International Journal of Lower Extremity Wounds最新文献

{"title":"Effect of Early Rehabilitation on Gait, Wound and Home Discharge in Lower Extremity Chronic Wound Patients: A Japanese Multicenter Retrospective Study.","authors":"Noriaki Maeshige Ph, Hisae Hayashi PhD, Hiroto Terashi PhD Md, Miki Fujii PhD Md, Tetsuya Iwamoto PhD, Yu Watanabe MSc, Shinsuke Imaoka MSc, Junichi Matsumoto MSc, Mayo Nishikawa BSc, Naoto Takeda BSc, Ryuzo Mikawa BSc, Yoriko Tsuji PhD Md, Ryuji Higashita PhD Md, Shinobu Ayabe Md, Yuta Terabe Md, Masahide Furukawa Md, Junko Tanaka PhD Md, Takehiko Ohura PhD Md, Nobuhide Kawabe PhD","doi":"10.1177/15347346211039588","DOIUrl":"10.1177/15347346211039588","url":null,"abstract":"<p><p>This study investigated the effect of early rehabilitation on gait restoration, wound healing, and home discharge in patients with lower extremity (LE) chronic wounds. This multicenter, retrospective cohort study included 233 Japanese inpatients who received treatment for LE chronic wounds from April 2012 to March 2015. A multivariate analysis was conducted using outcomes of gait restoration, wound healing, and home discharge as dependent variables. Other survey items were used as independent variables. Early rehabilitation was extracted as an independent factor with gait restoration (hazard ratio [HR] 1.82, <i>P </i>< .01) and home discharge (HR 1.77, <i>P </i>< .001) as dependent factors by the stepwise method in Cox proportional-hazards regression analysis, but it was not extracted as an independent factor with wound healing as the dependent factor by the stepwise method as well as the forced entry method (<i>P </i>= .44). A significant relationship between the presence of gait restoration and home discharge was observed in the chi-square test (<i>P</i><.001), and the duration from admission to gait restoration was significantly correlated to the duration from admission to home discharge (Pearson's product-moment correlation coefficient; <i>r</i>=.89, <i>P</i><.0001). Early rehabilitation was a positive factor for gait restoration and home discharge in chronic LE wound patients.</p>","PeriodicalId":49181,"journal":{"name":"International Journal of Lower Extremity Wounds","volume":" ","pages":"713-721"},"PeriodicalIF":1.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39366625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Necrotizing Fasciitis and Diabetic Foot: Results of a Prompt Identification, Surgery and Antibiotic Therapy (P.I.S.A.) Protocol.","authors":"Elisabetta Iacopi,&nbsp;Catia Sbarbaro,&nbsp;Letizia Pieruzzi,&nbsp;Irene Lorenzi,&nbsp;Luisa Baroni,&nbsp;Chiara Goretti,&nbsp;Paolo Malacarne,&nbsp;Alberto Piaggesi","doi":"10.1177/15347346211041452","DOIUrl":"10.1177/15347346211041452","url":null,"abstract":"<p><p>Necrotizing fasciitis (NF) is a rapidly progressive, life-threatening infection, involving the skin, soft tissue and fascia. We evaluated outcomes of its surgical management in diabetic foot (DF) patients in a tertiary referral centre. We retrospectively searched for NF in the database of our DF Section from 2016 to 2018. All cases were treated according to a multiprofessional integrated protocol, with Prompt Identification, Surgical debridement and systemic Antibiotic therapy (P.I.S.A. Protocol). We analysed short-term evolution (surgical procedures and major amputations), and long-term outcomes (survival and healing rates). Sixty-eight patients were referred to our DF clinic for suspicion of NF. The diagnosis was confirmed in 54 (79.4%; male/female 40/14; type 1/2 diabetes 6/48; age 62.8 ± 8.1 years; duration of diabetes 13.6 ± 10.1 years). According to the microbiological results, cases were classified as Type 1 (33-61.2%), 2 (7-12.9%) and 3 (14-25.9%). No significant differences were observed. All patients underwent a decompressive fasciotomy. Six patients (11.1%) required also a forefoot amputation and 12 (22.2%) a toe or ray amputation. No major amputation was performed in the short-term period. During the follow-up (26 ± 12 months) 46 patients (85%) healed in 94 ± 11 days. Of the remaining 8: 5 (9.2%) died for other reasons before healing, 2 (3.7%) recurred and one (1.9%) required a major amputation. Our experience reveals a relatively high prevalence of NF in DF; despite this, we observed how, when promptly and aggressively treated, NF has a good prognosis and it is not associated with an excess of limb loss and deaths.</p>","PeriodicalId":49181,"journal":{"name":"International Journal of Lower Extremity Wounds","volume":" ","pages":"733-741"},"PeriodicalIF":1.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39392022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Fistulas of Thigh Presenting Unusually in an Operated Patient of Carcinoma Rectum. More Than What Meets the Eye!","authors":"Zulqarnain Masoodi,&nbsp;Johannes Steinbacher,&nbsp;Peter Wimberger,&nbsp;Peter Tadeusz Panhofer,&nbsp;Chieh-Han John Tzou","doi":"10.1177/15347346211065526","DOIUrl":"10.1177/15347346211065526","url":null,"abstract":"<p><p>Chronic skin lesions of the thigh (wounds, fistulas etc) are relatively uncommon, vis-à-vis, their notorious cousins over the distal limb. Even when present, the cause is usually obvious, mostly as trauma or a systemic affliction. We present an unusual case of chronic fistulas over the right thigh in a patient of carcinoma rectum for which anterior resection and an end colostomy was done 4 years earlier. Postsurgical pelvic abscesses finding their way into the thigh are a known entity, but they are usually accompanied by systemic/local features and their presentation is within a shorter time span. The novelty of our case lies in its manifestation (as a cluster of chronic fistulas and not a frank abscess), its late presentation as well as in the absence of any systemic/local inflammatory signs. Our primary objective is to educate wound physicians about the origin of such fistulas whenever they deal with patients who have had a preceding surgical intervention of the abdomen. In our humble opinion, this will ease out many diagnostic and management dilemmas, that such patients can potentially pose.</p>","PeriodicalId":49181,"journal":{"name":"International Journal of Lower Extremity Wounds","volume":" ","pages":"774-778"},"PeriodicalIF":1.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39782642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remaining Question: Does Exercise Improve Healing of Diabetic Foot Ulcers?","authors":"Magali Brousseau-Foley, Virginie Blanchette","doi":"10.1177/15347346211063701","DOIUrl":"10.1177/15347346211063701","url":null,"abstract":"<p><p>Even though it is reasonable to think that exercise is beneficial to diabetic foot ulcer healing, there are currently no exercise recommendations for this population. A systematic review published recently attempted to answer this question. However, because of both the scarce and heterogenous literature on the subject identified by the selected study design and the chosen quality appraisal tool that is too permissive and overestimates the treatment effects, no clinical recommendations can be drawn from this review. We advocate for research on this topic in order to obtain more direct evidence that exercise benefits wound healing, and to close the persistent gap of knowledge regarding the impact of exercise on diabetic foot ulcer wound healing.</p>","PeriodicalId":49181,"journal":{"name":"International Journal of Lower Extremity Wounds","volume":" ","pages":"806-808"},"PeriodicalIF":1.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10631263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39956079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preference for Fasciocutaneous Flap Over Musculocutaneous Flap as a First-Line Option for Ischial Pressure Wound Reconstruction: A Review of 64 Cases.","authors":"Jaehoon Choi, Kyubeom Kim, Junhyung Kim, Woonhyeok Jeong, Taehee Jo, Sang Woo Park","doi":"10.1177/15347346211038768","DOIUrl":"10.1177/15347346211038768","url":null,"abstract":"<p><p>The ischial pressure wound usually comprises a large, extensive defect and involves the repair of more than a small opening. Most surgeons have used a musculocutaneous flap to fill the large dead space of an ischial pressure wound. However, sacrificing muscle tissue has a potential risk of postoperative bleeding. The transferred muscle ultimately loses function as a cushion to absorb pressure. Conservation of muscle structures may be beneficial for use in future recurrence, which is common with ischial pressure wound. We compared the difference in outcome between musculocutaneous and fasciocutaneous flaps and analyzed factors affecting complications with the flaps in ischial pressure wound reconstruction. This study reviewed the results of 64 flaps in 44 patients with ischial wounds. The wounds were reconstructed with 34 musculocutaneous flaps (53%) and 30 fasciocutaneous flaps (47%). Twenty-three cases (36%) had complete healing, and 41 (64%) had complications. There was no significant difference in outcomes between fasciocutaneous and musculocutaneous flap groups. Crude logistic regression analysis showed no significant risk factors for occurrence of major complications. When fasciocutaneous flaps were used, the neighboring perforators and muscle tissues could be conserved. With a perforator-based fasciocutaneous flap, a de-epithelized distal portion of the flap could be used to fill the dead space. Therefore, the fasciocutaneous flap may have priority over the musculocutaneous flap as a first-line option for ischial pressure wound reconstruction.</p>","PeriodicalId":49181,"journal":{"name":"International Journal of Lower Extremity Wounds","volume":" ","pages":"654-660"},"PeriodicalIF":1.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39318824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Bibliometric Study on Buruli Ulcer Based on the Web of Science Database.","authors":"Sevil Alkan,&nbsp;Mustafa Serhat Şahinoğlu","doi":"10.1177/15347346231200559","DOIUrl":"https://doi.org/10.1177/15347346231200559","url":null,"abstract":"<p><p>Buruli ulcer is caused by <i>Mycobacterium ulcerans</i>, a skin infection that occurs mostly in people living in the developing economies of Africa and is considered a neglected tropical disease by the World Health Organization (WHO). Left untreated, it can lead to chronic wounds and loss of limbs. This disease is one of the target diseases of the WHO, and there are very limited bibliometric studies published on this subject. Also, no similar study using the Web of Science Core Collection was found in the available literature. The aim of this study was to evaluate the bibliometric analysis of the literature on Buruli ulcers. For data visualization and analysis, the open-source visualization program Biblioshiny (version 2.0) was used. Although most publications are from Ghana, the United States, and European countries have also made significant contributions. The number of publications has increased especially since 2016. The most preferred keywords in the publications were treatment, diagnosis, and transmission routes. This is the first bibliometric analysis that examines the trend of scientific publications on Buruli ulcer that have been indexed in the Web of Science. Our findings have the potential to be used by academics to improve their research.</p>","PeriodicalId":49181,"journal":{"name":"International Journal of Lower Extremity Wounds","volume":" ","pages":"15347346231200559"},"PeriodicalIF":1.7,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10590253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Monocyte to Lymphocyte, Neutrophil to Lymphocyte, and Platelet to Lymphocyte Ratios With Non-Healing Lower Extremity Ulcers in Patients With Type 2 Diabetes.","authors":"Hai Gao,&nbsp;Yangyan Yi","doi":"10.1177/15347346231197884","DOIUrl":"https://doi.org/10.1177/15347346231197884","url":null,"abstract":"<p><strong>Objective: </strong>Diabetic ulcers are a prevalent complication of diabetes mellitus and represent one of the most complex and severe complications that can occur in diabetic patients. Most existing studies have separately examined the neutrophil-to-lymphocyte ratio (NLR) prognostic value or the platelet-to-lymphocyte ratio (PLR). However, to our knowledge, no study has evaluated the relationship between the monocyte-to-lymphocyte ratio (MLR) and non-healing lower extremity ulcers (NHLU) in patients. This study explored the association between 3 hematological parameters (MLR, NLR, and PLR) and the risk of non-healing ulceration in patients with type 2 diabetes (T2D).</p><p><strong>Methods: </strong>A cross-sectional study was performed using data from the National Health and Nutrition Examination Survey (NHANES) spanning 1999 to 2004. The primary outcome variable was NHLU status, determined by patients' self-reported responses to the question, \"Have you had an ulcer or sore on your leg or foot that took more than four weeks to heal?\" Logistic regression examined the relationships between MLR, NLR, PLR, and NHLU. Stratified analyses were also conducted based on age, gender, hemoglobin (HGB) level, and body mass index (BMI).</p><p><strong>Results: </strong>In the multivariate regression models, after adjusting for age, sex, race/ethnicity, marital status, poverty income ratio (PIR), BMI, HGB, family history of diabetes, and low-density lipoprotein (model 3), the odds ratios (ORs) of MLR and NLR were 1.21 (1.09-1.33) and 1.02 (1.01-1.03), respectively. However, the association was no longer statistically significant for the NLR (OR = 1.0002, 95% CI: 0.99-1.0005, <i>P</i> = .137). In the subgroup analysis, the effect sizes of MLR and NLR on the presence of NHLU were stable in all subgroups (all <i>P</i> > .05).</p><p><strong>Conclusions: </strong>After adjusting for confounding variables, MLR and NLR were significantly increased in T2D participants with NHLU. They may play a significant role in monitoring T2D patients during follow-up visits.</p>","PeriodicalId":49181,"journal":{"name":"International Journal of Lower Extremity Wounds","volume":" ","pages":"15347346231197884"},"PeriodicalIF":1.7,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10225221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Clinical Characteristics of Patients With Pyoderma Gangrenosum in a Tertiary Referral Hospital: A Retrospective Cohort Study.","authors":"Elif Afacan Yıldırım,&nbsp;Yusuf Can Edek,&nbsp;Esra Adısen","doi":"10.1177/15347346231196957","DOIUrl":"https://doi.org/10.1177/15347346231196957","url":null,"abstract":"<p><p>Since pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis, epidemiological and clinical data on the disease are scarce. In this single-center retrospective study, we aim to evaluate the clinical characteristics, underlying systemic associations and treatment modalities in patients with PG in a university hospital between 2014 and 2022. It is known that PG most commonly affects the lower extremities, but extracutaneous involvement should also be kept in mind. PG is usually associated with various comorbidities that share a similar inflammatory pathogenesis with the disease. The prevalence of PG-related comorbidities varies in different studies, arthritis and solid organ malignancies were observed most frequently in the current study. Non-PG-related comorbidities including diabetes mellitus, hypertension and peripheral vascular disease can adversely affect wound healing and limit treatment options; therefore, a holistic approach to patients with PG is crucial. Consistent with literature, the mainstay of treatment for PG is systemic corticosteroids and cyclosporine. However, the implementation of biologic agents in treatment-resistant patients is an increasingly important issue in the literature. Antitumor necrosis factors (anti-TNFs) are the most commonly preferred biological therapies, and these agents seem to have paved the way for a paradigm shift in the treatment of PG. In the present study, a relatively high per cent of (23.3%) patients treated with anti-TNFs, most commonly infliximab (87.5%). Recurrence was observed in 46.7% of our patients in the follow-up period and the relapse rate was found to be higher in patients using multiple systemic agents compared to those using single agents (64.7% vs 23.1%, <i>P</i> < .05). In conclusion, we emphasize that early diagnosis and treatment by considering the patient's comorbidities are important in preventing complications, and biologic treatments seem particularly promising in treatment-resistant patients.</p>","PeriodicalId":49181,"journal":{"name":"International Journal of Lower Extremity Wounds","volume":" ","pages":"15347346231196957"},"PeriodicalIF":1.7,"publicationDate":"2023-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10226817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Painless, Multiple Papulo-Nodular Skin Lesion at Foot Resembles Mycetoma Infection (Madura Foot): A Case Report.","authors":"Ahmed Suparno Bahar Moni,&nbsp;Md M Hoque","doi":"10.1177/15347346211030753","DOIUrl":"https://doi.org/10.1177/15347346211030753","url":null,"abstract":"<p><p>Madura foot is a chronic, progressively destructive bacterial or fungal infection of the subcutaneous tissues, which may affect skin, muscle, and bone. It is endemic in tropical and subtropical areas known as the \"Mycetoma belt\" between latitude 30°N and 15°S. Mycetoma is prevalent in the poor population living in remote areas of developing countries that lack proper reporting system and management. The World Health Organization recognized mycetoma as a neglected tropical disease back in 2016. Though the diagnosis is challenging, early detection and proper treatment can reduce morbidity and provide a promising outcome. We report a case of chronic painless, multiple papulo-nodular skin lesions at the foot that resembles mycetoma infection which was detected early and recovered with a satisfactory outcome with proper treatment.</p>","PeriodicalId":49181,"journal":{"name":"International Journal of Lower Extremity Wounds","volume":"22 3","pages":"616-619"},"PeriodicalIF":1.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/15347346211030753","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9903563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Peripheral Arterial Disease in Diabetic Foot Ulcer Patients and its Impact in Limb Salvage.","authors":"Ahmed Azhar,&nbsp;Magdy Basheer,&nbsp;Mohamed S Abdelgawad,&nbsp;Hossam Roshdi,&nbsp;Mohamed F Kamel","doi":"10.1177/15347346211027063","DOIUrl":"https://doi.org/10.1177/15347346211027063","url":null,"abstract":"<p><p>Diabetic foot ulcer syndrome is a common complication of diabetes mellitus. Three main factors contribute to it: neuropathy, vasculopathy, and infection. This study was conducted to evaluate the prevalence of peripheral arterial disease (PAD) in diabetic foot ulcer patients and its impact on limb salvage as an outcome. This prospective cross-sectional study included 392 cases, who were divided according to the presence of PAD into 2 groups; patients with PAD were labeled as PAD +ve (172 cases) and those without PAD were labeled as PAD -ve (22 cases). All cases were clinically assessed, and routine laboratory examinations were ordered. Moreover, duplex ultrasound was done for suspected cases of having PAD by examination. Computed tomography angiography was ordered for patients who are in need of a revascularization procedure. Cases were managed by debridement and/or revascularization. After that, these cases were assessed clinically and radiologically for vascularity and infection and the possibility for amputation was evaluated. Infection was classified using Wagner Classification System, and revascularization was decided according to the TASC II system. The incidence of PAD in cases with diabetic foot ulcer syndrome was 43.87%. No difference was detected between the 2 groups regarding age and gender (<i>P</i> > .05). The prevalence of smoking, hemodialysis, ischemic heart disease (IHD), and hypertension was more significantly higher in cases with PAD (<i>P</i> < .05). Revascularization procedures were only performed in cases that had documented severe PAD or chronic limb-threatening ischemia in addition to foot ulcer and/or infection. With regard to limb salvage, it was more significantly performed in cases without PAD (82.3% vs 48.3% in PAD cases; <i>P</i> < .001). Male gender, smoking, ankle-brachial pressure index, hemodialysis, IHD, neuropathy, HbA1C, PAD, and high Wagner classification were predictors of limb amputation (<i>P</i> < .05). PAD is associated with worse outcomes in diabetic foot ulcer patients. Not only does it constitute a great number among diabetic foot ulcer patients, but it also has a negative impact on limb salvage.</p>","PeriodicalId":49181,"journal":{"name":"International Journal of Lower Extremity Wounds","volume":"22 3","pages":"518-523"},"PeriodicalIF":1.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/15347346211027063","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9952722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}