The international journal of lower extremity wounds最新文献

Diabetic foot ulcer (DFU) is a common complication of diabetes. It is often accompanied by infection and, in severe cases, necessitates amputation. Early diagnosis and monitoring are crucial for improving prognosis. Novel inflammatory biomarkers, such as the systemic inflammatory response index (SIRI), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) are useful for the diagnosis and predicting prognosis of some diseases. This study aimed to clarify the association between SIRI, NLR, PLR and DFU and assess their utility for early diagnosis and monitoring of DFU. Cross-sectional data were extracted on individuals with diabetes who participated in the National Health and Nutrition Examination Survey (NHANES) between 1999 to 2004. DFU was diagnosed based on the presence of foot ulcers that had not healed within 4 weeks. Weighted multivariable regression, subgroup analysis, and smooth curve fitting were used to evaluate the relationships between the SIRI, NLR, and PLR with DFU.A total of 1204 participants were included in the analysis, of whom 112 had DFUs. Participants with DFUs had higher NLR, PLR, and SIRI values than those without DFUs. For each unit increase in SIRI, the prevalence of DFU increased by 27% . Subgroup analyses showed a consistent association between an elevated SIRI and the prevalence of DFUs.SIRI is a low-cost, readily accessible biomarker that can be used in conjunction with NLR and PLR to assess the severity and predict the prognosis of DFU. Continuous monitoring of these indicators could assist with early diagnosis and management of DFU.

ObjectiveTo measure the effect of neuromuscular stimulation of the common peroneal nerve on the microvascular blood flow within the wound bed of diabetic foot ulcers.Research Design and Methods13 patients with diabetic foot ulcers (11 neuropathic, 2 neuroischemic) were recruited. Microvascular flux and pulsatility were measured in real time in the wound bed, and at the wound edge, using Laser Speckle Contrast Imaging (Moor FLPI-2; Moor Instruments Ltd, Axminster, United Kingdom). Changes from baseline were measured when the leg muscle pump was activated by 1 Hz neuromuscular stimulation of the common peroneal nerve, using a wearable device (geko, Firstkind Ltd Daresbury, United Kingdom).ResultsIn the 11 neuropathic ulcers, significant increases were seen in all microvascular parameters. Wound bed flux increased by 36% (95%CI 11%-68%, P = .002), and peri-wound flux increased by 92% (95%CI 46%-160%, P = .001). Pulsatility in the wound bed increased by 183% (95%CI 61%-517%, P = .005), while pulsatility in the peri-wound increases by 359% (95%CI 264%-455%, P = .001). Additionally, an increase in flux and pulsatility was observed in the neuroischemic ulcers.ConclusionsNeuromuscular stimulation of the common peroneal nerve presents a mode of activating the leg muscle pump without additional pressure insult to the foot and has potential to support the microcirculation during wound-healing, effectively emulating exercise without any of the attendant risks of exercise to the neuropathic or neuroischemic foot.

This letter critically appraises the study by Juttada et al, (doi: 10.1177/15347346251332708) which explored ischemia-modified albumin (IMA) as a marker of healing in diabetic foot ulcers (DFUs). We acknowledge the study's novel contribution through its serial IMA monitoring during treatment and compare it with a growing body of evidence. While the study demonstrates promising clinical applicability, there are important limitations regarding its predictive strength, albumin adjustment, and the influence of oxidative therapies. We suggest that future studies adopt a multi-biomarker approach and address variability in oxidative stress conditions such as those encountered during hyperbaric oxygen therapy.

AimTo determine whether the use of continuous glucose monitoring (CGM) aids in improving glycaemic control in Type 2 diabetes patients (T2DM) with foot ulcers and improve wound healing.MethodsRetrospective study on patients attending the high-risk diabetes foot clinic for the management of complex diabetic foot ulcers were provided with Continuous Glucose Monitoring (CGM) devices (Freestyle Libre 2). Patients were reviewed in the foot clinic on a weekly to bi-weekly basis, depending on the severity of their foot ulcers and glycaemic control, which was reviewed at each visit. HbA1c was measured not more than 90 days prior to starting CGM and three months after the start of CGM. Wound size was measured at start and after 3 months of CGM use. Data of the eligible patients was reviewed from the medical records.Results22 patients with T2DM with active diabetic foot ulcers were included in this study. Mean age was 65.43 years (range 39-87). Mean HbA1c prior to providing CGM was 84.10 Mmol/mol (range 54-132). The mean HbA1c after three months of CGM use was 65.05 Mmol/mol (range 32-94). Mean reduction in HbA1c was 19.05 ± 22.07 mmol/mol (p = 0.0011) and the greatest improvements were noted in those who had higher HbA1c levels at baseline. Wound size at baseline was 1.53 (0.75-7.62) cm² and after 3 months it was 0.42 (0.0-1.16) cm² (p < 0.001); complete wound healing achieved in 3 patients.ConclusionThis study showed a significant improvement in glycaemic control with the use of CGM and had a positive influence on wound healing. The utility of CGM in improving glycaemic control is well established and is currently widely used in type 1 diabetes mellitus and pregnancy but not directly recommended for patients with foot ulcers according to NICE guidelines. Further follow-up and larger-scale studies are needed to validate these findings and to observe the impact on wound healing.

Wound care management has undergone significant advancements, driven by the increasing need for effective, sustainable, and cost-effective solutions, especially in low-resource countries. The primary goal of wound care is to expedite healing, minimize infection risk, and ensure cosmetic and functional recovery. This study explores the development of biobased antiseptic and ointment wipes as an eco-friendly, affordable alternative to conventional wound dressings. Spunlace viscose and bamboo fabrics (72 GSM and 114 GSM) were selected for their absorbency and biodegradability. Key bioactive components (tea tree oil, beeswax), and baby shampoo were infused via a padding method. Physical properties, water absorbency (AATCC197), and antibacterial effectiveness (AATCC 100) against S. aureus and E. coli were evaluated using standard textile and microbiological test methods. A subjective evaluation with 15 athletes assessed wound healing effectiveness.Bamboo fabric demonstrated superior wicking height (11.0 cm at 120 s) compared to viscose (10.8 cm). Antibacterial testing revealed a 100% reduction in S. aureus and a 96.2% reduction in E. coli for bamboo samples. Athlete trials indicated an average wound healing time of four days with high satisfaction levels. Cost analysis showed antiseptic wipes cost $0.062 per unit, and ointment wipes cost $0.104 per unit, making them cost-effective alternatives to synthetic and economically viable for mass adoption. Biodegradable antiseptic and ointment wipes infused with natural antimicrobial agents offer a sustainable and effective solution for wound care. Their superior absorbency, antibacterial efficacy, and affordability highlight their potential for widespread adoption in healthcare. Future research should focus on optimizing formulations for broader clinical applications.

Wound healing is a complex biological process that can be significantly impaired by numerous factors, resulting in chronic wounds. Recent advancements in nanotechnology have demonstrated the potential of biofunctionalized nanoparticles to improve wound healing. This review examines the methodology and application of biofunctionalized nanoparticles derived from Butea monosperma root extract, incorporated into electro spun nanofibers, presenting a novel approach for advanced wound dressings. This review examines the extraction process, nanoparticle synthesis, electrospinning techniques, and the assessment of the therapeutic properties of the nanofibers. In vitro and in vivo studies demonstrate the efficacy of this approach in promoting wound healing, highlighting significant antibacterial activity and improved tissue regeneration. Future research and clinical application directions are also examined.

The study aimed to evaluate the mid-term outcomes of patients admitted for a diabetic foot attack (DFA). It is a retrospective observational study including a population of patients admitted for diabetic foot ulcers (DFUs) into a specialized multidisciplinary diabetic foot service. Based on the type of hospital admission (emergency or elective), patients were divided into two groups: those with DFA and those without DFA (chronic diabetic foot, CDF). The DFA was considered in case of ischemia (acute or chronic), infection and Charcot foot requiring urgent hospitalization. Once discharged, patients were regularly followed as outpatients with the following six-month outcomes: healing; major amputation; mortality; hospital readmission; non-fatal major adverse limb and cardiovascular events (MALCE) including nonfatal myocardial infarction (MI), nonfatal stroke, and limb ischemia requiring revascularization. Overall, 141 patients were included. The mean age was 70 ± 12 years, most patients were male (76.6%) and had type 2 diabetes (93.6%) with a mean duration of 22 ± 13 years; 81 (57.4%) patients presented DFA while 60 (42.6%) presented CDF. No cases of admitted Charcot foot were recorded. The DFA group reported 81.5% cases of severe/moderate infections, while the CDF group presented 50% of mild infections. The DFA group reported higher HbA1c values (67 ± 22 vs 56 ± 14 mmol/mol, p = 0.0008) and more cases of first assessment for DFUs (59.3 vs 13.3%, p < 0.0001) when compared to the CDF group. The six-month follow-up outcomes for DFA and CDF were: healing (65.4 vs 60.0%, p = 0.3); major amputation (4.9 vs 1.7%, p = 0.2); mortality (8.6 vs 11.7%, p = 0.5); hospital readmission (27.2 vs 26.7%, p = 0.8); non-fatal MALCE (9.9 vs 23.3%, p = 0.1). Six-month outcomes did not show significant differences between the DFA and CDF groups in terms of healing, major amputation, mortality, readmission, and non-fatal MALCE. Adequate management of DFA seems to ensure favourable mid-term outcomes, even if compared to patients with CDF.

Length-dependent distal symmetrical polyneuropathy (DSPN) represents a highly prevalent complication associated with diabetes. Current standards for clinical diagnosis, severity assessment, and comprehensive staging of DSPN remain ambiguous. Numerous guidelines advocate for a qualitative evaluation of DSPN, primarily to identify loss of protective sensation (LOPS), without clearly enunciating its temporal importance. This approach has resulted in a lack of recognition of the earlier stages of DSPN within diabetes clinics. Our objective has been to establish a straightforward staging system for DSPN, taking into consideration the temporal trends in the pathogenesis of the condition. We categorise DSPN into five stages: Stage 1 represents absence of evident neuronal disease; Stage 2 involves small fibre changes with or without associated symptoms; Stage 3 comprises large fibre changes, with or without associated symptoms; Stage 4 denotes advanced DSPN characterised by LOPS; and Stage 5 includes LOPS with either a current or past history of neuropathic foot ulceration. We believe that this system may enable appropriate risk screening and significantly stratify DSPN, ideally enhancing the organisation of diabetic foot care through suitable counselling and referral.

AimsBurn injuries cause significant mortality, morbidity, and financial and psychological burdens for patients and families. Platelet-rich plasma (PRP) has shown some benefits in burn wound healing, but its efficacy is unproven. This meta-analysis aimed to evaluate PRP's effects on burn wounds.MethodA comprehensive search of Scopus, PubMed, Web of Science, and Cochrane Library was conducted until January 22, 2025, for randomized controlled trials (RCTs) on PRP's effect on burn wounds. The mean difference (MD), standardized MD (SMD), or odds ratio (OR) of the studies was calculated.ResultsNine RCTs with 413 participants were included. PRP significantly reduced wound healing time (MD: -6.68 days, 95% CI (-10.96, -2.39)), wound infection incidence (OR: 0.18, 95% CI (0.04, 0.88)), and dressing change frequency (MD: -14.50 times, 95% CI (-16.45, -12.55)). There was a significant increase in the healed area percentage in the intervention group (MD: 6.82%, 95% CI (2.58, 11.06)). However, there was no significant difference between the intervention and control groups in pain score or graft take percentage.ConclusionsThis review shows that PRP enhances wound healing and reduces adverse events like wound infection in burn patients. Future studies should further explore PRP's effects to support its broader clinical use.