Foot Ulcers Research Articles

Fillet Flap For Non-Healing Ulcer Of Foot Revisited

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Molecular characterization of chronic cutaneous wounds reveals subregion- and wound type-specific differential gene expression.

A limited understanding of the pathology underlying chronic wounds has hindered the development of effective diagnostic markers and pharmaceutical interventions. This study aimed to elucidate the molecular composition of various common chronic ulcer types to facilitate drug discovery strategies. We conducted a comprehensive analysis of leg ulcers (LUs), encompassing venous and arterial ulcers, foot ulcers (FUs), pressure ulcers (PUs), and compared them with surgical wound healing complications (WHCs). To explore the pathophysiological mechanisms and identify similarities or differences within wounds, we dissected wounds into distinct subregions, including the wound bed, border, and peri-wound areas, and compared them against intact skin. By correlating histopathology, RNA sequencing (RNA-Seq), and immunohistochemistry (IHC), we identified unique genes, pathways, and cell type abundance patterns in each wound type and subregion. These correlations aim to aid clinicians in selecting targeted treatment options and informing the design of future preclinical and clinical studies in wound healing. Notably, specific genes, such as PITX1 and UPP1, exhibited exclusive upregulation in LUs and FUs, potentially offering significant benefits to specialists in limb preservation and clinical treatment decisions. In contrast, comparisons between different wound subregions, regardless of wound type, revealed distinct expression profiles. The pleiotropic chemokine-like ligand GPR15L (C10orf99) and transmembrane serine proteases TMPRSS11A/D were significantly upregulated in wound border subregions. Interestingly, WHCs exhibited a nearly identical transcriptome to PUs, indicating clinical relevance. Histological examination revealed blood vessel occlusions with impaired angiogenesis in chronic wounds, alongside elevated expression of genes and immunoreactive markers related to blood vessel and lymphatic epithelial cells in wound bed subregions. Additionally, inflammatory and epithelial markers indicated heightened inflammatory responses in wound bed and border subregions and reduced wound bed epithelialization. In summary, chronic wounds from diverse anatomical sites share common aspects of wound pathophysiology but also exhibit distinct molecular differences. These unique molecular characteristics present promising opportunities for drug discovery and treatment, particularly for patients suffering from chronic wounds. The identified diagnostic markers hold the potential to enhance preclinical and clinical trials in the field of wound healing.

What lies beneath a maggot infestation of an ulcerated foot wound?

We present here the case of a 55-year-old male patient with a past medical history of HIV infection on appropriate antiretroviral therapy (Bictegravir/Emtricitabine/Tenofovir Alafenamide), previously treated for hepatitis C with sustained viral response, who was diagnosed with squamous cell cancer of his right hand 2 years before, and treated with carboplatin and taxol, and surgery (partial amputation) for cancer progression and recurrent infections. He presented to our emergency department for worsening pain (NRS 10/10) of a suppurative and foul-smelling interdigital ulcerated lesion of his left foot, that had been present for 3 months. He reported 100% adherence to his HIV therapy and denied fever or chills. Initial work-up showed 10,690/mm3 leukocytes (8,240/ mm3 neutrophils, 1,560/mm3 lymphocytes), and a C-reactive protein of 2.89 mg/dL (normal value 0-0.5). CD4 count on presentation was 225 cells/µL. The patient was immediately treated with morphine (10 mg iv) and piperacillin/tazobactam (4.5 gr iv). The lesion presented erythematous ulcerated bleeding surface with serous and fetid secretion on which mobile larvae were found inside (as showed in the video). We removed about 20 maggots with blunt pliers, identified as larvae of Musca domestica (housefly).

CPC14 A truly VEXing diagnosis

Abstract A 50-year-old man with a background of prostate cancer was admitted with fever, weight loss, polyarthritis, symptomatic anaemia and raised inflammatory markers. Multiple tender indurated violaceous plaques on the trunk and limbs were suggestive of Sweet syndrome. Skin biopsies revealed a neutrophilic dermal infiltrate and a pandermal vasculitis affecting small vessels. Laboratory screening (including rheumatoid factor, anticyclic citrullinated peptide, antinuclear antibody, antineutrophil cytoplasm antibodies, HIV, hepatitis B and C serology, antiphospholipid antibodies and cryoglobulins) was negative. Upper and lower endoscopies and gastrointestinal biopsies were normal. Biopsy of an axillary lymph node revealed reactive changes only. Computed tomography (CT) of the thorax, abdomen and pelvis showed sacroiliitis. A diffuse low signal on T1-weighted magnetic resonance imaging of his spine was suggestive of conversion of fatty marrow to red marrow. His cutaneous findings resolved fully with oral prednisolone 0.5 mg kg−1; however, he had ongoing transfusion-dependent anaemia and arthritis. Infliximab was started for presumed ankylosing spondylitis by rheumatology without improvement. Six months later, he was readmitted with multifocal ulceration of both feet. Histology demonstrated a leucocytoclastic vasculitis. He developed haemoptysis and chest pain. CT of the thorax showed multifocal, bilateral, ground–glass change consistent with pulmonary vasculitis. Bone marrow biopsy revealed hypercellular marrow with markedly increased granulopoiesis. A pathogenic missense mutation in UBA1 (c121A.G; pMet41Val) was found on next-generation sequencing of the bone marrow aspirate (Leeds Cancer Centre). Somatic variants at this codon have been implicated in vacuoles, E1 enzyme, X-linked, autoinflammatory and somatic (VEXAS) syndrome (Beck DB, Ferrada MA, Sikora KA et al. Somatic mutations in UBA1 and severe adult-onset autoinflammatory disease. N Engl J Med 2020; 383:2628–38). First described in 2020, VEXAS syndrome is a somatic monogenic autoinflammatory disorder of adulthood. Affected patients develop predominantly inflammatory and haematological symptoms. Cutaneous findings have been reported in up to 89% of cases (Georgin-Lavialle S, Terrier B, Guedon AF et al. Further characterization of clinical and laboratory features in VEXAS syndrome: large-scale analysis of a multicentre case series of 116 French patients. Br J Dermatol 2022; 186:564–74) and include neutrophilic dermatosis, vasculitis, urticaria, angioedema, erythematous papules and chondritis. Systemic manifestations are protean, but fever of noninfectious origin, weight loss, and ocular and pulmonary manifestations are most prevalent. Fifty per cent of patients with VEXAS have myelodysplastic syndrome (Georgin-Lavialle et al.). In our case, persistent haematological abnormalities coupled with multisystem inflammation (arthritis, vasculitis) prompted testing for VEXAS syndrome. This novel condition should be considered when assessing adult patients with neutrophilic dermatosis or cutaneous vasculitis who manifest other autoinflammatory phenomena. He was commenced on tocilizumab but, despite this, has ongoing acral vasculopathy.

Diabetic foot ulcer: A comprehensive review of pathophysiology and management modalities.

Diabetic foot ulcer (DFU) is a debilitating and severe manifestation of uncontrolled and prolonged diabetes that presents as ulceration, usually located on the plantar aspect of the foot. Approximately 15% of individuals with diabetes will eventually develop DFU, and 14%-24% of them will require amputation of the ulcerated foot due to bone infection or other ulcer-related complications. The pathologic mechanisms underlying DFU are comprise a triad: Neuropathy, vascular insufficiency, and secondary infection due to trauma of the foot. Standard local and invasive care along with novel approaches like stem cell therapy pave the way to reduce morbidity, decrease amputations, and prevent mortality from DFU. In this manuscript, we review the current literature with focus on the pathophysiology, preventive options, and definitive management of DFU.

SARS-CoV-2 Post-Infection and Sepsis by Saccharomyces cerevisiae: A Fatal Case Report—Focus on Fungal Susceptibility and Potential Virulence Attributes

The pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been responsible for approximately 6.8 million deaths worldwide, threatening more than 753 million individuals. People with severe coronavirus disease-2019 (COVID-19) infection often exhibit an immunosuppression condition, resulting in greater chances of developing co-infections with bacteria and fungi, including opportunistic yeasts belonging to the Saccharomyces and Candida genera. In the present work, we have reported the case of a 75-year-old woman admitted at a Brazilian university hospital with an arterial ulcer in the left foot, which was being prepared for surgical amputation. The patient presented other underlying diseases and presented positive tests for COVID-19 prior to hospitalization. She received antimicrobial treatment, but her general condition worsened quickly, leading to death by septic shock after 4 days of hospitalization. Blood samples collected on the day she died were positive for yeast-like organisms, which were later identified as Saccharomyces cerevisiae by both biochemical and molecular methods. The fungal strain exhibited low minimal inhibitory concentration values for the antifungal agents tested (amphotericin B, 5-flucytosine, caspofungin, fluconazole and voriconazole), and it was able to produce important virulence factors, such as extracellular bioactive molecules (e.g., aspartic peptidase, phospholipase, esterase, phytase, catalase, hemolysin and siderophore) and biofilm. Despite the activity against planktonic cells, the antifungals were not able to impact the mature biofilm parameters (biomass and viability). Additionally, the S. cerevisiae strain caused the death of Tenebrio molitor larvae, depending on the fungal inoculum, and larvae immunosuppression with corticosteroids increased the larvae mortality rate. In conclusion, the present study highlighted the emergence of S. cerevisiae as an opportunistic fungal pathogen in immunosuppressed patients presenting several severe comorbidities, including COVID-19 infection.

An investigation into the hammer toe effects on the lower extremity mechanics and plantar fascia tension: A case for a vicious cycle and progressive damage

Hammer toes are one of the common deformities of the forefoot that can lead to compensatory changes during walking in individuals with this condition. Predicting the adverse effects of tissue damage on the performance of other limbs is very important in the prevention of progressive damage. Finite element (FE) and musculoskeletal modeling can be helpful by allowing such effects to be studied in a way where the internal stresses in the tissue could be investigated. Hence, this study aims to investigate the effects of the hammer toe deformity on the lower extremity, especially on the plantar fascia functions. To compare the joint reactions of the hammer toe foot (HTF) and healthy foot (HF), two musculoskeletal models (MSM) of the feet of a healthy individual and that of a participant with hammer toe foot were developed based on gait analysis. A previously validated 3D finite element model which was constructed using Magnetic Resonance Imaging (MRI) of the diabetic participant with the hammer toe deformity was processed at five different events during the stance phase of gait.It was found that the hammer toe deformity makes dorsiflexion of the toes and the windlass mechanism less effective during walking. Specifically, the FE analysis results showed that plantar fascia (PF) in HTF compared to HF played a less dominant role in load bearing with both medial and lateral parts of PF loaded. Also, the results indicated that the stored elastic energy in PF was less in HTF than the HF, which can indicate a higher metabolic cost during walking. Internal stress distribution shows that the majority of ground reaction forces are transmitted through the lateral metatarsals in hammer toe foot, and the probability of fifth metatarsal fracture and also progressive deformity was subsequently increased. The MSM results showed that the joint reaction forces and moments in the hammer toe foot have deviated from normal, where the metatarsophalangeal joint reactions in the hammer toe were less than the values in the healthy foot. This can indicate a vicious cycle of foot deformity, leading to changes in body weight force transmission line, and deviation of joint reactions and plantar fascia function from normal. These in turn lead to increased internal stress concentration, which in turn lead to further foot deformities. This vicious cycle cause progressive damage and can lead to an increase in the risk of ulceration in the diabetic foot.

Factors Associated with Infection Severity of Diabetic Foot Ulcers: A Cross-Sectional Study.

Background: Infection in the ulcerated foot is a foremost cause of morbidity, constituting the biggest proportion of hospitalization and amputation among patients with diabetic foot ulcers. Assessment of infection severity lays a foundation for making treatment decisions, for which the IDSA/IWGDF classification is recommended. Different factors may cause various severity of infection. However, few investigations have been conducted concerning factors associated with infection severity of diabetic foot ulcers. Objective: To investigate factors associated with infection severity of diabetic foot ulcers. Methods: This cross-sectional study involved 150 subjects hospitalized in the Department of Endocrinology of Sun Yat-sen Memorial Hospital in Guangdong Province between July 2020 and September 2021. The IDSA/IWGDF classification was adopted to assess ulcer infection severity. Demographic and disease information, laboratory reports, and ulcer assessment results were evaluated for an association with the infection severity. The generalized linear model was performed to conduct multivariate analyses of the factors associated with the severity of foot infection. Results: The prevalence of mild, moderate, and severe infected diabetic foot was 23.3%, 64.7% and 10.2%, respectively. The results of generalized linear models showed a correlation between Alb (OR = -1.74, 95%CI1.12-6.58, p = .023), CRP (OR = 2.13, 95%CI1.38-7.21, p = .014), PCT (OR = 2.01, 95%CI1.29-7.64, p = .013), microbial type (OR = 2.04, 95%CI1.43-7.83, p = .004) and ulcer infection severity. Conclusion: Alb, CRP, PCT and microbial type were among the factors influencing infection severity of diabetic foot ulcers.

Bacteriological Profile of Diabetic Ulcer Foot and Their Antimicrobial Susceptibility Pattern in a Tertiary Care Hospital, Trichy

Background: Wound infections are the major factor for development of diabetic foot ulcer.Objectives: To identify the prevalence of aerobic bacterial isolates and its antimicrobial susceptibility pattern in diabetic foot ulcer patients.Methods: The Prospective observational study was undertaken from July 16th to September 16th 2017 in tertiary care teaching Hospital, Tiruchirappalli, Tamilnadu.Result: Seventy-three (73) organisms were isolated from 63 diabetic foot ulcer patients. Staphylococcus aureus (26%), E. coli (19.2%) and Pseudomonas aeruginosa (19.2%) were isolated. MRSA with 53% were showed 100% sensitivity to vancomycin, linizolid and teicoplanin. By phenotypic Confirmatory Disc Diffusion Test, 57.1% of E. coli were ESBL producers whereas 50% of Klebsiella species were ESBL producers. All ESBL producers showed 100% sensitivity to imipenem.Interpretation and Conclusion: The microbiological report helps for initiating the narrow spectrum antibiotic therapy and reduce the emergence of multidrug resistant organisms.

ODP186 Difficulties in diagnosing MODY: clinical case

Abstract Background MODY is one of the monogenic forms of diabetes mellitus, which includes 14 subtypes with different course and clinical picture. Final clinical diagnosis involves a molecular genetic study and is a key factor in successful treatment. Clinical case. Patient P., 33 years old, complained of aggravation of the condition after and during the dialysis procedure: general weakness, blood pressure rose to 220 mmHg, after the procedure a drop to 110-120 mmHg, lack of effect from hypertensive drugs, headaches. In 2004, type 1 diabetes mellitus was diagnosed based on complaints of polydipsia, polyuria, and fasting glycemia up to 9 mmol/l. Basic bolus insulin therapy was prescribed. Patient noted a frequent development of hypoglycemic conditions and independently canceled insulin therapy. For a long time the patient went without hypoglycemic therapy. In 2016, baseline insulin therapy was prescribed again, which resulted with frequent episodes of hypoglycemia resuming. In 2019, a diagnosis of MODY type 3 was made without medical and genetic counseling. Due to the high level of C-peptide 3057.1 pmol /L (160-1100), Repaglinide 0.5 mg was prescribed to be taken 3 times a day. Against the background of this treatment, compensation and stabilization of the condition has been observed. Family history: the mother has diabetes mellitus since the age of 22, manifested during pregnancy; receives Glibenclamide with a positive effect. Since 2011, diabetic distal sensorimotor polyneuropathy of the upper and lower extremities, diabetic foot syndrome, neuropathic form have been identified. Ulcerative defect of the I degree. Long-term non-healing trophic ulcer of the right foot for 6 years. In 2016, chronic kidney disease C5 A3 was detected. At the moment, the patient is on program dialysis. Complications of nephropathy were verified – secondary hyperparathyroidism, osteoporosis, moderate nephrogenic anemia, symptomatic nephrogenic arterial hypertension of grade 3, risk 4. In 2018, proliferative diabetic retinopathy of both eyes was detected. Total recurrent hemophthalmos of the right eye, subtotal hemophthalmos of the left eye. In 2021, autonomic neuropathy, gastrointestinal form and autonomic cardiovascular form were verified. The patient underwent a molecular genetic study for the identification of pathogenic mutations in the HNF1A gene, however, according to the study, mutations in the HNF1A gene were not detected. Thus, the diagnosis of MODY type 3 has not been confirmed. It is necessary to conduct a further diagnostic search for the type of MODY in order to make a final diagnosis. Conclusion This clinical case demonstrates the importance of a personalized approach to each patient, as well as conducting a molecular genetic study to make a final clinical diagnosis and prescribe timely pathogenetic therapy. Presentation: No date and time listed

Proteomic Analysis of Exudates from Chronic Ulcer of Diabetic Foot Treated with Scorpion Antimicrobial Peptide.

Scorpion peptides have good therapeutic effect on chronic ulcer of diabetic foot, but the related pharmacological mechanism has remained unclear. The different proteins and bacteria present in ulcer exudates from chronic diabetic foot patients, treated with scorpion antimicrobial peptide at different stages, were analyzed using isobaric tags for quantification-labeled proteomics and bacteriological methods. According to the mass spectrometry data, a total of 1865 proteins were identified qualitatively, and the number of the different proteins was 130 (mid/early), 401 (late/early), and 310 (mid, late/early). In addition, functional annotation, cluster analysis of effects and the analysis of signal pathway, transcription regulation, and protein-protein interaction network were carried out. The results showed that the biochemical changes of wound microenvironment during the treatment involved activated biological functions such as protein synthesis, cell proliferation, differentiation, migration, movement, and survival. Inhibited biological functions such as cell death, inflammatory response, immune diseases, and bacterial growth were also involved. Bacteriological analysis showed that Burkholderia cepacia was the main bacteria in the early and middle stage of ulcer exudate and Staphylococcus epidermidis in the late stage. This study provides basic data for further elucidation of the molecular mechanism of diabetic foot.

Ophthalmic manifestation of Hereditary Sensory and Autonomic Neuropathy – Five-year follow up

Hereditary Sensory and Autonomic Neuropathy (HSAN) is a rare genetic disorder that usually begins in childhood. It is associated with sensory dysfunction (depressed reflexes, altered pain and temperature perception). We report a case of an orphan and adopted girl child with HSAN type IV masquerading as keratomalacia with normal developmental milestones, absent sensation to pain and temperature, bilateral absent corneal reflexes, corneal xerosis, anhidrosis, and trophic ulcers in both hands and feet.

Study of risk factors and prevalence of hypertension among type 2 diabetes patients

According to the World Health Organization, hypertension is responsible for 13% of all deaths worldwide, making it a critical public health problem in developing and developed countries. Economic development, affluence, urbanization, and dietary westernization have contributed to a rise in the prevalence of type 2 diabetes mellitus (DM) and hypertension in South Asian countries. To study the prevalence of hypertension among adult type 2 diabetic patients and identify risk factors that may affect the development of hypertension in those patients. A cross-sectional study was conducted from May 2009 to May 2010 at the Department of Diabetology and Medicine Vinayaka Mission's Medical College & Hospital, Karaikal. 100 patients with Type 2 Diabetes of age 35 and above were screened and included in the study. Out of 100 patients with Diabetes Mellitus, 54 patients were hypertensive, and 46 were non-hypertensive. Hypertension was found to be more common in people aged 45 to 64.Our study reported that hypertension was present in 29% of males and 25% of females. Complications like neuropathy (9.3%) non-proliferative diabetic retinopathy (46.51%); proliferative diabetic retinopathy (4.65%); hypertensive retinopathy (2.33%); nephropathy (2.33%); ulcer foot (4.65%); coronary artery disease (27.9%) and stroke (2.33%) were observed in Diabetic patients and were identified as an independent risk factor for hypertension. It was also found that 31.94% of study populations were in the pre-hypertensive stage and 22.22% were in the second stage of hypertension. The prevalence of hypertension in patients with DM is high. Duration of diabetes was also one of the contributing factors for hypertension in Type 2 diabetes mellitus. It also concluded that the prevalence of hypertension increases with age advancement in DM.

Recurrent foot ulcers in patients with diabetes mellitus in out-patient care

OBJECTIVE. Relapses of diabetic foot ulcers are an urgent problem of outpatient surgery, however, risk factors for relapse, as well as the definition of relapse itself remain a subject of discussion. The presented study investigates the frequency of relapses of ulcerative foot defects in diabetes mellitus, the risk factors for their development and treatment outcomes, based on the definition of relapse as the development of a repeated defect in the same place as the healed defect.METHODS AND MATERIALS. The data of 1714 patients with foot ulcers (2213 ulcerative defects) from 01.2012 to 01.2017 were studied. Patients were divided into two groups: with relapses (n=239, 13.9%) and without them (n=1475). Risk factors for relapse, characteristics of patients and ulcerative defects, and treatment outcomes were evaluated.RESULTS. Relative risk for relapse: type 1 diabetes mellitus (1.36); Charcot foot (1.65); history of amputation of the great toe (1.35); severe polyneuropathy (1.25); neuropathic foot (1.37). Relapses/single ulcer (%): superficial lesion 72.8/63.3 (р<0.01); primary healing: 61.1/52.7 (p=0.025); healing after surgery (amputations excluded): 4.2/4.5 (ns); amputations: 7.1/6.6 (ns) of which major 5.9/20.6 (p=0.01); non-healing (%): 11.7/5.5 (р=0.001); loss of follow-up (%): 15.9/30.7 (р=0.0001). Median duration of the treatment (days) of relapses/single ulcer: conservative 147/114; healing after surgery (amputations excluded) 241/170; after amputation 286/182. Revascularization in relapses – 7 (100%), with single ulcers – 66 (59.5% of patients with critical ischemia).CONCLUSION. 5-years relapse rate was 13.9 %. Patients with Charcot foot, postoperative deformities and with neuropathic form of diabetic foot syndrome are more prone for foot reulceration. Recurrent ulcers are characterized with longer duration of the treatment however their primary healing rate is higher compared with single ulcer group. The results of the study were significantly influenced by the high frequency of loss of follow-up in both groups.

Relationship between Gene Polymorphism of Vascular Endothelial Growth Factor (VEGF) rs699947 with VEGF and Matrix Metalloproteinase-14 Protein Levels in Patient with Diabetic Foot Ulcer

BACKGROUND: Vascular endothelial growth factor (VEGF) protein levels in diabetes mellitus (DM) patients with ulcerative foot will tend to decrease. Matrix metalloproteinases (MMPs) and their inhibitors have also been identified in regulating capillary tubes formation (morphogenesis) with the collagen matrix, associated with the formation and regression of granulation tissue during the wound healing process. AIM: This study was aimed to determine the relationship between gene polymorphism VEGF rs699947 with VEGF and MMP-14 protein levels in cases of diabetic foot ulcers (DFUs). METHODS: This study was an observational research with cross-sectional comparative study design. The population in this study were type-2 DM patients who met the inclusion criteria. According to the Meggitt-Wagner classification, the study sample was divided into two groups: Type 2 DM group without DFU and type 2 DM group with DFU Grades 1–3. RESULTS: In this study, there were differences in the protein levels of MMP-14 (p = 0.039) VEGF (p = 0.002) between type-2 DM patients with and without FDU. However, there was no difference in the VEGF gene polymorphism rs6999947 between type-2 DM patients with and without FDU (p = 0.099). In addition, the results showed that type-2 DM patients with MMP-14 protein levels ≤ 3.864 had a 3.6 times greater risk of suffer FDU compared to type-2 DM patients with MMP-14 protein levels > 3.864 but not significant (PR = 3.600 (IK 5 % 1.142–11.346); p = 0.052). Meanwhile, type 2 DM patients with VEGF protein levels ≤567.42 were significantly more at risk of 9048 times to suffer FDU compared to type 2 DM patients with VEGF protein levels > 567.42 (PR = 9.048 (CI 5% 2.571–31.842); p = 0.001). CONCLUSION: In type 2 DM patients with FDU, there were lower levels of MMP-14 and VEGF compared to patients without FDU. There is a significant relationship between VEGF protein levels and the incidence of FDU in type 2 DM patients, but there is no relationship between MMP-14 and the gene polymorphism VEGF rs6999947 with the incidence of FDU in type 2 DM patients.

MiR-199a-5p Plays a Pivotal Role on Wound Healing via Suppressing VEGFA and ROCK1 in Diabetic Ulcer Foot.

Diabetes mellitus (DM) is a growing health problem. As a common complication of DM, diabetic foot ulcer (DFU) results in delayed wound healing and is a leading cause of nontraumatic amputation. miR-199a-5p, a short noncoding RNA, had abnormal expression in DFU wound tissues. The expression of miR-199a-5p was significantly increased in DFU wound tissues, skin tissues of diabetic rats, and high glucose-induced cells. Vascular endothelial growth factor A (VEGFA) and Rho-associated kinase 1 (ROCK1) are directly targets of miR-199a-5p. Inhibiting the expression of miR-199a-5p alleviated the inhibition of VEGFA and ROCK1, thereby rescued impaired proliferation and migration of HG-induced cells, and restored the normal function of the cells to some extent. In diabetic rats, inhibition of miR-199a-5p significantly increased the expression of VEGFA and ROCK1, significantly promoted wound healing, and rescued impaired wound healing. miR-199a-5p and its targets showed therapeutic effect on diabetic wounds.

Efficacy of two different types of island flaps for the repair of diabetic foot ulcers on the heel.

BackgroundHeel ulcer of diabetic foot (DF) is a difficulty in clinical repair. The current study aimed to investigate the clinical efficacy of the medial plantar island flap (MPIF) and the sural nerve nutritional artery island flap (SNNAIF) for the repair of chronic diabetic foot ulcers (DFU) on the heel.MethodsTwelve patients with chronic DFU on the heel were admitted to our department from August 2018 to August 2020. Upon admission, ulcer debridement and bone cement filling were performed for 2–3 weeks to control infection. Digital subtraction angiography (DSA) or computed tomography angiography (CTA) of the lower limb was performed to assess vascular status. Then, 5 patients were repaired with MPIF and 7 patients with SNNAIF.ResultsThe MPIF survived completely in 5 cases; SNNAIF was used in 7 cases, and 6 cases survived completely. Meanwhile, 1 patient who underwent SNNAIF presented with partial necrosis of the distal end of the flap. Then, it healed after debridement and dressing changes. All 12 flaps were followed up for 6–12 months. The flaps had a soft texture, and their shape was satisfactory. In 2 cases, SNNAIFs re-ruptured 8 months after surgery. However, they healed after dressing changes and weight-bearing reduction. During the 10-month follow-up, the sensory recovery of MPIF in 5 cases was satisfactory because the flap contained medial plantar cutaneous nerve. Meanwhile, 7 patients who underwent SNNAIF repair had poor sensory recovery. All patients had good dorsiflexion and plantarflexion of the ankle with satisfactory function.ConclusionsBoth the MPIF and SNNAIF flaps had a high survival rate and are feasible for DFU repair with good clinical outcomes. If DSA or CTA shows that the medial plantar artery is unobstructed and the heel wound is small, MPIF can retain sensory function and wear resistance. It is the first choice for repairing diabetic foot ulcers on the heel. If the heel wound are large or DSA or CTA shows that the posterior tibial artery is occluded and the peroneal artery is unobstructed, SNNAIF repair is safer.

IL-24 AND IL-29 IN T2DM WITH AND WITHOUT DIABETIC FOOT ULCERS

IL-24 AND IL-29 IN T2DM WITH AND WITHOUT DIABETIC FOOT ULCERS

Effectiveness of Infrared Radiation, in healing of diabetic ulcer foot at MAPIMS

Introduction: Diabetes is the non-communicable chronic health issue that affects people in the world wide. Studies shows that India is the second largest diabetes populated country in the world. Long standing uncontrolled diabetes leads to many systemic complications; diabetic ulcer foot is one among them that result in loss of foot or amputation and in severe cases even death. Objectives: this study investigated the pre and post test level would healing with infra-red radiation and also compared pre and post test mean score and found the demographic influences of the diabetic clients. Materials and methods: in a quantitative pre experimental one group pre-test post test design 75 diabetic ulcer foot clients who met the sampling criteria were included as sample. Consecutive sampling method was used to select the sample as they report to OPD or admitted as inpatient. Following pre-test Infra-red radiation was applied for 10 days and the post test was done seventh and tenth day. Result: The pre test mean and standard deviation were 51.5067 and 4.21828 respectively and the post test mean and standard deviation were 20.32 and 3.673 respectively. The” t” value was 68.352. Client’s demographic variables like education and occupation had significant influences in the wound healing process.

Effectiveness of Infrared Radiation, in healing of diabetic ulcer foot at MAPIMS

Effectiveness of Infrared Radiation, in healing of diabetic ulcer foot at MAPIMS