• Archives of Plastic Surgery
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• 제38권5호
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• pp.585-589
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• 2011

Purpose: Microcirculation of diabetic patients is commonly comporomised, regardless of the condition of the macrocirculation. Therefore, direct tissue oxygenation measurement is recommended in determining tissue viability and predicting wound healing potential. This study was designed to determine cut-off value of the tissue oxygenation in predicting wound healing in diabetic foot patients. Methods: This study included 41 feet of 41 diabetic foot patients who were treated in the Diabetic Wound Center of author's institution between January and June, 2009. Main inclusion criteria were type 1 or 2 diabetes and a foot ulcer (duration > 3 weeks) and ulcer area (from 1 $cm^2$ to 4 $cm^2$). Measurements of the area of diabetic foot ulcer were carried out before treatment. Transcutaneous oxygen pressure ($TcpO_2$) was measured at adjacent site of ulcer. The healing wound was defined as complete wound closure within 12 weeks. Results: Average diabetic foot ulcer areas with healing and nonhealing wounds were $2.67{\pm}0.76$ and $2.59{\pm}0.75\;cm^2$, respectively. There was no significant difference in the wound area between the groups. Average foot $TcpO_2$ in healing and nonhealing wounds were $68.56{\pm}23.07$ and $30.98{\pm}16.66$ mmHg, respectively ($p$ <0.01). The rate of healing wound increased as $TcpO_2$ increased. In particular, $TcpO_2$ lower than 40 mmHg and higher than 40 mmHg showed the most significant difference (wound healing rates of 25% and 71%, respectively). Conclusion: Based on the results of the study, the minimal $TcpO_2$ value thought to be required for adequate wound healing in diabetic wounds (cut-off value) is 40 mmHg.

• 대한한의학회지
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• 제24권4호
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• pp.136-138
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• 2003

Purpose : A clinical case of diabetic foot-wound repair using Hirudo medicinalis therapy and its application is reported and discussed. Methods : The subject was a sixty-six-year-old woman diagnosed with a non-healing wound indicating the amputation of her right diabetic foot. Instead, Hirudo medicinalis therapy was performed twelve times over forty days, twice a week. The transition of wound closure was observed with the naked eye, and the plethysmogram was measured at the beginning and end of the treatment period. Results : The wound contracted with decreased exudate, collagen-like connective tissue sprouted, and then the wound gradually closed. The initial value (-0.08) of the dicrotic elastic index rose to -0.03. Conclusion : Hirudo medicinalis therapy had a positive effect on the wound repair, without a negative effect on the circulation, allowing the foot to be saved. It is necessary to investigate its wound repair mechanism for the further development of the Sahyul method.

• 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.

• The Journal of Korean Physical Therapy
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• 제19권5호
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• pp.51-63
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• 2007

Diabetic foot ulcers result from abnormal mechanical loading of the foot, such as repetitive pressure applied to the plantar aspect of the foot while walking. Diabetic peripheral neuropathy causes changes in foot structure, affecting foot function and subsequently leading to increased plantar foot pressure, which is a predictive risk factor for the development of diabetic foot ulceration. To early identify the insensitive foot makes it possible to prevent diabetic foot ulceration and to protect the foot at risk from abnormal biomechanical loading. Abnormal foot pressures can be reduced using several different approaches, including callus debridement, prescription of special footwear, foot orthosis. injection of liquid silicone, Achilles tendon lengthening, and so forth. Off-loading of the diabetic wound is a key factor to successful wound healing as it is associated with reduced inflammatory and accelerated repair processes. Pressure relief can be achieved using various off-loading modalities including accommodative dressing, walking splints, ankle-foot orthosis, total contact cast, and removable and irremovable cast walkers.

• 대한족부족관절학회지
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• 제26권4호
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• pp.187-191
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• 2022

The author experienced a case of autologous platelet-rich plasma (PRP) affecting the recovery of a chronic neuropathic diabetic foot ulcer combined with infection. A 65-year-aged male with uncontrolled diabetes presented with a Wagner grade 2 diabetic foot ulcer on his left forefoot of more than 2 weeks duration. Osteomyelitis, gangrene, and ischemia requiring acute intervention were absent. Although infection was controlled to a moderate degree, wound healing was unsatisfactory following surgical debridement and simple dressing. Therefore, intralesional autologous PRP injection was performed 5 times as an adjuvant regeneration therapy, and the recalcitrant ulcer healed in 3 months. Intralesional PRP injections are worthwhile as they promote wound regeneration, are evidence-based, safe, and can be easily performed in ambulatory care facilities.

• 임상간호연구
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• 제21권2호
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• pp.196-206
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• 2015

Purpose: This study was done to use a guideline adaptation process to develop a Korean evidence-based diabetic foot care clinical practice guideline for diabetic foot prevention and management. Methods: The guideline adaptation process was conducted according to the guideline adaptation manual developed by the National Evidence-Based Healthcare Collaborating Agency. The process consists of three main phases, with 9 modules including a total of 23 steps. Results: The newly developed diabetic foot care clinical practice guideline consisted of an introduction, description of diabetic foot, summary of recommendations, recommendations, references, appendices, and glossary. There were 165 recommendations in 4 sections (risk assessment for diabetic foot ulcers, prevention of diabetic foot ulcers, wound assessment of diabetic foot ulcers, and management of the diabetic foot). In grading by recommendations, for A there were 30 (18.2%), B, 8 (4.8%), C, 30 (18.2%) D, 97 (58.8%). Conclusion: This guideline can be used as educational material for healthcare workers and diabetic patients. It can also be utilized as a practice guideline for healthcare workers in the hospital and community setting.

• 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.

• 대한족부족관절학회지
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• 제16권4호
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• pp.257-264
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• 2012

Purpose: The diabetic foot lesions are intractable, and aggravation often leads to amputation. None or minor amputation group was treated debridement or toe amputation and major amputation group was treated Ray, Lisfranc, Chopart, Below Knee and Above Knee amputation. We investigate the risk factors for major limb amputations among patients with diabetic foot lesion. Materials and Methods: The subjects were 73 diabetic foot lesion patients (83 diabetic foot lesions) treated at our department from January 2006 to December 2010. Non or Minor amputation group of 44 cases were treated with debridement or toe amputation. Major amputation group of 39 cases were treated with Ray, Lisfranc, Chopart, below or above Knee amputation. We investigated socioeconomic factors, diabetes mellitus related factors and wound related factors and laboratory factors. Statistical analysis was done by Students t-test, Chi-square test, Mann-Whitney's U test. Results: In our analysis, wound size, wound classification (Wagner classification, Brodsky classification), white blood cell counts, polymorphoneuclear neutrophil percentage, hemoglobin, C-reactive protein and albumin were risk factors for major amputation (p<0.05). Conclusion: Low education level, nutritional condition, premorbid activity level and progressed wound condition were observed in major amputation group compared with non or minor amputation group. In the major amputation group, higher white blood cell count, C-reactive protein level and lower albumin level were observed. Together with maintenance of adequate nutritional condition, early detection of lesions and foot care for early treatment is important. Therefore, active investigation with full risk evaluation of vascular complication is also important.

• 대한족부족관절학회지
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• 제28권2호
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• pp.41-47
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• 2024

Negative pressure wound therapy (NPWT) has emerged as a valuable tool for managing complex wounds within the foot and ankle field. This review article discusses the expanding applications of NPWT in this specialized field. Specifically, it discusses the efficacy of NPWT for various wound types, including diabetic foot wounds, traumatic wounds, surgical wounds, and wounds involving exposed bone or soft tissue defects. NPWT demonstrates versatile utility for foot and ankle wound management by promoting healing, potentially reducing the need for secondary surgery, improving diabetic and neuropathic ulcer healing times and outcomes, and optimizing the healing of high-risk incisions. In addition, this review explores the underlying mechanisms through which NPWT might enhance wound healing. By synthesizing current evidence, this review provides a comprehensive overview of the role of NPWT in foot and ankle surgery and offers valuable insights to clinicians navigating the complexities of wound care in this challenging anatomical area.

• 대한족부족관절학회지
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• 제18권1호
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• pp.1-7
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• 2014

In patients with diabetic foot, ulceration and amputation are the most serious consequences and can lead to morbidity and disability. Peripheral arterial sclerosis, peripheral neuropathy, and foot deformities are major causes of foot problems. Foot deformities, following autonomic and motor neuropathy, lead to development of over-pressured focal lesions causing the diabetic foot to be easily injured within the shoe while walking. Wound healing in these patients can be difficult due to impaired phagocytic activity, malnutrition, and ischemia. Correction of deformity or shoe modification to relieve the pressure of over-pressured points is necessary for ulcer management. Application of selective dressings that allow a moist environment following complete debridement of the necrotic tissue is mandatory. In the case of a large soft tissue defect, performance of a wound coverage procedure by either a distant flap operation or a skin graft is necessary. Patients with a Charcot joint should be stabilized and consolidated into a plantigrade foot. The bony prominence of a Charcot foot can be corrected by a bumpectomy in order to prevent ulceration. The most effective management of the diabetic foot is ulcer prevention: controlling blood sugar levels and neuropathic pain, smoking cessation, stretching exercises, frequent examination of the foot, and appropriate education regarding footwear.