• Archives of Plastic Surgery
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• v.51 no.3
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• pp.332-336
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• 2024

Reconstructive surgeons face challenges when considering limb salvage methods for the treatment of diabetic foot ulcers (DFUs). In this article, we present our experience with autologous fat grafting as a viable alternative in cases where flap reconstruction is difficult. We encountered a 78-year-old female patient with a nonhealing DFU who had multiple comorbidities, including renal failure and severe peripheral arterial disease. During the initial multidisciplinary meeting, due to extensive necrosis and osteomyelitis, amputation was recommended. However, the patient expressed a strong preference for a salvage procedure and refused amputation. After careful consideration, we opted to reconstruct the patient's foot using three-dimensional bioprinted autologous minimally manipulated homologous adipose tissue. The AMHAT was engrafted well without complications such as autolysis, graft failure, or infection. After the operation, the large defect with partial bone exposure was covered with healthy granulation tissue. The size of the wound decreased to less than half its original size after 6 weeks of surgery, and it decreased to less than 25% after 12 weeks of surgery. The AMHAT may be an appealing treatment option for diabetic foot patients who are unsuitable for flap reconstruction due to comorbidities.

• Journal of Microbiology and Biotechnology
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• v.26 no.2
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• pp.408-420
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• 2016

This study proposes an alternative approach for the use of chitosan silver-based dressing for the control of foot infection with multidrug-resistant bacteria. Sixty-five bacterial isolates were isolated from 40 diabetic patients. Staphylococcus aureus (37%) and Pseudomonas aeruginosa (18.5%) were the predominant isolates in the ulcer samples. Ten antibiotics were in vitro tested against diabetic foot clinical bacterial isolates. The most resistant S. aureus and P. aeruginosa isolates were then selected for further study. Three chitosan sources were tested individually for chelating silver nanoparticles. Squilla chitosan silver nanoparticles (Sq. Cs-Ag⁰) showed the maximum activity against the resistant bacteria when mixed with amikacin that showed the maximum synergetic index. This, in turn, resulted in the reduction of the amikacin MIC value by 95%. For evaluation of the effectiveness of the prepared dressing using Artemia salina as the toxicity biomarker, the LC₅₀ was found to be 549.5, 18,000, and 10,000 μg/ml for amikacin, Sq. Cs-Ag⁰, and dressing matrix, respectively. Loading the formula onto chitosan hydrogel dressing showed promising antibacterial activities, with responsive healing properties for the wounds in normal rats of those diabetic rats (polymicrobial infection). It is quite interesting to note that no emergence of any side effect on either kidney or liver biomedical functions was noticed.

• Journal of Korean Foot and Ankle Society
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• v.6 no.1
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• pp.35-39
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• 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.

• 대한족부족관절학회:학술대회논문집
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• 2008.11a
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• pp.21-21
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• 2008

• Journal of Korean Foot and Ankle Society
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• v.17 no.3
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• pp.209-214
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• 2013

Purpose: To evaluate correlation between the clinical results and causative bacteria in diabetic foot patients with lower extremity amputation. Materials and Methods: One hundred twenty nine patients(131 feet) of diabetic foot amputations were followed for more than one year. Wound cultures were done by deep tissue or bone debris at first visit to our clinics. Retrospective analysis was performed using chart review and interview with the patients. Depending on the culture result, level of amputation, reinfection, duration of treatment, death rate, patient satisfaction and admission dates were evaluated. Results: Microorganisms were confirmed in 114 cases. In the other 17 cases, there were no cultured microorganisms. In bacterial growth group, Methicillin-sensitive Staphylococcus aureus was the most common pathogen and accounted for 34 cases. As other common pathogens, there were Methicillin-resistant Staphylococcus aureus(24 cases) and mixed infection(14 cases). Mortality is no difference in each infected group. Mixed bacterial infected patients have higher reinfection, longer hospital day and duration of treatment, but there is no difference in patients satisfaction and pain at last follow up. Conclusion: The most common pathogen in diabetic foot patients with lower extremity amputation was Methicillin-sensitive Staphylococcus aureus, and mixed bacterial infected patients have higher reinfection rate, longer admission date and duration of treatment than other bacterial infected patients.

• Journal of Korean Foot and Ankle Society
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• v.23 no.4
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• pp.208-211
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• 2019

Diabetic foot ulcers can progress to the point where amputation is needed, and so these ulcers require active treatment. Skin grafts or flaps can be performed for coverage of this type of ulcer. Local flap surgery is relatively easy to perform and good results have been previously reported. We performed single-lobed rotation flap on 5 cases of forefoot ulcer around the site of weight bearing. The location of the foot ulcers was the medial part of the first metatarsophalangeal joint in all the patients. The mean size of the defect was 4.70 ㎠. Managing of ulcers, controlling of diabetes and infection, and improving of peripheral blood flow were performed before surgery. In two cases, infection progressed to the articular cartilage and so metatarsophalangeal joint fusions were performed simultaneously. All the cases were completely transplanted. There was no recurrence of the ulcers, and all the patients were able to walk.

• Journal of Korean Foot and Ankle Society
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• v.5 no.1
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• pp.23-27
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• 2001

It has been known that the ankle arthrodesis is a common surgical procedure for treating the ankle arthrosis and deformity that do not respond to the non-operative treatment. To date, various surgical techniques for the ankle arthrodesis have been reported. Clinical and biomechanical trials have shown that the rigid internal fixation leads the increased rate of the union. The ankle arthrodesis may be complicated with the nonunion, delayed union, malunion, and infection. In cases of the Charcot joint of the ankle in diabetic patients, however, arthrodesis could reduce the disadvantage of the nonoperative treatment, such as the loss of the reduction, progressive collapse, multiple ulcerations and infection. The object of this case report is to report our experience of a successful ankle arthrodesis using an anterior T plate in treating the unstable ankle of a diabetic patient, associated with the ankle fracture and the neuropathy. The surgical approach of this technique is simple so that it would allow less soft tissue injury, and this procedure would be regarded as one alternative to provide the rigid internal fixation in the ankle arthrodesis.

• Journal of Korean Foot and Ankle Society
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• v.15 no.4
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• pp.232-239
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• 2011

Purpose: Diabetic foot ulcer is one of the most important diabetic complications because it increases the risk of amputations. Moreover, it lowers the quality of patients' life and increases the social medical expenses. Authors analyzed risk factors of intractable diabetic foot ulcer using retrospective study. Materials and Methods: From January 2007 to December 2010, 40 patients who could not achieve complete healing despite more than 12 weeks of proper management among who had been diagnosed and treated as diabetic foot ulcer at our hospital were included and evaluated retrospectively. We compared the risk factors between two groups who were finally treated by amputation and non-amputation. Results: The sample was composed of 31 male patients (77.5%) and 9 female patients (22.5%). Comorbidity including hypertension and hyperlipidemia were 77.5% and 80% each. By Wagner classification, 30 patients (80%) had ulcerative lesion over the grade 3. From bacteriology results, 29 patients (72.5%) had polybacteria infection. 35 patients (87.5%) had neuropathy and 26 patients (65%) had vascular stenosis at least one level. The mean initial ankle-brachial index and toe-brachial index were 0.982 and 0.439. In comparison between amputation group and non-amputation group, ulcer severity, number of stenotic vessel and initial ankle-brachial index/toe-brachial index had statistical significance. Conclusion: The most commonly risk factor of intractable diabetic foot ulcer was peripheral neuropathy reaching 87.5% of cases. In comparison with non-amputation group, ulcer severity according to Wagner classification, number of stenotic vessel and initial ankle-brachial index/toe-brachial index were demonstrated as a risk factor of amputation in intractable diabetic foot ulcer.

• Journal of Korean Foot and Ankle Society
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• v.23 no.2
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• pp.58-66
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• 2019

Purpose: To evaluate the efficacy of antibiotic-loaded cement spacers (ALCSs) for the treatment of diabetic foot infections with osteomyelitis as a salvage procedure and to analyze the risk factors of treatment failure. Materials and Methods: This study reviewed retrospectively 39 cases of diabetic foot infections with osteomyelitis who underwent surgical treatment from 2009 to 2017. The mean age and follow-up period were $62{\pm}13years$ and $19.2{\pm}23.3months$, respectively. Wounds were graded using the Wagner and Strauss classification. X-ray, magnetic resonance imaging (or bone scan) and deep tissue cultures were taken preoperatively to diagnose osteomyelitis. The ankle-brachial index, toe-brachial index (TBI), and current perception threshold were checked. Lower extremity angiography was performed and if necessary, percutaneous transluminal angioplasty was conducted preoperatively. As a surgical treatment, meticulous debridement, bone curettage, and ALCS placement were employed in all cases. Between six and eight weeks after surgery, ALCS removal and autogenous iliac bone graft were performed. The treatment was considered successful if the wounds had healed completely within three months without signs of infection and no additional amputation within six months. Results: The treatment success rate was 82.1% (n=32); 12.8% (n=5) required additional amputation and 5.1% (n=2) showed delayed wound healing. Bacterial growth was confirmed in 82.1% (n=32) with methicillin-resistant Staphylococcus aureus being the most commonly identified strain (23.1%, n=9). The lesions were divided anatomically into four groups; the largest number was the toes: (1) toes (41.0%, n=16), (2) metatarsals (35.9%, n=14), (3) midfoot (5.1%, n=2), and (4) hindfoot (17.9%, n=7). A significant difference in the Strauss wound score and TBI was observed between the treatment success group and failure group. Conclusion: The insertion of ALCSs can be a useful treatment option in diabetic foot infections with osteomyelitis. Low scores in the Strauss classification and low TBI are risk factors of treatment failure.

• Journal of Korean Foot and Ankle Society
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• v.10 no.2
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• pp.250-254
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• 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.