Diabetic Foot & Ankle最新文献

{"title":"A developing world experience with distal foot amputations for diabetic limb salvage.","authors":"Omer Salahuddin,&nbsp;Muhammad Azhar,&nbsp;Aqsa Imtiaz,&nbsp;Munawer Latif","doi":"10.3402/dfa.v4i0.22477","DOIUrl":"https://doi.org/10.3402/dfa.v4i0.22477","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the functional outcome, morbidity, and viability of foot salvage in diabetic patients.</p><p><strong>Materials and methods: </strong>This prospective case series was conducted from March 2007 to December 2012 at the department of surgery Pakistan Ordnance Factories Hospital, Wah Cantt, Pakistan. 123 males and 26 female patients were included in the study. All the patients were treated after getting admitted in the hospital and wounds were managed with daily dressings, nursing care and debridement of necrotic tissue with adequate antibiotic coverage.</p><p><strong>Results: </strong>In total, 149 patients (mean age: 56±7.52 years) with 171 amputations were included in the study. The mean duration of diabetes mellitus (DM) was 9±4.43 years. Ninety-seven percent of the patients were diagnosed with type 2 DM. Wound debridement was performed under general anesthesia in 48 (33.2%) patients, whereas local anesthesia was used for the rest of the patients after having good glycemic control and improvement in general health. The most common pathogen isolated from the infected wounds was Staphylococcus aureus in approximately 46% cases. Regarding the types of amputation, partial toe amputation was performed in 21 (12.2%) cases, second-toe amputation in 60 (35%) cases, hallux amputation in 41 (24%) cases, multiple toe amputations in 29 (17%) cases, bilateral feet involvement was observed in 16 (9.3%) cases, and transmetatarsal amputation was performed in 4 (2.3%) cases. The wounds healed well except in 19 cases where amputation had to be revised to a more proximal level. Thirty-nine patients died during the study period: 3 died of wound-related complications and 36 died of systemic complications.</p><p><strong>Conclusion: </strong>With the ever-increasing epidemic of DM, the number of patients with diabetic foot ulcers has also significantly risen. Early surgical management with good glycemic control and foot care with close monitoring can decrease amputations and thus foot salvage can be successfully achieved.</p>","PeriodicalId":45385,"journal":{"name":"Diabetic Foot & Ankle","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3402/dfa.v4i0.22477","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40260343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The system of care for the diabetic foot: objectives, outcomes, and opportunities.","authors":"Neal R Barshes,&nbsp;Meena Sigireddi,&nbsp;James S Wrobel,&nbsp;Archana Mahankali,&nbsp;Jeffrey M Robbins,&nbsp;Panos Kougias,&nbsp;David G Armstrong","doi":"10.3402/dfa.v4i0.21847","DOIUrl":"https://doi.org/10.3402/dfa.v4i0.21847","url":null,"abstract":"<p><p>Most cases of lower extremity limb loss in the United States occur among people with diabetes who have a diabetic foot ulcer (DFU). These DFUs and the associated limb loss that may occur lead to excess healthcare costs and have a large negative impact on mobility, psychosocial well-being, and quality of life. The strategies for DFU prevention and management are evolving, but the implementation of these prevention and management strategies remains challenging. Barriers to implementation include poor access to primary medical care; patient beliefs and lack of adherence to medical advice; delays in DFU recognition; limited healthcare resources and practice heterogeneity of specialists. Herein, we review the contemporary outcomes of DFU prevention and management to provide a framework for prioritizing quality improvement efforts within a resource-limited healthcare environment. </p>","PeriodicalId":45385,"journal":{"name":"Diabetic Foot & Ankle","volume":"4 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3402/dfa.v4i0.21847","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31811253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Charcot foot and ankle with osteomyelitis.","authors":"Ryan Donegan,&nbsp;Bauer Sumpio,&nbsp;Peter A Blume","doi":"10.3402/dfa.v4i0.21361","DOIUrl":"https://doi.org/10.3402/dfa.v4i0.21361","url":null,"abstract":"<p><p>This paper presents a review of the current literature discussing topics of Charcot osteoarthropathy, osteomyelitis, diagnosing osteomyelitis, antibiotic management of osteomyelitis, and treatment strategies for management of Charcot osteoarthropathy with concurrent osteomyelitis. </p>","PeriodicalId":45385,"journal":{"name":"Diabetic Foot & Ankle","volume":"4 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3402/dfa.v4i0.21361","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31784104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Negative-pressure wound therapy in the management of diabetic Charcot foot and ankle wounds.","authors":"Crystal L Ramanujam,&nbsp;John J Stapleton,&nbsp;Thomas Zgonis","doi":"10.3402/dfa.v4i0.20878","DOIUrl":"https://doi.org/10.3402/dfa.v4i0.20878","url":null,"abstract":"<p><p>As the prevalence of diabetes mellitus continues to rise, innovative medical and surgical treatment options have increased dramatically to address diabetic-related foot and ankle complications. Among the most challenging clinical case scenarios is Charcot neuroarthropathy associated with soft tissue loss and/or osteomyelitis. In this review article, the authors present a review of the most common utilizations of negative-pressure wound therapy as an adjunctive therapy or combined with plastic surgery as it relates to the surgical management of diabetic Charcot foot and ankle wounds. </p>","PeriodicalId":45385,"journal":{"name":"Diabetic Foot & Ankle","volume":"4 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3402/dfa.v4i0.20878","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31761562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relative sensory sparing in the diabetic foot implied through vibration testing.","authors":"Todd O'Brien,&nbsp;Joseph Karem","doi":"10.3402/dfa.v4i0.21278","DOIUrl":"https://doi.org/10.3402/dfa.v4i0.21278","url":null,"abstract":"Background The dorsal aspect of the hallux is often cited as the anatomic location of choice for vibration testing in the feet of diabetic patients. To validate this preference, vibration tests were performed and compared at the hallux and 5th metatarsal head in diabetic patients with established neuropathy. Methods Twenty-eight neuropathic, diabetic patients and 17 non-neuropathic, non-diabetic patients underwent timed vibration testing (TVT) with a novel 128 Hz electronic tuning fork (ETF) at the hallux and 5th metatarsal head. Results TVT values in the feet of diabetic patients were found to be reduced at both locations compared to controls. Unexpectedly, these values were significantly lower at the hallux (P < 0.001) compared to the 5th metatarsal head. Conclusion This study confirms the hallux as the most appropriate location for vibration testing and implies relative sensory sparing at the 5th metatarsal head, a finding not previously reported in diabetic patients.","PeriodicalId":45385,"journal":{"name":"Diabetic Foot & Ankle","volume":"4 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3402/dfa.v4i0.21278","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31745773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrical stimulation to accelerate wound healing.","authors":"Gaurav Thakral, Javier Lafontaine, Bijan Najafi, Talal K Talal, Paul Kim, Lawrence A Lavery","doi":"10.3402/dfa.v4i0.22081","DOIUrl":"10.3402/dfa.v4i0.22081","url":null,"abstract":"<p><strong>Background: </strong>There are several applications of electrical stimulation described in medical literature to accelerate wound healing and improve cutaneous perfusion. This is a simple technique that could be incorporated as an adjunctive therapy in plastic surgery. The objective of this review was to evaluate the results of randomized clinical trials that use electrical stimulation for wound healing.</p><p><strong>Method: </strong>We identified 21 randomized clinical trials that used electrical stimulation for wound healing. We did not include five studies with treatment groups with less than eight subjects.</p><p><strong>Results: </strong>Electrical stimulation was associated with faster wound area reduction or a higher proportion of wounds that healed in 14 out of 16 wound randomized clinical trials. The type of electrical stimulation, waveform, and duration of therapy vary in the literature.</p><p><strong>Conclusion: </strong>Electrical stimulation has been shown to accelerate wound healing and increase cutaneous perfusion in human studies. Electrical stimulation is an adjunctive therapy that is underutilized in plastic surgery and could improve flap and graft survival, accelerate postoperative recovery, and decrease necrosis following foot reconstruction.</p>","PeriodicalId":45385,"journal":{"name":"Diabetic Foot & Ankle","volume":"4 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3776323/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31745772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An analysis of clinical activity, admission rates, length of hospital stay, and economic impact after a temporary loss of 50% of the non-operative podiatrists from a tertiary specialist foot clinic in the United Kingdom.","authors":"Catherine Gooday,&nbsp;Rachel Murchison,&nbsp;Ketan Dhatariya","doi":"10.3402/dfa.v4i0.21757","DOIUrl":"https://doi.org/10.3402/dfa.v4i0.21757","url":null,"abstract":"<p><strong>Introduction: </strong>Podiatrists form an integral part of the multidisciplinary foot team in the treatment of diabetic foot-related complications. A set of unforeseen circumstances within our specialist diabetes foot service in the United Kingdom caused a loss of 50% of our non-operative podiatry team for almost 7 months during 2010. Some of this time was filled by non-specialist community non-operative podiatrists.</p><p><strong>Methods: </strong>We assessed the economic impact of this loss by examining data for the 5 years prior to this 7-month interruption, and for the 2 years after 'normal service' was resumed.</p><p><strong>Results: </strong>Our data show that the loss of the non-operative podiatrists led to a significant rise in the numbers of admissions into hospital, and hospital length of stay also increased. At our institution a single bed day cost is £275. During the time that the numbers of specialist non-operative podiatry staff were depleted, and for up to 6 months after they returned to normal activities, the extra costs increased by just less than £90,000. The number of people admitted directly from specialist vascular and orthopaedic clinics is likely to have increased due to the lack of capacity to manage them in the diabetic foot clinic. Our data were unable to assess these individuals and did not look at the costs saved from avoiding surgery. Thus the actual costs incurred are likely to be higher.</p><p><strong>Conclusions: </strong>Our data suggest that specialist non-operative podiatrists involved in the treatment of the diabetic foot may prevent unwarranted hospital admission and increased hospitalisation rates by providing skilled assessment and care in the outpatient clinical settings.</p>","PeriodicalId":45385,"journal":{"name":"Diabetic Foot & Ankle","volume":"4 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3402/dfa.v4i0.21757","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31736387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Charcot neuroarthropathy in simultaneous kidney-pancreas transplantation: report of two cases.","authors":"Jorge Javier Del Vecchio,&nbsp;Nicolás Raimondi,&nbsp;Horacio Rivarola,&nbsp;Carlos Autorino","doi":"10.3402/dfa.v4i0.21819","DOIUrl":"https://doi.org/10.3402/dfa.v4i0.21819","url":null,"abstract":"<p><p>Charcot neuroarthropathy (CN) is considered a major complication in diabetes mellitus (DM), and it is estimated that 1% of diabetic patients may develop this complication. Simultaneous kidney-pancreas transplantation (SKPT) is one of the most effective therapies for patients with type 1 DM and end-stage diabetic nephropathy. Some cases with a Charcot-modified clinical presentation during the postoperative convalescence period after SKPT have been described. The clinical presentation may condition severe destructive lesions, and good practices include systematic follow-up. Based on the cases described, SKPT is one more entity that might lead to CN 'foot-at-risk'. The aim of this article is to describe two cases of neuropathic arthropathy with rapid progression in the short term after SKPT. </p>","PeriodicalId":45385,"journal":{"name":"Diabetic Foot & Ankle","volume":"4 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3402/dfa.v4i0.21819","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31705561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conservative and surgical treatment of the chronic Charcot foot and ankle.","authors":"Mehmet Fatih Güven,&nbsp;Atakan Karabiber,&nbsp;Gökhan Kaynak,&nbsp;Tahir Oğüt","doi":"10.3402/dfa.v4i0.21177","DOIUrl":"https://doi.org/10.3402/dfa.v4i0.21177","url":null,"abstract":"<p><p>Charcot neuroarthropathy (CN) is a severe joint disease in the foot and ankle that can result in fracture, permanent deformity, and limb loss. It is a serious and potentially limb-threatening lower-extremity late complication of diabetes mellitus. The aim of this manuscript was to evaluate modern concepts of chronic CN through a review of the available literature and to integrate a perspective of management from the authors' extensive experience. </p>","PeriodicalId":45385,"journal":{"name":"Diabetic Foot & Ankle","volume":"4 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3402/dfa.v4i0.21177","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31277272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An overview of the Charcot foot pathophysiology.","authors":"Gökhan Kaynak,&nbsp;Olgar Birsel,&nbsp;Mehmet Fatih Güven,&nbsp;Tahir Oğüt","doi":"10.3402/dfa.v4i0.21117","DOIUrl":"https://doi.org/10.3402/dfa.v4i0.21117","url":null,"abstract":"<p><p>Charcot arthropathy of the foot is a rare but devastating complication of diabetes that remains to be a challenging issue for the foot and ankle surgeons. Charcot foot fails to be an obvious diagnostic option that comes to mind, even in a pathognomonic clinical appearance. The rarity of the disorder, more common pathologies that mimic the condition, and the self-limiting prognosis deviate the clinician from the right diagnosis. The clinical challenges in the diagnosis of Charcot foot require in-depth investigations of its enigmatic nature to establish useful guidelines. Yet, this goal seems to be beyond reach, without a holistic view of the immense literature concerning the pathophysiology of the disorder. The primary objective of this article is to put together and review the recent advancements about the etiology and intrinsic mechanisms of diabetic Charcot foot. </p>","PeriodicalId":45385,"journal":{"name":"Diabetic Foot & Ankle","volume":"4 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3402/dfa.v4i0.21117","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31277271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}