• Archives of Reconstructive Microsurgery
• /
• 제17권1호
• /
• pp.28-35
• /
• 2008

The purpose of this study was to present the clinical analysis of the results of lateral arm free flap for small sized and infected diabetic foot ulcer around toes. From May 2006 to December 2007, Seven patients were included in our study. Average age was 52.8 years, six were males and one was female. All had infected diabetic foot ulcer and had exposures of bone or tendon structures. Ulcers were located around great toe in four patients, 4th toe in one and 5th toe in two. Three patients had osteomyelitis of metatarsal or phalanx. After appropriate control of infection by serial wound debridement and intravenous antibiotics, lateral arm flap was applied to cover remained soft tissue defects. Posterior radial collateral artery of lateral arm flap was reanastomosed to dorsalis pedis artery of recipient foot by end to side technique in all cases in order to preserve already compromised artery of diabetic foot. All flaps were designed over lateral epicondyle to get longer pedicle and averaged pedicle length was 8 cm. Two cases were used as a sensate flap to achieve protective sensation of foot. All flaps survived and provided satisfactory coverage of soft tissue defects on diabetc foot ulcers. All patients could achieve full weight-bearing ambulation. No patients has had recurrence of infection, ulceration and further toe amputations. There were three complications, a delayed wound healing of flap with surrounding tissue, a partial peripheral loss of flap and a numbness of forearm below donor site. All patients were satisfied with their clinical results, especially preserving their toes and could return to the previous activity levels. Lateral arm free flap could be recommend for infected diabetic foot ulcers around toes, to preserve toes, coverage of soft tissue defect and control of infection with low donor site morbidity.

• Annals of Clinical Neurophysiology
• /
• 제10권1호
• /
• pp.33-37
• /
• 2008

Diabetic polyneuropathy (DPN) is the most common form of diabetic neuropathy, and causes a significant morbidity with an impact on the quality of life in the patients with diabetes. Since DPN frequently induces foot deformity and ulceration, which finally leads to foot amputation, the early detection and treatment is very important for the prevention of a permanent structural change. In the early stage of DPN, the diagnostic methods which can evaluate the function or structure of small nerve fibers should be employed because small nerve fibers are first involved in the course of DPN. However, the nerve conduction study cannot reflect the function of the small nerve fibers, and thus, has a definite limitation in the early diagnosis of DPN. For the early detection of DPN, electrodiagnostic data should be interpreted on a clinical context, along with the careful evaluation of the small nerve fiber functions using the tests such as the analysis of intraepidermal nerve fiber density.

• 대한족부족관절학회지
• /
• 제10권2호
• /
• pp.250-254
• /
• 2006

Purpose: The treatment of diabetic foot ulcers with total contact cast has been reported to be associated with numerous undesirable complications. This study shows that our technique of total contact casting that incorporates high concentration silver coated foam dressing. Materials and Methods: Forty-four diabetic foot ulcers were treated with total contact cast along with high concentration silver coated foam dressing. Complication and healing rates were evaluated. Results: Eighty five percent of the ulcers healed within 6 weeks with an overall complication rate of 7%. There were only two cases (5%) of infection and no recurrent ulceration and no another site new pressure ulcer in our study. Conclusion: Total contact casting incorporates high concentration silver coated foam dressing resulted in fewer complications rate and healing rate that is comparable to other studies.

• 대한족부족관절학회지
• /
• 제13권2호
• /
• pp.150-155
• /
• 2009

Purpose: To help the empirical antibiotics selection in diabetic foot infection patients, we investigated prevalence of microorganisms and their antibiotics sensitivity results. Materials and Methods: Patients who came to our clinics to treat diabetic foot infections with deep ulceration and were followed up more than 6 months until complete recovery were adopted. From March 2006 to June 2009, there were 140 patients who corresponded with such a inclusion criteria. Wound cultures were done by deep tissue or bone debris at first visit to our clinics. Microorganisms which was documented by wound culture and most susceptible antibiotics by minimum inhibitory concentrations were surveyed retrospectively. Results: Microorganisms were confirmed in 113 cases (80.7%). In the other 27 cases (19.3%), there were no cultured microorganisms. In bacterial growth group, there were 72 cases (63.7%) of gram-positive bacteria and 41 cases (36.3%) of gram-negative bacteria. All of them were aerobic microorganisms and there were no anaerobic microorganisms. Methicillin-sensitive staphylococcus aureus was the most common pathogen and accounted for 35 cases (31.0%). As other common pathogens, there were Enterobacter cloacae (11 cases, 9.7%), pseudomonas aeruginosa (10 cases, 8.8%), Methicillin-resistant staphylococcus aureus (10 cases, 8.8%) and enterococcus faecalis (6 cases, 5.3%), and so on. Common susceptible antibiotics in gram positive microorganism were vancomycin (60 cases, 83.3%), teicoplanin (60 cases, 83.3%), nitrofurantoin (60 cases, 83.3%) and ciprofloxacin (53 cases, 73.6%). In gram negative ones, common susceptible antibiotics were imipenem (35 cases, 85.3%), piperacillin/tazobactam (33 cases, 80.5%) and gentamicin (31 cases, 75.6%). Conclusion: Methicillin-sensitive Staphylococcus aureus in gram positive and enterobacter cloacae in gram negative was the most common pathogen in each group. Ciprofloxacin and gentamicin might be adaptable as a first-line empirical antibiotics in infected diabetic foot patients.

• 한방안이비인후피부과학회지
• /
• 제33권3호
• /
• pp.125-137
• /
• 2020

Objectives : Charcot neuroarthropathy(CN) is condition characterized by a progressive joint deformation with sensorial and autonomic neuropathy. This study is to report a case of CN improved by Korean medical treatment. Methods : The patient's left foot with CN was treated by Shudihuangkushen-tang, Haifu-san wet dressing, acupuncture and herbal acupuncture. We evaluated the progress by laboratory investigation, radiograph and photograph comparison, visual analogue scale(VAS) of edema and pain sensation. Results : After treatment, VAS score of edema dropped from 6 to 1, of pain sensation slightly improved from 0 to 1. Average blood sugar level decreased and rebounded, but Hemoglobin A1c level improved from 9.5% to 7.7%. Improvement of the left foot was recognized from the radiograph and photograph comparison. Conclusions : This study suggests Korean medicine is effective in treating CN, especially using Shudihuangkushen-tang, Haifu-san wet dressing.

• Archives of Plastic Surgery
• /
• 제41권3호
• /
• pp.248-252
• /
• 2014

Background Patients with diabetes mellitus often have a difficult life, suffering from foot ulceration or amputation. Diabetes is characterized by chronic inflammation, and one of the features of inflammation is hypoxia. Recently, it has been reported that KAI1 is a hypoxia target gene. There is no published research on hypoxia-related KAI1 protein levels in human diabetic skin. Therefore, we have investigated the expression of KAI1 protein in diabetic skin tissue in vivo. Methods The expression of KAI1 protein was evaluated by western blotting in 6 diabetic skin tissue samples and 6 normal skin samples. Immunohistochemical staining was carried out to identify KAI1 expression. Results The western blotting revealed significantly increased expression of the KAI1 protein in diabetic skin tissues as compared to normal skin tissues. Immunohistochemical examination demonstrated that KAI1 was expressed in all diabetic skin tissues with moderate-to-strong positivity and weakly expressed in normal skin tissues. Conclusions Our data suggest that a high expression of the KAI1 protein can be observed in diabetic skin tissue. To the best of our knowledge, this is the first report suggesting that KAI1 protein expression in diabetic skin tissues may be associated with chronic inflammatory states and hypoxia.

• Mycobiology
• /
• 제45권3호
• /
• pp.178-183
• /
• 2017

Diabetes mellitus is a chronic disorder which affects millions of population worldwide. Global estimates published in 2010 reported the world diabetic prevalence as 6.4%, affecting 285 million adults. Foot ulceration and wound infection are major forms of disabilities arising from diabetic diseases. This study was aimed to develop a natural antimicrobial finishing on medical grade textile that meets American Association of Textiles Chemists and Colorists (AATCC) standard. The textile samples were finished with the ethanolic extract of Penicillium amestolkiae elv609, an endophytic fungus isolated from Orthosiphon stamineus Benth (common name: cat's whiskers). Endophyte is defined as microorganism that reside in the living plant tissue, without causing apparent disease symptom to the host. The antimicrobial efficacy of the ethanolic extract of P. minioluteum was tested on clinical pathogens isolated from diabetic wound. The extract exhibited significant inhibitory activity against 4 bacteria and 1 yeast with the minimal inhibitory concentration ranged from 6.25 to 12.5 mg/mL. The results indicate different susceptibility levels of the test microorganism to the ethanolic extract. However, the killing activity of the extract was concentration-dependent. The finished medical textile showed excellent antimicrobial efficacy on AATCC test assays. All the microbial cultures treated with the textile sample displayed a growth reduction of 99.9% on Hoheinstein Challenge Test. The wash durability of the finished textile was found good even after 50 washes with commercial detergent. Besides, the gas chromatography mass spectrometry analysis showed that 6-octadecenoic acid and diethyl phthalate were the main bioactive constituents of the extract. In conclusion, the developed medical textile showed good antimicrobial efficacy on laboratory tests. This work can be extended to in vivo trials for developing healthcare textile products for antimicrobial applications.

• 대한족부족관절학회지
• /
• 제14권2호
• /
• pp.140-145
• /
• 2010

Purpose: The diabetic charcot neuroarthropathy of ankle is an infrequent site (around 5%), but is definitely the location that, because of the instability and progressive deformity it involves, cause ulceration in a high percentage of patients, and this can then become a reason for amputation. However, the treatment of this disastrous disease is still challenging. We analyzed the clinical and radiological results of ankle arthrodesis by our fixation method in Charcot neuroarthropathy. Materials and Methods: Seven cases that were diagnosed as charcot neuroarthropathy of ankle arthrodesis were followed for more than 16 months postoperatively. Mean age was 57 years, and the mean follow-up period was 27 months. Anterior approach was used in arthrodesis, and internal fixation by 3 or more cannulated screws and hybrid type external fixation were used. Auto iliac bone for grafting was combined in all cases. External fixator was kept for 3 months without weight-bearing. Then, boots brace was applied for more 3 months allowing partial weight-bearing. Four cases had minor complications such as pin site infection. Preoperative and postoperative AOFAS score, time to fusion and postoperative complications were checked. Results: Postoperative fusion was completed in all cases, and the mean time to fusion was 3.4 months. No postoperative complication was checked. At the last follow-up, the mean AOFAS score had increased from 54 points to 72 points. Patient's satisfaction was over 80%. Conclusion: Satisfactory results were obtained after ankle arthrodesis using internal and hybrid type external fixation combined with auto iliac bone graft in charcot neuroarthropathy with minor complications.