The international journal of lower extremity wounds最新文献

{"title":"Tracking a Fatal Disease: Lower Limb Gas Gangrene's Mortality-Related Factors.","authors":"Mohamed Farès Mahjoubi, Bochra Rezgui, Mohamed Maatouk, Nada Essid, Yasser Karoui, Hajer Kandara, Mounir Ben Moussa","doi":"10.1177/15347346231158858","DOIUrl":"10.1177/15347346231158858","url":null,"abstract":"<p><strong>Introduction: </strong>Because of its rarity compared to dry and wet gangrene of the lower limb, the gaseous form has often been considered as the most severe form of gangrenous disease. We aimed to report clinical, paraclinical, and therapeutic features, and to identify mortality risk factors of gas gangrene of the lower limb.</p><p><strong>Patients and methods: </strong>We conducted a one-center case series retrospective study over a period of 13 years from January 2006 to December 2018.</p><p><strong>Results: </strong>A total of 19 patients were included: 12 men, 7 women. Mean age was 59.3  ±  11.3 years. There were 17 diabetic patients and one patient was on radio-chemotherapy for lower rectal cancer. Septic shock was initially present in 4 cases. Hyperleukocytosis was noted in 17 patients. C-reactive protein was elevated in 11 patients. All patients were put on antibiotics then operated on. A total of 8 patients died postoperatively (42%) in an average time of 9.6 days after surgery. On univariate analysis, factors associated with mortality were: Septic shock on admission (<b>p  =  0.02</b>); local signs limited to foot (<b>p  =  0.05</b>) or extended above the knee (<b>p  =  0.02</b>); leukocytosis (<b>p  =  0.005</b>); glycemia level (<b>p  =  0.02</b>); antibiotic therapy duration (<b>p  =  0.04</b>); antibiotic association of Penicillin G, metronidazole, and gentamicin (<b>p  =  0.02</b>); amputation procedure solely (<b>p  =  0.04</b>) or debridement procedure without amputation (<b>p  =  0.05</b>); intraoperative transfusion (<b>p  =  0.006</b>); and hospital stay (<b>p  =  0.01</b>).</p><p><strong>Conclusion: </strong>Identifying gas gangrene mortality factors is fundamental to standardize management. Our study was able to build on the small size of our series, but further prospective and large-scale studies are required.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":"18 8 1","pages":"192-197"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83201539","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":"Effectiveness of Specific Single-Use Incisional Negative Pressure Wound Therapy (PICO System) After Major Lower Extremity Amputation.","authors":"Hiroshi Takahashi, Shinsuke Takeda, Yoshihiro Tanaka, Ryutaro Shibata, Hiroki Ito, Shingo Kurahashi, So Mitsuya, Hideki Murakami","doi":"10.1177/15347346231221116","DOIUrl":"10.1177/15347346231221116","url":null,"abstract":"<p><p>Lower extremity amputation (LEA), particularly in patients with diabetes or peripheral vascular disease, often results in complications such as surgical site infections (SSIs) and wound dehiscence. This study examined whether utilizing the portable and user-friendly PICO system (Smith and Nephew Medical Ltd, Hull, UK) as incisional negative-pressure wound therapy can reduce post-LEA complications. This study was conducted at a Japanese tertiary medical center and involved a retrospective analysis of LEA cases (n = 32) between January 2021 and December 2022. The PICO dressing group (n = 16) was compared to the conventional dressing group (n = 16) for post-LEA wound management. The primary outcome was the incidence of postoperative wound complications, including SSI and wound dehiscence, within 15 days of LEA. Superficial/deep SSI and wound dehiscence occurred less frequently in the PICO dressing group than in the conventional dressing group (12.5% vs 43.8%; p = .054). There were no cases of deep SSIs in the PICO dressing group. Although this study has limitations owing to its retrospective design and small sample size, the results suggest the potential of the PICO system for improving outcomes in post-LEA wound management.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"130-134"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138813484","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":"Risk Factors Associated with Failure of Toe Amputation in Diabetic Foot Infections.","authors":"Gerardo Víquez-Molina, Javier Aragón-Sánchez, Mariana Villalobos-Vargas, Rebeca Alvarado-Prado, Juan José Romero-Zuñiga","doi":"10.1177/15347346231207679","DOIUrl":"10.1177/15347346231207679","url":null,"abstract":"<p><p>We aim to identify the factors associated with the failure of amputation of one to three toes (index toe amputation) in patients with diabetes and foot infection. We conducted a retrospective cohort of 175 patients with diabetes who were hospitalized for moderate to severe foot infection and underwent amputation of one to three toes. A Poisson regression model was used to determine the prevalence ratio (PR) as a measure of association. The mean age was 63.3 ± 11.4 years. Fifty-three patients presented failure after undergoing toe amputation (30.3%). Multivariate analysis, adjusted for age and sex, showed the following significant variables: severe infection (PR: 1.78; 95% confidence interval [CI]: 1.14-2.78; <i>P = </i>0.011), infection by <i>Escherichia coli</i> (PR: 2.21; 95% CI: 1.42-3.43; <i>P </i>< 0.001), infection by <i>Pseudomonas aeruginosa</i> (PR: 2.11; 95% CI: 1.29-3.43; <i>P = </i>0.003) and prothrombin time (PR: 1.13; 95% CI: 1.05-1.21; <i>P = </i>0.001), obesity (PR: 0.58; 95% CI: 0.37-0.93; <i>P = </i>0.024), and haemoglobin value (PR: 0.92; 95% CI: 0.86-0.99; <i>P = </i>0.023). About one-third of patients who underwent amputation of one to three toes for diabetic foot infection presented a failure and required a more proximal surgery. Severe infections, isolation of <i>Pseudomonas aeruginosa</i> and <i>Escherichia coli</i>, and prolonged prothrombin time were associated with a higher prevalence of failure. However, obesity and an elevated haemoglobin level were associated with a lower prevalence of failure.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"135-142"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54233012","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":"Incidence and Risk Factors for Amputations in Persons with Diabetes Mellitus: A Retrospective Cohort Study.","authors":"Mariana Alves Bandeira, Rosana Nascimento Macedo, José Luis Lázaro-Martinez, Yolanda Garcia Alvarez, Michele Neves Brajão Rocha, Vera Lucia Conceição de Gouveia Santos","doi":"10.1177/15347346241292377","DOIUrl":"10.1177/15347346241292377","url":null,"abstract":"<p><p>The aim of this study was to identify and analyze the incidence rate of amputations and their risk factors in people with Diabetes Mellitus (DM) in two specialized outpatient clinics in Brazil. This is an epidemiological, retrospective cohort study using data collected from electronic health records of 281 adult diabetic patient types 1 or 2; attended in specialized outpatient service between 2015 and 2020. Statistical analyses were performed using the 2 sample t-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 risk factors for amputation was carried out through logistic regression. The study was approved by ethical committee. The sample mean age was 65.6 years (SD 13.05), predominating male gender n = 211 (75%), type 2 DM n = 223 (86.7%), with cardiovascular disease n = 143 (63.2%), and about 68.7% (n = 156) with peripheral arterial disease (PAD). Seventy-seven had lower limb amputation (LLA), with a rate incidence of 31.9% during five years. Logistic regression analysis showed the following associations with amputation: Diabetic peripheral neuropathy increased the rate of amputation by 3.6 times (OR = 3.631, 95% CI = 1.214-11.353; <i>P</i> = .022), and peripheral arterial disease increased by 10 times (OR = 10.631; 95% CI = 2.969-57.029; <i>P</i> = .001). The LLA in individuals with DM in two specialized outpatient services was higher compared to international literature; DPN and PAD were confirmed as risk factors for amputation, according to literature. This finding suggests that the study population faces an increased risk of amputation, highlighting the urgent need for targeted interventions and implementing robust preventive strategies to transform the current scenario and mitigate these severe outcomes. A comprehensive approach is essential to proactively address the underlying issues and reduce the prevalence and impact of amputations in Brazil.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"59-65"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592362","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":"Free Flap Limb Salvage and Ulcer Recurrence in Chronic Limb-threatening Ischemia.","authors":"Norifumi Matsuda, Dongkyung Seo, Riho Suzuki, Yutaka Dannoura, Katsumi Horiuchi","doi":"10.1177/15347346241287335","DOIUrl":"10.1177/15347346241287335","url":null,"abstract":"<p><p>Free flap transfer is a well-established treatment for foot reconstruction in patients with chronic limb-threatening ischemia (CLTI) and can achieve prolonged amputation-free survival. However, reports on ulcer recurrence after free flap transfer are scarce, with most focusing on trauma patients. Therefore, we retrospectively reviewed patients with CLTI who underwent free flap reconstruction at our institution over a 17-year period. Patient characteristics, ulcer recurrence rates, activity level, and variables associated with ulcer recurrence were investigated in patients who met the following criteria: successful reconstructive surgery, complete wound healing, and at least 1 year of follow-up. Free flap foot reconstruction was performed in 42 patients (92.9% male, 7.1% female; mean age 57.1 years, range 37-81 years). Among them, 39 patients (92.9%) had diabetes mellitus, 15 (35.7%) had critical limb ischemia, and 15 (35.7%) had end-stage renal disease/hemodialysis. Mean postoperative follow-up was 60.5 (range 12.0-208.0) months. The 5-year primary ulcer recurrence-free survival rate was 48.7%. High activity level and selection of the posterior tibial artery as the recipient artery were significantly associated with ulcer recurrence [hazard ratio, 3.59 and 9.81; <i>P </i>= .046 and <i>P </i>< .001, respectively]. Activity levels were not significantly different before and 1 year after surgery. In conclusion, survival analysis revealed that ulcer recurrence is most likely to occur within the first 2 years after surgery. Although recurrence occurred in approximately half of the patients, most patients maintained activity levels comparable to their preoperative levels.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"66-73"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142335513","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":"Analysis of the Factors of Wound Healing Problems After Transtibial Amputation in Diabetic Patients.","authors":"Sang Yoon Lee, Myoung Jin Lee, Sung Bin Byun","doi":"10.1177/15347346231198940","DOIUrl":"10.1177/15347346231198940","url":null,"abstract":"<p><p>Diabetes mellitus has a global impact, necessitating surgical intervention when conservative methods fail. Transtibial amputation (TTA) is commonly performed on diabetic patients, yet surgical site complications can lead to more procedures. This study aimed to identify factors linked to wound healing issues post-TTA in diabetics.A total of 181 patients who underwent TTA between 2004 and 2021 at a single hospital were included in the study. Exclusion criteria comprised trauma, non-diabetic mellitus, follow-up duration of less than 1 year, incomplete medical records, and surgeries performed by different surgeons. The comparison focused on underlying diseases other than diabetes between the group with wound problems and the group without. Additionally, factors impacting blood flow, such as presurgery hemoglobin levels, intraoperative blood transfusion, the use of antithrombotic or anticoagulant drugs, and the presence of procedures like percutaneous transluminal angioplasty (PTA) and bypass surgery, were analyzed.Among the 181 cases, 22.1% experienced problems at the surgical site while 77.9% did not. Statistical analysis revealed that age was a significant variable affecting wound healing problems after TTA in diabetic patients (<i>p</i> = .007). However, there were no significant differences in wound problems based on comorbidities other than diabetes (<i>p</i> = .209), gender (<i>p</i> = .677), preoperative anemia (<i>p</i> = .102), intraoperative blood transfusion (<i>p</i> = .633), the use of antithrombotic or anticoagulant medications (<i>p</i> = .556), and the performance of PTA or bypass surgery (<i>p</i> = .6).In conclusion, this study found that age was a significant variable affecting wound healing problems after TTA in diabetic patients. Although no association was observed between underlying diseases and wound healing problems, further investigation and cautious management of factors such as preoperative anemia, intraoperative blood transfusion, the use of antithrombotic or anticoagulant drugs, and the performance of PTA or bypass surgery are warranted to prevent complications and optimize wound healing outcomes in diabetic patients undergoing TTA.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"156-164"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41163953","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":"Influence of Fractures and Dislocations in Severity of Rocker-Bottom Deformity in Patients with Charcot Foot.","authors":"Raúl J Molines-Barroso, Mateo López-Moral, Marta García-Madrid, Esther García-Morales, Yolanda García-Álvarez, José Luis Lázaro-Martínez","doi":"10.1177/15347346241275186","DOIUrl":"10.1177/15347346241275186","url":null,"abstract":"<p><p>The objective of this study was to identify bone fractures and joint dislocations that have greater association with the severity of arch collapse in patients with Charcot foot involving the midfoot.A retrospective study in 28 (N = 29 feet) patients who had Charcot foot deformity of the midfoot. The study included stage III of Eichenholtz classification, and Schon classification types I to III. Talar-first metatarsal and calcaneal pitch angles and cuboid height were used to evaluate the severity of the midfoot deformity in a weightbearing lateral radiograph. Two investigators evaluated the bone fracture and joint dislocation involved in weightbearing antero-posterior and lateral radiographs.There were 13 (46%) feet that showed pattern 1, 9 (31%) feet with pattern 2, and 7 (25%) feet with pattern 3 according to the Schon classification. One foot had a combination of patterns 1 and 2. Midfoot ulceration occurred in 64% (n = 19) of feet. In the multivariate analysis, plantarflexion of talar-first metatarsal angle was predicted by navicular-medial cuneiform dislocation (p = .007 [-20.620-3.683]), an increase of the negative calcaneal pitch angle by fragmentation of the cuboid (p = .003 [-15.568-3.626]), and increment of the negative cuboid height by navicular-medial cuneiform and medial cuneiform-first metatarsal dislocations (p = .040 [-12.779-0.317], p = .002 [-13.437-3.267], respectively).Bone fractures and dislocations in the sagittal plane seem to contribute to midfoot collapse, but navicular-medial cuneiform dislocation/non-union and cuboid fragmentation predict severe rocker-bottom deformity in cases of Charcot foot.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"82-87"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141977603","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":"Two-Step Conservative Surgery for Complicated Forms of Diabetes-Related Foot Osteomyelitis.","authors":"Gerardo Víquez-Molina, José María Rojas-Bonilla, Javier Aragón-Sánchez","doi":"10.1177/15347346241273224","DOIUrl":"10.1177/15347346241273224","url":null,"abstract":"<p><p>Diabetes-related foot osteomyelitis (DFO) is a common yet complex condition, often complicated by concurrent soft tissue infections (STIs). This study evaluates the efficacy of a two-step conservative surgical approach, hypothesizing that it offers comparable outcomes to a one-step procedure. Conducted on a cohort of 93 patients with DFO, the study categorized cases into two types: OM1 (osteomyelitis without STI) and OM2 (osteomyelitis with STI). OM2 was further subdivided into OM2a (early diagnosis) and OM2b (late diagnosis), with OM2 patients undergoing initial soft tissue debridement followed by elective bone surgery. The results indicated no significant differences in infection recurrence or amputation rates between the two surgical approaches, with recurrence observed in 20.7% of cases and amputations in 10.8%. The two-step procedure was associated with higher inflammatory responses and greater need for antibiotics and hospital admissions. However, these factors did not translate into increased recurrence or amputation compared to the one-step procedure. The study supports the two-step approach as a safe and effective method for managing complicated DFO cases, providing a viable alternative to immediate amputation or single-stage surgery. Despite some limitations, including regional specificity and potential underdiagnosis in late-diagnosed cases, the findings offer valuable insights for clinical management and suggest further research to refine treatment protocols. The study's strengths include confirmed histopathological diagnoses and consistent follow-up, reinforcing the validity of the two-step surgical approach for complex DFO treatment.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"88-91"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141895123","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 Foot Amputations: Engagement Still Needed to Improve Outcomes.","authors":"Alfred Gatt, Cynthia Formosa, Nikolaos Papanas","doi":"10.1177/15347346251316041","DOIUrl":"10.1177/15347346251316041","url":null,"abstract":"","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"5-6"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143049375","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":"Infection Relapse and Time-to-Healing After Conservative Surgery for Non-Acute Presentations of Diabetes-Related Forefoot Osteomyelitis: Does Site Matter?","authors":"Javier Aragón-Sánchez, Gerardo Víquez-Molina, Javier Aragón-Hernández, José María Rojas-Bonilla","doi":"10.1177/15347346241312442","DOIUrl":"10.1177/15347346241312442","url":null,"abstract":"<p><p>Diabetes-related foot osteomyelitis (DFO) can present as an acute condition with soft tissue involvement or as a non-acute form characterized by long-standing ulcers without immediate limb-threatening features. This study evaluates infection relapse and healing times after conservative surgery in non-acute DFO, with a focus on osteomyelitis localization. A retrospective cohort of 60 patients treated for forefoot DFO without soft tissue involvement or necrosis was analyzed. Conservative surgery, defined as resection of infected bone without amputation, was performed in all cases. Postoperative antibiotic therapy was guided by bone biopsy cultures. Infection relapse was defined as new evidence of infection localized to the previously treated bone. Infection arrest was achieved in 98.3% of cases, with a recurrence rate of 10%. Relapse was significantly associated with osteomyelitis localized to the first metatarsal head, which presented a 57.1% relapse rate compared to 3.8% in other locations (OR: 34.0, 95% CI: 4.34-266, p < 0.001). Healing times were longer for the first metatarsal head, first toe, and second to fifth metatarsal heads compared to the lesser toes, but the association with the first metatarsal head lost significance when relapse was included in the analysis. This study highlights the effectiveness of conservative surgery in non-acute DFO, achieving high healing rates while preserving limb function. The findings emphasize the critical role of osteomyelitis localization, particularly the first metatarsal head, in determining relapse and healing outcomes. These results provide a basis for future research into individualized surgical strategies for high-risk anatomical sites.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"41-50"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960893","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}