• 대한족부족관절학회지
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• 제13권1호
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• pp.50-54
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• 2009

Purpose: The authors evaluated the clinical results and prognosis after amputating the lower extremity due to diabetic foot. Materials and Methods: From 1991 to 2003, the patients who had suffered amputation of his lower extremity due to diabetic foot ulcer were evaluated retrospectively. 79 patients were male and 6 patients were female. The author evaluated the patient who had the ipsilateral additional surgery, contralateral amputation, level of blood sugar, combined disease and mortality rate within 5 years from medical record. Statistical analysis was done by Chi-square test and Kaplan-Meier survival test. Results: Mean age of patients who had first experienced amputation was 63.4 years old. The mean duration of diabetes until amputation was $14.5{\pm}7.5$ years. Major amputations were 50 cases and minor amputations 35 cases. 20 patients (23.5%) were suffered ipsilateral secondary surgery including revised stump. Overall 5-year mortality rate was 18.8% (16 cases). Death rate within 1 year was 8.2% (7 cases), mortality rate within 3 years was 14.1% (12 cases). 5-year mortality rate after major amputation was 20% (10 cases) and after minor amputation was 17.1% (6 cases). It was statistically significant (p<0.05). Patient who underwent more than 2 combined vascular related disease had higher mortality rate than diabetic amputee without combined disease (p<0.05). Conclusion: Mortality rate after major amputation was significant higher than amputation after minor amputation in diabetic patients from our data.

• 가정∙방문간호학회지
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• 제18권1호
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• pp.32-39
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• 2011

Purpose: The purpose of this study was to investigate treatment types and the status of referral to home care services for patients with diabetic foot. Methods: A retrospective survey was conducted by reviewing medical records from January to December in 2008 at a university hospital. The subjects were 76 patients at the age of 20 years or older who were admitted, had home care services, or received outpatient care for diabetic foot. The data were analyzed using descriptive statistics. Results: Among the total of 9,317 patients diagnosed with diabetes, 5.03% (n=469) had diabetic foot. Admission (81.6%) was the most frequently used treatment type followed by outpatient care only (7.9%) and hemodialysis only (10.5%). Of the 76 admission cases, 44.9% received post-discharge care at outpatient clinics, 20.5% had both outpatient and home care services, and 16.7% were transferred to other hospitals. Readmission rate after discharge was 15.6% for one year. Conclusion: This study suggests referral to home care services should be encouraged to provide effective follow-up care to patients with diabetic foot after discharge from a hospital.

• 대한족부족관절학회지
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• 제17권4호
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• pp.251-256
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• 2013

Neuropathy is a common complication of diabetes. It is characterized by a progressive loss of peripheral nerve fibers. The development of the neuropathy is linked to poor glycemic control, age, and the duration of diabetes. Peripheral sensory polyneuropathy is the most common type in neuropathy. Diabetic neuropathy is the most significant etiologic factor of the foot ulcer that may leads to amputation. Current treatments in diabetic neuropathy have no definitive effects on repair or reverse the damaged nerve but only to relieve of symptoms, especially on pain. When the focal compressive neuropathy is combined with diabetic neuropathy, the nerve would be more vulnerable and symptoms might get worse. Surgery is indicated for decompression of an entrapped nerve, like posterior tibial nerve in tarsal tunnel, after failure of the initial conservative treatments.

• 대한족부족관절학회지
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• 제17권3호
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• pp.209-214
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• 2013

Purpose: To evaluate correlation between the clinical results and causative bacteria in diabetic foot patients with lower extremity amputation. Materials and Methods: One hundred twenty nine patients(131 feet) of diabetic foot amputations were followed for more than one year. Wound cultures were done by deep tissue or bone debris at first visit to our clinics. Retrospective analysis was performed using chart review and interview with the patients. Depending on the culture result, level of amputation, reinfection, duration of treatment, death rate, patient satisfaction and admission dates were evaluated. Results: Microorganisms were confirmed in 114 cases. In the other 17 cases, there were no cultured microorganisms. In bacterial growth group, Methicillin-sensitive Staphylococcus aureus was the most common pathogen and accounted for 34 cases. As other common pathogens, there were Methicillin-resistant Staphylococcus aureus(24 cases) and mixed infection(14 cases). Mortality is no difference in each infected group. Mixed bacterial infected patients have higher reinfection, longer hospital day and duration of treatment, but there is no difference in patients satisfaction and pain at last follow up. Conclusion: The most common pathogen in diabetic foot patients with lower extremity amputation was Methicillin-sensitive Staphylococcus aureus, and mixed bacterial infected patients have higher reinfection rate, longer admission date and duration of treatment than other bacterial infected patients.

• 대한족부족관절학회지
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• 제17권1호
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• pp.52-59
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• 2013

Purpose: The purpose of this study is to evaluate treatment results of multidisciplinary approach of critical ischemic limb with diabetic foot. Materials and Methods: From March 2005 to March 2012, 674 diabetic foot patients were analyzed. Among them, 85 patients were neuroarthropathic type, 383 patients were infectious type, and 206 patients were ischemic type. The subjects were 206 patients who had critical ischemic limbs and major or minor amputations were done. Various single or combined treatment method before amputation was performed. We investigated their ABI, HbA1c, main occlusion lesion, limb salvage and hospitalization period by various treatment method. Results: Major amputation was 27 cases, minor amputation was 179 cases. Mean HbA1c was 8.2%, and mean ABI was 0.66. Main occlusion lesion was 6 cases at common iliac artery, 13 cases at external iliac artery, 9 cases at internal iliac artery, 11 cases at common femoral artery, 23 cases at deep femoral artery, 52 cases at superficial femoral artery, 35 cases at popliteal artery, 40 cases at posterior tibia artery, 35 cases at anterior tibial artery, 28 cases at peroneal artery, and 13 cases at dorsalis pedis artery. Major amputations were decreased, minor amputations were increased, and hospitalization period was reduced by treatment of multidisciplinary approach. Conclusion: Treatment of multidisciplinary approach, which include preoperation percutaneus transluminal angioplasty, vascular surgery, and amputation, of critical ischemic limb with diabetic foot had advantages of limb salvage and hospitalization period reduction.

• 대한족부족관절학회지
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• 제26권3호
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• pp.148-150
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• 2022

Myiasis is the parasitic infestation of the body of a live animal by fly larvae that grow inside the host while feeding on its tissue. Necrotic tissue is a favorable environment for larvae to thrive, which can be seen easily in patients with a diabetic foot. Myiasis in a diabetic foot is rare but is constantly being reported. The common larvae genera causing myiasis are Calliphoridae, Sarcophagidae, and Muscidae. This paper reports a rare case of sarcophaga myiasis in a diabetic foot. To the best of the author's knowledge, this is the first case report in Korea regarding human myiasis with the sarcophaga genus.

• 대한족부족관절학회지
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• 제28권3호
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• pp.96-101
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• 2024

Purpose: Diabetic foot ulcers and gangrene are major complications of diabetes, often accompanied by peripheral vascular occlusion. Revascularization is performed to restore blood flow and reduce complications such as amputation surgery. Nevertheless, reocclusion, a frequently reported complication after revascularization, often necessitates further lower limb amputations to facilitate rehabilitation and ambulation. This study examined the factors influencing the performance of secondary revascularization procedures in patients with diabetic foot gangrene who even underwent transtibial amputation (TTA) following revascularization. Materials and Methods: A retrospective study was conducted on 36 patients with diabetic foot gangrene who underwent TTA after revascularization from March 2005 to March 2022. The factors influencing restenosis were classified into three categories: revascularization factors, preoperative factors, and intraoperative factors. The revascularization factors were categorized based on whether percutaneous transluminal angioplasty (PTA) or bypass surgery had been performed. Preoperative factors included the patient's age, gender, body mass index (BMI), hypertension, and other relevant factors. Intraoperative factors included surgery duration, blood loss, and transfusion. The study examined the factors influencing secondary revascularization in these three categories. Results: Among the 36 patients in the study, 27.8% (11 patients) underwent secondary revascularization procedures. There was no significant correlation between the performance of secondary revascularization and the type of revascularization procedure, whether PTA or bypass surgery (p>0.05). Similarly, no significant differences were observed in preoperative factors (including age, BMI, smoking status, HbA1c, and underlying diseases) and intraoperative factors (surgery duration, blood loss, and transfusion). On the other hand, regarding gender, all patients who underwent revascularization procedures were male, indicating a statistically significant result (p=0.039). Conclusion: This study suggests that while most clinical variables showed no association with reocclusion, the fact that all patients who underwent secondary revascularization procedures were male indicates that gender may be a significant predictive factor of revascularization.

• 대한족부족관절학회지
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• 제21권2호
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• pp.66-69
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• 2017

Purpose: This study reports on limb amputations in diabetic patients according to gender, age, and region based on the data from the Korean Health Insurance Review & Assessment Service. Materials and Methods: The number of amputations was compared by region, age, gender, and year, as well as by femoral region, lower leg, foot, and toe in diabetic patients who received limb amputation. This analysis was performed based on the data from the Korean Health Insurance Review & Assessment Service, between January 2009 and December 2014. Results: The total number of amputations between the study period was 9,155. The number of patients who were treated at hospitals for diabetes in 2009 was 1.9 million, among which, 1,214 patients underwent amputation. In 2014, the incidence of diabetes was 1,747 in 2.58 million individuals. With this rising incidence of diabetes, the amputation of limbs due to diabetes is increasing every year. In particular, the following regions were amputated more often: femoral region, 2.3%; lower legs, 19.6%; feet, 18.1%; and toes 60.0%. Regarding gender differences, males showed a higher amputation rate than females for all body parts. With respect to region, Seoul was the highest with 30.2%, followed by Gyeonggi with 19.9%, and Busan with 8.8%. According to age, older age showed greater diabetic amputation rate. Conclusion: In accordance with the rising incidence of diabetes, the diabetic amputation is also increasing. Here, we showed that toes were amputated with the highest percentage and males had greater amputation rate than females for all body parts. Moreover, amputation rate was highest in older diabetic patients, especially for those in their seventies. Additionally, Seoul was the region with highest amputation rate.

• 성인간호학회지
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• 제18권1호
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• pp.81-91
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• 2006

Purpose: The purpose of this study was to investigate foot ulcer risk factors, foot care knowledge, and foot care practice in patients with type 2 diabetes. Method: One hundred fifty type 2 diabetic patients were in and out-patients in a large urban hospital. The data were collected using a self-report questionnaire, chart review and foot examination. The questionnaires were developed by the researchers through the experts consultation and literature review. High risk for foot ulcer was evaluated by peripheral neuropathy(PN), peripheral vascular disease(PVD), and prior foot ulcer. Foot risk scores(FRS) means numbers of present risk factors. Results: 31.3% of subjects show 1 FRS, and 13.3% showed 2 FRS. Mean foot care frequency was 3.5 times per week. There were significant differences in foot care knowledge according to DM education (t=2.96, p=.004) and foot care education (t=3.65, p=.001). There were significant differences in the foot care practice activities according to duration of DM (t=3.48, p=.010) and educational levels. Conclusion: There were high proportion of foot ulcer risk among the patients. It is necessary to screen high risk foot ulcer patients and provide practical education for foot care practice of diabetic patients.

• 대한족부족관절학회지
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• 제17권4호
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• pp.243-250
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• 2013

다시 강조하지만 신경관절병증의 수술 목표는 정상발을 만드는 것이 아니라 보조기 착용이 가능하고 발바닥을 이용한 체중 부하 보행이 가능하도록 하는 것이라는 것을 늘 유념하여 치료 계획을 세워야 한다. 따라서 적절한 수술 방법을 선택하기 위해서는 병의 진행 경과와 특성을 이해하여 적절한 술 전 계획을 수립하는 것이 가장 중요할 것이다.