Wagner Classification Research Articles

RISK OF NON-HEALING IN ISCHEMIC VERSUS NEUROPATHIC DIABETIC FOOT ULCERS IN RELATION TO GRADE, STAGE OF INFECTION AND TREATMENT PROTOCOL: A FOLLOW-UP STUDY

Background & Objectives: Diabetic foot ulcer (DFU) is a potentially crippling consequence of diabetic foot disease. Aim of this study was to determine the risk of non-healing in ischemic as compared to neuropathic diabetic foot ulcers in relation to its grade and stage of infection. Methods: This prospective non-interventional study was conducted from July 2019 to February 2020 in Diabetes Management Center, Services Hospital Lahore Pakistan. Patients presenting with DFU were assessed for neurological and vascular status in the lower limbs. Ulcer grading was determined by Wagner's and Texas classification. Patients were followed up to 2-6 months for healing status of the diabetic foot ulcer.Results: Of 132 patients, 97 (73%) patients presented with neuropathic ulcer and 35 (27%) were having ischemic ulcers. Most participants were aged between 40-59 years. Based on Wagner's ulcer classification, it was observed that patient with score 2 had three times more likely to have their ulcer healed compared to those with score 1 and 3 [OR =3.09(95% CI:0.62-15.38, P=0.17)]. Kaplan-Meier survival curves showed that healing pattern among ischemic ulcer is considerably better compared to neuropathic foot ulcers. The evidence of equal survival hypothesis using Log-rank (Mantel Cox) test was statistically significant (p<0.001). No statistically significant difference in healing pattern through time was found across Wagner's scoring categories.Conclusion: Peripheral neuropathy was the commonest pathology underlying DFU presenting at our tertiary level diabetes clinic. Early detection of neuropathy and timely foot care may help prevent ulceration with its often-grave consequences.

Serum Procalcitonin (PCT) - Is there a Role as an Early Biomarker in Infected Diabetic Foot Ulcer (IDFU) Patients?

Infected diabetic foot ulcers may lead to serious complications if not recognised in the early stage. Diagnosis of infection is particularly challenging at that stage; thus, a sensitive inflammatory biomarker may be helpful. We aimed to evaluate the role of procalcitonin (PCT) as an early biomarker for infected diabetic foot ulcers (IDFU). This cross-sectional study was conducted at Klinik Rawatan Keluarga (KRK), Orthopedic clinic and wards in Hospital Universiti Sains Malaysia (USM) from May 2020 to December 2020. A total of 264 participants were recruited and divided into three groups: 50 diabetic patients with no ulcers (control), 107 patients with non-infected diabetic foot ulcers (NIDFU), and 107 patients with infected diabetic foot ulcers (IDFU). The level of PCT was taken for all patients. Total white count (TWC) and C-reactive protein (CRP) were taken only for IDFU patients. Diagnosis of infection was based on the Infectious Disease Society of America-International Working Group of Diabetic Foot (IDSA-IMWGDF), and the severity of infection was graded according to the Wagner Classification. The level of PCT was higher in IDFU than in NIDFU and diabetic patient, with a median (IQR) of 0.355 (0.63) ng/mL, 0.077 (0.15) ng/mL and 0.028 (0.02) ng/mL, respectively. PCT and CRP showed moderate positive correlations in IDFU patients (p<0.001). The sensitivity and specificity were 63.6% and 83.2%, respectively, at the best cut-off at 0.25 ng/mL. PCT is a valuable biomarker for the diagnosis of infection; however, it adds little value in the early diagnosis of IDFU in view of its low sensitivity.

Predictive Factors for Lower Limb Amputation in Type 2 Diabetics.

Type 2 diabetes mellitus (T2DM) is a major public health problem.Foot-related complications are common in diabetic patients. The aim of this study is to identify predictive factors for lower limb amputation (LLA) in order to better identify this at-risk population. This was a cross-sectional study involving 134 patients who were hospitalised for the management of T2DM complicated by diabetic foot, in the department of endocrinology and diabetology.We included patients with T2DM whose diabetes was diagnosed 10 years ago or more, and who had a diabetic foot problem. Statistical differences between predictors of amputations were tested using: t-tests for numerical variables and chi-square tests for categorical variables. Significant variables were analysed by logistic regression to determine significant predictors. The mean duration of diabetes was 17±7 years. We found that 70% of patients with LLA were older than 50 years (p<10-3). The prevalence of LLA was higher (p=0.015) in patients with diabetes for more than 20 years. We noted that 58% of patients who underwent LLA were hypertensive (p<10-3). The majority of patients with LLA (58%) had abnormal micro-albuminuria (p<10-3). We found that 70% (n=12) of patients with LLA had low-density protein cholesterol levels above the target value (p<10-3). Diabetic foot grade ≥4 (4 or 5) according to Wagner's classification, was present in 24% of amputee patients. Based on a 95% confidence interval level, the independent significant predictive factors for LLA in our patients were: T2DM for more than 20 years, hypertensionand diabetic foot grade ≥4. After multivariate analysis, the significant independent predictive factorsassociated with LLA were: T2DM for more than 20 years, hypertension, and diabetic foot grade ≥4. Early management of diabetic foot problems is therefore recommended to avoid amputations.

Analysis of NLR in Type 2 Diabetes Mellitus with and without Diabetic Foot Ulcer

Patients with type 2 diabetes mellitus (T2DM) have increased followed by complications including diabetic foot ulcer. Systemic inflammatory conditions in T2DM with diabetic foot ulcers can be assessed by inflammatory markers. Neutrophil Lymphocyte Ratio (NLR) is a good indicator of systemic inflammatory conditions. A retrospective study of the medical record at Dr. Wahidin Sudirohusodo Hospital, Makassar from September 2019 – September 2021 involved 120 patients consisting of 60 patients for each group of T2DM with and without diabetic foot ulcers. Leukocytes, neutrophils, lymphocytes, and NLR based on routine blood results using the flow cytometry method. Mann-Whitney test was used for comparison between the two groups on NLR and Kruskal-Wallist test was used for the relationship between NLR and Wagner classification. There was a significant difference in leukocytes, neutrophils, lymphocytes, and NLR in T2DM patients with diabetic foot ulcers compared to those without 16.2±8.6 and 9.8±4.2 103/µL (p&lt;0.001); 13.3±8.4 and 5.0±3.8 103/µL(p&lt;0.001); 1.6±1.7 and 2.5±2.5 103/µL(p&lt;0.001); 10.0±10.1 and 3.5±4.5, respectively. The relationship between the NLR and Wagner classification was the highest at Wagner grade 5 (12.87±5.0) and the lowest was at Wagner grade 2 (6.18±7.83) with significant statistical test results (p&lt;0.037). There was increasing NLR in T2DM with diabetic foot ulcers due to systemic inflammation. The NLR integrates different immune pathways, such as neutrophils as an inflammatory response and lymphocytes controlling the inflammatory response. Lymphocytes count and NLR level on T2DM with diabetic foot ulcer were higher than those without diabetic foot ulcer.

Healing Diabetic Ulcers with Pure Honey dressing: Literature Review

Poor peripheral circulation in patients with diabetes mellitus causes wounds to be difficult to heal. Therefore, patients with diabetes mellitus with diabetic ulcers require wound care to reduce the risk of amputation. One alternative material that can be used for wound care is the topical application of pure honey. The purpose of the study was to determine the effect of honey dressing on the healing process of diabetic ulcers through a literature review. The databases used include PubMed, ScienceDirect, Google Scholar, and Garuda. Keywords using (((honey) OR honey dressing) AND wound healing) AND diabetic ulcer) OR diabetic foot ulcer. The library sources used are from 2010-2020. The search results obtained 9,507 articles. Furthermore, articles were selected based on inclusion and exclusion criteria, obtained 11 articles. The assessment of articles uses a checklist on the JBI (Joanna Briggs Institute) assessment list. Eleven articles that met the assessment criteria were then analyzed one by one. The results showed that eleven articles showed the effect of giving honey dressing on the healing process of diabetic ulcers. A total of 3 articles showed wound healing based on changes in score, 2 articles based on changes in grade, 5 articles based on changes in wound characteristics, and 2 articles based on healing time. Of the eleven journals analyzed, honey dressing on diabetic ulcers were most effectively used in wound Grade I and II (Wagner Classification) ulcer patients who received drug therapy with a GDS &lt;200 mg/dL and received daily wound care for 1 month. Healthcare professionals may consider using honey dressings for the treatment of diabetic ulcers. In addition to a more affordable price, honey has good benefits for wound healing. Further research is needed on the type of honey that is more effective as an ingredient in wound care.

Distribution of Causative Microorganisms in Diabetic Foot Infections: A Ten-Year Retrospective Study in a Tertiary Care Hospital in Central Malaysia.

Diabetes mellitus is a global pandemic, especially in Southeast Asia. Diabetic foot infection (DFI) is a common complication of this condition and causes significant morbidity and mortality in those affected. There is a lack of locally published data on the types of microorganisms and empirical antibiotics being prescribed. This paper highlights the importance of local microorganism culture and antibiotic prescription trends among diabetic foot patients in a tertiary care hospital in central Malaysia. This is a retrospective, cross-sectional study of data taken from January 2010 to December 2019 among 434 patients admitted with diabetic foot infections (DFIs) using the Wagner classification. Patients between the ages of 58 and 68 years old had the highest rate of infection. Pseudomonas Aeruginosa, Proteus spp., and Proteus mirabilis appeared to be the most isolated Gram-negative microorganisms, and Staphylococcus aureus, Streptococcus agalactiae, and MRSA appeared to be the most common Gram-positive microorganisms. The most common empirical antibiotics prescribed were ampicillin/sulbactam, followed by ciprofloxacin and ceftazidime, and the most common therapeutic antibiotics prescribed were ampicillin/sulbactam, ciprofloxacin, and cefuroxime. This study could be immensely pertinent in facilitating future empirical therapy guidelines for treating diabetic foot infections.

Cytostéatonécrose après reconstruction mammaire par lambeau graisseux avec ou sans préconditionnement ischémique

Cytosteatonecrosis (CTN) is a frequent postoperative complication after breast autologous reconstruction using DIEP (deep inferior epigastric perforator) flap. CTN radiological diagnostic reveals different types of lesions, as nodes or extended fat necrosis, which become in some cases infected, or pass for tumor recurrence after breast cancer treatment. CTN is caused by intraoperative ischemia of the flap, and no current method can prevent postoperative CTN development after DIEP breast reconstruction. Mechanical ischemic preconditioning, consisting in intraoperative briefs consecutive cycles of ischemia reperfusion using vascular clamp upon the graft pedicle, is used in transplantation surgery. This procedure improves the graft tolerance towards ischemic surgical lesions. The aim of this retrospective observational study was to assess PCIM effects on CTN development after DIEP surgery, comparing CTN occurrence after breast reconstruction using DIEP flap with or without intraoperative PCIM. All patients breats reconstructed using DIEP flap between novembre 2020 and may 2022, presenting 6 months postoperative breast echography were retrospectively included. Primary outcome was the ultrasonic existence of CTN, according to the Wagner classification. Clinical data, postoperative outcomes such as infection, hematoma or surgical revision, and length of stay in hospital were also recorded. Twenty nine patients among which 8 PCIM were included. CTN occurrence rate after PCIM (25%) was quite lower than CTN rate without PCIM (71,4%), although the difference was not significant (P=0,088). Other postoperative complications rates were not significantly different with or without PCIM. PCIM seems to improve CTN occurrence after DIEP breast reconstruction, improving fat flap tolerance to ischemic perioperative lesions. Those preliminary results need to be confirmed with clinical prospective study.

Association of Severity of Diabetic Foot Ulcer with Glycated Hemoglobin A1C Levels

Diabetic foot ulcer is a well-documented complication of uncontrolled diabetes and its association with the variables involved in Diabetes like FBS, RBS and HBA1C has been thoroughly researched. This research aims to identify the association of diabetic foot ulcer under Wagner classification with HBA1C classes. Objectives: To determine the severity of diabetic foot ulcer at various level of HBA1C and determine the association. Methods: A cross-sectional study with 360 diabetic patients who after giving consent filled questionnaires. The information was analyzed using SPSS v26 (IBM) through Chi Square test. The results were tabulated and inferred from. Results: Our work depicts a statistically significant correlation between grades of diabetic foot ulcer and HBA1C levels of the patients (p-value &lt;0.001). Patients with higher levels of HBA1C suffered foot ulcer of higher grades. Specifically, patients with Grade 1 foot ulcers primarily had HBA1C levels of ≤ 11.00 with 6(50%) falling in the group “7.01-9.00” while patients with Grade 5 ulcers had higher HBA1C levels with bulk of patients having levels of &gt;11.00. Conclusions: This research further supplemented an already strongly established association between uncontrolled diabetes and diabetic foot ulcer. We focused on specifically HBA1C and how increased lab values are linked with different grades of Diabetic Foot ulcer and found a strong association demanding a proactive approach towards patient care and education

Evaluation Of The Relationship Between Air Temperature And Treatment Cost In Diabetic Foot Infections

Abstract: &#x0D; Aim: When diabetic patients have problems in foot care, diabetic foot wounds can occur, and untreated diabetic foot infections can cause amputation and death. In this study, it is aimed to evaluate the air temperature and treatment costs in diabetic foot patients treated in a University Hospital.&#x0D; Materials and Methods: The study is of ecological type. The population of the study consisted of 123 diabetic foot patients who were treated in a hospital in 2019. Demographic characteristics of the patients such as age, gender, duration of diabetes, Wagner classification, length of hospital stay, cost of treatment, and climate parameters were examined.&#x0D; Results: The mean hospital stay of the patients was 13.81±9.22 (min:1 max:43) days. The mean hospitalization cost of the patients was 2,724.95±2,344.04 (min:228 max:15,208) Turkish Lira (TL). The cost of treatment was higher in patients who were elderly, had a long hospital stay, and had a Wagner classification of 3 and above (p

Association between triglyceride glucose index and severity of diabetic foot ulcers in type 2 diabetes mellitus

BackgroundTriglyceride glucose (TyG) index is a good surrogate biomarker to evaluate insulin resistance (IR). The study aimed to investigate whether the TyG index is related to the severity of diabetic foot ulcers (DFUs) in patients with type 2 diabetes mellitus (T2DM).MethodsA total of 1059 T2DM patients were enrolled in this observational, retrospective, single-center study. TyG index was calculated as ln[fasting triglycerides (mg/dl) × fasting glucose (mg/ dl)/2]. The severity of DFUs was classified into mild-to-moderate DFUs (Wagner grade score < 3) and severe DFUs (Wagner grade score ≥ 3) based on Wagner classification. Patients were stratified according to the tertiles of TyG index. Logistic regression models were implemented to explore the association between TyG index and the severity of DFUs. Subgroup analyses were used to verify the reliability of results.ResultsCompared with the reference lowest TyG tertile (T1), the highest tertile (T3) was associated with 0.377-fold increased risk of prevalence of severe DFUs (odds ratio [OR] 1.377, 95% confidence interval [CI] 1.017–1.865) (P = 0.039). After adjusting for potential confounders, the multivariable-adjusted OR and 95% CI were 1.506 (1.079–2.103) (P = 0.016) in patients with highest tertile. Moreover, subgroup analyses indicated that the association was stronger among men, patients with age ≥ 65 years, duration of diabetes more than 10 years, or without PAD.ConclusionsElevated TyG index is independently associated with severity of DFUs even after adjusting conventional confounders.

To Determine Frequency and Outcome of Dyslipidemia in Diabetic Foot Patients

Objective: To determine frequency and outcome of Dyslipidemia in Diabetic foot patient Study Design: Cross sectional study Place and Duration: Divisional Head Quarter Teaching (DHQ) Hospital Mirpur AJK from January 2021 to January 2022. Methodology: This study includes one hundred and thirty nine (139) patients with Type 2 diabetes and diabetic foot related complication. Patient diagnosed case of type2 DM on oral hypoglycemic agents or on insulin therapy of age &gt;30 of either gender admitted with history of wound in lower limb confirmed on physical examination measuring ankle brachial pressure Index(ABPI) were evaluated for ulcer ,cellulitis and gangrene by using WAGNER's classification. Dyslipidemia is assessed in these patient by sending their fasting lipid profile and data is entered into specially designed Performa. Results: We found that majority of cases having abnormal lipid profile. Dyslipidemia with significant difference was found in diabetic foot patients, 54.7% (n=76) patients show HDL &lt;35 ,56.1%(n=77 )have cholesterol &gt;200mg/dl and 69.8%(n=97) have TAG&gt;150mg/dl. 29.5% patient with diabetes have superficial ulcer, while deep ulcer, cellulitis, localized and extensive gangrene was found with percentage of 31.7% , 20.1% ,10.8%, 7.9% respectively . Conclusion: We concluded that Dyslipidemia is a modifiable risk factor for diabetic foot related complications. So diabetic patients must be advised regular Lipid Profile to decrease risk of diabetic foot related complication. Keywords: Diabetes Mellitus (DM), Dyslipidemia, Diabetic foot, PAD and neuropathy

Hubungan Kadar Hemoglobin (Hb) Dengan Derajat Diabetic Foot Ulcers (DFU) Di Kabupaten Bone

Objective: Vascular assessment, including the assessment of hemoglobin (Hb) levels or anemia, is a very important part of the treatment of Diabetic Foot Ulcers (DFU). However, several studies have shown different results regarding the relationship of Hemoglobin as a DFU wound healing factor.This study was to determine the relationship between hemoglobin levels and the degree of Diabetic Foot Ulcers (DFU).Methods: The design of this study was an analytic observational study in which the research subjects were Diabetic Foot Ulcers (DFU) patients undergoing treatment at a nurse's independent practice clinic in Bone Regency). The independent variable is hemoglobin level while the dependent variable is the degree of injury according to Meggitt Wagner's classification. The sampling technique used was the total sampling method.Results: This study was conducted in the independent practice of nurses in Bone Regency and involved 30 samples that met the inclusion and exclusion criteria. Data on hemoglobin levels and severity of Diabetic Foot Ulcers (DFU) were obtained from direct observation. Furthermore, the data were analyzed descriptively and tested with Spearman correlation. Spearman correlation test results obtained p = 0.083 (p&gt; 0.05) and r = -0.322.Conclusion: there is a negative but not significant relationship between hemoglobin levels and the severity of diabetic ulcers with a weak correlation strength level. The lower the hemoglobin level, the more severe the severity of the ulcer.

Diabetic Foot, Conservative Management.

Diabetic foot ulcers are serious complications of Diabetes Mellitus and are known to be resistant to conventional treatment; they may herald severe complications and may lead to lower limb amputation if not treated wisely. Objectives: To assess the efficacy of conservative management and LowLevel Laser Therapy (LLLT) in the treatment of diabetic foot ulcers. Setting: Baghdad Teaching Hospital. Time, from January 2015 through April 2020. Patients and methods: A prospective randamised study included (45) patients who were proved to have a diabetic foot ulcer, the ulcers were graded according to Wagner classification into six grades from (0 to 5), and patients with Wagner grades 1, 2, and 3 were treated conservativly by wound cleaning, controlling of blood sugar in the ward and send for laser therapy. Results: There were six patients with grade 1 ulcers, and all of them (100%) showed complete healing over a period of 3 weeks of conservative treatment and laser therapy. Also, 22 patients out of 25 (88%) with grade 2 ulcers and 11 patients out of 14 (78.6%) with grade 3 ulcers showed complete healing in about six weeks of treatment. Forty-five patients were treated by laser, and only six patients (13.3%) showed minor complications (itching, numbness, erythema, or even blisters), which were reported after the 2nd. Weak of treatment. Conclusion: Diabetic foot ulcers are a common problem in Baghdad Teaching Hospital; it is most commonly occure in patients with long-standing uncontrolled diabetes. Conservatie treatment by wound cleaning, controlling of blood sugar, and laser therapy (LLLT) was proved to be effective in treating grade 1,2 and 3 ulcers and decreasing the time of ulcer healing

Correlation Between Controlling Nutritional Status Scores and Amputation Risks in Patients with Diabetic Foot Ulcers

To retrospectively analyze the clinical features and treatment outcomes of patients with diabetic foot ulcers (DFU), and to investigate the effect of controlling nutritional status (CONUT) scores on the amputation risks and hospital length-of-stay of DFU patients. A total of 357 DFU inpatients admitted to the Department of Endocrinology, PLA Strategic Support Force Characteristic Medical Center between January 1, 2016 and December 31, 2018 were enrolled and analyzed retrospectively. Based on their CONUT scores, the patients were divided into 3 groups, a normal nutritional status group consisting of patients with CONUT scores 0-1 ( n=100), a mild malnutrition group consisting of patients with CONUT scores 2-4 scores ( n=164), and a moderate-to-severe malnutrition group consisting of patients with CONUT scores≥5 ( n=93). According to whether they underwent amputation, patients were divided into an amputation group ( n=110) and a non-amputation group ( n=247). The clinical characteristics, amputation rate, and hospital length-of-stay were compared between groups with different CONUT scores. Logistic regression was conducted to analyze the independent risk factors of amputation. The total amputation rate of DFU patients was 30.6%. Among all amputations, the major amputation (above-the-ankle amputation) rate was 1.8%, and the minor amputation rate was 98.2%. The amputation rate in patients with mild and moderate-to-severe malnutrition were 1.5 and 3.0 times higher than those in the normal nutritional status group, respectively. Logistic regression analysis showed that the moderate-to-severe nutritional status (5-12 scores), white blood cell, Wagner classification and ankle-brachial index were independent risk factors for amputation. CONUT score is closely associated with amputations in DFU patients. Improving the nutritional status of patients in the early stage could reduce the risk of amputation.

Comparing Radiotherapy (RT) Late Toxicities to the Reconstructed DIEP Flap in Breast Cancer Patients Treated with Neoadjuvant RT (NART) vs. Post-Mastectomy RT (PMRT)

<h3>Purpose/Objective(s)</h3> The use of PMRT in patients undergoing immediate Deep Inferior Epigastric Perforator (DIEP) flap reconstructions is well known to cause significant long-term toxicity such as flap contracture, fat necrosis and cosmetic detriment. This can lead to significant long-term pain and impact on quality of life (QOL) (Yun et al, 2018). On the other hand, NART prior to the DIEP reconstruction performed in our institution has been shown to have no detriment in safety and local control but the long-term impact on the DIEP reconstruction remains unclear (Chidley et al, 2021). The aim of this retrospective study is to compare the long-term consequences of NART followed by DIEP versus immediate DIEP with PMRT on the reconstruction. <h3>Materials/Methods</h3> Retrospective comparison of long-term toxicities was done on the patient cohort who underwent NART followed by DIEP reconstruction (from 03/2013 to 09/2019) and patients who had immediate DIEP reconstruction followed by RT (from 01/2013 to 05/2021). Clinical examination was performed to assess the presence of fat necrosis (graded using the Wagner classification et al. 2013) and flap contracture. Breast cosmesis was graded using the Kroll classification (Kroll et al, 1994). Statistical analysis was performed to identify the rate of cosmesis problem, fat necrosis and flap contracture between these two patient's cohorts. <h3>Results</h3> Total of 155 patients who underwent NART and 31 patients who went through PMRT were analyzed. The median age of each cohort is 48 and 49 respectively for NART vs PMRT (p=0.26). Majority of patients in the NART and PMRT cohort received 50.4Gy/28# (78.6% [121] vs 74.2% [23]). Median follow up for NART and PMRT group was 32.5 months and 28.8 months respectively. No difference in local control was reported (98.1% NART vs 100% PMRT). Patients who had NART reported a higher satisfaction rating with their cosmesis. This was reported as ‘excellent to good' in 96.1% for NART compared to 80.1% for PMRT p<0.001. In addition, the risk of developing a flap contracture was significantly increased in patients who had PMRT (1.9% NART vs 41.9% PMRT; p<0.001). This was described as minimal in 29% and moderate in 12.9%. The risk of developing fat necrosis rate was also significantly increased in patients who had PMRT (12.9% NART vs 19.4% PMRT; p<0.001). While all fat necrosis in the NART cohort was grade 2, 50% of patients in the PMRT cohort had pain as well (grade 4). <h3>Conclusion</h3> Our retrospective analysis suggests that PMRT following immediate DIEP has significantly higher risk of late toxicities compared to NART followed by DIEP reconstruction. Whether this translates to a meaningful impact on QOL can only be determined by a randomized study.

Relationship Between Social Isolation and Health Behaviors and Ulcer Severity in Diabetic Foot Patients

To explore the relationship between social isolation and health behaviors and ulcer severity in patients with diabetic foot. A cross-sectional study was conducted with 160 patients suffering from type 2 diabetes mellitus combined with diabetic foot. The patients received treatment at the Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University between September 2020 and December 2021. Patient information was collected, including the scores for Lubben Social Network Scale and the Wagner classification of foot ulcers. Analysis was conducted to study the characteristics of the patients' health behaviors, including whether they received information and education on diabetic foot, whether there were delays in their attempt to access medical service, the frequency of foot examinations, etc. In addition, patient demographic data were collected, including sex, age, education, and employment status. According to their scores for Lubben Social Network Scale, the patients were divided into a social isolation group ( n=60) and a non-social-isolation group ( n=100). The severity of the foot ulcers and the health behaviors of the two groups were compared to identify differences. The findings suggest that, compared with the non-social-isolation group, the social isolation group had a higher proportion of diabetic foot patients with Wagner grade 3-5 diabetic foot ulcers ( P<0.05). Analysis of the health behaviors showed that the social isolation group had a higher proportion of diabetes foot patients who had never undergone examination of their feet and those who had delayed attempts to access medical service for their condition ( P<0.05). There were no significant differences between the two groups in terms of whether the patients had received information and education concerning diabetic foot, causes of foot injury, self-treatment of wounds, smoking, and drinking. Correlational analysis suggested that the scores of Lubben Social Network Scale were negatively correlated with the delayed attempts to access medical service ( r=-0.353, P=0.001), that is, the higher the degree of social isolation, the longer the delay in patients' attempt to access medical service for their diabetic foot. Social isolation is correlated to health behaviors and ulcer severity in patients with diabetic foot. Giving more attention to the problem of social isolation of diabetic foot patients and increasing their ties with the social environment and the members of their social network may have a positive effect on improving the delays in diabetic foot patients' attempt to access medical service, which is particularly important for follow-up treatment.

Clinical application of microdissected thin thoracodorsal artery perforator flaps for repair of diabetic foot ulcers

To explore the effectiveness of microdissected thin thoracodorsal arterial perforator flap (TDAP) in repairing diabetic foot ulcers (DFUs). The clinical data of 11 patients with DFUs admitted between March 2020 and February 2021 were retrospectively analyzed, including 5 males and 6 females, aged from 22 to 67 years, with an average of 49.3 years. There were 10 cases of type 2 diabetes and 1 case of type 1 diabetes; the duration of diabetes ranged from 3 months to 25 years (median, 8 months). The duration of DFUs ranged from 6 days to 120 months (median, 1 month). There were 6 cases of grade 3 and 5 cases of grade 4 according to Wagner classification. The tissue necrosis and purulent secretions were found in all ulcer wounds, as well as different degrees of tendon and bone exposure; skin defects ranged from 5 cm×3 cm to 17 cm×6 cm. The DFUs were repaired by microdissected thin TDAP, including 6 cases of flaps (including 1 case of lobulated flap), ranging from 10.0 cm×4.5 cm to 26.0 cm×7.0 cm; 5 cases of chimeric perforator flaps, the range of the flap was 10.0 cm×4.5 cm to 16.0 cm×5.5 cm, and the range of the muscle flap was 6 cm×2 cm to 10 cm×3 cm. The donor site was sutured directly. The operation time ranged from 3.42 to 11.17 hours, with an average of 5.92 hours. All 11 flaps survived and no vascular crisis occurred; 1 patient had a sinus at the edge of the flap, and the surgical area healed well after dressing change. All 11 patients were followed up 6-12 months, with an average of 9 months. The flap texture was good, the recipient site was in good shape, and there was no swelling; the foot contour was good, the shoes were comfortable to wear, and the movement was good. The incision at the donor site healed by first intention, leaving only linear and concealed scar, without obvious depression deformity, and the shoulder joint function was good. On the premise of ensuring sufficient blood supply to the lower extremities and strengthening perioperative management, the microdissected thin TDAP to repair DFUs wounds can achieve better effectiveness and appearance; however, the prolonged operation time increases the probability of anesthesia and surgical risks in patients with DFUs.

Effectiveness analysis of modified tibial transverse bone transport technique combined with vancomycin calcium phosphate bone cement local filling and covering in treatment of diabetic foot

To investigate the effectiveness of modified tibial transverse bone transport technique combined with vancomycin calcium phosphate bone cement local filling and covering in the treatment of diabetic foot (DF). The clinical data of 22 DF patients treated with modified tibial transverse bone transport technique combined with vancomycin calcium phosphate bone cement local filling and covering between October 2019 and December 2021 were retrospectively analyzed. There were 13 males and 9 females with an average age of 61.3 years (range, 41-74 years). The duration of diabetes mellitus was 8-30 years, with an average of 12.5 years, and the duration of DF was 10-42 days, with an average of 28.2 days. There were 2 cases of grade 3 and 20 cases of grade 4 according to Wagner classification. CT angiography was performed on both lower extremities of the patients, and the blood vessels of the affected extremities were narrowed to varying degrees and the blood supply was poor. The preoperative skin temperature of affected foot was (28.27±0.91)°C, the ankle brachial index (ABI) was 0.42±0.11, and the visual analogue scale (VAS) score was 7.7±0.6. Preoperative size of DF ulcer ranged from 2.5 cm×2.0 cm to 3.5 cm×3.0 cm. The skin temperature of affected foot, ABI, VAS score, and skin wound healing of the affected foot were recorded and compared between before operation and at 3 months after operation. All patients were followed up 3-18 months, with an average of 10.5 months. The infection of 1 patient with Wagner grade 4 did not improve significantly after operation, and there was a trend of further deterioration, and the amputation of the left leg was finally performed at 22 days after operation.The remaining 21 patients recovered well after operation, the external fixator was removed at 1 month after operation, the wound healed at 3 months after operation, and there was no recurrence of ulcer in situ or other sites during follow-up. At 3 months after operation, the skin temperature of affected foot was (31.76±0.34)°C, the ABI was 0.94±0.08, and the VAS score was 2.1±0.3, which significantly improved when compared with those before operation ( t=25.060, P<0.001; t=32.412, P<0.001; t=-51.746, P<0.001). Modified tibial transverse bone transport technique combined with vancomycin calcium phosphate bone cement local filling and covering for DF patients can effectively improve the blood supply of the affected limb, promote wound healing, and improve effectiveness.

Clinical characteristics and risk factors of lower extremity amputation in patients with diabetic foot.

To investigate the risk factors of lower limb amputation, and help physicians better understand the clinical characteristics of patients with diabetic foot, and make treatment strategies for these patients correctly. In this study, the inpatients with diabetic foot treated in our hospital form January 2013 to February 2021 were reviewed retrospectively. The patients were divided into amputation and conservative treatment groups. The variables of the patients, consisting of age, gender, smoking history, alcohol use, diabetes and ulcer duration, ulcer size, Wagner classification, ankle brachial index, previous amputation history, laboratory data, and medical comorbidities including hypertension, coronary artery disease, peripheral arterial disease, chronic renal insufficiency, retinopathy, and sequelae of cerebral infarction were selected for analysis to determine the risk factors of lower limb amputation. In this study, a total of 856 patients with diabetic foot were enrolled, in which 487 patients received amputation surgeries, and the amputation rate was 56.9%. There were significant differences between the two groups in gender (p=0.014), smoking history (p=0.011), ulcer duration (p=0.023), ulcer size (p=0.000), Wagner classification (p=0.000), ABI (p=0.031), peripheral arterial disease (p=0.000), HDL-C (p=0.013), osteomyelitis (p=0.000), and fibrinogen (p=0.001). A stepwise multiple logistic regression analysis revealed that male gender (p=0.003), larger ulcer size (p=0.001), higher Wagner classification grades (p=0.002), higher rate of peripheral arterial disease (p=0.02) and osteomyelitis (p=0.0001), and increased fibrinogen level (p=0.004) were independent risk factors of lower limb amputation in patients with diabetic foot. The diabetic foot patients with male sex, larger ulcer size, higher grade of Wagner classification, peripheral arterial disease or higher fibrinogen level may face higher risk of lower limb amputation.

Effectiveness of Injected Platelet-Rich Plasma in the Treatment of Diabetic Foot Ulcer Disease.

ObjectivesPlatelet-rich plasma (PRP) has become quite a popular course of treatment and has tremendous healing properties. Our research question inquired about the effectiveness of injected formula of PRP as the cure for diabetic foot ulcer in comparison to the conventional dressing.Methodology A prospective observational study was conducted at the Department of Diabetes and Endocrinology, Lady Reading Hospital, Peshawar, Pakistan, between July 2020 to January 2021. Patients' data were collected from the department's database after taking approval from the department. In our study, the selected patients were categorized into two equal groups - i.e. 80 cases in each group and were randomized by using randomization allocation software. In group I (study group) patients received PRP (1 ml /1 cm2) around the wound edges and in the base of the ulcer, while group II (control group) patients were treated with conventional dressing. Each patient was inspected for wounds on days 0, 14, 28, 90, and 180 on the basis of Wagner's classification of wounds to assess efficacy. A proforma was used to collect the required data and then utilized electronically for research analysis.ResultsThe mean ± SD of age was 54.4±8.56 and 57.7±10.1 years in the injected PRP (study) and conventional dressing (control) groups, respectively. Of the 30 patients, 13 (43.3%) males and 17 (56.7%) females were enrolled in the study group, while 14 (46.7%) males and 16 (53.3%) females were included in the control group. The PRP was found effective in reducing the wound in about 64 (80%) patients, while wound dressing was effective in 37 (46.25%) patients (p<0.0001). In female patients, the wound healing was significantly better in the study group as compared to the control group (p<0.0001). Moreover, in patients aged above 55 years, frequently higher rates of wound reduction were observed in the study group as compared to the control group (p<0.0001). ConclusionThe study concluded that injected PRP was significantly better than conventional dressing in the management of diabetic foot ulcer. More clinical trials are necessary to evaluate the effectiveness of injected PRP to validate the current findings.