• 대한족부족관절학회지
• /
• 제18권3호
• /
• pp.133-136
• /
• 2014

Skin grafting is often required for diabetic ulcerative foot lesions. In skin grafting, effective regional or local anesthesia into the donor and recipient areas plays a significant role in continuous control of pain. We report on a technique of ultrasound-guided nerve block on the femoral, sciatic, and lateral femoral cutaneous nerves in large split-thickness skin grafting for ulcer of the foot and leg.

• The Korean Journal of Physiology and Pharmacology
• /
• 제27권5호
• /
• pp.437-448
• /
• 2023

Diabetic ulcer is usually seen in people with uncontrolled blood sugar. Reportedly, many factors such as impaired glucose metabolism, and macrovascular and microvascular diseases caused angiogenesis disorders and delayed the healing of diabetic ulcers, thus affecting the body's metabolism, nutrition, and immune function. This study aimed to explore the effect of paeonol on skin wound healing in diabetic rats and the related mechanism. A rat model of diabetic ulcer was established. High glucose-treated mouse skin fibroblasts were co-cultured with M1 or M2-polarized macrophages treated with or without paeonol. H&E and Masson staining were used to reveal inflammatory cell infiltration and collagen deposition, respectively. Immunohistochemistry visualized the expression of Ki67, CD31, and vascular endothelial growth factor (VEGF). Western blot was used to detect interleukin (IL)-1β, tumor necrosis factor (TNF)-α, IL-4, IL-10, CD31, VEGFA, and collagen I/III. The expression of iNOS and arginase 1 was revealed by immunofluorescence staining. Paeonol treatment augmented collagen deposition and the expression of Ki67, CD31, VEGF, and macrophage M2 polarization markers (IL-4 and IL-10) and reduced wound area, inflammatory cell infiltration, and macrophage M1 polarization markers (IL-1β and TNF-α) in the ulcerated area. In vitro, paeonol treatment promoted M2-polarization and repressed M1-polarization in macrophages, thereby improving the repair of cell damage induced by high glucose. Paeonol accelerates the healing of diabetic ulcers by promoting M2 macrophage polarization and inhibiting M1 macrophage polarization.

• 대한족부족관절학회지
• /
• 제22권2호
• /
• pp.78-81
• /
• 2018

This paper presents a case of an early malignant transformation of untreated ulcers in a patient with diabetes. This case shows that Marjolin's ulcer can occur not only after chronic injury, but can also develop in the early stages after the onset. Hence, an early biopsy for diabetic foot ulcers that fail to heal with acute treatment can enable an earlier diagnosis and treatment without amputation, resulting in a better quality of life for the patient.

• 대한족부족관절학회지
• /
• 제8권1호
• /
• pp.16-21
• /
• 2004

Purpose: To investigate the characteristics of the patients and therapeutic shoes for diabetic patients. Materials and Methods: Forty two diabetic patients who had their own therapeutic shoes which were prescribed somewhere else were studied from March 2003 to December 2003. There were 27 males and 15 females, and the mean age was 62.1 years (range, 49-72 years). Duration of diabetes was average 14 years (range, $6{\sim}30$ years), all had type 2 diabetes. Sensation was examined with 5.07 nylon monofilament. The route of purchasing the shoes, compliance to the prescribed shoes were investigated by interview. The shape of shoe, stiffness of upper, conformity of insole to the shape of the foot were recorded. In-shoe plantar pressure was measured in 15 patients. Results: Eighteen patients were insensate to the monofilament. Seven patients did not wear the therapeutic shoes, and only 18 of 35 patients were wearing the therapeutic shoes more than 6 hours a day. The shoes of 17 patients were prescribed by medical doctor and the rest were purchased by the recommendation of acquaintances or advertisement. Ulcer recurred in four of five patients to whom the shoe was prescribed by medical doctor and the cause of three recurrences were evident by just observing the foot and shoe. The therapeutic shoes were made from 11 different makers. Eight shoes were adequate for diabetic patients with respect to the material, shape of insole, type of shoe. In-shoe plantar pressure was examined in 15 patients and was less than 300 kPa in all patients. Conclusion: The therapeutic shoes for the diabetic patients need to be prescribed by medical doctor for selective patients with neuropathy or previous history of ulcer and follow-up examination is important to monitor the compliance of the patients and adequacy of the shoes.

• 대한족부족관절학회지
• /
• 제6권1호
• /
• pp.35-39
• /
• 2002

Purpose: The purpose of this study was to evaluate the effect of hyperbaric oxygen therapy(HBOT) and the resultant amputation rate in the treatment of diabetic foot ulcer. Material and methods: From 2000 Jan. to 2002 April, thirty two diabetic foot patients were admitted for treatment of foot ulcers and infection. Of the thirty two cases, thirteen patients received HBOT and nineteen did not. The results were analyzed by amputation rate and healing time. All were classified according to the Wagner classification. Results: Of the HBOT treated group, three(23%) patients underwent amputation: two below knee and one metatarsophalangeal disarticulations. Of the non-treated group, eleven(58%) patients underwent amputation, : four below knee and seven metatarsophalangeal disarticulations. The healing times, based on hospital days were average 16, 38, 43 days in the HBOT treated group and average 20, 50, 35 days in the non treated group respectively in Wagner grade II, III, IV. Conclusions: HBOT might be effective in decreasing amputation rate and hospital stay in diabetic patients with severe foot ulcers.

• 대한족부족관절학회지
• /
• 제16권4호
• /
• 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.

• 대한족부족관절학회지
• /
• 제24권4호
• /
• pp.142-147
• /
• 2020

Purpose: Diabetic foot ulcers are closely related to body surface heat, which can be affected easily by temperature differences. This study examined the correlation between the healing process of diabetic wounds and abnormal diurnal temperature through an animal study. Materials and Methods: Rats in the abnormal diurnal temperature group and control group were given a 10 mm sized full-thickness skin ulcer. Wound size progression was observed in both groups. H&E and Masson's trichrome staining was performed at 14 days after wound formation, and the number of vessels per unit area and histology analysis were performed. The changes in the ulcer were measured through three dimensional cross-section area using INSIGHT^® devices. Results: The wound recovery period (granulation ingrowing) was 24 days in the abnormal diurnal temperature model and 20 days in the control group. The thickness of scar tissue was 402±23.19 ㎛ in the control group and 424.5±36.94 ㎛ in the diurnal temperature model. Neovascular formation was counted as 5.1±0.97 for the control group and 4.16±0.94 for the diurnal temperature model group. Conclusion: Delayed and inferior diabetic wound healing was observed in the abnormal diurnal temperature group, which was characterized by greater diurnal variations than the typical growth environment.

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

• Journal of Yeungnam Medical Science
• /
• 제40권4호
• /
• pp.343-351
• /
• 2023

Diabetic foot is one of the most devastating consequences of diabetes, resulting in amputation and possibly death. Therefore, early detection and vigorous treatment of infections in patients with diabetic foot are critical. This review seeks to provide guidelines for the therapy and rehabilitation of patients with moderate-to-severe diabetic foot. If a diabetic foot infection is suspected, bacterial cultures should be initially obtained. Numerous imaging studies can be used to identify diabetic foot, and recent research has shown that white blood cell single-photon emission computed tomography/computed tomography has comparable diagnostic specificity and sensitivity to magnetic resonance imaging. Surgery is performed when a diabetic foot ulcer is deep and is accompanied by bone and soft tissue infections. Patients should be taught preoperative rehabilitation before undergoing stressful surgery. During surgical procedures, it is critical to remove all necrotic tissue and drain the inflammatory area. It is critical to treat wounds with suitable dressings after surgery. Wet dressings promote the formation of granulation tissues and new blood vessels. Walking should begin as soon as the patient's general condition allows it, regardless of the wound status or prior walking capacity. Adequate treatment of comorbidities, including hypertension and dyslipidemia, and smoking cessation are necessary. Additionally, broad-spectrum antibiotics are required to treat diabetic foot infections.

• 대한족부족관절학회지
• /
• 제9권1호
• /
• pp.26-30
• /
• 2005

Purpose: To evaluate the precipitating factors of amputation as initial treatment in diabetic foot patients. Materials and Methods: Between March, 1994 and February 2003, 41 cases (37 patients) diabetic foot patients who had diabetic ulcer, pyogenic inflammation and gangrene and followed up over 1 year were collected. Among them, We evaluate the precipitating factors of amputation for average 39.6months (12-118months). Results: Among many factors, Wagner classification, pulse volume recording of toes, Ankle-Brachial Index and Albumin level are statistically significant in amputation patients. Conclusion: In determining the amputation of diabetic foot as initial treatment, the trauma history, circulation of foot and serum albumin level are important precipitating factors. So the education about preventing even minor trauma and maintaining good nutrition state decrease the amputation rate in diabetic foot patients.