International Journal of Lower Extremity Wounds最新文献

{"title":"\"Hurricane-like\" Presentation of a Recurrent Marjolin's Ulcer in a Young Female.","authors":"Aakansha G Goswami,&nbsp;Somprakas Basu,&nbsp;Vijay K Shukla","doi":"10.1177/15347346211028687","DOIUrl":"https://doi.org/10.1177/15347346211028687","url":null,"abstract":"<p><p>Marjolin's ulcer (MU) with rapid progression and multiple distant metastases is rare. We report a case of an MU of the thigh developing in a postburn scar, which after successful R0 resection developed multiple bony and visceral metastasis to femur, vertebra, skull, lung, and liver within 3 months of excision. We highlight the \"hurricane-like\" recurrence in an MU, which is unusual for the metachronous disease. We stress that MUs, unlike conventional wisdom, need a thorough metastatic workup at presentation, and prognostication of a possible rapidly progressive course after surgery which may lead to grave prognosis and mortality.</p>","PeriodicalId":49181,"journal":{"name":"International Journal of Lower Extremity Wounds","volume":"22 3","pages":"612-615"},"PeriodicalIF":1.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/15347346211028687","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9946410","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":"Immediate Effects of Weight-Bearing Calf Stretching on Ankle Dorsiflexion Range of Motion and Plantar Pressure During Gait in Patients with Diabetes Mellitus.","authors":"Noriaki Maeshige,&nbsp;Mikiko Uemura,&nbsp;Yoshikazu Hirasawa,&nbsp;Yoshiyuki Yoshikawa,&nbsp;Maiki Moriguchi,&nbsp;Nobuhide Kawabe,&nbsp;Miki Fujii,&nbsp;Hiroto Terashi,&nbsp;Hidemi Fujino","doi":"10.1177/15347346211031318","DOIUrl":"https://doi.org/10.1177/15347346211031318","url":null,"abstract":"<p><p>High plantar pressure is a risk factor for diabetic foot ulcers, and it is known that restriction of ankle dorsiflexion range of motion (ROM) causes high plantar pressure. Stretching is a non-invasive and general means to improve ROM; however, the effect of stretching on the ROM and plantar pressure has not been clarified in patients with diabetes mellitus. We aimed to study the effects of intermittent weight-bearing stretching on ankle dorsiflexion ROM and plantar pressure during gait in patients with diabetes mellitus. Seven patients with diabetes mellitus participated, and their triceps surae was stretched using weight-bearing stretching with a stretch board. Five minutes of stretching was performed 4 times with a rest interval of 30 s. Ankle dorsiflexion ROM was measured with the knee flexed and extended. Peak pressure and pressure-time integral during gait were measured and calculated for the rearfoot, midfoot, forefoot, and total plantar surface before and after stretching. Ankle dorsiflexion ROM with the knee extended or bent increased significantly after stretching (<i>P < </i>.05). Peak pressure and the pressure-time integral decreased significantly, especially in the forefoot (<i>P < </i>.01), and these also decreased significantly in the total plantar surface (<i>P < </i>.05). The duration of foot-flat decreased after stretching (<i>P < </i>.05). Weight-bearing stretching improved ankle dorsiflexion ROM and reduced plantar pressure during gait. These results suggest that weight-bearing calf stretching may be an effective means to prevent and treat diabetic foot ulcers.</p>","PeriodicalId":49181,"journal":{"name":"International Journal of Lower Extremity Wounds","volume":"22 3","pages":"548-554"},"PeriodicalIF":1.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/15347346211031318","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9955647","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":"Analysis of the Relationship Between Lower leg Muscle Mass and Preservation of Lower Extremity in Patients with Diabetic Foot Ulcer.","authors":"Sung Y Jung,&nbsp;Myoung J Lee,&nbsp;Sang Y Lee","doi":"10.1177/15347346211024493","DOIUrl":"https://doi.org/10.1177/15347346211024493","url":null,"abstract":"<p><p>This study aimed to determine how the muscle mass of the lower leg affects the preservation of the lower extremities in patients with diabetic foot ulcer. This study analyzed patients with diabetic foot ulcer between January 2014 and June 2018 with a follow-up of at least 2 years. Of these 181 patients whose ulcer is located distal to the metatarsophalangeal joint, which was categorized as grade ≤2 by the Wagner classification were classified into 4 grades: grade 0 (treated without amputation), grade 1 (amputation distal to the metatarsophalangeal joint), grade 2 (Ray, transmetatarsal, Lisfranc, and Chopart amputation), and grade 3 (Syme, below-knee, and above-knee amputation) according to the final amputation degree. The muscles of the lower leg were classified into 4 compartments: anterior, lateral, deep posterior, and superficial posterior. The cross-sectional area and attenuation to estimate the muscle volume and density were measured at the axial image of computed tomography (CT) angiography. No significant differences were observed in the sex ratio and mean age among the grades (<i>P</i> = .966 and .962). The cross-sectional area of the anterior, lateral, and posterior compartments demonstrated no significant differences, but that of the superficial posterior compartment exhibited significant differences among the grades (<i>P</i> < .001). Moreover, the attenuation of the anterior, lateral, and deep posterior compartments showed no significant differences, but that of the posterior compartment showed significant differences among the grades (<i>P</i> = .003). The muscle mass of the superficial posterior compartment of the lower leg could be a good indicator of the preservation of the lower extremity in patients with diabetic foot ulcer. Therefore, a strengthening exercise for the triceps surae and plantaris muscles in the early stage could help preserve as much of the lower extremities as possible.</p>","PeriodicalId":49181,"journal":{"name":"International Journal of Lower Extremity Wounds","volume":"22 3","pages":"503-508"},"PeriodicalIF":1.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/15347346211024493","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9958073","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":"Major Lower-Limb Amputation During the COVID Pandemic in South India.","authors":"Vijay Viswanathan,&nbsp;Sukanya Nachimuthu","doi":"10.1177/15347346211020985","DOIUrl":"https://doi.org/10.1177/15347346211020985","url":null,"abstract":"<p><p>People with diabetes have a higher risk of lower-limb amputations than people without diabetes. The risk of avoidable lower-limb amputations has increased in the coronavirus disease 2019 (COVID-19) lockdown period. Hence, we conducted a retrospective, single-centered study on major amputations during the prepandemic period (March 25, 2019-December 31, 2019) and pandemic period (March 25, 2020-December 31, 2020). During the prepandemic period, 24 major amputations (below-knee and above-knee amputations) were performed and during the pandemic period, 37 major amputations were performed. There was a 54.1% increase in major amputations noted in the pandemic period more than the prepandemic period. This increase may also be due to irregular/missed hospital visits, improper diet, nonadherence to the medications, and physical inactivity. This study shows the indirect effect of the COVID-19 pandemic on people with diabetes, resulting in the increased incidence of lower-extremity amputations (below-knee and above-knee amputations) which might cause a drastic impact on their quality of life. This study also emphasizes the importance of easy and routine access to foot-care specialists to prevent avoidable amputations.</p>","PeriodicalId":49181,"journal":{"name":"International Journal of Lower Extremity Wounds","volume":"22 3","pages":"475-479"},"PeriodicalIF":1.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/15347346211020985","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10270027","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":"Closure of Complex Wounds by a Simple Skin Stretching System Associated With Vacuum Sealing Drainage-Clinical Outcome of 34 Patients.","authors":"Yaojun Wu,&nbsp;Liang Chen,&nbsp;Xinliang Mao,&nbsp;Zhengliang Ru,&nbsp;Liying Yu,&nbsp;Mimi Chen,&nbsp;Jingnan Wang,&nbsp;Jiejie Chen,&nbsp;Qingjiang Pang","doi":"10.1177/15347346211032046","DOIUrl":"https://doi.org/10.1177/15347346211032046","url":null,"abstract":"<p><p>Management of complex wounds with large skin defects presents a real challenge for orthopedic or reconstructive surgeons. We developed a simple skin stretching system associated with vacuum sealing drainage to examine the efficiency and complication. A total of 34 patients with different types of complex wounds were retrospectively included from January 2015 to March 2021. All patients in the study were underwent the treatment by 2 stages. The method was used to the wounds from 4.71 to 169.65 cm² with a median defect size of 25.13 cm². The median time for wound closure was 11.5 days (range: 5-32 days), although the median absolute reduction was 2.08 cm²/day (range: 0.15-25.66 cm²/day). Depending on the site of the wounds, the cause of the wound, and the rate of max-width/max-length (<i>W</i>/<i>L</i>), these complex wounds could be separately divided into several groups. There were statistically significant differences in the median value of the above variables (<i>P</i> < .05 Kruskal-Wallis test). The results showed that different anatomical sites had different viscoelastic properties, the complex wounds caused by trauma were easier to close than caused by diabetic foot and the complex wounds in group A (<i>W</i>/<i>L</i> ＞ 0.5) were more difficult to close than in group B (<i>W</i>/<i>L</i> ≤ 0.5). No major complications were encountered in this study. In summary, the results of our study showed that the simple skin stretching system associated with vacuum sealing drainage was a safe approach for closure of complex wounds. Nevertheless, more attention should be paid to the viscoelasticity of the wounds to ensure closure and avoid undue complications when applying the method.</p>","PeriodicalId":49181,"journal":{"name":"International Journal of Lower Extremity Wounds","volume":"22 3","pages":"555-562"},"PeriodicalIF":1.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/15347346211032046","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10287995","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":"Transplantation of Bone Marrow Cells Preactivated With Sodium Nitroprusside Improves Acute Wound Healing in Rabbits.","authors":"Nazira Fatima,&nbsp;Muhammad Saleem","doi":"10.1177/15347346211029078","DOIUrl":"https://doi.org/10.1177/15347346211029078","url":null,"abstract":"<p><p>The development of wound healing impairment mainly represents challenging clinical problems. The less and high concentrations of nitric oxide can influence angiogenesis, remodeling, and proliferation of skin cells. Delayed acute wounds generally have failed to progress via the normal stages of healing. Such wounds usually enter a state of pathological inflammation due to a postponed, incomplete, and uncoordinated healing process. This study aimed to investigate the effect of normal bone marrow cells (BMCs) and preconditioning of BMCs with minimum concentrations of sodium nitroprusside (NaNP) solution for acute wound healing. For acute wound healing, full-thickness dorsal wounds were created on rabbits. The acute wound of rabbits was treated with BMCs and preactivated BMCs with NaNP. Histological results showed that BMCs preactivated with NaNP could improve collagen deposition, enhanced reepithelization, and decreased inflammatory infiltration. Overall, BMCs treated with NaNP can help to improve acute wound healing in rabbits. The result strongly confirmed the beneficial effect in augmenting the wound healing process. The combination of BMCs with NaNP was safe and convenient for acute wound healing.</p>","PeriodicalId":49181,"journal":{"name":"International Journal of Lower Extremity Wounds","volume":"22 3","pages":"531-541"},"PeriodicalIF":1.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/15347346211029078","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9961676","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":"Acrocyanosis and Progressive Skin Necrosis as Manifestation of Waldenstrom Macroglobulinemia Associated With Type I Cryoglobulinemia: A Case Report.","authors":"Seyed M Nekooghadam,&nbsp;Rama Bozorgmehr,&nbsp;Seyed A A Safavi-Naini","doi":"10.1177/15347346211026994","DOIUrl":"https://doi.org/10.1177/15347346211026994","url":null,"abstract":"<p><p>Waldenstrom macroglobulinemia (WM), a rare malignant disorder, occurs as a result of abnormal proliferation of lymphocytes that produce immunoglobulin M. In rare cases, WM complicates by type I cryoglobulinemia. Type I cryoglobulinemia usually presents with cutaneous manifestations such as Raynaud's phenomenon, purpura, necrosis, and gangrene. Various medical conditions, including thrombotic events, rheumatologic disorders, and malignancies, may present with skin discoloration and necrosis. Patients suffering from malignant diseases who initially present with skin manifestations usually are misdiagnosed by physicians. Here, we describe a 72-year-old man presenting with a 6-month acrocyanosis and progressive skin necrosis who was misdiagnosed by physicians. Finally, he was diagnosed to have WM associated with type I cryoglobulinemia. Though uncommon, hematologic malignancies can present with cutaneous manifestations. In some cases, patients may manifest with skin disorders alone. Early and prompt treatment of these diseases may save the patient life, relieve patient symptoms, and increase life quality.</p>","PeriodicalId":49181,"journal":{"name":"International Journal of Lower Extremity Wounds","volume":"22 3","pages":"605-609"},"PeriodicalIF":1.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/15347346211026994","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9946409","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":"Incidence and Predictive Factors for Amputations Derived From Charcot's Neuroarthropathy in Persons With Diabetes.","authors":"Mariana A Bandeira,&nbsp;Alexandre L G Dos Santos,&nbsp;Kevin Woo,&nbsp;Mônica A Gamba,&nbsp;Vera L C de Gouveia Santos","doi":"10.1177/15347346211025893","DOIUrl":"https://doi.org/10.1177/15347346211025893","url":null,"abstract":"<p><p>Charcot's neuroarthropathy (CN) is the progressive destruction of the bones and joints of the feet, as a consequence of severe peripheral neuropathy, which predisposes patients to amputations. The purpose of this study was to measure the cumulative incidence of amputations resulting from CN and risk factors among amputated people with diabetes mellitus (DM). This was an epidemiological, observational, and retrospective study of 114 patients with DM who had an amputation involving the lower limbs. Data were collected from 2 specialized outpatient clinics between 2015 and 2019, including socio-demographic and clinical variables (cause of amputation: CN, peripheral arterial disease [PAD], infected ulcers, fracture, osteomyelitis, and others; body mass index [BMI]; 1 or 2 DM, time since DM diagnosis, insulin treatment, glycated hemoglobin; creatinine; smoking and drinking; systemic arterial hypertension, diabetic retinopathy, diabetic kidney disease, diabetic peripheral neuropathy, acute myocardial infarction, PAD, and stroke; characteristics of amputation [level and laterality], in addition to the specific variables related to CN [time of amputation in relation to the diagnosis of CN, diagnosis of CN in the acute phase, and treatment implemented in the acute phase]). We compared socio-demographic and clinical characteristics, including types of amputation, between patients with and without CN. Statistical analyses were performed using the 2 sample <i>t</i>-test or Wilcoxon-Mann-Whitney test, for quantitative variables, and the Pearson's χ² test or Fisher's exact test for categorical variables. The investigation of the possible association of predictive factors for a CN amputation was carried out through logistic regression. The amputation caused by CN was present in 27 patients with a cumulative incidence of 23.7% in 5 years. There was a statistically significant association between BMI and the occurrence of CN (odds ratio: 1.083; 95% confidence interval: 1.001-1.173; <i>P</i> = .048); higher values of BMI were associated with a higher occurrence of amputations secondary from CN.</p>","PeriodicalId":49181,"journal":{"name":"International Journal of Lower Extremity Wounds","volume":"22 3","pages":"509-517"},"PeriodicalIF":1.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/15347346211025893","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9912659","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":"Mechanism of Origin of Positive Tissue Pressure During Negative-Pressure Wound Therapy.","authors":"Valdas Macionis","doi":"10.1177/15347346211024566","DOIUrl":"https://doi.org/10.1177/15347346211024566","url":null,"abstract":"<p><p>This report provides a simplified insight into the previously unexplained physical mechanism of the origin of local positive tissue pressure during negative-pressure wound therapy (NPWT). A chain of 2 spring model could be used to show the biomechanical interaction between the NPWT dressing and the adjacent body tissues. It is important to assume that the application of NPWT dressing to the body surface creates a new closed compartmentalized volume. Air suction generates local positive pressure within the dressing due to unopposed atmospheric load, which in turn leads to compression of the adjacent tissues and induction of positive pressure there. Analysis of the biomechanical events during NPWT implies the possibility of tissue injury by positive pressure and suggests clinical alertness in regard to the balance between the size of the NPWT dressing and suction pressure as well as further related research.</p>","PeriodicalId":49181,"journal":{"name":"International Journal of Lower Extremity Wounds","volume":"22 3","pages":"625-627"},"PeriodicalIF":1.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/15347346211024566","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9958074","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":"Early and Intensive Glycemic Control for Diabetic Foot Ulcer Healing: A Prospective Observational Nested Cohort Study.","authors":"Aditya Dutta,&nbsp;Anil Bhansali,&nbsp;Ashu Rastogi","doi":"10.1177/15347346211033458","DOIUrl":"https://doi.org/10.1177/15347346211033458","url":null,"abstract":"<p><p>We aimed to assess the effect of glycemic control on diabetic foot ulcer (DFU) healing. A prospective nested cohort study was employed of individuals with poorly controlled diabetes (glycated hemoglobin [HbA_1c] >9%) and neuropathic DFU of >2-week duration. All individuals received standard diabetes and ulcer interventions for 12 weeks. Baseline demographic characteristics, ulcer area (automated assessment by wound zoom camera), and biochemical parameters were analyzed. The cohort was stratified into ulcer healed and unhealed groups. Ulcer area and glycemic parameters at 4 and 12 weeks on follow up were compared. Forty-three individuals (47 DFU) with baseline HbA_1c 11.6% and ulcer area 9.87 cm² were enrolled. After 12 weeks, mean HbA_1c was 7.2%, 17 ulcers closed (healed group) and 30 ulcers did not close (unhealed group). The median time to ulcer healing was 10 weeks. Individuals in the healed group had lower fasting blood glucose (<i>P</i> = .010), postprandial blood glucose (<i>P</i> = .006), and HbA_1c at 4 weeks (<i>P</i> = .001), and 12 weeks (0.018) compared to the unhealed group. Cox-regression analysis that revealed lower baseline ulcer area (<i>P</i> = .013) and HbA_1c at 4 weeks (<i>P</i> = .009) significantly predicted DFU healing by 12 weeks. Baseline ulcer area of >10.58 cm² and HbA_1c at 4 weeks of >8.15% predicted delayed DFU healing. In conclusion, early and intensive glycemic control in the first 4 weeks of treatment initiation is associated with greater healing of DFU independent of initial ulcer area.</p>","PeriodicalId":49181,"journal":{"name":"International Journal of Lower Extremity Wounds","volume":"22 3","pages":"578-587"},"PeriodicalIF":1.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/15347346211033458","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10327546","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}