The international journal of lower extremity wounds最新文献

{"title":"Histopathology is More Reliable Than Microbiology for Detecting Residual Osteomyelitis After Conservative Surgery for Diabetic Foot: The Pitfall of False-Positive Cultures and the Role of Pseudomonas aeruginosa.","authors":"Gerardo Víquez-Molina, José María Rojas-Bonilla, Javier Aragón-Sánchez","doi":"10.1177/15347346251338689","DOIUrl":"10.1177/15347346251338689","url":null,"abstract":"<p><p>The optimal method for assessing residual osteomyelitis after conservative surgery for diabetic foot infection remains controversial. Microbiological cultures are frequently used due to their rapid turnaround and utility in guiding antibiotic therapy, but their diagnostic reliability is uncertain. This study compared microbiological cultures and histopathology in evaluating bone resection margins, using histopathology as the gold standard. We included 93 patients undergoing conservative surgery for diabetic foot osteomyelitis. Bone samples were obtained from the proximal resection margin for both microbiology and histopathology. A microbiological result was considered contamination when cultures were positive but histopathology was negative. Microbiological cultures at bone resection margins yielded 52 true positives, 23 false positives (contamination), 10 false negatives, and 8 true negatives when compared to histopathology. This resulted in a sensitivity of 83.9%, specificity of 25.8%, positive predictive value of 69.3%, and negative predictive value of 44.4%. Contamination was not associated with the severity of infection, presence of soft tissue involvement, inflammatory markers, or glycemic control. No association was found between contamination and polymicrobial flora in the primary surgical specimen. However, <i>Pseudomonas aeruginosa</i> was the only species significantly associated with contamination (p = .008), suggesting species-specific factors may contribute to microbiological false positives. These findings emphasize that microbiology, while sensitive, is not a specific method for assessing residual bone infection and should not be used in isolation. Histopathology remains the more reliable diagnostic tool. Future research should explore biofilm-targeted strategies and intraoperative antiseptic protocols to reduce contamination of bone biopsy specimens obtained from resection margins.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"570-576"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036444","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":"Association Between Systemic Inflammatory Response index and Diabetic Foot Ulcer in the US Population with Diabetes in the NHANES: A Retrospective Cross-Sectional Study.","authors":"Yungang Hu, Feng Xiong, Lei Zhao, Fei Wan, Xiaohua Hu, Yuming Shen, Weili Du","doi":"10.1177/15347346251324478","DOIUrl":"10.1177/15347346251324478","url":null,"abstract":"<p><p>Diabetic foot ulcer (DFU) is a common complication of diabetes. It is often accompanied by infection and, in severe cases, necessitates amputation. Early diagnosis and monitoring are crucial for improving prognosis. Novel inflammatory biomarkers, such as the systemic inflammatory response index (SIRI), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) are useful for the diagnosis and predicting prognosis of some diseases. This study aimed to clarify the association between SIRI, NLR, PLR and DFU and assess their utility for early diagnosis and monitoring of DFU. Cross-sectional data were extracted on individuals with diabetes who participated in the National Health and Nutrition Examination Survey (NHANES) between 1999 to 2004. DFU was diagnosed based on the presence of foot ulcers that had not healed within 4 weeks. Weighted multivariable regression, subgroup analysis, and smooth curve fitting were used to evaluate the relationships between the SIRI, NLR, and PLR with DFU.A total of 1204 participants were included in the analysis, of whom 112 had DFUs. Participants with DFUs had higher NLR, PLR, and SIRI values than those without DFUs. For each unit increase in SIRI, the prevalence of DFU increased by 27% . Subgroup analyses showed a consistent association between an elevated SIRI and the prevalence of DFUs.SIRI is a low-cost, readily accessible biomarker that can be used in conjunction with NLR and PLR to assess the severity and predict the prognosis of DFU. Continuous monitoring of these indicators could assist with early diagnosis and management of DFU.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"611-620"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627115","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":"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":"594-604"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12301529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034392","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":"Ischemia Modified Albumin in Diabetic Foot Ulcers: Promising Marker or Incomplete Picture?","authors":"Seshadri Reddy Varikasuvu","doi":"10.1177/15347346251371804","DOIUrl":"https://doi.org/10.1177/15347346251371804","url":null,"abstract":"<p><p>This letter critically appraises the study by Juttada et al, (doi: 10.1177/15347346251332708) which explored ischemia-modified albumin (IMA) as a marker of healing in diabetic foot ulcers (DFUs). We acknowledge the study's novel contribution through its serial IMA monitoring during treatment and compare it with a growing body of evidence. While the study demonstrates promising clinical applicability, there are important limitations regarding its predictive strength, albumin adjustment, and the influence of oxidative therapies. We suggest that future studies adopt a multi-biomarker approach and address variability in oxidative stress conditions such as those encountered during hyperbaric oxygen therapy.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"15347346251371804"},"PeriodicalIF":1.5,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144984587","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":"Charcot's Legacy in Cast and Canvas: Visual Healing in Modern Diabetic Foot Care.","authors":"Nina L Petrova, Wegin Tang, Maureen Bates, Michael E Edmonds","doi":"10.1177/15347346251369242","DOIUrl":"https://doi.org/10.1177/15347346251369242","url":null,"abstract":"","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"15347346251369242"},"PeriodicalIF":1.5,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144984470","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":"Impact of Continuous Glucose Monitoring on Glycemic Control in Type 2 Patients with Diabetic Foot Ulcers: A Pilot Study.","authors":"Radhakrishnan Srinivasan, Aakansha Sinha, Nikolaos Tentolouris, Edward B Jude","doi":"10.1177/15347346251369622","DOIUrl":"10.1177/15347346251369622","url":null,"abstract":"<p><p>AimTo determine whether the use of continuous glucose monitoring (CGM) aids in improving glycaemic control in Type 2 diabetes patients (T2DM) with foot ulcers and improve wound healing.MethodsRetrospective study on patients attending the high-risk diabetes foot clinic for the management of complex diabetic foot ulcers were provided with Continuous Glucose Monitoring (CGM) devices (Freestyle Libre 2). Patients were reviewed in the foot clinic on a weekly to bi-weekly basis, depending on the severity of their foot ulcers and glycaemic control, which was reviewed at each visit. HbA1c was measured not more than 90 days prior to starting CGM and three months after the start of CGM. Wound size was measured at start and after 3 months of CGM use. Data of the eligible patients was reviewed from the medical records.Results22 patients with T2DM with active diabetic foot ulcers were included in this study. Mean age was 65.43 years (range 39-87). Mean HbA1c prior to providing CGM was 84.10 Mmol/mol (range 54-132). The mean HbA1c after three months of CGM use was 65.05 Mmol/mol (range 32-94). Mean reduction in HbA1c was 19.05 ± 22.07 mmol/mol (p = 0.0011) and the greatest improvements were noted in those who had higher HbA1c levels at baseline. Wound size at baseline was 1.53 (0.75-7.62) cm² and after 3 months it was 0.42 (0.0-1.16) cm² (p < 0.001); complete wound healing achieved in 3 patients.ConclusionThis study showed a significant improvement in glycaemic control with the use of CGM and had a positive influence on wound healing. The utility of CGM in improving glycaemic control is well established and is currently widely used in type 1 diabetes mellitus and pregnancy but not directly recommended for patients with foot ulcers according to NICE guidelines. Further follow-up and larger-scale studies are needed to validate these findings and to observe the impact on wound healing.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"15347346251369622"},"PeriodicalIF":1.5,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884712","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":"Innovative Biodegradable Antiseptic and Ointment Wipes for Advanced Wound Management.","authors":"Arjun Dakuri, P Gopi Chandrakanth, Renuka Tejaswini Lolla, Lalith Kumar, J Hayavadana","doi":"10.1177/15347346251367075","DOIUrl":"https://doi.org/10.1177/15347346251367075","url":null,"abstract":"<p><p>Wound care management has undergone significant advancements, driven by the increasing need for effective, <b>sustainable, and cost-effective solutions, especially in low-resource countries</b>. The primary goal of wound care is to expedite healing, minimize infection risk, and ensure cosmetic and functional recovery. This study explores the development of biobased antiseptic and ointment wipes as an eco-friendly, <b>affordable</b> alternative to conventional wound dressings. Spunlace viscose and bamboo fabrics (72 GSM and 114 GSM) were selected for their absorbency and biodegradability. Key bioactive components (tea tree oil, beeswax), and baby shampoo were infused via a padding method. Physical properties, water absorbency (AATCC197), and antibacterial effectiveness (AATCC 100) against <i>S. aureus</i> and <i>E. coli</i> were evaluated using standard textile and microbiological test methods. A subjective evaluation with 15 athletes assessed wound healing effectiveness.Bamboo fabric demonstrated superior wicking height (11.0 cm at 120 s) compared to viscose (10.8 cm). Antibacterial testing revealed a 100% reduction in <i>S. aureus</i> and a 96.2% reduction in <i>E. coli</i> for bamboo samples. Athlete trials indicated an average wound healing time of four days with high satisfaction levels. Cost analysis showed antiseptic wipes cost $0.062 per unit, and ointment wipes cost $0.104 per unit, making them cost-effective alternatives to synthetic and <b>economically viable for mass adoption</b>. Biodegradable antiseptic and ointment wipes infused with natural antimicrobial agents offer a sustainable and effective solution for wound care. Their superior absorbency, antibacterial efficacy, and affordability highlight their potential for widespread adoption in healthcare. Future research should focus on optimizing formulations for broader clinical applications.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"15347346251367075"},"PeriodicalIF":1.5,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144850237","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":"Comment on \"Advanced Wound Healing with Cadaveric Grafts in Ischemic and Complex Wound: A Single Centre Experience\".","authors":"Rachana Mehta, Ranjana Sah","doi":"10.1177/15347346251366860","DOIUrl":"https://doi.org/10.1177/15347346251366860","url":null,"abstract":"","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"15347346251366860"},"PeriodicalIF":1.5,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144801393","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":"Review on Advancements in Wound Dressing: Biofunctionalized Nanoparticles from <i>Butea monosperma</i> Root Extract.","authors":"Rajeshreeba A Jadeja, Suranjana V Mayani","doi":"10.1177/15347346251365421","DOIUrl":"https://doi.org/10.1177/15347346251365421","url":null,"abstract":"<p><p>Wound healing is a complex biological process that can be significantly impaired by numerous factors, resulting in chronic wounds. Recent advancements in nanotechnology have demonstrated the potential of biofunctionalized nanoparticles to improve wound healing. This review examines the methodology and application of biofunctionalized nanoparticles derived from <i>Butea monosperma</i> root extract, incorporated into electro spun nanofibers, presenting a novel approach for advanced wound dressings. This review examines the extraction process, nanoparticle synthesis, electrospinning techniques, and the assessment of the therapeutic properties of the nanofibers. In vitro and in vivo studies demonstrate the efficacy of this approach in promoting wound healing, highlighting significant antibacterial activity and improved tissue regeneration. Future research and clinical application directions are also examined.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"15347346251365421"},"PeriodicalIF":1.5,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144796589","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":"Six-month Outcomes of Patients Admitted for Diabetic Foot Attack.","authors":"Federico Rolando Bonanni, Marco Meloni, Martina Salvi, Ermanno Bellizzi, Aurora Buccolini, Luigi Uccioli, Valeria Ruotolo, Aikaterini Andreadi, Alfonso Bellia, Davide Lauro","doi":"10.1177/15347346251365832","DOIUrl":"https://doi.org/10.1177/15347346251365832","url":null,"abstract":"<p><p>The study aimed to evaluate the mid-term 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 (DFUs) into a specialized multidisciplinary 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 (acute or chronic), infection and Charcot foot requiring urgent hospitalization. Once discharged, patients were regularly followed as outpatients with the following six-month outcomes: healing; major amputation; mortality; hospital readmission; non-fatal major adverse limb and cardiovascular events (MALCE) including nonfatal myocardial infarction (MI), nonfatal stroke, and limb ischemia requiring revascularization. Overall, 141 patients were included. The mean age was 70 ± 12 years, most patients were male (76.6%) and had type 2 diabetes (93.6%) with a mean duration of 22 ± 13 years; 81 (57.4%) patients presented DFA while 60 (42.6%) presented CDF. No cases of admitted Charcot foot were recorded. The DFA group reported 81.5% cases of severe/moderate infections, while the CDF group presented 50% of mild infections. The DFA group reported higher HbA1c values (67 ± 22 vs 56 ± 14 mmol/mol, p = 0.0008) and more cases of first assessment for DFUs (59.3 vs 13.3%, p < 0.0001) when compared to the CDF group. The six-month follow-up outcomes for DFA and CDF were: healing (65.4 vs 60.0%, p = 0.3); major amputation (4.9 vs 1.7%, p = 0.2); mortality (8.6 vs 11.7%, p = 0.5); hospital readmission (27.2 vs 26.7%, p = 0.8); non-fatal MALCE (9.9 vs 23.3%, p = 0.1). Six-month outcomes did not show significant differences between the DFA and CDF groups in terms of healing, major amputation, mortality, readmission, and non-fatal MALCE. Adequate management of DFA seems to ensure favourable mid-term outcomes, even if compared to patients with CDF.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"15347346251365832"},"PeriodicalIF":1.5,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144796590","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}