• Archives of Plastic Surgery
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• v.36 no.5
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• pp.548-554
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• 2009

Purpose: To evaluate clinical efficacy and safety of hyaluronic acid based autologous dermal fibroblasts (Hyalograft 3D) in the treatment of diabetic foot ulcers. Methods: A total of 28 patients with diabetic ulcers were randomized to either the control group with nonadherent foam dressings(n=14) or the treatment group with autologous tissue - engineered grafts(n=14). Weekly assessment contained vital sign checks, ulcer size measurements, and wound photos. At 12th week, percentages of complete wound healing and mean healing times were compared. Safety was also monitored by adverse events. Results: Complete wound healing was achieved in 84.6% of the treatment group and 23.1% of the control group (p<0.005). The mean times of closures for the treatment versus control groups were 6.1 weeks and 10.9 weeks, respectively. No adverse events related to the study treatment occurred. Conclusion: The use of hyaluronic acid based autologous fibroblast grafts was found to be a safe and effective treatment for diabetic foot ulcers.

• Journal of Korean Foot and Ankle Society
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• v.26 no.1
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• pp.30-39
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• 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 Korean Foot and Ankle Society
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• v.17 no.4
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• pp.277-282
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• 2013

Purpose: This study was performed to evaluate the effectiveness of self-home dressing with nanocrystalline silver dressing method on the treatment of chronic ulcer wounds of the foot. Material and Methods: One hundred-nine patients with chronic foot ulcer due to various causes were treated with nanocrystalline silver dressing material. Dressing was done by themselves in their home. Dressing changes were performed every 2 to 3 days until complete reepithelization. Results: One hundred two cases of all cases had a complete reepithelization. It took 49 days to have a complete reepithelization on average. Seven cases failed to complete reepithelization because of infection. There was no silver intoxication in any cases. Conclusion: Using nanocrystalline silver is a useful dressing method for various superficial chronic ulcer and it can be done by themselves at their home. Thus it is considered to be more comfortable to both patients and doctors.

• Journal of Korean Foot and Ankle Society
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• v.26 no.2
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• pp.66-70
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• 2022

Purpose: A group of patients who were hospitalized for diabetic foot ulcers was classified according to the University of Texas Staging System for Diabetic Foot Ulcers, and we attempted to evaluate whether this staging system could be a criterion for treatment success using vacuum-assisted closure (VAC) technique. Materials and Methods: A total of 32 patients were diagnosed with diabetic foot ulcers according to the University of Texas Staging System for Diabetic Foot Ulcers. Of these, 24 patients who were evaluated as stage B according to the staging system were classified as Group 1, and 8 patients in stage D were classified as Group 2. After applying VAC, the treatment success rate was compared by evaluating the size and severity of ulcers between the two groups. Results: The grade of granulation after VAC was on average 3.75±0.53 in Group 1 and 2.25±0.71 in Group 2. There was better granulation after VAC application in Group 1 (p<0.01). The success rate of the treatment was 22 cases (91.67%) in Group 1 and one case (12.5%) in Group 2. Thus there were statistically significant differences in the success rate of treatment between groups 1 and 2 (Pearson's chisquare test, p=0.01; odd ratio 77.00, 95% confidence interval [CI] 1.26~14.66; relative risk 4.30, 95% CI 1.26~14.66). Conclusion: These results suggest that there was a higher success rate of treatment with VAC in stage B patients. The University of Texas Staging System for Diabetic Foot Ulcers can thus be an index for applying VAC to patients with infective diabetic foot ulcers.

• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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• v.30 no.4
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• pp.62-74
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• 2017

Objectives : The purpose of this study is to investigate the effect of laser therapy for diabetic ulcer by using methods of systematic review. Methods : In this review, PubMed, Cochrane library, Web of Science, CNKI, CiNii, J-STAGE, NDSL and OASIS were used as the search engines. The search period is from the start date of the search engine to October 3, 2016. Randomized controlled trials(RCTs) using laser therapy for diabetic ulcer were searched and extracted by two independent researchers. Risk of bias(RoB) of Cochrane was used to assess methodological quality of studies. Results : Finally, five RCTs were selected. The follow-up period ranged from 15 days to 20 weeks. InGaAlP laser, GaAlAs laser and light emitting diode(LED) were used to treat diabetic ulcer. The clinical trials used sham laser irradiation or standard treatment as control in comparison to laser therapy. The endpoints included ulcer size, rate of healing and time to healing with follow-up period. The RCTs demonstrated therapeutic outcomes with no adverse effect. Most items of RoB were unclear and methodological quality was low. Conclusions : Our analysis suggests that laser therapy has therapeutic effects for diabetic ulcer. However, more systematic and stringent clinical trials will be required.

• Archives of Plastic Surgery
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• v.35 no.5
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• pp.491-494
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• 2008

Purpose: When deciding a treatment plan in diabetic foot ulcer patients, predicting a possibility of healing wounds is important since not a few patients have poor general condition to get successful wound healing. This study was planned to find out if a serum collagen level can be used as a predictor for healing wounds in diabetic foot patients. Methods: Fifty-seven patients, who visited our clinic from January to June, 2007 for treatment of diabetic foot ulcers, were included in this study. Serum levels of type I collagen were checked using carboxy terminal type I propeptide kits. Simultaneously serum levels of vitamin C and iron, cofactors of collagen synthesis, were checked. The patients were divided into two groups; a group of successfully healed wounds and the other of unhealed wounds. Serum levels of the parameters were compared between the 2 groups. Results: The serum level of collagen was $197.65{\pm}86.26ng/ml$ in a healed group and $87.91{\pm}28.76ng/ml$ in the unhealed group(p<0.05). The serum iron and vitamin C levels were did not show significant differences. Conclusion: The serum collagen level may predict healing or nonhealing wounds in diabetic foot ulcers.

• Journal of Korean Foot and Ankle Society
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• v.10 no.1
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• pp.1-6
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• 2006

Purpose: To evaluate the clinical manifestations, the patterns and the functional outcome of the amputations due to the diabetic foot complications. Materials and Methods: Fifty patients (50 feet) of diabetic foot amputations were followed for more than 1 year. The mean age was 62.5 years, and the mean follow-up period was 46 months. Retrospective analysis was performed using chart review and interview with the patients. The outcome was assessed with modified AOFAS scale. Results: The diabetic foot lesions were infection in 45 feet, gangrene in 35 feet and ulcer in 15 feet. Toe amputation was most commonly performed procedure (23 cases) followed by below knee and ray amputation. Postoperative modified AOFAS score was average 51.5 points, and 94% were satisfied with outcome. Minor amputations showed better outcome than the major amputations. Conclusion: Overall postoperative functional outcome was encouraging with high patient satisfaction rate (94%). Better outcome was obtained with the minor amputations.

• Journal of Korean Foot and Ankle Society
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• v.8 no.1
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• pp.16-21
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• 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.

• Journal of Korean Foot and Ankle Society
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• v.24 no.4
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• pp.142-147
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• 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.

• Journal of Korean Foot and Ankle Society
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• v.8 no.1
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• pp.26-30
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• 2004

Purpose: The infected diabetic foot patients were reviewed to analyze the result of new dressing methods using a wall-suction instruments. Materials and Methods: Eighteen patients treated with wall-suction assisted vacuum dressing were included. After debridement under local anesthesia, a sponge pad, a drain, and a surgical drape were used to seal the wound. Negative pressure applied by the wall-suction at around 200 mmHg and dressing were repeated in every two to three days. The results of repeated wound cultures, growth of granulation tissues, and CRP level were closely observed on the regular basis. Results: Rapid growth of granulation tissues was noticed around the wound in 16 cases. No organism was obtained in an average 5 days and wound coverage was possible in an average 18 days. The CRP level returned to normal in an average 4 weeks. Two patients with end stage renal disease, who were regularly hemodialised, underwent major amputation. Conclusion: New dressing method has the following advantages: a rapid wound improvement in the patients with infected diabetic foot, less expensive, less painful, impediment of bacterial contamination in the hospital room. However, further study will be needed for the end stage renal disease patients.