• Archives of Plastic Surgery
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• v.38 no.5
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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.

• Archives of Plastic Surgery
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• v.49 no.2
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• pp.258-265
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• 2022

Background Chitosan (CS) is a well-known antimicrobial dressing material. Moreover, widely used amniotic membranes contain growth factors beneficial for wound healing. Herein, we created a novel amnion-conjugated CS-alginate membrane dressing and tested its wound healing potency in a diabetic swine model. Methods The bovine amniotic powder growth factor contents were evaluated by protein assay, and the powder's wound healing effects were assessed in vitro by HaCaT cell scratch closure. In vivo, two minipigs developed streptozotocin-induced diabetes. Serial serum glucose measurements and intravenous glucose tolerance tests were performed to confirm their diabetic status. Twelve square-shaped wounds created on each pig's back were randomly divided into control (n = 4), CS (n = 4), and amnion-CS (AC; n = 4) groups and treated accordingly with different dressings. Wound healing in each group was assessed by measuring wound contraction over time, capturing wound perfusion with indocyanine green (ICG) angiography, and histologically analyzing inflammatory markers. Results Amniotic powder elution promoted HaCaT cell migration in the scratch wound model, suggesting its beneficial in vitro wound healing effects. In vivo, the CS and AC groups showed earlier wound contraction initiation and reepithelialization and earlier wound perfusion improvement by ICG angiography than the control group. Additionally, the wound size of the AC group at week 3 was significantly smaller than those in the control group. There was no significant difference in the numbers of acute and chronic inflammatory cells between the groups. Conclusion The amnion-conjugated CS-alginate membrane, as well as CS dressing alone, could be a favorable dressing option for diabetic wounds.

• Journal of the Korean Academy of Clinical Electrophysiology
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• v.1 no.1
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• pp.87-100
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• 2003

The present studies have been designed to evaluate the effect of acute wound healing that frequency and intensity of pulsed ultrasound application in diabetic rat. Mild diabetes mellitus was induced in rat with 45 mg/kg streptozotocin. The results were analyzed and summarized as follows: 1. The rate of wound length on ultrasonic capacity in $1.0\;W/cm^2$ $SATA_i$ group was more significantly decreased than $0.5\;W/cm^2$ $SATA_i$ group. 2. In the histological change, the $1.0\;W/cm^2$ $SATA_i$ application group was more effective than $0.5\;W/cm^2$ $SATA_i$ group, decrease of inflammatory cell was significantly in several groups. From the conclusions above, in this study application of 3 MHz pulsed ultrasound in acute wound healing, $1.0\;W/cm^2$ $SATA_i$ capacity can be an effective way of promotion wound healing than $0.5\;W/cm^2$ $SATA_i$ capacity in diabetic rat.

• Archives of Plastic Surgery
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• v.34 no.3
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• pp.285-290
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• 2007

Purpose: Many clinical trials have shown the effectiveness of platelet releasate on chronic wounds. However, a large volume of blood must be aspirated from a patient and a platelet separator is required. Here, we hypothesized that platelet concentrate obtained from a blood bank (PCBB) would be also effective at stimulating wound healing. The purpose of this study was to investigate the effectiveness of PCBB on accelerating healing of diabetic wounds in vivo. Methods: Round wounds of 5 mm diameter were made at four sites(two wounds on the left and two on the right side) on the backs of nine diabetic mice. Three hundred million platelets suspended in 0.05 ml fibrinogen were dispersed on each wound on left sides. Same amount of fibrinogen without platelets was dispersed on right side control wounds. Thereafter, 0.05 ml thrombin was applied to the each wound. Ten days after wound treatment, healed wounds were excised and the extent of wound healing in each group was compared. Results: Quantitative histologic analysis of epithelial gap distances revealed that PCBB treatment had greatly accelerated wound healing. Mean epithelial gap distances for PCBB treated and control wounds were $2.5{\times}0.6mm\;and\;3.6{\times}0.5mm$, respectively(p<0.05). Conclusion: Our results suggest that PCBB has potential to accelerate the healing of diabetic wounds.

• Biomolecules & Therapeutics
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• v.18 no.3
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• pp.329-335
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• 2010

The extract from Hydnocarpi Semen (HS) has been used to treat leprosy and its anti-inflammatory activity has been reported. However, the effect of HS on the treatment of diabetic or peripheral ulcer is not well known. We therefore examined its wound healing effects on ulcer area in diabetic mice. GC and GC/MS analysis with the total extract of HS show that the main constituents of the extract are chaulmoogric acid, hydnocarpic acid, and gorlic acid. Whereas HS showed wound healing effect in diabetic ulcer, there was no hypoglycemic effect in diabetic mice. The treatment of HS extract significantly decreased the level of total WBC and neutrophils in mice compared to control mice. Cutting ulcer was induced by the round-shaped punch on the backside of diabetic mice and the extract of HS was given orally or topically. The wound area score significantly decreased after treatment of HS at dose of 50 mg/kg. The treatment of HS also induced the activation of macrophages and increased the production of IL-12 and TNF-$\alpha$ in macrophages, indicating that the wound healing by HS extract is associated with the inflammatory effect via the activation of macrophages. Our results suggest that HS extract can be a new therapeutic candidate for treatment of diabetic ulcer.

• Korean Journal of Clinical Laboratory Science
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• v.40 no.2
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• pp.118-128
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• 2008

The aim of this study was to investigate the effect of electrical stimulation on healing of impaired wound and alteration of mast cells in experimental diabetic rats. Thirty male Sprague-Dawley rats were divided into three groups : incision (control), diabetes+incision (diabetes) and diabetes + incision + electrical stimulation (D/ES). Diabetes was induced in rats by streptozotocin (STZ) injection (60 mg/kg, one time) and 20 mm length incision wounds were created on the back after shaving hair. The electrical stimulation rats were treated with a current intensity of 30~50 V at 120 pps and $140{\mu}s$ for 10 days from 3 days after STZ injection. The lesion and adjacent skin tissues were fixed with 10% buffered formalin, embedded with paraffin. For wound healing analysis, hematoxylin-eosin (HE) and picrosirius red staining were performed. Mast cells (MC) were stained with toluidine blue (pH 0.5) and quantified at ${\times}200$ using a light microscope. The density of keratinocyte proliferation and microvessels in skin tissues were analyzed using a computerized image analysis system on sections immunostained with proliferative cell nuclear antigen (PCNA) and ${\alpha}$-smooth muscle actin (${\alpha}$-SMA), respectively. The results showed that the wound healing rate, collagen density and neoepidermis thickness, density of PCNA-positive cells and density of ${\alpha}$-SMA-positive vessels were significantly higher in D/ES rats than in diabetic rats. The density of MCs and degranulated MCs in D/ES rats were also significantly higher than those in diabetic rats. These findings suggest that the electrical stimulation may promote the tissue repair process by accelerating collagen production, keratinocyte proliferation and angiogenesis in the diabetic rats, and MCs are required for wound healing of skin in rats.

• Archives of Plastic Surgery
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• v.39 no.2
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• pp.106-112
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• 2012

Background : Complicated diabetic patients show impaired, delayed wound healing caused by multiple factors. A study on wound healing showed that platelet-rich plasma (PRP) was effective in normal tissue regeneration. Nonetheless, there is no evidence that when platelet-rich plasma is applied to diabetic wounds, it normalizes the diabetic wound healing process. In this study, we have analyzed matrix metalloproteinase (MMP)-2, MMP-9 expression to investigate the effect of PRP on diabetic wounds. Methods : Twenty-four-week-old male Otsuka Long-Evans Tokushima Fatty rats were provided by the Tokushima Research Institute. At 50 weeks, wounds were arranged in two sites on the lateral paraspinal areas. Each wound was treated with PRP gel and physiologic saline gauze. To determine the expression of MMP-2, MMP-9, which was chosen as a marker of wound healing, reverse transcription polymerase chain reaction (RT-PCR) was performed and local distribution and expression of MMP-2, MMP-9 was also observed throughout the immunohistochemical staining. Results : RT-PCR and the immunohistochemical study showed that the levels of MMP-2, MMP-9 mRNA expression in PRP applied tissues were higher than MMP-2, MMP-9 mRNA expression in saline-applied tissues. MMP-9 mRNA expression in wounds of diabetic rats decreased after healing began to occur. But no statistical differences were detected on the basis of body weight or fasting blood glucose levels. Conclusions : This study could indicate the extracellular matrix-regulating effect observed with PRP. Our results of the acceleration of wound healing events by PRP under hyperglycemic conditions might be a useful clue for future clinical treatment for diabetic wounds.

• Archives of Plastic Surgery
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• v.35 no.4
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• pp.355-359
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• 2008

Purpose: Oncostatin M(OSM) has been known as a role in fibrosis and anti-inflammatory effects of various organs and tissues. Although there have been a number of studies which are focused on the roles and mechanisms of OSM, there are few reports on its effects in chronic wound healing. The purpose of this study is to evaluate the effects of OSM in wound healing activities of dermal fibroblasts of chronic wound in vitro. In particular, this study is focused on cell proliferation and synthesis of collagen and glycosaminoglycan(GAG), which are the major components of the extracellular matrices, of diabetic fibroblasts. Methods: Fibroblasts were isolated from excess skin that was obtained from diabetic foot ulcer patients who underwent debridement. The isolated fibroblasts were cultivated in presence of OSM(100 ng/mL). Cell proliferation, collagen synthesis and GAG levels were compared. Results: All the components tested in this study increased in OSM treatment group. In particular, collagen and GAG synthesis demonstrated statistically significant increases(p<0.05 in the Mann-Whitney U-test). Conclusion: These results indicate that OSM increases wound healing activities of dermal fibroblasts of chronic wound in vitro.

• Journal of Korean Foot and Ankle Society
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• v.26 no.2
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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.

• Biomedical Science Letters
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• v.16 no.4
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• pp.365-376
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• 2010

The purpose of this study was to clarify the effect of light emitting diode (LED) irradiation on healing of impaired wound and alteration of mast cells in experimental diabetic rats. Twenty-four male Sprague-Dawley rats were divided into four groups: excision (Ex), excision-LED irradiation (Ex-LED), diabetes + excision (DM) and diabetes + excision + LED irradiation (DM-LED). Diabetes was induced in rats by streptozotocin (STZ) injection (70 mg/kg, single dose) and 6 mm punch excision wounds were created on the back after shaving hair. The LED-irradiated rats were treated to a daily dose of $5\;J/cm^2$ LED (630 nm) light for 11 days after surgery, and were killed at day 1, 3, 7 and 11. The lesion and adjacent skin tissues were excised, fixed with 10% buffered formalin and embedded with paraffin. For evaluation of wound healing, hematoxylin-eosin (HE) and Masson trichrome staining were performed. Mast cells (MCs) were stained with toluidine blue (pH 0.5) and quantified using a computerized image analysis system. The proliferation activity of keratinocyte in skin tissues was analyzed on sections immunostained with proliferative cell nuclear antigen (PCNA). The results showed that wound healing rate, collagen density and neo-epidermis length, number of PCNA-positive cells, fibroblasts and mast cells were significantly higher in the LED-irradiated rats than in the DM and Ex rats throughout the periods of experiment. Exceptionally, the number of MCs was significantly lower at day 11 compared with day 7 after surgery in the all groups. These findings suggest that the LED irradiation may promote the tissue repair process by accelerating keratinocyte and fibroblast proliferation and collagen production in normal rats as well as in diabetic rats, and MCs may play an important role at an early stage of skin wound healing in normal and diabetic rats.