The international journal of lower extremity wounds最新文献

{"title":"Predictive Value of Neutrophil-to-Lymphocyte Ratio (NLR) for Amputation in Patients with Diabetic Foot Ulcer: A Meta-Analysis.","authors":"Ruibin Feng, Cairu Chen, Qikai Hua","doi":"10.1177/15347346261483973","DOIUrl":"https://doi.org/10.1177/15347346261483973","url":null,"abstract":"<p><p>Diabetic foot ulcers frequently lead to amputation, and early risk identification remains challenging. Although the neutrophil-to-lymphocyte ratio (NLR) may predict amputation risk, supporting evidence remains limited. This study evaluated the association between NLR and amputation risk in patients with diabetic foot (DF). We systematically searched PubMed, Embase, Scopus, Cochrane Library, and Web of Science up to May 31, 2026. Studies reporting NLR value in DF patients with and without amputation were included. The primary outcome was the pooled mean difference (MD) in NLR between groups. Additionally, We performed a diagnostic accuracy analysis extracting sensitivity and specificity. Odds ratios (ORs) for amputation based on NLR were summarized descriptively. Study quality was assessed with the Newcastle-Ottawa Scale (NOS). Fifteen studies comprising 2757 patients were included. The amputation group had significantly higher NLR than the non-amputation group (pooled MD 3.66, 95% CI 2.60-4.71; I² = 81%). For major versus minor amputation, the pooled MD was 4.00 (95% CI 1.81-6.19; I² = 96%). Diagnostic analysis showed moderate discriminatory ability (area under the curve [AUC] 0.798), with a pooled sensitivity of 0.71 (95% CI 0.66-0.75), specificity of 0.71 (95% CI 0.66-0.75), and a diagnostic odds ratio of 6.85 (95% CI 3.54-13.27). Furthermore, studies reporting ORs indicated a positive association between elevated NLR and amputation risk. In conclusion, elevated NLR is significantly associated with amputation risk in DF patients, including major versus minor amputation. Diagnostic analysis suggests moderate discriminatory ability. However, substantial heterogeneity was observed across studies, which warrants caution in interpreting the pooled estimates. Despite this limitation, NLR remains a valuable, cost-effective biomarker for identifying high-risk patients, particularly in resource-limited settings.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"15347346261483973"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868634","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":"Folic Acid and Diabetic Foot Ulcers.","authors":"Elisavet E Pyrgioti, Nikolaos D Karakousis, Petros N Georgakopoulos, Dimitrios S Karagiannakis, Nikolaos Papanas","doi":"10.1177/15347346241226677","DOIUrl":"10.1177/15347346241226677","url":null,"abstract":"<p><p>Diabetic foot ulcers (DFUs) remain a major cause of morbidity. This narrative mini-review aimed to investigate the potential role of folic acid (FA) in DFUs. Individuals with DFUs exhibit lower levels of FA and lower daily intake, compared to those without DFUs. There is preliminary evidence that FA administration may contribute to improved DFUs healing. In this context, regular evaluation of dietary FA intake may prove important towards reduction or even prevention of DFUs. However, data are still limited and further research is required to enable definitive conclusions and any recommendations.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"659-662"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139486904","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":"Diabetic Sensorimotor Polyneuropathy: An Overview on Epidemiology, Risk Factors, Classification, Diagnosis, and Treatment.","authors":"Georgia Anastasiou, Evangelos Liberopoulos, Nikolaos Tentolouris, Nikolaos Papanas","doi":"10.1177/15347346241240513","DOIUrl":"10.1177/15347346241240513","url":null,"abstract":"<p><p>Diabetic distal symmetric sensorimotor polyneuropathy (DSPN) is a common complication of diabetes with devastating consequences. Hyperglycaemia is the major aetiological factor, while emerging data demonstrate that cardiometabolic risk factors also contribute to its development. Diagnosis of DSPN involves interview of medical and neurological history, foot inspection, and sensory and motor function examination with specific tests such as temperature and pinprick perception for small nerve fibers, and vibration and light touch assessments for large nerve fibers. Management includes optimised glycaemic control, treatment of cardiovascular risk factors, and symptomatic treatment aiming at improving life quality. This article provides an overview on epidemiology, risk factors, classification, diagnosis and current treatment of DSPN.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"663-674"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140295765","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":"Ultra-High Frequency Ultrasound (UHFUS) Features of Pyoderma Gangrenosum, Venous Leg Ulcers, and Acute Ulcerative Lesions.","authors":"Giammarco Granieri, Alessandra Michelucci, Bianca Cei, Agata Janowska, Riccardo Morganti, Marco Romanelli, Valentina Dini","doi":"10.1177/15347346251324503","DOIUrl":"10.1177/15347346251324503","url":null,"abstract":"<p><p>Pyoderma gangrenosum (PG) is a neutrophilic dermatological disorder, marked by the dysregulation of both innate and adaptive immunity. Recently, non-invasive imaging techniques, including the use of Ultra-High Frequency Ultrasound (UHFUS), have been used to assess patients with PG. The primary objective of this study is to characterize the UHFUS differences among various cutaneous ulcerative diseases. We enrolled 45 patients: 15 patients suffered from PG (Group 1), distinguished in inflammatory phase (PG-i) and non-inflammatory phase (PG-ni); 15 patients had Venous Leg Ulcers (VLU) (Group 2); and 15 patients had Acute Injury (AI) (Group 3). For each lesion, UHFUS examination was performed with a 70 MHz linear probe to examine the angle of ulceration, epidermal and dermal morphological characteristics vascular morphology and the \"scattering\" signal. The study identified significant differences in the ulceration angle among various ulcerative pathologies: obtuse in Group 2, flat or straight in Group 3, predominantly acute or straight in Group 1. Moreover, PG-i phase exhibited significant fragmentation of the dermoepidermal junction (DEJ). The presence of a Subepidermal Low Echogenic Band (SLEB), hypoechogenicity of the dermis, and fluid collections were predominantly observed in the PG-i. The predominant vascular morphology in Groups 2 and 3 was regular, while in Groups 1 was irregular, presenting a high degree of \"scattering\" signals. The study highlights the usefulness of UHFUS as an imaging tool for assessing skin ulcers, especially those related to PG. This approach could be promising for improving diagnosis and treatment. However, further research is needed for standardization and clinical implementation.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"997-1006"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143545583","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 <i>Moringa oleifera</i> Hydro-Alcoholic Bark Extract on Diabetic Wound Healing: A Topical Approach.","authors":"Diksha Manhas, Udayabanu Malairaman","doi":"10.1177/15347346241297829","DOIUrl":"10.1177/15347346241297829","url":null,"abstract":"<p><p>PurposeThe current study was aimed to evaluate the potential of <i>Moringa oleifera</i> against diabetic foot ulcer, where the wound healing is impaired and susceptible to infection.MethodsThe effects of <i>M. oleifera</i> hydroalcoholic bark extract (MOHE) on different parameters influencing diabetic wound healing were comprehensively investigated including: anti-inflammatory effects, antibacterial properties, antioxidant activity, anti-diabetic properties, and fibroblast proliferation and migration. Furthermore, in vivo studies were conducted in diabetic rats and Zebrafish to investigate the topical effects of MOHE on wound healing.ResultsThe findings of this study demonstrated that MOHE has strong anti-diabetic effect, including a significant inhibition of α-amylase activity (IC50 = 0.043 mg/mL) and 2.92-fold increase in 2-NBDG uptake in McCoy cells. MOHE demonstrated considerable antioxidant activity, inhibiting DPPH (IC50: 0.046 mg/mL) and ABTS (IC50: 0.04 mg/mL) free radicals. In <i>in vitro</i> wound healing studies employing MOHE revealed a significant increase in McCoy fibroblast proliferation (148.83%) and improved migration, resulting in a wound closure rate of 46.3%. MOHE exhibited significant antibacterial activity against pathogenic bacteria species. It efficiently reduced heat-induced RBC hemolysis, with anti-inflammatory effect of 73% at 0.2 mg/mL. Furthermore, MOHE demonstrated better results in the treatment of diabetic wounds in Wistar rats and fin regeneration in Zebra fish compared to Calendula cream.ConclusionThis evidence based pharmacological study highlights the promising potential of MOHE in facilitating the healing of diabetic wounds, offering a topical approach to address this challenging healthcare issue.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"835-851"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786969","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":"Do you still want to write a review? Then, consider the 3Ts.","authors":"Nikolaos Papanas, Dimitri P Mikhailidis","doi":"10.1177/15347346261446181","DOIUrl":"10.1177/15347346261446181","url":null,"abstract":"","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"653-654"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793826","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 Role of Clinicians' Self-Efficacy in Exercise Promotion for Adults with Venous Leg Ulcers: A Cross-Sectional Study.","authors":"Jane O'Brien, Damhnat McCann, Christina N Parker, Kathleeen Finlayson, Andrew Jull","doi":"10.1177/15347346251321550","DOIUrl":"10.1177/15347346251321550","url":null,"abstract":"<p><p>IntroductionPhysical activity is recognised for its functional, physical, and psychological benefits in managing venous leg ulcers. Despite these advantages, individuals with venous leg ulcers often remain inactive, largely due to fear of exacerbating their condition and a lack of comprehensive guidance. Clinicians play a crucial role in promoting physical activity, providing support to patients to engage in safe and beneficial exercises. This study aimed to assess clinicians' knowledge, attitudes, and practices toward physical activity in adults with venous leg ulcers to inform clinical practice and the development of targeted physical activity strategies.MethodsAn online questionnaire was developed to assess clinicians' familiarity with physical activity guidelines, their confidence in recommending physical activity, and the barriers they encountered in practice.ResultsA total of 141 clinicians, predominantly nurses (99%), completed the survey, with 83% reporting awareness of clinical guidelines for venous leg ulcer management. However, only 25% regularly recommended a general increase in physical activity, 27% recommended calf strengthening exercises, and 38% consistently recommended ankle joint mobility exercises. Key barriers; 1) insufficient training to recommend specific exercises, 2) lack of evidence-based information to provide to patients and 3) limited access to exercise specialists for referrals. Statistical modelling showed that self-efficacy significantly influenced recommendations for ankle mobility exercises; clinicians with higher confidence were 7.6 times more likely to make such recommendations (p < .001). Although attitudes toward prescribing ankle exercises to adults with venous leg ulcers in compression were not statistically significantly related to reported practice (p = .087), they demonstrated relevance to clinical decision making and warrant further investigation.ConclusionWhile clinicians recognise the importance of physical activity for adults with venous leg ulcers, gaps in knowledge, resources, and training limit their ability to provide specific exercise recommendations. Addressing these gaps through large-scale implementation of structured physical activity strategies is essential.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"979-987"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13438010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506689","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":"Randomized Clinical Trial to Compare Cryopreserved and Lyopreserved Umbilical Cord Tissue to Treat Complex Diabetic Foot Wounds.","authors":"Lawrence A Lavery, Mehmet A Suludere, Matthew J Johnson, Amanda L Killeen, Katherine M Raspovic, Peter A Crisologo, Arthur N Tarricone","doi":"10.1177/15347346241273282","DOIUrl":"10.1177/15347346241273282","url":null,"abstract":"<p><p>To compare the incidence of infection, wound closure and time to wound closure in patients treated with cryopreserved (CPUT) and lyopreserved umbilical tissue (LPUT) in complex diabetic surgical wounds. This single-blinded 12-week randomized clinical trial compared cryopreserved and lyopreserved amniotic cord tissue to treat complex diabetic foot wounds. LPUT or CRAT was applied at baseline and again after four weeks. We enrolled subjects with UT2A-D and 3A-D wounds (depth to tendon, muscle, or bone with infection and/or PAD) and excluded subjects with ABI < 0.5 or TBI < 0.3, untreated osteomyelitis, and autoimmune diseases. We used a 3-D camera to evaluate wound area and volume. The mean baseline wound areas were 12.9 ± 10.7 cm² for CPUT and 11.7 ± 7.0 cm² for LPUT. The mean baseline wound volume was 7.5 ± 8.1 for CPUT and 9.2 ± 10.2 cm³ for LPUT. There was no difference between CPUT and LPUT in wound closure (36.8% vs 19.0%, <i>P</i> = .21) or infection (10.5% vs 4.8%, <i>P</i> = .60). There was no difference in mean wound area reduction between CPUT and LPUT (75.9 ± 32.3% vs 65.5 ± 38.4%, <i>P</i> = .41), nor in mean volume reduction (85.0 ± 30.8% vs 79.9 ± 31.9%, <i>P</i> = .61). In addition, there was no difference in wound closure trajectories for changes in area (<i>P</i> = .75) or volume (<i>P</i> = .43). Cryopreserved and lyopreserved amniotic tissue provided similar results in patients with complex diabetic foot wounds.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"852-860"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787462","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":"Effectiveness of Stem Cell Therapy for Diabetic Foot Ulcers: Cell Therapy Alone is Not Enough for Effective Management of Chronic Wounds.","authors":"Ekaterina Evstratova, Elena Yatsenko, Denis Baranovskii, Ilya Klabukov","doi":"10.1177/15347346241295306","DOIUrl":"10.1177/15347346241295306","url":null,"abstract":"<p><p>We read with great interest the meta-analysis by Mudgal et al. (2024) regarding the effectiveness and safety assessment of stem cell therapy for diabetic foot ulcers. Indeed, The management of chronic wounds requires innovative approaches to avoid unsuccessful outcomes, and stromal cell therapies have emerged as a potential solution for soft tissue repair. A critical aspect of this therapeutic strategy is the role of mast cells in stimulating delayed inflammation through their interactions with various cells as well as the extracellular matrix. Mast cells are critical in orchestrating the inflammatory response and their activation can influence macrophage behavior and secondary healing efficacy. The use of mesenchymal stromal cells in regenerative medicine for diabetic foot ulcers treatment is often limited by their time-limited anti-inflammatory responses. However, these time-limited effects could not achieve the prolonged effects and impact of cell therapy efficacy and the potential enhancement of cell function by biologically active factors such as growth factors or gene therapeutics for prolonged release. The integration of cell and prolonged release gene therapeutics is a promising approach that goes beyond regenerative medicine by preventing secondary inflammatory complications. While mesenchymal stromal cells have shown promising results in experimental and clinical studies, there are limitations to their efficacy in regenerative medicine for diabetic foot ulcers. These limitations include the heterogeneity of cell populations used in the studies, the difficulty in determining the contribution of cells when used in combination with materials, the lack of data on optimal cell numbers for tissue repair, the effect of culture conditions on cell therapy efficacy, and the potential enhancement of cell efficacy by the use of additional biologics such as growth factors or gene therapeutics. The combination of cell and gene therapy is seen as a promising approach that goes beyond regenerative medicine into the field of molecular surgery of chronic wounds.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"1063-1065"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142690196","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":"Advancements in Deep Wounds Therapies: The Synergistic Application of Laser Therapy and Nanomaterials.","authors":"Zahra Al Timimi, Diwan Mohsen","doi":"10.1177/15347346251345255","DOIUrl":"10.1177/15347346251345255","url":null,"abstract":"<p><p>There have been advances in the treatment of wounds in recent years due to the innovative combination of nanomaterials and lasers. Laser therapy for wounds enhances cell proliferation at the wound site. This promotes angiogenesis, tissue healing, and anti-inflammatory effects. Because of their unique physicochemical properties, nanoparticles are also found to possess antibacterial effects, improve biocompatibility, and provide targeted drug delivery, thereby being beneficial as wound therapies. Nanomaterials and medical lasers are aimed at improving the therapeutic efficacy for the standard management of wounds with infection control and impaired healing. This research is intended to elucidate the mechanisms of the new treatment approach, clinical applications, and objectives for future research towards improving wound healing.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"687-695"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144153123","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}