The international journal of lower extremity wounds最新文献

{"title":"Impact of Heel Ulcers on Patients Admitted for Diabetic Foot Disease.","authors":"Martina Salvi, Marco Meloni, Federico Rolando Bonanni, Ermanno Bellizzi, Valeria Ruotolo, Aikaterini Andreadi, Alfonso Bellia, Davide Lauro","doi":"10.1177/15347346251337264","DOIUrl":"https://doi.org/10.1177/15347346251337264","url":null,"abstract":"<p><p>The current study aimed to evaluate the clinical outcomes of patients admitted for diabetic foot ulcers (DFUs) located in the heel. The study is a retrospective observational study including a population of patients admitted for DFUs from April 2024 to September 2024. According to the wound location, patients were divided in two groups: those with heel ulcers and those with forefoot/midfoot ulcers without calcaneal involvement. All patients have been managed through a limb salvage protocol in the respect of international guidelines. The following hospital outcomes were evaluated: minor and major amputation, mortality, length of stay, need for regenerative surgery by using dermal-epidermal graft. Overall, 150 patients were included. The mean age was 70.2 ± 12.2 years, most patients were male (76.0%), had type 2 diabetes (92.7%) with a mean duration of 22.1±13.2 years; 27 (18%) patients had heel ulcers, while 123 (82%) had forefoot/midfoot lesions. Outcomes for patients with heel location and without were: minor amputation (18.5 vs 32.5%, p = 0.1), major amputation (7.4 vs 0.8%, p = 0.02), mortality (0 vs 0.8%, p = 0.5), length of hospital stay (17.5 ± 8.5 vs 14.4 ± 8.7 days, p = 0.08), need for regenerative therapy using dermal-epidermal substitutes (48.1 vs 19.5%, p = 0.003) respectively. In addition, heel ulcer was found to be an independent predictor for major amputation [OR 5.06, CI95% (3.1-11.4), p = 0.02] and length of stay [OR 6 CI95% (3.6-10.9), p = 0.003]. In patients admitted for DFUs, wounds located in the heel were associated to an increased risk of major amputation, need for regenerative therapy and length of stay (even though in the limit of statistical difference) than wounds not located in the heel. These data underline the need for tailored management strategies in this high-risk subgroup of patients.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"15347346251337264"},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144002457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gremlin-1 and Wagner Classification: Potential Biomarker for Amputation in Diabetic Foot Patients.","authors":"Şeyma Açık, Şevki Çetinkalp, Çiğdem Gözde Aslan, Yasemin Akçay","doi":"10.1177/15347346251337157","DOIUrl":"https://doi.org/10.1177/15347346251337157","url":null,"abstract":"<p><p>Diabetic foot (DF) is a significant complication with high morbidity and mortality, often resulting from neuropathy and ischemia. In our study, we aimed to evaluate the relationship between serum Gremlin-1 levels and disease severity based on the Wagner classification in DF patients, and to determine its prognostic value in predicting the need for amputation.Eighty-five patients with DF ulcers or considered at high risk for DF were included in the study. The patients' complications were evaluated, and laboratory results were obtained from their records. The Wagner classification was applied, and serum Gremlin-1 levels were analyzed using the ELISA method.It was found that as the Wagner stage of the DF increased, Gremlin-1 levels decreased significantly at the statistical borderline (p = 0.05). In the group of patients who underwent amputation, Gremlin-1 levels decreased significantly (p < 0.05). The sensitivity of Gremlin-1 in predicting amputation, with a cut-off value of 2.47 ng/ml, was 67%, and its specificity was 46%. Additionally, a positive correlation was found between total cholesterol, LDL, fasting glucose, and Gremlin-1 (p < 0.05). In the group of patients with an HbA1c value >7.5%, Gremlin-1 levels increased significantly (p < 0.05). In patients with albuminuria, serum Gremlin-1 levels decreased significantly (p < 0.05).It was determined that Gremlin-1 plays a role through an unknown mechanism in DF patients, and its levels decrease as the Wagner stage increases. Gremlin-1 levels were significantly decreased in the amputation group (p < 0.05). It was shown that Gremlin-1 could be a prognostic marker for predicting amputation.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"15347346251337157"},"PeriodicalIF":0.0,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144002434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuromuscular Electrostimulation of the Common Peroneal Nerve Increases Microvascular Flux in the Wound bed of Diabetic Foot Ulcers.","authors":"David C Bosanquet, Melissa Blow, Faye Ashton, Keith Harding","doi":"10.1177/15347346251331254","DOIUrl":"https://doi.org/10.1177/15347346251331254","url":null,"abstract":"<p><p>ObjectiveTo measure the effect of neuromuscular stimulation of the common peroneal nerve on the microvascular blood flow within the wound bed of diabetic foot ulcers.Research Design and Methods13 patients with diabetic foot ulcers (11 neuropathic, 2 neuroischemic) were recruited. Microvascular flux and pulsatility were measured in real time in the wound bed, and at the wound edge, using Laser Speckle Contrast Imaging (Moor FLPI-2; Moor Instruments Ltd, Axminster, United Kingdom). Changes from baseline were measured when the leg muscle pump was activated by 1 Hz neuromuscular stimulation of the common peroneal nerve, using a wearable device (geko, Firstkind Ltd Daresbury, United Kingdom).ResultsIn the 11 neuropathic ulcers, significant increases were seen in all microvascular parameters. Wound bed flux increased by 36% (95%CI 11%-68%, <i>P</i> = .002), and peri-wound flux increased by 92% (95%CI 46%-160%, <i>P</i> = .001). Pulsatility in the wound bed increased by 183% (95%CI 61%-517%, <i>P</i> = .005), while pulsatility in the peri-wound increases by 359% (95%CI 264%-455%, <i>P</i> = .001). Additionally, an increase in flux and pulsatility was observed in the neuroischemic ulcers.ConclusionsNeuromuscular stimulation of the common peroneal nerve presents a mode of activating the leg muscle pump without additional pressure insult to the foot and has potential to support the microcirculation during wound-healing, effectively emulating exercise without any of the attendant risks of exercise to the neuropathic or neuroischemic foot.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"15347346251331254"},"PeriodicalIF":0.0,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive Management of Venous Leg Ulcers: Evidence-Based Strategies and Treatment Options.","authors":"Myo Zin Oo, Boonying Siribumrungwong, Saritphat Orrapin, Nuttawut Sermsathanasawadi, Nikolaos Papanas, Kittipan Rerkasem","doi":"10.1177/15347346251333202","DOIUrl":"https://doi.org/10.1177/15347346251333202","url":null,"abstract":"","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"15347346251333202"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Effects of Weekly and Biweekly Low-Frequency Ultrasound Debridement Versus Standard of Wound Care in Patients with Diabetic Foot Ulcers: A Pilot Randomized Clinical Trial.","authors":"Sebastián Flores-Escobar, Yolanda García-Álvarez, Francisco Javier Álvaro-Afonso, Mateo López-Moral, Marta García-Madrid, José Luis Lázaro-Martínez","doi":"10.1177/15347346251332795","DOIUrl":"https://doi.org/10.1177/15347346251332795","url":null,"abstract":"<p><p>The aim of this study was to evaluate clinical effects of weekly (UD/week) and biweekly (UD/2-weeks) low-frequency ultrasound debridement (UD) on wound healing, healing time, wound area, granulation tissue, and transcutaneous oxygen pressure (TcPO₂) in patients with diabetic foot ulcers (DFUs), compared to the standard of care (SoC). A pilot randomized clinical trial was conducted involving 30 patients with DFUs who received either UD/week (n = 10), UD/2-weeks (n = 11), or SoC (n = 9) every week over a 12-week treatment period. Healing rates at 6 months were 70% in the UD/week, 54.4% in the UD/2-weeks, and 33.3% in the SoC (<i>P</i> = .27). The healing times were 11 (IQR 7-19) weeks for UD/week, 18 (IQR 15-36) weeks for the SoC, and 24.5 (IQR 16-30) weeks for the UD/2-weeks group (<i>P</i> = .036). Wound area was reduced by 87.5 ± 18.5% in the UD/week, 68.6 ± 26.2% in the UD/2-weeks, and 38.9 ± 16.6% in the SoC (<i>P</i> = .014). Wollina wound scores were 7 (IQR 6-7) in the UD/week, 7 (IQR 6.5-7) in the UD/2-weeks, and 4 (IQR 3-6) in the SoC (<i>P</i> = .002). UD/week showed not significantly higher healing rates than the UD/2-weeks and SoC, but experienced significantly shorter healing time, a greater percentage of wound area reduction and higher Wollina wound score. These findings suggest that UD/week could be a valuable therapeutic option in clinical practice, particularly for patients in whom sharp debridement is not a viable option or who require an alternative approach to promote wound healing. This study is registered in ClinicalTrial.gov.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"15347346251332795"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low Serum Uric Acid Levels are Associated with Severe Diabetic Foot Infection: A Cross-Sectional Study from China.","authors":"Jie Zhao, Xiaowei Wei, Ping Zhu, Mei Zhang, Zhangrong Xu, Aihong Wang","doi":"10.1177/15347346251319080","DOIUrl":"https://doi.org/10.1177/15347346251319080","url":null,"abstract":"<p><p><b>Diabetic</b> foot ulcers (DFUs) are among the most serious complications of diabetes which are associated with high disability and mortality rates. This study aims to investigate the associations between uric acid (UA) levels and diabetic foot ulcer (DFU) characteristics. In total, 1820 participants with DFUs were included in this study; 192 and 1628 participants were included in the hyperuricemia group (HUA, UA > 420 µmol/L) and the nonhyperuricemia group (NHUA, UA ≤420 µmol/L), respectively. The NHUA group was divided into a middle-UA subgroup (SMUA, 420 µmol/L ≥ UA ≥ 180 µmol/L; 304 individuals) and a low-UA subgroup (SLUA, UA <180 µmol/L; 1324 individuals). There were no significant differences in the rates of deep ulcers, severe infection or amputation between NHUA and HUA. In univariate analysis of subgroups, the differences in the rates of deep ulcers, severe infection and amputation were significant. After adjusting for confounders (sex, fasting glucose level, diabetes duration, eGFR, deep ulcers and severe infection) in multivariate analysis, the severe infection rate (OR = 4.0, 95%CI 1.6-10.0, P < 0.01) was still significantly greater in the SLUA group than in the SMUA group while the rate of deep ulcers (OR =2.4, 95%CI 1.0-6.1, P = 0.06) and amputation (OR =1.1, 95%CI 0.3-4.3, P = 0.91) showed non-statistical difference. UA levels below 180 µmol/L can be a risk factor for severe infection in DFUs.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"15347346251319080"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Prevalence of Contact Allergies for Wound Dressings in Patients With Diabetic Foot Ulcers (PAID Study), an Observational Prospective Trial.","authors":"Birgitte M Visch, Daphne van der Veen, Luuk Smeets, Roland Toeter, Arianne van Bon, Diana Romijn","doi":"10.1177/15347346251332028","DOIUrl":"https://doi.org/10.1177/15347346251332028","url":null,"abstract":"<p><p>This investigator initiated prospective observational study investigates the prevalence of contact allergies in patients with a Diabetic Foot Ulcer (DFU). Patients with a DFU received a combined PATCH-test (a test used to investigate the origin of an allergic reaction on the skin) at the upper back, with the European baseline series, the European leg ulcer series, and local used material for leg ulcers. A total of 108 patients with DFU were included of which 86 (79.6%) were male, and 9 (8.3%) and 99 (91.7%) patients had Type 1 and Type 2 diabetes, respectively. Twenty-one patients had a sensitization in the standard series, 30 patients in the leg ulcer series, and 11 patients in both series. Two patients had a positive reaction for one of the local used materials. Most frequent sensitizations were found for Perubalsem (N = 6) and Fragrance-Mix II (N = 4) in the standard series. A sensitization for Povidone-Iodine (N = 20) was most frequently seen in the leg ulcer series. In the local used materials a sensitization for silver sulfadiazine (N = 1) and cutimed-gel (n = 1) were seen. In conclusion, this study provides novel information about sensitizations in patients with DFU, but more research is needed to demonstrate the relationship between allergic reactions and delayed wound healing. The study protocol was registered in www.clinicaltrials.gov (NCT04085705, PAID study).</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"15347346251332028"},"PeriodicalIF":0.0,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the Relationship Between SVS WIfI and IWGDF Scoring Systems and Reamputation Risk in Patients With Diabetic Foot and Peripheral Artery Disease.","authors":"Alkan Bayrak, Mustafa Yalın, Mehmet Utku Çiftçi, Malik Çelik, Vedat Öztürk, Serdar Hakan Basaran","doi":"10.1177/15347346251333835","DOIUrl":"https://doi.org/10.1177/15347346251333835","url":null,"abstract":"<p><p>Determining the optimal amputation level in diabetic foot (DF) and peripheral artery disease (PAD) patients is crucial for minimizing reamputation risk while preserving functionality. The Society for Vascular Surgery Wound, Ischemia, and Foot Infection (SVS WIfI) and International Working Group on Diabetic Foot (IWGDF) scoring systems are widely used for risk stratification, but their predictive value for reamputation remains unclear. The current study aimed to evaluate the predictive utility of these scoring systems for reamputation risk in patients undergoing amputations due to DF or PAD. A retrospective cohort study was conducted on 108 patients who underwent unilateral amputations due to DF or PAD between 2016 and 2021. Patients were categorized based on WIfI and IWGDF classifications, and clinical outcomes, including reamputation rates, ICU admissions, and mortality, were analyzed using logistic regression and post hoc analyses. Reamputation occurred in 41 (38%) patients. Higher WIfI (OR: 3.85, 95% CI: 2.10-7.05, <i>P</i> = .001) and severe IWGDF scores (OR: 3.25, 95% CI: 1.80-5.88, <i>P</i> = .008) significantly correlated with increased reamputation risk. Patients with high-risk scores also exhibited higher ICU admission (<i>P</i> = .03) and mortality rates (<i>P</i> = .01). Male gender (OR: 3.47, 95% CI: 1.45-8.31, <i>P</i> = .005), diabetes (OR: 2.32, 95% CI: 1.10-4.90, <i>P</i> = .027), and prolonged hospitalization (OR: 1.04, 95% CI: 1.01-1.08, <i>P</i> = .021) were independent predictors, while above-ankle amputations were protective for reamputation (OR: 0.22, 95% CI: 0.11-0.43, <i>P</i> < .001). Both scoring systems are effective in predicting reamputation risk, with WIfI providing a more comprehensive risk assessment. Combining these tools may enhance decision-making and improve patient outcomes in terms of reamputation prevention, hospital stay, ICU admission, and mortality.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"15347346251333835"},"PeriodicalIF":0.0,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the Effectiveness and Safety of Different Non-surgical Offloading Interventions for Diabetic Foot Ulcers: A Network Meta-analysis of Randomized Controlled Trials.","authors":"Yuxia Wu, Yiyuan Chen, Hui Wang, Suyun Dong, Hai-Ou Yan, Juan Xie","doi":"10.1177/15347346251329609","DOIUrl":"https://doi.org/10.1177/15347346251329609","url":null,"abstract":"<p><p>ObjectiveThe aim of this study is to conduct a network meta-analysis of the effectiveness and safety of different non-surgical offloading interventions for patients with diabetic foot ulcers.MethodsWe searched PubMed, EMBASE, OVID, Web of Science, and Cochrane Library for randomized controlled trials (RCTS) on the efficacy of non-surgical interventions for DFU offloading. Outcome measures included the rate of ulcer healing, reduction in ulcer area, and incidence of adverse events. The Cochrane Risk of Bias Tool version was used to assess the risk of bias of the included trials.ResultsA total of 22 RCTs involving 1226 patients were included. Network meta-analysis showed that compared to removable knee high offloading device (OR = 3.66, 95% CI (1.78, 8.46)], removable ankle high offloading device (OR = 3.17, 95% CI (1.32, 7.85)], therapeutic shoe (OR = 3.72, 95% CI (1.53, 9.78)], standard treatment (OR = 4.15, 95% CI (1.05, 13.89)], TCC significantly increased the ulcer healing rate (<i>P</i> < .05). The analyses did not reveal any statistically significant differences between the results of the various types of non-surgical offloading measures in terms of ulcer reduction area and incidence of adverse events. The ranking probability graph showed that TCC (SUCRA = 0.59) was most likely to improve ulcer healing rates, therapeutic shoes (SUCRA = 0.25) performed best in terms of ulcer reduction area, and non-removable walkers (SUCRA = 0.63) were most likely to reduce the incidence of adverse events.ConclusionsNon-removable offloading devices (TCC and non-removable walkers) have the best effectiveness and safety in the non-surgical offloading interventions of patients with diabetic foot ulcers, which is of great significance in promoting ulcer healing and improving prognosis.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"15347346251329609"},"PeriodicalIF":0.0,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics and Outcomes of Patients Admitted for Diabetic Foot Attack.","authors":"Federico Rolando Bonanni, Marco Meloni, Martina Salvi, Ermanno Bellizzi, Valeria Ruotolo, Aikaterini Andreadi, Alfonso Bellia, Davide Lauro","doi":"10.1177/15347346251328724","DOIUrl":"https://doi.org/10.1177/15347346251328724","url":null,"abstract":"<p><p>The current study aimed to evaluate characteristics and outcomes of patients admitted for a diabetic foot attack (DFA). It is a retrospective observational study including a population of patients admitted for diabetic foot ulcers (DFU) in a specialized diabetic foot service. Based on the type of hospital admission (emergency or elective), patients were divided into two groups: those with DFA and those without DFA (chronic diabetic foot, CDF). The DFA was considered in case of ischemia, infection and Charcot foot requiring urgent hospitalization. The following in-hospital outcomes were evaluated: minor and major amputation, number of surgical procedures, length of stay (LOS), mortality. Overall, 150 patients were included. The mean age was 70.3 ± 12.2 years, most patients were male (76.0%) and had type 2 diabetes (92.7%) with a mean duration of 22.1 ± 13.2 years; 88 (58.7%) patients presented DFA while 62 (41.3%) presented CDF. The DFA group reported a greater rate of foot infection (81.8 vs 50.0%, p = 0.002), higher HbA1c values (67.9 ± 22 vs 56.6 ± 14.3 mmol/mol, p = 0.0005) and more cases of first assessment for DFUs (43.2 vs 12.9%, p = 0.005) compared with the CDF group. Outcomes for DFA and CDF were minor amputation (36.4 vs 21%, p = 0.04), major amputation (2.3 vs 1.6%, p = 0.7), need for surgical procedures (>1) (27.3 vs 11.3%, p = 0.0001), LOS (17 ± 9.6 vs 12 ± 6.3 days, p = 0.0004), mortality (1.1 vs 0%, p = 0.6). In addition, foot infection and poor glycometabolic control were independently related to the DFA presentation. The DFA increases the risk of minor amputations, more surgical procedures and longer hospitalization. Foot infection and poor metabolic control resulted closely related to the DFA.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"15347346251328724"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}