The international journal of lower extremity wounds最新文献

Management of residual deformity in patients with Charcot Neuro-osteoarthropathy represents a therapeutic challenge. The midfoot is the most frequently affected area, leading to the typical rocker-bottom deformity. Surgical exostectomy in these areas of bony prominences offers a non-reconstructive method to remove pressure and allow ulcers to heal or prevent their development when conservative measures fail. This review includes a total of 11 studies, aimed to assess the outcome of exostectomies in the prevention and recurrence of ulcers under the bony prominence in patients with Charcot midfoot and its main complications. Exostectomy was successful in 60% of cases after the first surgery and in 90.7% of cases in total. The procedure, when done below the lateral column, seems to have a higher number of diverse complications. This fact must be taken into account when performing this procedure.

Diabetic foot ulcers (DFUs) represent a severe complication of diabetes mellitus, leading to significant morbidity, amputation risk, and healthcare burden. This systematic review and meta-analysis aimed to evaluate the association between circulating ischemia-modified albumin (IMA) levels and DFU. A comprehensive search of PubMed, Scopus, Cochrane Central and Google Scholar databases was conducted to identify eligible observational studies reporting IMA concentrations in DFU patients, diabetics without foot ulcers, and healthy controls. Meta-analyses were performed using both frequentist random-effects models and Bayesian approaches. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were used to express continuous outcomes. PET-PEESE regression analyses assessed publication bias and small-study effects. A total of six studies were included, with five eligible for meta-analysis. Compared to healthy controls, DFU patients exhibited significantly higher IMA levels [pooled SMD = 3.21 (95% CI: 1.40, 5.03)]. Similarly, DFU patients had higher IMA levels than diabetics without foot ulcers [pooled SMD = 1.21 (95% CI: 0.23, 2.20)]. Both frequentist and Bayesian analyses consistently supported these findings despite notable heterogeneity. Adjusted analyses of IMA for serum albumin further confirmed its discriminative value in DFU. PET-PEESE analyses did not detect significant publication bias. This meta-analysis highlights the potential of IMA as a biomarker for diagnosis, risk stratification, and monitoring in DFU management. Despite significant associations, high inter-study heterogeneity and the limited number of studies restrict generalizability. Future research should focus on standardizing measurement protocols, validating clinical cut-offs, and conducting large-scale prospective studies to confirm its utility.

Charcot neuro-osteoarthropathy (CNO) is a complication of diabetes occurring in people with diabetic neuropathy with a prevalence of 0.5% to 1% that may culminate to foot deformity, amputation, and early mortality. However, it is not known why only certain patients with diabetic neuropathy develop CNO. Hence, early recognition of risk factors, timely diagnosis, and appropriate intervention of CNO is pertinent. Recent understanding of the pathophysiology of CNO has expanded to suggest the involvement of RANKL-OPG pathways. But pharmaco-therapeutic interventions targeting bone metabolism predominantly inhibiting RANKL were not found to be useful. Moreover, there are not enough markers to help identify patients with diabetes who are at a higher risk of developing CNO. Hence, we explored the literature in the present systematic review of mainly case-control studies to identify genetic factors that could help in understanding the pathophysiology and risk factors for the development of CNO. We could identify 7 relevant studies identifying single nucleotide polymorphism of OPG and RANK genes. There is an isolated study identifying alterations of micro RNA associated with RANKL-OPG pathway. Another study found epigenetic alterations by performing whole methylome sequencing in people with CNO compared to control. These genetic factors can be used as a diagnostic marker and their functional counterparts as targets for future therapeutic interventions. However, we found that literature is sparse on the genetic risk factors for CNO in people with diabetic neuropathy and there is still a lot of scope for future studies towards finding the molecular and genetic markers for CNO.

Charcot neuro-osteoarthropathy (CN) is a severe and often underrecognized complication of diabetes mellitus, primarily affecting individuals with diabetic neuropathy. Its clinical course is marked by progressive joint destruction and foot deformities. This review aims to summarize current evidence regarding the role of CN in the development and recurrence of diabetic foot ulcers (DFUs), the risk of amputation, and long-term survival outcomes, as well as to highlight key mechanisms contributing to these complications. Individuals with CN exhibit a significantly higher risk of DFUs, particularly in the midfoot region, due to structural deformities and increased plantar pressure. The risk of amputation is markedly elevated in individuals with CN, especially when DFUs are present. Mortality rates in CN are substantial, with five-year survival comparable to or worse than several malignancies. The development of foot ulcers and amputations in CN results from a complex interaction of neuropathy, structural deformity and chronic inflammation. Therefore, CN is a high-risk condition associated with serious foot complications and elevated mortality. Early recognition, multidisciplinary management, and further research into its independent prognostic impact are essential to improve long-term outcomes.

Charcot neuropathic arthropathy (CN) impacts peripheral lower extremity nerves, leading to joint destruction, and has a significant economic burden on the healthcare system. This economic burden is further exacerbated by the projected increase in diabetes mellitus cases over the coming decades, with a corresponding anticipated rise in CN. This study assesses CN management costs through a single institution retrospective chart review and cost-effectiveness through economic modeling by utilizing a well-established equation to determine the cost-effectiveness of conservative management. This retrospective chart review from a single academic center analyzed costs and outcomes for CN patients undergoing exostectomy, arthrodesis, major amputation, minor amputation, or casting from 2000-2022. This retrospective review analyzed 216 CN patients (average age 58, 54% male). Costs were $57 949 for exostectomy, $149 009 for arthrodesis, $40 313 for major amputation, $55 035 for minor amputation, $125 851 for failed casting, and $8233 for casting. We conducted a break-even analysis that determined that intervention with casting was cost-effective compared to failed casting. Total contact casting is a cost-effective first-line treatment for CN, capable of managing non-advanced cases effectively and reducing the economic burden of surgical intervention. This study provides a critical framework for practitioners to assess cost-effectiveness in various institutional contexts.

Background and aimsCharcot neuroosteoarthropathy (CN) is considered a rare complication of diabetic neuropathy. Due to its insidious mode of presentation, CN may be difficult to diagnose timely and a high index of suspicion is required from both, the diabetic patient (especially those with neuropathy) and their physicians for the early diagnosis and treatment to prevent major complications.MethodsWe planned a narrative review and searched MEDLINE database to identify evidence regarding CN incidence, treatment options, and recent guidelines. As practitioners do not commonly treat CN, a characteristic clinical case is also presented.ResultsThe available evidence for diagnosis and treatment remains of low quality. On the one hand, there is an urgent need for action to increase awareness of the disease in both practitioners and people with diabetes. On the other hand, prospective nationwide registries of patients with diabetic neuropathy will help clarify the prognostic factors that may predispose to this complication, and more randomized clinical trials are needed to identify whether medical treatment may improve CN outcomes. For the time being, offloading of the foot to stop the perpetuation of trauma, and inflammation, and importantly to arrest the progression to a deformed nonfunctional foot is the cornerstone of medical therapy of CN. Multidisciplinary assessment between diabetologists and radiologists is fundamental for prompt diagnosis.ConclusionsTo avoid potentially deleterious delays in diagnosis and treatment, every physician should bear in mind that every patient with diabetic neuropathy presenting with a warm swollen foot should be treated as having CN until proven otherwise.

AimsThe goal was to gather and assess information about the features of patients suffering from Diabetic Foot Syndrome with active ulcers. This data was compared to findings gathered by a designated researcher for evaluation.Materials and MethodsThis cross-sectional observational study was designed using data from a validated survey.ResultsWe conducted 102 surveys, revealing positive data on the respondents' knowledge, awareness, attitudes, and practices. However, discrepancies appeared between the participants' self-assessments, the researcher's evaluations and the actual implementation of recommendations, such as wearing inappropriate footwear, not moisturizing the feet or avoiding walking more than an hour while there is an active ulcer.ConclusionDespite participants showing positive knowledge, awareness, attitudes, and practices, it is crucial to enhance educational measures in regular clinical practice. This would further reinforce patients' preventative actions against DFU in everyday life.Practice ImplicationsThis study highlights the need to enhance patient education and preventative measures in clinical practice, ensuring patients consistently apply knowledge to prevent diabetic foot ulcers daily.

Aims/hypothesisDiabetic foot ulcers are a common and serious complication of diabetes, frequently resulting in infection, amputation, and increased mortality. Cold atmospheric plasma (CAP) is a new treatment modality that combines antimicrobial activity with promotion of tissue regeneration. We aimed to systematically review and meta-analyse randomized controlled trials to determine whether cold atmospheric plasma therapy, when added to standard wound care, improves healing outcomes and safety in patients with diabetic foot ulcers (DFUs).MethodsFollowing PRISMA 2020 guidelines, we included randomized controlled trials in adults with DFUs comparing adjunctive CAP plus standard care versus standard care. Non-RCTs, non-CAP energy modalities, CAP without concomitant standard care, and studies without a concurrent control were excluded. The primary outcome was final fractional wound area (final/baseline; unitless proportion, 0-1). Secondary outcomes were ≥50% wound-size reduction by week 3, bacterial load, and adverse events.ResultsThree RCTs (107 participants; 126 ulcers) showed that CAP reduced final fractional wound area (mean difference -0.29 proportion units, 95% CI -0.47 to -0.11; p = 0.002; I² = 22%). The proportion achieving ≥50% wound-size reduction by week 3 was higher with CAP (RR 2.39, 95% CI 1.46-3.91; p < 0.001; I² = 0%). Bacterial load declined over time in both groups with no sustained between-group difference; immediate post-application reductions were observed with CAP within sessions. No serious treatment-related adverse events were reported.Conclusions/interpretationAdjunctive cold atmospheric plasma improved early healing of diabetic foot ulcers and showed a favourable short-term safety profile, with no sustained advantage in infection control over standard care. Larger, longer randomized trials are warranted to assess complete closure and recurrence outcomes and to define optimal treatment parameters.RegistrationPROSPERO registration ID CRD4201113940.