• 대한족부족관절학회지
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• 제20권3호
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• pp.121-125
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• 2016

Purpose: This study investigates the amputation rate within 1 year after the diagnosis of diabetic foot ulcer and its associated risk factors. Materials and Methods: This study enrolled 60 patients with diabetic foot ulcer. The mean and standard deviation age was $64.4{\pm}12.8years$ (range, 32~89 years); the mean and standard deviation prevalence period for diabetes mellitus was $21.0{\pm}7.5years$ (range, 0.5~36 years). The amputation rate was evaluated by dividing the subjects into two groups - the major and minor amputation groups - within 1 year following the initial diagnosis of diabetic foot ulcer. Multivariate Cox proportional hazards regression analysis was used to identify the risk factors for amputation. Results: The total amputation rate of 38.3% (n=23) was comprised of the amputation rate for the major amputation group (10.0%) and rate for the minor amputation group (23.8%). There was a high correlation between peripheral artery disease (toe brachial pressure index <0.7) and amputation (hazard ratio [HR] 5.81, confidence interval [CI] 2.09~16.1, p<0.01). Nephropathy was significantly correlated with the amputation rate (HR 3.53, CI 1.29~9.64, p=0.01). Conclusion: Clinicians who treat patients with diabetic foot complications must understand the fact that the amputation rate within 1 year is significant, and that the amputation rate of patients with peripheral artery disease or nephropathy is especially high.

• 대한족부족관절학회지
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• 제26권2호
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• pp.78-83
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• 2022

Purpose: The purpose of this study was to evaluate the surgical outcome of split-thickness skin graft (STSG) for chronic diabetic wounds of the foot and ankle. Materials and Methods: The medical records of 20 patients who underwent surgery for chronic diabetic wounds of the foot and ankle between October 2013 and May 2018 were reviewed. Surgical management consisted of consecutive debridement, followed by negative-pressure wound therapy and STSG. We used an acellular dermal matrix between the wound and the overlying STSG in some patients with wide or uneven wounds. Patient satisfaction, comorbidities, wound size and location, length of hospital stay, wound healing time, and complications were investigated. Results: Of 20 patients, 17 (85.0%) were satisfied with the surgical outcome. Eight patients had diabetic wounds associated with peripheral vascular disease (PVD), 7 patients had diabetic wounds without PVD, and 5 patients had acute infection superimposed with necrotizing abscesses. The mean size of the wound was 49.6 cm². The mean length of hospital stay was 33.3 days. The mean time to wound healing was 7.9 weeks. The mean follow-up period was 25.9 months. Complications included delayed wound healing (4 cases) and recurrence of the diabetic wounds (2 cases), which were resolved by meticulous wound dressing. Conclusion: STSG remains a good treatment strategy for chronic diabetic wounds of the foot and ankle.

• 대한족부족관절학회지
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• 제6권2호
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• pp.139-143
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• 2002

Purpose: We analyzed the Metatarso-Phalangeal Oblique Angle(MPOA) of Diabetic foot. Materials and methods: We studied retrospectively 60 cases of diabetic foot in 52 patients, for the evaluation of the correlations between clinical outcomes and radiologic findings in the conservative management group (Group A; 36 cases) and the major operation group (Group B; 24 cases). We measured MPOA on AP view. The MPOA was defined as the intersection angle of the Metatarso-Phalangeal Break Line (a line passing from the second to fifth metatarsal heads) and the long axis of foot in sagittal plane. We performed the statistical analysis between MPOA and clinical outcomes. by independent t-test. Results: The mean of MPOA in group B, $70.79^{\circ}$ (range: $62.8^{\circ}-81.3^{\circ}$), was significantly higher than that in group A, $68.04^{\circ}$ (range: $62.0^{\circ}-76.4^{\circ}$). The mean of MPOA in patients of fore foot lesions(30 cases), $71.30^{\circ}$ (range: $62.0^{\circ}-71.5^{\circ}$), was significantly higher than that in patients of hind foot lesions(30 cases), $66.97^{\circ}$(range: $62.8^{\circ}-81.3^{\circ}$). Conclusions: We recognized the MPOA might be useful simple parameter in assessing the diabetic foot.

• 대한전기학회:학술대회논문집
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• 대한전기학회 2005년도 심포지엄 논문집 정보 및 제어부문
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• pp.39-41
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• 2005

The population of diabetes is continuously increasing because of the economic development and the lifestyle modification. If diabetes become chronic condition, it can cause various complications. Among many other complications, diabetic foot is the most fatal issue since it may require amputation of the legs. Diabetic foot has three different types such as neuropathic, neuro-ischemic and ischemic. Among these types, patients of neuropathic foot experience sensory abnormality. Nerve conduction velocity (NCV) is used for diagnosing neuropathic foot but this method uses strong electric stimulus to cause severe pain to the patients In this study, two channel photo-plethysmography was used as noninvasive screening tool for distinguish neuropathic foot and normal group by observing blood flow of both finger and toe simultaneously.

• Archives of Plastic Surgery
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• 제37권2호
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• pp.148-152
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• 2010

Purpose: In treating diabetic foot ulcers, satisfactory vascularity is an essential prerequisite. To improve vascularity, a bypass graft has long been carried out. Recently, however, percutaneous transluminal angioplasty (PTA) has also been tried since the PTA is less invasive than the bypass graft. However, publication demonstrating the improvement of vascularity after the PTA are lacking. Therefore, this study was designed to show usefulness of the PTA in treating vasculopathy of diabetic foot. Materials: and Methods This study included 30 feet of 24 ischemic diabetic foot patients. Inclusion criteria were diabetes (duration > 5 years) and a significant lower extremity ischemia, as determined by a transcutaneous oxygen pressure ($TcpO_2$) < 30 mmHg. The PTA was carried out in 61 arteries. PTA procedure was considered successful, when residual stenosis was less than 30%. The procedure was considered failed when residual stenosis was more than 50%. Residual stenosis between 30% and 50% was considered acceptable. For evaluation of PTA effect, foot $TcpO_2$ and infrared thermography were measured before and 7th day after PTA. Results: Immediately after PTA performed in 61 arteries, 58 and 3 arteries were evaluated as being successful and acceptable, respectively. Before PTA, average foot $TcpO_2$ was $12.6{\pm}8.8$ mmHg and its value was increased to $44.2{\pm}23.9$ on 7th day after PTA (p<0.01). Average skin temperature was $31.8{\pm}1.2^{\circ}C$ before PTA and it was increased to $33.5{\pm}1.1^{\circ}C$ on 7th day after PTA (p<0.01). Conclusion: PTA procedure increases tissue oxygenation of ischemic diabetic feet which do not have wound healing potential due to low tissue oxygenation, to the level of possible wound healing. In addition, PTA increases skin temperature of ischemic diabetic feet which can imply an improvement of peripheral circulation.

• 대한한방내과학회지
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• 제36권2호
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• pp.207-216
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• 2015

Objectives: The purpose of this study is to report the clinical application of acupuncture, herbal medication, and antibiotic treatment to a patient with a diabetic foot infection. Methods: We treated the patient-who had ulcerations of the 1st, 2nd, and 4th toes and osteomyelitis on the right 1st and 2nd toes-with acupuncture, herbal medication, and antibiotics. We measured the state of this case by changes in his MRI signal and ulceration of his toes. Results: After treatment, the MRI signal indicated that the osteomyelitis had disappeared and the ulceration was diminished. Conclusions: A combination of acupuncture, herbal medication, and antibiotic treatment is effective for treatment of ulceration and osteomyelitis caused by diabetic foot infection.

• 대한지역사회영양학회지
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• 제19권3호
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• pp.241-249
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• 2014

합병증으로 당뇨병성 족부질환을 가진 환자와 그렇지 않은 당뇨병 환자에서 DFS를 조사하고 이것이 생활습관, 식습관 및 당뇨병 자가 관리와 상관관계가 있는지 규명하고자 하였다. 1) 당뇨병성 족부질환군 69명(남/녀 48/21)과 일반당뇨군 59명(남/녀 33/26)으로 구성되었고, 당뇨병성 족부질환군이 일반당뇨군에 비해 당뇨병 유별기간이 유의적으로 길었으며(각각 $17.3{\pm}11.0$년, $11.3{\pm}9.46$년, p<0.01), 연령이 유의적으로 낮았고(각각 $51.2{\pm}11.6$세, $64.2{\pm}12.6$세, p<0.01), 기혼자의 비율이 유의적으로 낮았다 (p<0.05). 2) 당뇨병성 족부질환군은 일반당뇨군에 비해 부정적인 식사 특히, 패스트푸드, 배달음식, 인스턴트식품 및 편의점 음식의 섭취 빈도가 유의적으로 높은 반면(각각 $1.37{\pm}1.02$일/주와 $0.91{\pm}0.85$일/주, p<0.01), 긍정적인 식사 빈도와(각각 $2.74{\pm}1.76$일/주와 $3.61{\pm}2.05$일/주, p<0.01), 발 관리, 특히 발 씻기와 씻은 후 말리기의 빈도는 유의적으로 낮았다(각각 $4.61{\pm}1.97$일/주와 $5.53{\pm}2.22$ 일/주, p<0.05). 3) 12 항목으로 된 DFS의 Chronbach's ${\alpha}$는 당뇨병성 족부질환군에서 0.614로 매우 낮고, 자아효능감 관련 하부 영역의 세 항목은 제거되었을 때 내적일치도가 증가하였다. 따라서 당뇨병의 자가관리를 예측하는 인자로서 DFS의 유용성은 적어도 당뇨병성 족부질환 환자에서, 현재 12 항목의 DFS 도구로는 제한적임을 시사한다. 4) 당뇨병성 족부질환 합병증이 없는 일반당뇨군의 경우 12 항목 DFS는 Chronbach's ${\alpha}$가 0.869로 높고, 음주(r=0.247, p=0.059)와 부정적인 식사(r=0.241, p=0.066)와는 양의 상관관계가, 긍정적인 식사(r=-0.227, p=0.083)와는 음의 상관관계의 경향이 있었다. 자아효능감과 관련된 DFS와의 양의 상관관계는 음주(r=0.257, p<0.05), 흡연(r=0.350, p<0.01) 및 부정적 식습관(r=0.295, p<0.05)과 유의적이었고, 운동 (r=-0.224, p<0.088) 및 발 관리(r=-0.247, p<0.059)와는 경향이 있었다. 따라서 DFS는 적어도 당뇨병성 족부질환이 없는 환자의 경우에 특히 자아효능감 관련 항목에서 생활습관, 식습관 및 발 관리 충실도를 예측할 수 있는 도구로서의 잠재적 유용성을 있음을 제시한다. 본 연구에서는 당뇨병성 족부질환으로 족부 절단 위험에 처한 당뇨 환자가 그렇지 않은 당뇨 환자에 비해 식생활이 바람직하지 못할 뿐 아니라 발 관리가 잘 되고 있지 않음을 보여주어 비록 그 인과관계가 밝혀지지는 못했지만 당뇨병성 족부질환의 예방과 관리에서 당뇨 환자를 위한 식생활과 발관리 교육의 중요성이 확인되었다. 또한 이 연구는 우리나라에서 당뇨환자의 생활습관, 식습관 및 당뇨 자가관리를 예상할 수 있는 척도로서 미국에서 최근 개발된 DFS가 사용될 수 있는지 알아보는 첫 시도로 의미가 있는데 연구 결과는 종교, 당뇨병 형태, 심각한 합병증 유무에 따른 당뇨병 환자군별로 그 유용성을 규명할 필요성을 제시하였다.

• 월간당뇨
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• 통권171호
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• pp.70-77
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• 2004

Diabetic Foot Ulcers often pose a difficult problem for health care professionals because of the defects associated with fibroblast functioning. Although there has been much interest recently in the use of topical growth factors for the treatment of diabe

• 사상체질의학회지
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• 제14권2호
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• pp.169-174
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• 2002

A 55-year-old woman who was diagnosed as Diabetic foot was admitted to Dong-so Oriental-medical hospital on April 15th, 2002. Her great toe and secondary were to be tut off, and she was much depressed. We diagnosed her constitution as Taeumin(太陰人), and classified her symptom as Taeumin-Ban-Chang-Byung( 太陰人 ?瘡病 ) and prescribed Yuldahansotang(熱多寒少湯) for the purpose of chengganjoyoil(淸肝燥熱). During admission, the ulceration had nearly disappeared and so she could save her pre[ious toes. From this case, even though we could not say that Diabetic foot is equal to Ban-Chang-Byung but could suppose that there was some relationship between one and the other.

• 대한족부족관절학회지
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• 제15권1호
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• pp.7-12
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• 2011

Purpose: To evaluate the incidence and risk factors of ipsilateral reamputation after lower limb amputation in the patient with diabetic foot lesions. Materials and Methods: Between May 2005 and June 2009, 88 patients who underwent lower limb amputation were analyzed. Group 1 consisted of 73 patients who didn't have a ipsilateral reamputation after lower limb amputation and group 2 consisted of 15 patients who underwent reamputation. We compared several factors between two groups, such as age, gender, BMI, ABI, Wagner classification, wound culture, site of amputation, vascular surgery, the period of diabetes mellitus, chronic renal failure. Results: Fifteen (17%) of 88 patients had a ipsilateral limb reamputation and 13 patients (87%) of them underwent reamputation within 6 months. When we compared the two groups, average age was 59.3 (range, 48-74 years); 62.9(range, 44-78 years). Age was significantly associated with reamputation rate (p=0.02) and no reamputation after initial amputation above ankle joint was found. Other factors did not show statistically difference between both groups. Conclusion: There were no significant difference between diabetic limb amputation and reamputation group in our concerned risk factors except age and amputation level. There should be careful consideration when determine level of amputation in diabetic foot lesions especially in elder patients.