• Vascular Specialist International
• /
• v.34 no.4
• /
• pp.109-116
• /
• 2018

Purpose: Diabetic foot wound (DFW) is known as a major contributor of nontraumatic lower extremity amputation. We aimed to evaluate overall amputation rates and risk factors for amputation in patients with DFW. Materials and Methods: From January 2014 to December 2017, 141 patients with DFW were enrolled. We determined rates and risk factors of major amputation in DFW and in DFW with peripheral arterial occlusive disease (PAOD). In addition, we investigated rates and predictors for amputation in diabetic foot ulcer (DFU). Results: The overall rate of major amputation was 26.2% in patients with DFW. Among 141 DFWs, 76 patients (53.9%) had PAOD and 29 patients (38.2%) of 76 DFWs with PAOD underwent major amputation. Wound state according to Wagner classification, congestive heart failure, leukocytosis, dementia, and PAOD were the significant risk factors for major amputation. In DFW with PAOD, Wagner classification grades and leukocytosis were the predictors for major amputation. In addition, amputation was performed for 28 patients (38.4%) while major amputation was performed for 5 patients (6.8%) of 73 DFUs. Only the presence of osteomyelitis (OM) showed significant difference for amputation in DFU. Conclusion: This study represented that approximately a quarter of DFWs underwent major amputation. Moreover, over half of DFW patients had PAOD and about 38.2% of them underwent major amputation. Wound state and PAOD was major predictors for major amputation in DFW. Systemic factors, such as CHF, leukocytosis, and dementia were identified as risk factors for major amputation. In terms of DFU, 38.4% underwent amputation and the presence of OM was a determinant for amputation.

• Journal of the Korean Burn Society
• /
• v.23 no.1
• /
• pp.20-24
• /
• 2020

Diabetic patients have an increased risk of burn injuries on foot. Because of their diabetic neuropathy, they could contact with hot water or warming device without being aware of it. Split-thickness skin graft (STSG) is successful in treatment of various wound types; however, donor site wounds are sometimes problematic, and complications such as pain and impaired healing often occur. Although, donor site wounds in healthy young individuals can rapidly heal without complications, the wound-healing capacity of elderly patients or those with a comorbidity has been reported to be low. The dermatome is the most commonly used tool because it can harvest a large skin graft in one attempt. However, it is difficult to harvest tissues if the area is not flat. Furthermore, because the harvested skin is usually rectangular, additional skin usually remains after skin grafting. Therefore, use of razor blade and fragmented STSG on a large defect area is advantageous for harvesting a graft with a desired size, shape, and thickness. From January 2018 to July 2018, fragmented STSG was used in 9 patients who suffered from burn induced open wound on foot with diabetic neuropathy. With this approach, healing process was relatively rapid. The mean age of patients was 70 (57~86 years) and all of 9 patients had diabetes mellitus type 2. In all patients, the skin graft on the defect site healed well and did not result in complications such as hematoma or seroma.

• Archives of Plastic Surgery
• /
• v.34 no.5
• /
• pp.543-550
• /
• 2007

Purpose: Diabetic foot ulcer is a representative disease of chronic would with multiple defects of wound healing factors. Many nutrition factors have been known to be essential for wound healing, but objective data are lacking. The purpose of this study is to determine those factors essential for wound healing, and to find out which of those factors are lacking in diabetic foot ulcer patients through this pilot study. Methods: We studied 100 patients who visited our clinic from March 2005 to February 2006 for treatment of diabetic foot ulcers with a duration of more than 6 weeks. We checked serum levels of protein, albumin, vitamin A, C, E, iron, magnesium, zinc, copper and hemoglobin by drawing 23cc blood after 8 hours of fasting. Protein, albumin, iron, magnesium levels were measured by colorimetry; hemoglobin levels were measured by auto analysis. Vitamin levels were measured by high performance liquid chromatography (HPLC), copper and zinc levels were measured by Inductively coupled plasma (ICP). They were compared with normal values. The patients were divided by transcutaneous oxygen pressure levels, age and sex to study the effects of these parameters. Results: 76% and 61% of patients had within-normal range serum protein and albumin levels, respectively. Among vitamins, only the level of vitamin C was low in 55% of the patients. Levels of vitamin A, E were normal or high in 93% and 100% of patients. As for trace elements, levels of iron and zinc were low in 63% and 60% of patients, but levels of magnesium and copper were usually normal or high. Levels of vitamin C, iron and zinc were lower in the low-transcutaneous oxygen pressure group. There were no definite differences according to age and sex. Conclusion: Serum levels of Hb, vitamin C, iron, zinc were low in most diabetic foot ulcer patients. The deficit was very severe in the low-transcutaneous oxygen pressure group.

• Journal of Korean Foot and Ankle Society
• /
• v.16 no.4
• /
• pp.217-222
• /
• 2012

Purpose: The purpose of this study is to establish guidelines for ankle-brachial index (ABI), toe-brachial index (TBI) and toe pressure with regard to healing of diabetic foot amputation wound. Material and Methods: We designed a retrospective study that included patients with diabetic foot ulcer. From 2008 to 2011, 46 patients who had suffered from amputation of a foot due to diabetic foot ulcer were included in this study. We divided them into amputation-success group and amputation-revision group, and compared their ankle-brachial index (ABI), toe-brachial index (TBI) and toe pressure between two groups. Amputation-revision group is that first forefoot amputation is failed to heal successfully and need to have another proximal amputation. Results: Toe pressure was 78 mmHg (54~107) in the amputation success group, 0 mmHg (0~43) in the amputation revision group (p=0.000). Ankle-brachial index was 1.1650(1.0475~1.1975) in the amputation success group, 0.92(0.5275~1.0750) in the amputation revision group (p=0.05), and toe-brachial index was 0.6100(0.4050~0.7575) in the amputation success group, 0.00(0.00~0.4150) in the amputation revision group (p=0.04), respectively. Conclusion: ABI, TBI, toe pressure of amputation success group were significantly higher than those of amputation revision group.

• Archives of Plastic Surgery
• /
• v.35 no.5
• /
• pp.495-500
• /
• 2008

Purpose: Adequate tissue oxygenation is considered as an essential factor for wound healing. In the non-diabetic population, an uncompromised macrocirculation generally leads to adequate tissue oxygenation. On the contrary, the macrocirculation in diabetic patients may not correlate with tissue oxygenation because of structural changes in the capillary basement membrane. Nevertheless, many medical professionals in Korea rely on macrocirculation evaluation when predicting wound healing potential of the diabetic ulcers. The purpose of this study is to compare reliability of two common macrocirculation assessment methods, Doppler probing and CT angiography, on tissue oxygenation in diabetic foot patients. Methods: Doppler and CT angiography scores were given according to the patency of the anterior and posterior tibial arteries. Tissue oxygenation was measured by transcutaneous partial oxygen tension($TcpO_2$). Doppler and CT angiography scores were statistically analyzed against $TcpO_2$ values. Sixty-eight diabetic foot ulcer patients were included in this study. Results: The test was carried out on Doppler score and $TcpO_2$ variables displayed a p-value of 0.0202, and concluded that the two variables were statistically dependent. The test used to determine for linear trends between Doppler scores and $TcpO_2$ variables displayed a p-value of 0.0149, displaying statistical linear trend between the two variables. On the contrary, the tests between CT angiography scores and $TcpO_2$ variables showed p-values of 0.1242 and 0.6590, that means no correlation between CT angiography and $TcpO_2$ scores. Conclusion: Doppler probing is more reliable than CT angiography in predicting tissue oxygenation of diabetic foot ulcers.

• Journal of Korean Foot and Ankle Society
• /
• v.26 no.1
• /
• pp.30-39
• /
• 2022

Purpose: This study aimed to report the current trends in the management of diabetic foot over the last few decades through a survey of the Korean Foot and Ankle Society (KFAS) members. Materials and Methods: A web-based questionnaire containing 40 questions was sent to all KFAS members in September 2021. The questions were mainly related to the demographics of patients with diabetic foot, diagnostic tools, and multidisciplinary treatment. Answers with a prevalence of ≥50% of respondents were considered a tendency. Results: Seventy-eight of the 550 members (14.2%) responded to the survey. The most common demographic factors of diabetic foot patients were male dominance with a high percentage in the 60- to 70-year-old. Although the need for multidisciplinary treatment is highly recognized in the treatment of diabetic foot patients, the actual implementation rate is about 39%. The contrast-enhanced magnetic resonance imaging (88.5%) was reported to be the most used tool for the diagnosis of osteomyelitis of the diabetic foot. It was reported that the use of antibiotics was started empirically and then changed based on bacterial culture tests in 82.1% of patients. Simple wound dressing and antibiotic treatment were most frequently reported for mild ulcers. Conclusion: This study provides updated information on the current trends in the management of a diabetic foot in Korea. Both consensus and variations in the approach to patients with diabetic foot were identified by this survey study. Further efforts are required for better access to a multidisciplinary approach, such as appropriate insurance payment policies and patient education.

• Journal of Yeungnam Medical Science
• /
• v.40 no.4
• /
• pp.321-327
• /
• 2023

Recently, the International Working Group on the Diabetic Foot and the Infectious Diseases Society of America divided diabetic foot disease into diabetic foot infection (DFI) and diabetic foot osteomyelitis (DFO). DFI is usually diagnosed clinically, while numerous methods exist to diagnose DFO. In this narrative review, the authors aim to summarize the updated data on the diagnosis of DFO. An extensive literature search using "diabetic foot [MeSH]" and "osteomyelitis [MeSH]" or "diagnosis" was performed using PubMed and Google Scholar in July 2023. The possibility of DFO is based on inflammatory clinical signs, including the probe-to-bone (PTB) test. Elevated inflammatory biochemical markers, especially erythrocyte sedimentation rate, are beneficial. Distinguishing abnormal findings of plain radiographs is also a first-line approach. Moreover, sophisticated modalities, including magnetic resonance imaging and nuclear medicine imaging, are helpful if doubt remains after a first-line diagnosis. Transcutaneous bone biopsy, which does not pass through the wound, is necessary to avoid contaminating the sample. This review focuses on the current diagnostic techniques for DFOs with an emphasis on the updates. To obtain the correct therapeutic results, selecting a proper option is necessary. Based on these numerous diagnosis modalities and indications, the proper choice of diagnostic tool can have favorable treatment outcomes.

• Journal of Korean Foot and Ankle Society
• /
• v.12 no.1
• /
• pp.59-65
• /
• 2008

Purpose: To evaluate the results of anterolateral thigh perforator free flap for reconstruction of foot and ankle in old diabetic patients. Materials and Methods: Fifteen diabetic foot ulcer patients over the age of 55 were operated with anterolateral thigh perforator free flap. Hematological, hemodynamic, diabetic, bacteriologic and radiologic tests were checked with examination of blood vessel state in both the donor site and the recipient site. After surgery, serial check-up was performed at 6 week, 6 month, and 1 year postoperatively on the survival of transplantation tissue, condition of foot, and condition of walking. Results: There are one case of transplantation failure and four cases of partial tissue-necrosis. Delayed wound-healing was observed both recipient and donor tissue sites. At the final follow up, three cases of small ulcer were found at junction of flap and recipient tissue in plantar area. Fourteen out of fifteen patients could walk without any brace or walking aids. Conclusion: Reconstruction of foot and ankle region in old diabetic patients with the anterolateral thigh perforator free flap is a useful method which can prevent the amputation of foot and ankle.

• Journal of Korean Foot and Ankle Society
• /
• v.24 no.4
• /
• pp.148-155
• /
• 2020

Purpose: Minor foot amputations are performed for recurrent or infected ulcers or osteomyelitis of the diabetic feet. Patients may require a large amount of bone resection for wound closure. On the other hand, this results in more foot dysfunction and a longer time to heal. The authors describe fillet flap coverage to avoid more massive resection in selected cases. This study shows the results of fillet flap coverage for the closure of diabetic foot minor amputation. Materials and Methods: This was a retrospective case series of patients who underwent forefoot and midfoot amputation and fillet flap for osteomyelitis or nonhealing ulcers between March 2013 to November 2017. In addition, the patient comorbidities, hospital days, complications, and duration to complete healing were evaluated. Results: Fourteen fillet flap procedures were performed on 12 patients. Of those, two had toe necrosis, nine had forefoot necrosis, and three had midfoot necrosis. Eleven forefoot amputations and three midfoot amputations were performed. Among forefoot necrosis after a fillet flap, three patients had revision surgery for partial necrosis of the flap, and two patients had an additional amputation. Two patients had additional amputations among those with midfoot necrosis. By the fillet flap, the amputation size was reduced as much as possible. The mean initial healing days, complete healing days, and hospital stay was 70.6 days, 129.0 days, and 60.0 days, respectively. Conclusion: The fillet flap facilitates restoration of the normal foot contour and allows salvage of the metatarsal or toe.

• Journal of Korean Foot and Ankle Society
• /
• v.13 no.2
• /
• 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.