.02] and length of stay [OR 6 CI95% (3.6-10.9), p = 0.003]. In patients admitted for DFUs, wounds located in the heel were associated to an increased risk of major amputation, need for regenerative therapy and length of stay (even though in the limit of statistical difference) than wounds not located in the heel. These data underline the need for tailored management strategies in this high-risk subgroup of patients.

Lower extremity arteriovenous (AV) access serves as a crucial alternative for hemodialysis when upper extremity options are no longer viable. While there are numerous reports on functional patency, limited information exists regarding complications related to venous insufficiency and postoperative quality of life. This study aims to assess the actual incidence of such complications and provide evidence-based insights for clinical decision-making. We retrospectively analyzed 121 end-stage renal disease patients who underwent lower extremity AV access at Maharaj Nakorn Chiang Mai Hospital from 2006 to 2023. Among them, 105 patients (86.8%) had lower extremity AV grafts, while 16 patients (13.2%) had lower extremity AVF. Primary and secondary patency rate were 69.4% and 81.8% at one year, respectively. The mortality probability was 50.4% with a mean follow-up of 58 months. Mortality predictors included age (P = .001), aspirin use (P = .022) and statin use (P = .005). Primary failure occurred in 8 patients (6.6%) and vascular graft infection is the primary cause. There were no occurrences of venous leg ulcers developed, suggesting that the risk of this complication may be lower than previously thought in the short to medium term. However, 13.3% of patients experienced leg swelling and 21.7% had hyperpigmentation. The mean revised venous clinical severity score was 1.22 and the average EQ-5D-5L quality of life score was 0.99. Our findings suggest that the risk of venous leg ulcers in patients with lower extremity AV access may be lower than previously thought, at least in the short to medium term. This should encourage surgeons to consider this technique when upper extremity options are exhausted, while maintaining vigilance for early signs of venous insufficiency. Continued research into the detrimental effects of the hyper-dynamic blood flow rate on AV access and preventive strategies will enhance the benefit of lower extremity AV access in the future.