Subjects -> EDUCATION (Total: 2388 journals)
    - ADULT EDUCATION (22 journals)
    - COLLEGE AND ALUMNI (10 journals)
    - E-LEARNING (35 journals)
    - EDUCATION (2048 journals)
    - HIGHER EDUCATION (141 journals)
    - INTERNATIONAL EDUCATION PROGRAMS (4 journals)
    - ONLINE EDUCATION (39 journals)
    - SCHOOL ORGANIZATION (14 journals)
    - SPECIAL EDUCATION AND REHABILITATION (39 journals)
    - TEACHING METHODS AND CURRICULUM (36 journals)

EDUCATION (2048 journals)            First | 1 2 3 4 5 6 7 8     

Showing 801 - 857 of 857 Journals sorted alphabetically
International Journal of Early Childhood     Hybrid Journal   (Followers: 12)
International Journal of Early Years Education     Hybrid Journal   (Followers: 12)
International Journal of Education     Open Access   (Followers: 17)
International Journal of Education and Development using Information and Communication Technology     Open Access   (Followers: 10)
International Journal of Education and Literacy Studies     Open Access   (Followers: 6)
International Journal of Education and Management Engineering     Open Access   (Followers: 2)
International Journal of Education in Mathematics, Science and Technology     Open Access   (Followers: 2)
International Journal of Education Policy and Leadership     Open Access   (Followers: 1)
International Journal of Educational Administration and Policy Studies     Open Access   (Followers: 6)
International Journal of Educational and Psychological Researches     Open Access   (Followers: 4)
International Journal of Educational Development     Hybrid Journal   (Followers: 14)
International Journal of Educational Methodology     Open Access  
International Journal of Educational Psychology     Open Access   (Followers: 16)
International Journal of Educational Research     Hybrid Journal   (Followers: 28)
International Journal of Educational Technology     Open Access   (Followers: 3)
International Journal of Electrical Engineering Education     Hybrid Journal   (Followers: 6)
International Journal of Emerging Technologies in Learning     Open Access   (Followers: 10)
International Journal of English Language Education     Open Access   (Followers: 14)
International Journal of English Language Teaching     Open Access   (Followers: 3)
International Journal of Ethics Education     Hybrid Journal  
International Journal of Evaluation and Research in Education     Open Access   (Followers: 11)
International Journal of Experiential Learning & Case Studies     Open Access   (Followers: 1)
International Journal of Foreign Language Teaching and Research     Open Access   (Followers: 4)
International Journal of Health Administration and Education Congress (Sanitas Magisterium)     Open Access  
International Journal of Health Education     Open Access   (Followers: 1)
International Journal of Health Promotion and Education     Hybrid Journal   (Followers: 13)
International Journal of Inclusive Education     Hybrid Journal   (Followers: 23)
International Journal of Indonesian Education and Teaching     Open Access  
International Journal of Information and Operations Management Education     Hybrid Journal   (Followers: 8)
International Journal of Innovation in Education     Hybrid Journal   (Followers: 9)
International Journal of Integrated Education and Development     Open Access  
International Journal of Knowledge and Learning     Hybrid Journal   (Followers: 4)
International Journal of Language Teaching and Education     Open Access   (Followers: 1)
International Journal of Leadership in Education: Theory and Practice     Hybrid Journal   (Followers: 23)
International Journal of Learning Analytics and Artificial Intelligence for Education (iJAI)     Open Access   (Followers: 1)
International Journal of Learning and Development     Open Access   (Followers: 5)
International Journal of Learning and Intellectual Capital     Hybrid Journal   (Followers: 2)
International Journal of Learning and Media     Hybrid Journal   (Followers: 4)
International Journal of Lifelong Education     Hybrid Journal   (Followers: 11)
International Journal of Lower Extremity Wounds     Hybrid Journal   (Followers: 4)
International Journal of Management Education     Hybrid Journal   (Followers: 10)
International Journal of Management in Education     Hybrid Journal   (Followers: 8)
International Journal of Mathematical Education in Science and Technology     Hybrid Journal   (Followers: 10)
International Journal of Modern Education and Computer Science     Open Access   (Followers: 2)
International Journal of Multicultural Education     Open Access   (Followers: 10)
International Journal of Music Education     Hybrid Journal   (Followers: 18)
International Journal of New Education     Open Access   (Followers: 1)
International Journal of Nurse Practitioner Educators     Open Access   (Followers: 12)
International Journal of Online Pedagogy and Course Design     Full-text available via subscription   (Followers: 8)
International Journal of Pedagogies and Learning     Hybrid Journal   (Followers: 7)
International Journal of Pedagogy, Policy and ICT in Education     Full-text available via subscription   (Followers: 3)
International Journal of Play     Hybrid Journal   (Followers: 6)
International Journal of Pluralism and Economics Education     Hybrid Journal  
International Journal of Qualitative Studies in Education     Hybrid Journal   (Followers: 37)
International Journal of Quantitative Research in Education     Hybrid Journal   (Followers: 4)
International Journal of Rehabilitation and Health     Hybrid Journal   (Followers: 19)
International Journal of Rehabilitation Research     Hybrid Journal   (Followers: 20)
International Journal of Research & Method in Education     Hybrid Journal   (Followers: 19)
International Journal of Research in Education Methodology     Open Access   (Followers: 11)
International Journal of Research in Undergraduate Mathematics Education     Hybrid Journal  
International Journal of Research Studies in Education     Open Access   (Followers: 8)
International Journal of Research Studies in Educational Technology     Open Access   (Followers: 11)
International Journal of Research Studies in Language Learning     Open Access   (Followers: 13)
International Journal of School & Educational Psychology     Hybrid Journal  
International Journal of Science and Mathematics Education     Hybrid Journal   (Followers: 25)
International Journal of Science and Technology Education Research     Open Access   (Followers: 9)
International Journal of Science Education     Hybrid Journal   (Followers: 30)
International Journal of Science Education, Part B Communication and Public Engagement     Hybrid Journal   (Followers: 10)
International Journal of Servant-Leadership     Full-text available via subscription   (Followers: 1)
International Journal of Social Media and Interactive Learning Environments     Hybrid Journal   (Followers: 16)
International Journal of Social Sciences and Education Research     Open Access  
International Journal of Sociology of Education     Open Access   (Followers: 8)
International Journal of STEM Education     Open Access   (Followers: 6)
International Journal of Synergy and Research     Open Access  
International Journal of Teaching and Case Studies     Hybrid Journal   (Followers: 5)
International Journal of Technology and Design Education     Hybrid Journal   (Followers: 11)
International Journal of Technology and Educational Marketing     Full-text available via subscription   (Followers: 3)
International Journal of Technology Enhanced Learning     Hybrid Journal   (Followers: 20)
International Journal of Training Research     Hybrid Journal   (Followers: 6)
International Journal of Trends in Mathematics Education Research     Open Access   (Followers: 1)
International Journal on Lifelong Education and Leadership     Open Access   (Followers: 2)
International Journal on School Disaffection     Full-text available via subscription  
International Journal Pedagogy of Social Studies     Open Access  
International Online Journal of Education and Teaching     Open Access   (Followers: 1)
International Online Journal of Teachers in Collaboration     Open Access   (Followers: 1)
International Quarterly of Community Health Education     Full-text available via subscription   (Followers: 1)
International Research in Education     Open Access   (Followers: 6)
International Research in Geographical and Environmental Education     Hybrid Journal   (Followers: 5)
International Review of Economics Education     Hybrid Journal   (Followers: 3)
International Review of Education     Hybrid Journal   (Followers: 6)
International Review of Qualitative Research     Full-text available via subscription   (Followers: 32)
International Review of Research in Open and Distance Learning     Open Access   (Followers: 25)
International Studies in Catholic Education     Hybrid Journal   (Followers: 4)
International Studies in Sociology of Education     Hybrid Journal   (Followers: 17)
International Technology and Education Journal     Open Access  
Interritórios     Open Access  
InterScientia     Open Access  
Intervention in School and Clinic     Hybrid Journal   (Followers: 1)
Investigación en la Escuela     Open Access   (Followers: 1)
Investigaciones Sobre Lectura     Open Access  
Investigations in Mathematics Learning     Hybrid Journal  
Irish Educational Studies     Hybrid Journal   (Followers: 2)
Irish Journal of Academic Practice     Open Access   (Followers: 1)
IRJE (Indonesian Research Journal in Education)     Open Access   (Followers: 1)
Islamic Counseling : Jurnal Bimbingan Konseling Islam     Open Access  
Issues and Trends in Educational Technology     Open Access  
Issues in Informing Science and Information Technology     Open Access   (Followers: 2)
Istanbul Journal of Innovation in Education     Open Access  
Istawa : Journal of Islamic Education     Open Access  
Italiano LinguaDue     Open Access  
Itinerario Educativo     Open Access  
Itinerarios Educativos     Open Access  
Izdihar : Journal of Arabic Language Teaching, Linguistics, and Literature     Open Access  
Izvestia Ural Federal University Journal. Series 1. Issues in Education, Science and Culture     Open Access  
JADECS : Journal of Arts, Design, Art Education and Culture Studies     Open Access   (Followers: 3)
JALIE : Journal of Applied Linguistics and Islamic Education     Open Access   (Followers: 1)
JAMP : Jurnal Administrasi dan Manajemen Pendidikan     Open Access   (Followers: 1)
Jendela Olahraga     Open Access  
JET (Journal of English Teaching)     Open Access  
JINoP (Jurnal Inovasi Pembelajaran)     Open Access  
JIPM (Jurnal Ilmiah Pendidikan Matematika)     Open Access  
JMIR Medical Education     Open Access   (Followers: 1)
JMPM : Jurnal Matematika dan Pendidikan Matematika     Open Access  
JOHME : Journal of Holistic Mathematics Education     Open Access  
Jornal Internacional de Estudos em Educação Matemática     Open Access  
Journal for Counselor Preparation and Supervision     Open Access   (Followers: 2)
Journal for Educators, Teachers and Trainers     Open Access   (Followers: 4)
Journal for Language Teaching = Tydskrif vir Taalonderrig     Full-text available via subscription   (Followers: 1)
Journal for Learning Through the Arts     Open Access   (Followers: 7)
Journal for Research in Mathematics Education     Full-text available via subscription   (Followers: 27)
Journal for STEM Education Research     Hybrid Journal  
Journal for the Study of Sports and Athletes in Education     Hybrid Journal   (Followers: 2)
Journal of Abnormal Child Psychology     Hybrid Journal   (Followers: 10)
Journal of Academic Advising     Open Access  
Journal of Academic Ethics     Hybrid Journal   (Followers: 5)
Journal of Academy of Dental Education     Hybrid Journal   (Followers: 1)
Journal of Accounting and Business Education     Open Access   (Followers: 2)
Journal of Accounting Education     Hybrid Journal   (Followers: 7)
Journal of Adolescent & Adult Literacy     Full-text available via subscription   (Followers: 11)
Journal of Adult Development     Hybrid Journal   (Followers: 9)
Journal of Advances in Medical Education & Professionalism     Open Access   (Followers: 10)
Journal of Adventure Education & Outdoor Learning     Hybrid Journal   (Followers: 8)
Journal of Aesthetic Education     Full-text available via subscription   (Followers: 3)
Journal of Agricultural Education and Extension     Hybrid Journal   (Followers: 4)
Journal of Al-Qadisiya in Arts and Educational Sciense     Open Access   (Followers: 1)
Journal of Applied Studies in Language     Open Access  
Journal of Appreciative Education     Open Access   (Followers: 1)
Journal of Architectural Education     Hybrid Journal   (Followers: 12)
Journal of Assessment and Institutional Effectiveness     Full-text available via subscription   (Followers: 1)
Journal of Attention Disorders     Hybrid Journal   (Followers: 2)
Journal of Behavioral Education     Hybrid Journal   (Followers: 3)
Journal of Beliefs & Values: Studies in Religion & Education     Hybrid Journal   (Followers: 5)
Journal of Biological Education     Hybrid Journal   (Followers: 2)
Journal of Business Ethics Education     Full-text available via subscription   (Followers: 4)
Journal of Case Studies     Open Access   (Followers: 1)
Journal of Cases in Educational Leadership     Hybrid Journal   (Followers: 10)
Journal of Chandrakasemsarn     Open Access  
Journal of Chemical Education     Hybrid Journal   (Followers: 25)
Journal of Child and Adolescent Psychiatric Nursing     Hybrid Journal   (Followers: 5)
Journal of Childhood Studies     Open Access   (Followers: 1)
Journal of Classics Teaching     Open Access  
Journal of Cognitive Education and Psychology     Hybrid Journal   (Followers: 11)
Journal of College Student Development     Full-text available via subscription   (Followers: 8)
Journal of College Student Psychotherapy     Hybrid Journal   (Followers: 2)
Journal of College Student Retention : Research, Theory and Practice     Full-text available via subscription   (Followers: 6)
Journal of Computing in Higher Education     Hybrid Journal   (Followers: 15)
Journal of Contemporary Integrative Ideas     Open Access   (Followers: 1)
Journal of Contemporary Water Resource & Education     Hybrid Journal   (Followers: 2)
Journal of Continuing Education in the Health Professions     Hybrid Journal   (Followers: 12)
Journal of Copyright in Education & Librarianship     Open Access   (Followers: 33)
Journal of Creative Behavior     Hybrid Journal   (Followers: 10)
Journal of Criminal Justice Education     Hybrid Journal   (Followers: 7)
Journal of Curriculum and Instruction     Open Access   (Followers: 6)
Journal of Curriculum and Pedagogy     Hybrid Journal   (Followers: 10)
Journal of Curriculum and Teaching     Open Access   (Followers: 7)
Journal of Curriculum Studies     Hybrid Journal   (Followers: 19)
Journal of Curriculum Theorizing     Open Access   (Followers: 2)
Journal of Dance Education     Hybrid Journal   (Followers: 11)
Journal of Deaf Studies and Deaf Education     Hybrid Journal   (Followers: 12)
Journal of Dental Education     Full-text available via subscription   (Followers: 2)
Journal of Developmental and Physical Disabilities     Hybrid Journal   (Followers: 8)
Journal of Distance Learning     Full-text available via subscription   (Followers: 16)
Journal of Early Childhood Teacher Education     Hybrid Journal   (Followers: 14)
Journal of Early Intervention     Hybrid Journal   (Followers: 9)
Journal of Economic Education     Open Access  
Journal of Economic Education     Hybrid Journal   (Followers: 10)
Journal of Economics and Economic Education Research     Full-text available via subscription   (Followers: 2)
Journal of Education Advancement & Marketing     Full-text available via subscription   (Followers: 2)
Journal of Education and e-Learning Research     Open Access   (Followers: 14)
Journal of Education and Educational Development     Open Access   (Followers: 3)
Journal of Education and Future     Open Access   (Followers: 1)
Journal of Education and Health Promotion     Open Access   (Followers: 6)
Journal of Education and Learning     Open Access   (Followers: 3)
Journal of Education and Learning     Open Access   (Followers: 12)
Journal of Education and Practice     Open Access   (Followers: 25)
Journal of Education and Research     Open Access   (Followers: 8)
Journal of Education and Training     Open Access   (Followers: 3)
Journal of Education and Training Studies     Open Access   (Followers: 3)
Journal of Education and Work     Hybrid Journal   (Followers: 14)
Journal of Education Finance     Full-text available via subscription   (Followers: 1)

  First | 1 2 3 4 5 6 7 8     

Similar Journals
Journal Cover
International Journal of Lower Extremity Wounds
Journal Prestige (SJR): 0.501
Citation Impact (citeScore): 1
Number of Followers: 4  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1534-7346 - ISSN (Online) 1552-6941
Published by Sage Publications Homepage  [1086 journals]
  • Use of Integra Dermal Regeneration Template for Limb Salvage in Diabetic
           Patients With No-Option Critical Limb Ischemia
    • Authors: Luca Dalla Paola, Paolo Cimaglia, Anna Carone, Giulio Boscarino, Giuseppe Scavone
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      We have analyzed in a retrospective study of consecutive diabetic patients affected by no-option critical limb ischemia (CLI) the efficacy of the dermal substitute Integra Dermal Regeneration Template for treatment of complicated foot lesions. The primary end point was limb salvage and 1-year amputation-free survival. The secondary end point was healing time of surgical site. Between October 2014 and October 2017, 1024 patients with diabetic foot ulcer (DFU) and CLI were admitted. In 84 patients (8.2%), there was a failure in distal revascularization with a persistent CLI after the procedure. Despite the persistent CLI, a group of 26 patients of this cohort obtained complete wound healing. Among them, 13 patients were treated with surgical debridement or open amputations and application of dermal substitute Integra Dermal Regeneration Template and the other 13 patients were treated without any dermal substitute. The Integra group healed within a mean time of 83.5 days, and the control group healed within a mean of 139 days (P = .028). No major amputation was carried out at 1-year follow-up in the Integra group versus 15% in the control group. A conservative foot surgery or an approach with minor amputation in diabetic patients with no-option CLI may achieve limb salvage. The use of Integra Dermal Regeneration Template in patients with DFU and no-option CLI may be a useful option in a limb salvage program.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-02-14T11:00:31Z
      DOI: 10.1177/1534734620905741
       
  • Association of Circulating Osteopontin Levels With Lower Extremity
           Arterial Disease in Subjects With Type 2 Diabetes Mellitus: A
           Cross-Sectional Observational Study
    • Authors: Ioanna Eleftheriadou, Dimitrios Tsilingiris, Anastasios Tentolouris, Iordanis Mourouzis, Pinelopi Grigoropoulou, Christos Kapelios, Constantinos Pantos, Konstantinos Makrilakis, Nikolaos Tentolouris
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Osteopontin (OPN) is involved in the atherosclerotic and inflammatory process. In this article, we examined the relationship between circulating OPN levels with lower extremity arterial disease (LEAD) in individuals with type 2 diabetes mellitus (T2DM). Seventy individuals with T2DM and 66 individuals without T2DM were recruited. Diagnosis of LEAD was based on the absence of triphasic waveform on the pedal arteries. Plasma OPN levels were determined by Luminex Multiplex immunoassay. LEAD was present in 34 (48.6%) patients with T2DM. In the diabetes cohort, individuals with LEAD had higher plasma OPN concentrations than those without LEAD (geometric mean [95% confidence intervals]; 43.4 [37.5-50.4] vs 26.1 [22.9-29.8] ng/mL, respectively, P < .001). Multivariable analysis showed that presence of LEAD independently associated with higher OPN levels in subjects with T2DM, with marginal statistical significance (P = .049). In both cohorts, plasma OPN concentrations were negatively associated with ankle-brachial index values (P < .05). In the total sample, there was a gradual increase of OPN levels across subgroups with triphasic, biphasic, and monophasic/blunted waveforms (P < .001). In conclusion, plasma OPN levels are associated with the presence and severity of LEAD in subjects with T2DM. Further studies are needed to investigate the role of OPN in the pathogenesis and progression of LEAD.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-02-11T08:57:29Z
      DOI: 10.1177/1534734619898097
       
  • Use of the New Vergenix Soft Tissue Repair Matrix to Heal a Chronic
           Neuropathic Diabetic Foot Ulcer
    • Authors: Nikolaos Papanas, Stella Papachristou, Chrysoula Kefala, Soultana Kyroglou
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.

      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-02-10T11:10:36Z
      DOI: 10.1177/1534734620903597
       
  • Cost-effectiveness of Platelet-Rich Plasma for Diabetic Foot Ulcer in
           Spain
    • Authors: Renata Linertová, Tasmania del Pino-Sedeño, Lidia-García Pérez, Javier Aragón-Sánchez, Isabel Andia-Ortiz, Mar Trujillo-Martín, Francisco J. Iruzubieta-Barragan, Pedro Serrano-Aguilar
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      This study evaluated the cost-effectiveness of platelet-rich plasma (PRP) added to usual care versus usual care alone in elderly patients with chronic diabetic foot ulcer (DFU) from the Spanish health care system perpective. A 6-state Markov model with 3-month cycles was used to estimate costs and outcomes of wound healing and risk of recurrences, infections, and amputations over 5 years. Three treatment strategies were compared: (a) usual care plus PRP obtained with a commercial kit, (b) usual care plus PRP obtained manually, and (c) usual care. Data on effectiveness were taken from a recent meta-analysis. Outcomes and costs were discounted at 3% and resources were valued in 2018 euro. Compared with usual care, the PRP treatment with the manual method was more effective and less costly (dominant option), whereas the PRP treatment with the commercial kit was more effective but also more costly, with the incremental ratio being above the cost-effectiveness threshold (€57 916 per quality-adjusted life year). These results are sensitive to the price of PRP kits (a 20% discount would make the PRP treatment a cost-effective option) and effectiveness data, due to the heterogeneity of primary studies. In conclusion, PRP treatment for DFUs could be considered a cost-effective or even cost-saving alternative in Spain, depending on the method of obtaining the PRP. Despite the dominance of the manual method, its general use is limited to hospitals and specialized centers, whereas PRP kits could be used in primary care settings, but their prices should be negotiated by health authorities.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-02-10T11:08:29Z
      DOI: 10.1177/1534734620903239
       
  • Monitoring the Prognosis of Diabetic Foot Ulcers: Predictive Value of
           Neutrophil-to-Lymphocyte Ratio and Red Blood Cell Distribution Width
    • Authors: Gökhun Arıcan, Hamit Çağlayan Kahraman, Ahmet Özmeriç, Serkan İltar, Kadir Bahadır Alemdaroğlu
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      The aim of this study was to investigate the prognostic values of neutrophil-to-lymphocyte ratio and red blood cell distribution width in diabetic foot ulcers treatment. A total of 250 adult patients who were treated in our clinic between 2007 and 2018 for diabetic foot ulcers were evaluated retrospectively. Diabetic foot ulcers were divided into 4 groups: major amputation, minor amputation, chronic wound, and complete healing. The mean age of our study groups was 60 years (range = 55-65 years). The mean follow-up period was 28 ± 4.3 months. Neutrophil-to-lymphocyte ratio and red blood cell distribution width cutoff values were determined as 4.3 and 12.1, respectively, for patients in complete recovery group (C sig. = .995 and .871, respectively; P < .05). Neutrophil-to-lymphocyte ratio and red blood cell distribution width cutoff values for patients in the major amputation group were 6.73 and 13.4 (C sig. = .864 and .951, respectively; P < .05), respectively. According to the χ2 comparison of the groups, major amputation was seen in patients with neutrophil-to-lymphocyte ratio>6.3, and complete recovery was seen in patients with neutrophil-to-lymphocyte ratio 13.4, major amputation was found to be significant (P < .05). According to these results, neutrophil-to-lymphocyte ratio and red blood cell distribution width are inexpensive and easy to access predictive parameters in the diagnosis and follow-up of diabetic foot ulcers.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-02-10T10:58:33Z
      DOI: 10.1177/1534734620904819
       
  • Successful Treatment of Lower Limb Burn Wounds With Long-Term Survived
           Human Skin Allograft in an Immunosuppressed Patient: A Case Report
    • Authors: Chun-Kai Chang, Julia Bartkova, Yi-Shu Liao, Yuan-Sheng Tzeng
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Early excision and autografting have been the principles in managing acute burn wounds. Despite the known benefits of early autografting, there are situations in which the placement of autograft is unsafe or even unavailable. In these clinical situations, skin substitutes like artificial dressings and human skin allografts are considered as useful for temporary wound coverage. We present an immunosuppressed patient with deep lower limb burn wound who received human skin allograft for wound management. The applied human skin allograft persisted for a longer period without infection or rejection and successfully improved her wound healing. Large and well-designed prospective studies are needed to confirm the encouraging results of the present case report.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-02-10T10:54:32Z
      DOI: 10.1177/1534734620904566
       
  • Feasibility of Percutaneous Bone Biopsy as Part of the Management of
           Diabetic Foot Osteomyelitis in a 100% Neuropathic, Grade 3 IDSA/IWGDF
           Population on an Outpatient Basis
    • Authors: Olga Anna Kosmopoulou, Isabelle J. Dumont
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      The present study aimed to evaluate the feasibility of percutaneous bone biopsy in an ambulatory setting as part of the management of diabetic foot osteomyelitis (DFO) on an outpatient basis. DFO may complicate some cases of apparently nonsevere foot infections in patients with diabetes and greatly increase the risk of a lower extremity amputation. It has been suggested that bone culture–based antibiotic therapy is a predictive factor of success in patients with diabetes treated nonsurgically for osteomyelitis of the foot. It is recommended to identify the causative microorganism(s) by the means of either a surgical or percutaneous bone biopsy taken appropriately to select the proper antibiotic therapy. Percutaneous bone biopsy in patients not requiring surgery is, however, not performed in everyday practice as it should be according to the current recommendations. In the present retrospective study, we report a series of 23 consecutive patients with a suspicion of DFO in whom 28 bone samples were collected by percutaneous biopsy at the bedside in an outpatient setting. The percentage of positive cultures was in accordance with that reported in the literature. The mean number of isolates per specimen was 1.04. After a mean 12-month follow-up, the remission was almost of 78%. No adverse event related to the bone biopsy was noted. After a 1-year follow-up, no recurrence was recorded among the patients in remission. The results of the present study suggest that bedside percutaneous bone biopsy performed in the ambulatory setting is a valuable and safe tool in the management of DFO on an outpatient basis.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-01-31T05:05:34Z
      DOI: 10.1177/1534734620902609
       
  • Evaluation of the Effect of Platelet-Rich Fibrin on Wound Healing at
           Split-Thickness Skin Graft Donor Sites: A Randomized, Placebo-Controlled,
           Triple-Blind Study
    • Authors: Mojtaba Vaheb, Maryam Karrabi, Mahtab Khajeh, Alireza Asadi, Ehsan Shahrestanaki, Mohammad Sahebkar
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Split-thickness skin grafting (STSG) is widely used to heal wounds resulting from trauma, burns, and chronic wounds. This study aimed to determine the true effect of platelet-rich fibrin (PRF) on patients with burn wounds requiring STSG during treatment of donor wounds. This randomized, triple-blind clinical trial was conducted on patients who referred to the burn ward of Vasei Hospital of Sabzevar, Iran, from May 2017 to May 2018. The donor site was randomly divided into 2 groups: PRF and control (Vaseline petrolatum gauze) using Vaseline gauze. In the intervention group, the PRF gel was applied to the wound and covered with Vaseline gauze and wet dressing. Conversely, only Vaseline gauze and wet dressing were applied to the control group. Outcome evaluation was conducted using paired t test and Wilcoxon signed rank-sum test, as appropriate, on days 8 and 15. The mean age of the patients was 33.10 ± 2.60 years, and 51.50% were male. The mean wound healing time in the PRF and control groups was 11.80 ± 3.51 and 16.30 ± 4.32 days, respectively (P < .001). The PRF group showed significantly higher wound healing rates than the control group at 8 and 15 days dressing (P < .001 and P < .001, respectively). Moreover, the mean wound healing for all wound healing indices diagnosed by 2 specialists in PRF was higher than control group on days 8 and 15 (P < .001). We found a statistically significant difference on days 8 and 15 regarding the mean pain levels between the 2 groups (P < .001). The findings showed that PRF can significantly increase the time and rate of donor wound healing compared with conventional treatment and also reduce the severity of pain.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-01-31T04:59:08Z
      DOI: 10.1177/1534734619900432
       
  • A Narrative Review of the Use of Neuromuscular Electrical Stimulation in
           Individuals With Diabetic Foot Ulceration
    • Authors: Richard James Goodall, Benjamin Langridge, Tristan Lane, Alun Huw Davies, Joseph Shalhoub
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      This review aims to summarize the evidence reported on the use of neuromuscular electrical stimulation (NMES) in individuals with diabetic foot ulceration (DFU). A systematic search of EMBASE and MEDLINE databases was performed in February 2019, using search terms relating to the domains DFU and NMES. All primary evidence assessing outcomes of NMES in DFU were included. Of 344 references obtained from database searching, 7 met the inclusion criteria and included a total of 140 participants, 77 of whom had DFU. All included studies used prospective designs. Two studies demonstrated improvements in chronic ulcer healing with NMES use; however, in each study, only 3 of the included participants had DFU and subgroup analyses based on ulcer etiology was omitted. The remaining 5 studies were produced by the same research group and positive effects of NMES (in combination with heat therapy) on DFU healing were consistently demonstrated. They reported significantly better healing rates with NMES in DFU than in nondiabetic wounds of a similar grade (healing rate: 70.0 ± 32.3% in DFU vs 38.4 ± 22.3% in nondiabetic ulcers [P < .01]). These studies did not provide data assessing the isolated effects of NMES without concomitant heat exposure. Data on device tolerability and compliance were lacking. The existing data support a potential role for NMES in individuals with DFU; however, the identified studies inadequately controlled for confounding and were underpowered. Given the significant morbidity and mortality associated with DFU, higher quality evidence is needed to assess the adjunctive role for NMES in this group.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-01-31T04:47:18Z
      DOI: 10.1177/1534734619898978
       
  • Livedo Racemosa: Clinical, Laboratory, and Histopathological Findings in
           33 Patients
    • Authors: Marcella Soares Pincelli, Alejandra Maria Jimenez Echavarria, Paulo Ricardo Criado, Gabriela Franco Marques, Thâmara Cristiane Alves Batista Morita, Neusa Yuriko Sakai Valente, Josélio Freire de Carvalho
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Livedo racemosa is a cutaneous finding characterized by a persistent, erythematous, or violaceous discoloration of the skin, in a broken, branched, discontinuous, and irregular pattern. A retrospective review of 33 cases with clinical diagnosis of livedo racemosa over the past 6 years was evaluated in the dermatology department of a tertiary care hospital. We found predominance in Caucasian women (78.8%); age ranged from 8 to 81 years, with a mean age of 36 years. Livedo racemosa was described as generalized in 12 patients (36.4%), although the main localization was on lower limbs (42%). After laboratory testing and histopathological examinations, 12 patients (36.4%) were classified with idiopathic livedo racemosa; secondary diseases were diagnosis in 21 patients (63.6%), including Sneddon’s syndrome, cutaneous polyarteritis nodosa, systemic lupus erythematosus, and others. Medical history of thrombotic events was described in 8 (24.2%) patients, and also 8 (24.2%) patients had abnormal results for 2 or more thrombophilia laboratory tests. Skin biopsy showed no histological abnormalities in 11 cases (33.3%), thrombosis of dermal blood vessels in 10 (30.3%), intimal/subintimal thickening in 7 (21.2%), and vasculitis in 5 (15.2%). In conclusion, livedo racemosa is a clinical feature that might be correlated to vascular disorders, such as thrombotic and/or hypercoagulable states, autoimmune diseases, and neoplastic diseases, or it can be secondary to specific medications. It is essential to establish a correct approach in cases of livedo racemosa, which includes anamnesis, physical examination, laboratory test, histological examination, and complementary examination according to clinical findings, in order to diagnosis underlying causes.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-01-30T06:19:35Z
      DOI: 10.1177/1534734619896938
       
  • Bioactive Glass in a Rare Case of Osteomyelitis of the Heel in a
           Guillain-Barré Syndrome: A Case Report
    • Authors: Elisabetta Iacopi, Simone Ferranti, Nicola Riitano, Lorenza Abbruzzese, Letizia Pieruzzi, Chiara Goretti, Virna Zampa, Alberto Piaggesi
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Guillain-Barré syndrome (GBS) represents an acute inflammatory immune-mediated demyelinating polyradiculoneuropathy with an incidence of 0.6 per 100 000 people. In this article, we report the case of a 19-year-old girl affected by GBS since the age of 2 who presented at our clinic complaining for a chronic plantar hindfoot–infected ulceration. Serology showed increase of inflammatory markers and leukocytosis, and magnetic resonance imaging revealed osteomyelitis of calcaneum and soft tissue alterations with air bubbles. The patient was treated in our clinic by an integrated multidisciplinary approach consisting of immediate admission, soft tissue and bone debridement, and administration of antibiotics under the close control of infectious disease specialist. After the control of acute condition, the patient underwent negative pressure therapy associated with instillation of antiseptic solution until the restoration of bone and soft tissue loss of substance and, eventually, to the application of bioactive glass substitute until the achievement of complete wound healing.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-01-30T06:15:06Z
      DOI: 10.1177/1534734619896462
       
  • Use of Nevelia Dermal-Epidermal Regenerative Template in the Management of
           Ischemic Diabetic Foot Postsurgical Wounds
    • Authors: Luigi Uccioli, Marco Meloni, Valentina Izzo, Laura Giurato
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      The purpose of this cross-sectional study is evaluate the effectiveness of a dermal-epidermal substitute (DES) composed of 3-dimensional porous matrix of type 1, purified, stabilized, bovin-origin collagen (Nevelia, SYMATESE, Chaponost, France) without a subsequent skin graft in the treatment ischemic postsurgical diabetic foot ulcers. This study group was composed of a sample of consecutive diabetic patients with critical limb ischemia and postsurgical wounds. All patients received a preset limb salvage protocol including the application of the DES, but none received a skin graft. Patients were closely followed until wound healing or different outcome. The outcome measures were healing, nonhealing, major amputation, and death evaluated at 1 and 2 years of follow-up. Forty-one patients were included. The average postsurgical wound area was 69.6 ± 50 cm2. Twenty-one patients (51%) healed; 10 patients (24%) did not heal after 1 year of follow-up; however, all of them achieved a mean ulcer size reduction>50%; 7 patients (17%) were amputees; 3 patients (7.3%) died. In a later follow-up (2 years), wounds in 8 additional patients healed. Successful revascularization was an independent predictor of healing (hazard ratio = 5.1, 95% confidence interval [CI] = 2.5-14-9; P = .0001), the postsurgical ulcer size (>50 cm2) was an independent predictor of nonhealing (hazard ratio = 6.2, 95% CI = 2.1-38.4; P = .0001) while recurrence of critical limb ischemia was an independent predictor of major amputation (odds ratio = 3.4, 95% CI = 1.1-4.5; P = .002). The DES composed of type 1 bovin-origin collagen is useful in the treatment of large postsurgical diabetic foot ulcers, even when the skin graft is not a suitable therapeutic option.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-01-30T06:03:28Z
      DOI: 10.1177/1534734619896460
       
  • Quality of Life in Diabetic Foot Ulcer: Associated Factors and the Impact
           of Anxiety/Depression and Adherence to Self-Care
    • Authors: Maria Polikandrioti, Georgios Vasilopoulos, Ioannis Koutelekos, Georgios Panoutsopoulos, Georgia Gerogianni, Fotoula Babatsikou, Afroditi Zartaloudi, Georgia Toulia
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Diabetic foot ulcer (DFU) is a major complication of diabetes mellitus that needs a multidisciplinary approach. The purpose of this study was to assess the impact of patients’ characteristics, anxiety/depression, and adherence to guidelines on the QoL of patients with diabetic ulcer. The sample of the study consisted of 195 patients. Data collected by the completion of SF-36 Health Survey, the Hospital Anxiety and Depression Scale, and a questionnaire that measured adherence to self-care activities. Patients had moderate- to high-quality levels in emotional well-being, pain, social functioning, and energy/fatigue (median: 68, 68, 63, and 60, respectively), while they had low levels of quality in physical functioning, role physical, and role emotional (median: 21, 0, and 33, respectively). In their general health, patients had moderate levels (median: 50). High levels of anxiety and depression were observed in 13.8% and 20.0% of the participants, respectively. After multiple regression, regarding general QoL, patients living in the capital city had 9.89 points worse general health than patients living in Attica (β = −9.89, 95% confidence interval [CI] = −16.86 to 2.93, P = .006). Patients with moderate or high levels of anxiety had 9.37 and 16.08 points, respectively, worse general health than those with low levels (β = −9.37, 95% CI = −17.04 to 1.70, P = .017, and β = −16.08, 95% CI = −26.65 to −5.51, P = .003, respectively). Clinically, these findings may help health professionals attain effective treatment of emotional burden to DFU patients and increase adherence to self-care.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-01-24T04:58:03Z
      DOI: 10.1177/1534734619900415
       
  • December Is Here: And an Issue in a Pear Tree
    • Authors: Nikolaos Papanas, Massimo Papi, Kittipan Rerkasem
      Pages: 349 - 349
      Abstract: The International Journal of Lower Extremity Wounds, Volume 18, Issue 4, Page 349-349, December 2019.

      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2019-12-01T08:00:00Z
      DOI: 10.1177/1534734619892739
      Issue No: Vol. 18, No. 4 (2019)
       
  • Efficacy of Recombinant Human Epidermal Growth Factor (Regen-D 150) in
           Healing Diabetic Foot Ulcers: A Hospital-Based Randomized Controlled Trial
           
    • Authors: Vijay Viswanathan, Udyama Juttada, Mary Babu
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      To validate the efficacy of recombinant human epidermal growth factor (hEGH) in healing diabetic foot ulcers (DFUs) at biochemical and molecular levels. A total of 50 noninfected DFU subjects were recruited for the study and divided into 2 groups based on the treatment application on the subjects. Group 1: DFU subjects treated with hEGH gel-based product called Regen-D 150 (n = 27) and group 2: DFU subjects treated with alternative placebo as the control group (n = 23). Patients were observed for 30 days and punch biopsy was taken at days 0 and 14. Histologic analysis was done to study the matrix alignment, cellular infiltration, and differentiation of epithelial layers. Biochemical analysis was done to quantitatively estimate the amount of collagen and proteoglycans regenerated in the wound area. Complete healing of ulcers was observed in 21 (78%) subjects in group 1, whereas only 12 (52%) subjects among group 2 reported of complete healing of ulcer after completion of the study period of 30 days. Collagen and fibroblasts were significantly developed in group 1 when observed in the follow-up samples. Healing time of the wound among the group 1 subjects was significantly less than the group 2 subjects (45 ± 12 vs 72 ± 18 days, P < .0001) and even showed a better blood glucose level. Early and regular application of the hEGH on DFUs will lead to prevention of leg amputations and would serve to act as a major treatment therapy for healing of chronic wounds.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2019-12-27T05:04:26Z
      DOI: 10.1177/1534734619892791
       
  • Calcaneal Osteomyelitis: Current Treatment Concepts
    • Authors: Michael J. McCann, Ashleigh Wells
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Calcaneal osteomyelitis can be a debilitating disease if proper treatment protocols are not initiated. This literature review details the epidemiology, clinical, diagnostic, and prognostic factors, and medical management in those who developed this disease.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2019-12-19T07:41:04Z
      DOI: 10.1177/1534734619895187
       
  • Complex Wound Healing Outcomes for Outpatients Receiving Care via
           
    • Authors: Luc Téot, Chloé Geri, Julie Lano, Marjorie Cabrol, Christine Linet, Grégoire Mercier
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Use of telemedicine has expanded rapidly in recent years, yet there are few comparative studies to determine its effectiveness in wound care. To provide experimental data in the field of telemedicine with regard to wound care, a pilot project named “Domoplaies” was publicly funded in France in 2011. A randomized, controlled trial was performed to measure the outcomes of patients with complex wounds who received home wound care from a local clinician guided by an off-site wound care expert via telemedicine, versus patients who received in-home or wound clinic visits with wound care professionals. The publicly funded network of nurses and physicians highly experienced in wound healing was used to provide wound care recommendations via telemedicine for the study. The healing rate at 6 months was slightly better for patients who received wound care via telemedicine (61/89; 68.5%) versus wound care professional at home (38/59; 64.4%) versus wound care clinic (22/35; 62.9%), but the difference was not significant (P = .860833). The average time to healing for the 121/183 wounds that healed within 6 months was 66.8 ± 32.8 days for the telemedicine group, 69.3 ± 26.7 for the wound care professional at home group, and 55.8 ± 25.0 days for the wound care clinic group. Transportation costs for the telemedicine and home health care groups were significantly lower than the wound clinic group, and death rate was similar between all the 3 groups (P < .01). Telemedicine performed by wound healing clinicians working in a network setting offered a safe option to remotely manage comorbid, complex wound care patients with reduced mobility.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2019-12-19T07:35:37Z
      DOI: 10.1177/1534734619894485
       
  • The Complexity of Diabetic Foot Management: From Common Care to Best
           Practice. The Italian Expert Opinion by Delphi Survey
    • Authors: Elisabetta Salutini, Enrico Brocco, Roberto Da Ros, Luca Monge, Luigi Uccioli, Roberto Anichini
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Diabetic foot is a major public health issue, driven by diabetes complications (neuropathy, peripheral vascular disease, foot deformity, and abnormal leucocyte function), which may lead to leg amputation, thus resulting in severe disability, reduced quality of life, and high health costs. The prevention of diabetes complications and the early detection and proper management of diabetic foot wounds are the milestones to avoid major amputations. Unfortunately, in many areas, the prevention of diabetic foot lesions is inadequate and wounds may proceed toward infection and chronicity, with limb- and life-threatening results. Using the Delphi method, we conducted a survey on diabetic foot among Italian experts, selected across different Italian clinical centers. This method was used to achieve a consensus on current opinion and clinical leanings on the diagnosis and management of diabetic foot ulcers. Specifically, the aim of the survey was to evaluate the current management of the diabetic foot syndrome; highlight the differences in the approach among a group of experts; evaluate the role of wound bed preparation and antisepsis; and discuss any areas of disagreement in which evidences are sparse and the clinical judgment plays a crucial role in the decision-making process.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2019-12-16T04:39:17Z
      DOI: 10.1177/1534734619890814
       
  • Relationship Between Glycated Hemoglobin and Vibration Perception
           Threshold in Diabetic Peripheral Neuropathy
    • Authors: Arun G. Maiya, Anche Parameshwar, Manjunath Hande, Vinayak Nandalike
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Foot ulcers, infections, and deformity are some of the major sources of mortality and morbidity among the diabetic population. The relationship between glycated hemoglobin (HbA1c) and diabetic peripheral neuropathy (DPN) has been well established. There is a dearth of literature on the relationship between vibration perception threshold (VPT) and HbA1c values. So, the objective of the study was to determine the strength of linear relationship between HbA1c levels and vibration perception threshold in DPN. This cross-sectional study was conducted at Kasturba Hospital, Manipal, and diabetic foot screening camps held at various parts of Udupi district. Ethical approval was obtained from the Institutional Ethics Committee, Kasturba Hospital, Manipal (IEC:281/2017). A total of 534 participants ranging from 30 to 70 years of age and were diagnosed with type 2 diabetes mellitus on medications were included in the study. Neuropathy assessment consisting of monofilament and vibration perception threshold was done using Neurotouch beta version (Yostra Labs, Bengaluru, India). HbA1c measurement was done using turbidimetric inhibition immunoassay technique (Roche Diagnostics, Mannheim, Germany). Pearson correlation coefficient showed a moderate to good correlation between HbA1c and VPT (r = .0.753, P < .001). Linear regression result has shown a significant relationship of VPT with HbA1c (4.033 [95% confidence interval = 3.67-4.39]). The present study has concluded that there is strong relationship between HbA1c values and VPT and could be a predictor for complications in the foot following DPN.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2019-12-16T04:29:24Z
      DOI: 10.1177/1534734619882173
       
  • Use of Customized Bacteriophages in the Treatment of Chronic Nonhealing
           Wounds: A Prospective Study
    • Authors: Dev Raj Patel, Satyanam K. Bhartiya, Rajesh Kumar, Vijay K. Shukla, Gopal Nath
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Nonhealing ulcers are a great challenge to surgeons as they may occasionally culminate in amputation of the affected part. Mostly nonhealing of wounds results due to infection by antibiotic-resistant bacteria and subsequent biofilm formation. However, customized bacteriophage therapy may take care of both of the above-mentioned hurdles. A total of 48 study subjects of age group 12 to 70 years, having minimum one eligible full-thickness wound and failed to heal in 6-week duration with conventional therapy, were included in this exploratory prospective study. Patients with systemic diseases, that is, burn, malignancy, dermatological disorders, and ulcers with leprosy or tuberculosis, were excluded. However, subjects having diabetes and hypertension were included in the study. The customized monophage for single bacterial infection and cocktail of phages specific to 2 or more infecting bacteria were applied on an alternate day over the wound surface. A total of 5 to 7 applications were made till the wound became free of infecting bacteria. The study period extended from August 2018 to May 2019. The study subjects were followed for 3 months since the start of therapy. A cure rate of 81.2% could be obtained, of which 90.5% (19/21) patients were nondiabetic and 74.1% (20/27) diabetic. The wounds infected with Klebsiella pneumoniae were observed with relatively delayed healing. Post phage therapy, the mean hemoglobin level and percentage of lymphocytes increased significantly. The customized local phage therapy is very promising in nonhealing ulcers.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2019-11-22T08:19:07Z
      DOI: 10.1177/1534734619881076
       
  • Surgical Offloading Techniques Should be Used More Often and Earlier in
           Treating Forefoot Diabetic Ulcers: An Evidence-Based Review
    • Authors: Kaissar Yammine, Chahine Assi
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Conservative treatment is the basis for diabetic foot ulcer (DFU) management, whereas surgical treatment is usually reserved for patients with failed, recurrent, or nonresponsive infected wounds. However, many reports demonstrated good to excellent results following surgery. Evidence synthesis on surgical offloading techniques and clear guidelines regarding the timing of surgery are lacking. The present study aimed to investigate the evidence behind surgical offloading techniques and propose a cutoff time for surgical indication following failed conservative treatment of neuropathic diabetic forefoot ulcers. Electronic databases were searched from inception to identify the best evidence level articles related to non-vascular surgical treatment of DFUs, such as metatarsal head resection, resection arthroplasty, metatarsal osteotomy, Achilles tendon lengthening, gastrocnemius recession, and flexor tenotomy, that have been employed for managing DFUs. Based on the highest level of evidence available, surgery was found to generate better values than standard conservative care for all outcomes except for the transfer rate. In particular, surgical bony offloading procedures demonstrated significantly better outcomes than standard conservative nonsurgical care in terms of higher healing rates, shorter healing durations, and lower recurrence rates. Moreover, 96% of DFUs healed in
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2019-11-20T09:35:51Z
      DOI: 10.1177/1534734619888361
       
  • Limb Salvage in Diabetic Patients With Ischemic Heel Ulcers
    • Authors: Marco Meloni, Valentina Izzo, Laura Giurato, Enrico Brocco, Roberto Gandini, Luigi Uccioli
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      The purpose of this study is to investigate the outcomes of diabetic individuals with ischemic heel ulcers. The study group was composed of a consecutive sample of persons with diabetic ischemic foot ulcers managed by a preset multidisciplinary limb salvage protocol, including revascularization through endovascular technique. The outcome measures were healing, major amputation (above the ankle), and death at 1-year of follow-up. The outcomes between patients with heel ulcers (HUs) and without (NHUs) were compared. A total of 254 patients were recruited. There were 50/254 (19.7%) HUs and 204/254 (79.3%) NHUs. Overall, 190/254 (74.8%) patients healed. The rate of healing for HUs and NHUs was 30/50 (60%) and 160/204 (78.4%); P = .03, respectively. Major amputation occurred in 24/254 (9.4%) patients. The rates of major amputation for HUs and NHUs were 10/50 (20%) and 14/204 (6.9%; P = .002), respectively; 40/254 (15.7%) patients died, unhealed. The rates of mortality for HUs and NHUs were 10/50 (20%) and 30/204 (14.7%; P = .07), respectively. In HUs patients, absence of infection [95% CI = 3.1 (1.6-5.5); P = .002] and superficial ulcers [95% CI = 4.4 (2.2-9.3); P = .0001] were independent predictors of healing, whereas revascularization failure [95% CI = 8.1 (1.5.0-19.4); P = .0001], involvement of the plantar arch [95% CI = 6.3 (2.0-15.4); P = .0001], and dialysis [95% CI = 2.2 (1.3-4.5); P = .006] were independent predictors of major amputation. A multidisciplinary approach achieves good rate of limb salvage in people with diabetic ischemic heel ulcers.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2019-11-20T09:32:07Z
      DOI: 10.1177/1534734619884438
       
  • A Study on Isolation, Characterization, and Exploration of
           Multiantibiotic-Resistant Bacteria in the Wound Site of Diabetic Foot
           Ulcer Patients
    • Authors: Selvakumar Thanganadar Appapalam, Anbarasan Muniyan, Kanimozhi Vasanthi Mohan, Rajasekar Panchamoorthy
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      This study collected wound swab samples from 50 diabetic patients, especially in Wagner’s grade 2 (28) and grade 3 (22) foot ulcers. The samples were processed and subjected to bacterial isolation and characterization. The obtained diabetic foot ulcer (DFU) bacterial isolates were also subjected to antibiotic susceptibility assay. All the collected samples were culture positive and produced a total of 85 isolates. Monomicrobial and polymicrobial infections were observed from the collected grade 2 and 3 samples, respectively. Gram’s staining and morphological analyses of the obtained bacterial colony demonstrated the presence of both Gram-positive and Gram-negative bacilli, Gram-positive cocci, and Gram-negative cocco-bacilli in the wounds of diabetic patients. The bacterial profiling of 85 isolates revealed the presence of Gram-negative bacteria such as Pseudomonas aeruginosa, Escherichia coli, Proteus spp, Acinetobacter spp, Enterobacter spp, Klebsiella pneumoniae, Citrobacter spp, K oxytoca, and Stenotrophomonas spp Gram-positive bacteria such as Staphylococcus aureus, Bacillus subtilis, Enterococcus faecalis, Corynebacterium spp, and Streptococcus dysgalactiae were also identified. The predominant microbial flora found in the collected samples were Staphylococcus aureus (38%) and P aeruginosa (23.2%), followed by B subtilis (21%) and Escherichia coli (18%) and other bacteria. Furthermore, the obtained antibiotic susceptibility assay data of DFU isolates have also confirmed the distribution of multiantibiotic-resistant bacteria in the wound site of diabetic patients. The findings of the present study suggest that there is a need for the discovery of novel drug(s) to alleviate antibiotic-resistant bacterial infections in DFU patients.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2019-11-18T09:24:21Z
      DOI: 10.1177/1534734619884430
       
  • Fusarium spp.—An Emerging Pathogen in Chronic Diabetic Ulcer: Case
           Report and Review of the Literature
    • Authors: Ana Luísa João, André Lencastre, Eduardo Dutra, Tomás Pessoa e Costa, Ana Formiga, José Neves
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      The genus Fusarium is ubiquitous in the environment and has been emerging as an opportunistic human pathogen. We report the case of a 65-year-old man with a history of neuroischemic, otherwise unamenable to revascularization, diabetic foot, who was admitted due to an infected deep foot ulcer. Despite conventional antibiotic and wound care treatment, no improvement was initially observed. A reappraisal of the diagnosis, with microbiological and histological analyses, documented infection of the foot ulcer with Fusarium oxysporum. Clinical improvement was noted under prolonged oral voriconazole therapy. The present case broadens the differential diagnosis of diabetic foot infection. Subcutaneous fusariosis should be considered in recalcitrant infected diabetic ulcers, as early diagnosis and management may help prevent amputation and life-threatening disease.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2019-11-14T06:34:46Z
      DOI: 10.1177/1534734619879030
       
  • Canagliflozin and Amputation Risk: Evidence So Far
    • Authors: Eleni Papadokostaki, Evangelos Rizos, Stelios Tigas, Evangelos N. Liberopoulos
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      The CANVAS program detected a 2-fold increased risk of lower limb amputation in patients treated with canagliflozin compared with those with placebo. This adverse effect was not confirmed in the CREDENCE trial. Moreover, randomized controlled trials with other agents in this class, dapagliflozin and empagliflozin, did not detect increased risk of amputation. Observational studies, cohort studies, and pharmacovigilance reports with sodium-glucose cotransporter 2 inhibitor (SGLT2i) have reported conflicting results. Whether this adverse event is a drug effect specific to canagliflozin, or a SGLT2i class effect, remains controversial. Until more evidence emerges, clinicians should avoid using SGLT2i, especially canagliflozin, in patients with previous amputations or existing foot ulceration.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2019-11-08T09:09:09Z
      DOI: 10.1177/1534734619878090
       
  • Effect of Collagen Scaffold With Bcl-2-Modified Adipose-Derived Stem Cells
           on Diabetic Mice Wound Healing
    • Authors: Sheng Ding, Ye Xu, Xin Yan, Yue Lin, Qian Tan
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      This study aimed at evaluating the effects of collagen scaffold with Bcl-2-modified adipose-derived stem cells (ADSCs) on wound repair in streptozotocin-induced diabetic mice. A round full thickness skin defect with a diameter of 7 mm was made in the mice model. The experimental mice were divided into 4 groups (n = 12 each): group A (control group), group B (scaffold group), group C (ADSCs-scaffold group), and group D (Bcl-2-ADSCs-scaffold group). On days 3, 7, 10, and 14 after surgery, characteristics of wound healing was observed, and wound tissues were sampled for histology characteristics via hematoxylin-eosin staining and immunohistochemical staining. Compared with other groups, the wound healing rate was significantly higher in group D a week after operation (P < .05). On the seventh day postoperation, group D exhibited higher blood vessel in the wounds granulation tissue than other groups according to results of hematoxylin-eosin staining and immunohistochemistry. In conclusion, these findings demonstrated that collagen scaffold with Bcl-2 modified ADSCs may effectively improve the wound healing process in diabetic mice.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2019-11-04T10:35:16Z
      DOI: 10.1177/1534734619880055
       
  • A New Human-Derived Acellular Dermal Matrix for 1-Stage Coverage of
           Exposed Tendons in the Foot
    • Authors: Davide Melandri, Francesco Marongiu, Andrea Carboni, Corrado Rubino, Sergio Razzano, Valeria Purpura, Paola Minghetti, Elena Bondioli
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      The closure of wounds associated with soft tissue defects is surgically challenging, frequently requiring extensive plastic surgery and free flaps. The combination of ADM and STSG is an innovative method used to cover such wounds. The human-derived ADMs (H-ADMs) are the most described in the literature but according to European legislations, Companies H-ADMs outside the EC are not allowed to commercialize them in Europe, H-ADMs being “human products” and not “medical devices”, so being ruled by European legislations on transplants. The Skin Bank of the Bufalini Hospital (Cesena, Italy) obtained in 2009 the approval for the production and distribution of the first human cadaver-donor derived ADM from the Italian National Transplant Center and National Health Institute, we called with the Italian acronym M.O.D.A. (Matrice Omologa Dermica Acellulata). We present here the first use of a new H-ADM for treatment of distal lower extremity wounds with exposed tendons managed in one-stage pocedure with STSG. The excellent performance suggests that in cases where autologous tissue is unavailable or undesirable, the use of M.O.D.A. in one-stage procedure represents a promising alternative for covering wounds associated with tendons exposition.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2019-11-04T08:54:59Z
      DOI: 10.1177/1534734619884422
       
  • Evaluating the Far-Infrared Radiation Bioeffects on Micro Vascular
           Dysfunction, Nervous System, and Plantar Pressure in Diabetes Mellitus
    • Authors: Yi-Ching Cheng, Chi-Wen Lung, Yih-Kuen Jan, Fang-Chuan Kuo, Yung-Sheng Lin, Yu-Chou Lo, Ben-Yi Liau
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      The most frequent clinical complication is diabetes. Diabetes is characterized by elevated blood glucose levels resulting in sensory nerve damage or lesions. Diabetic foot wounds are often slow to heal and require medical attention and monitoring. This study evaluates the effect of far-infrared radiation on the microcirculation and plantar pressure in the diabetic foot. Ten diabetics and 4 nondiabetics were recruited in this study. The diabetic group was examined before and after the intervention in each month for 3 consecutive months. Four nondiabetic groups were also measured before and after the intervention for 2 weeks in each month. The surface temperature and blood flow in the diabetic foot was significantly improved (temperature: 32.1 ± 2.3°C vs 33.5 ± 2.2°C, P < .05; blood flow image: 118.3 ± 58.1 PU [perfusion unit] vs 50.4 ± 4.3 PU, P < .05). The sympathetic nerve activity index LF also increased from 40.8 ± 18.6% to 61.8 ± 13.5% (P = .07) in the second month. Plantar pressure tended to increase in the third month. This might indicate that far-infrared radiation could affect the mechanical properties of the plantar foot soft tissue. These results indicated that the effects of far-infrared radiation would improve blood circulation and change the soft tissue properties in the diabetic foot.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2019-10-18T09:25:58Z
      DOI: 10.1177/1534734619880741
       
  • Malignant Transformation of Hypertrophic Lichen Planus in a Young Pregnant
           Woman: A Case Report
    • Authors: Bharathi Ravikumar, S. Kumudhini, S. Krishnan
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      In this article, we report a case of hypertrophic lichen planus transforming into cutaneous squamous cell carcinoma in a 24-year-old Indian woman at 34 weeks of gestational age. We hypothesize that immunologic alterations during pregnancy could transform a long-standing hypertrophic lichen planus into cutaneous neoplasm.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2019-10-18T09:22:31Z
      DOI: 10.1177/1534734619881584
       
  • A Study of Clinical Applications of Perforator-Based Propeller Flaps in
           Leg Reconstructive Surgery: A Single-Center Experience of 40 Cases
    • Authors: Shahab Faria Shahabuddin, Mohammed Fahud Khurram
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Soft tissue management in lower limb poses a considerable challenge to a reconstructive plastic surgeon. Perforator-based propeller flaps can cover large wounds without sacrificing a major vascular axis and allows reconstruction using nearby similar tissues, thereby following the principle of replace like with like. This study was undertaken with the objective to look for the results of propeller flap in lower limb reconstruction and how the results can be improved. This was a retrospective study on 40 patients who underwent the reconstruction of soft tissue defects of lower limb with propeller flap. All the relevant data were collected and analyzed. Patients with soft tissue defect anywhere in the leg were included, but patients who had history of degloving injury, peripheral vascular disease, and diabetes mellitus were excluded. All these patients were divided in 2 groups according to the angle of rotation of propeller flap. Group I had 20 patients in which the flap was rotated by 150° to 180°. Group II had 20 patients, and the flap was rotated by 90° to 150°. Postoperatively, the first 2 cases in Group I showed total flap congestion and had complete necrosis, which were debrided and an alternate method was used to reconstruct. Thereafter, no patient had total flap necrosis. Minor complications were seen in 3 patients who showed transient venous congestion of the flap. Group II had no flap necrosis except for mild dehiscence, which was managed by secondary suturing. In most cases, the aesthetic result was acceptable and patients were completely satisfied. When parameters of the defect are suitable for treatment with a propeller-based local flap, this technique may be considered as the first option for surgical reconstruction. Proper planning, location of perforator with preoperative and intraoperative audio Doppler, and use of magnification would make this procedure more successful and definitely decrease the use of long-duration microvascular surgery.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2019-10-16T06:17:12Z
      DOI: 10.1177/1534734619876797
       
  • Maximally Disfiguring Surgery for Forefoot Osteomyelitis: Time for a
           Rethink'
    • Authors: Han Jie Lee, Ken Min Chin, Shaun Lee, Hao Yun Yap, Jack Kian Ch’ng, Siew Ping Chng, Hsien Ts’ung Tay
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      The treatment of choice for diabetic foot osteomyelitis is surgical debridement and targeted antibiotics with or without revascularization, depending on vascular status. In our society, debridement is done by either a vascular or orthopedic surgeon, and the common teaching is that generous amputation of bone with the accompanying soft tissue envelope is essential for adequate source control and to prevent recurrence (which remains as high as 30% even with this approach). Most of our patients undergo formal ray amputation through the metatarsal neck, while a few get digital amputations through the interphalangeal joints. Many of the resultant wounds cannot be closed and are left to heal by secondary intention. These amputations invariably alter the biomechanics of the foot and leave large and slow-healing open wounds, which have associated adverse psychosocial impacts. We describe 2 cases of patients who had osteomyelitis in the region of the forefoot who underwent complete bony resections of the osteomyelitis but with sparing of the soft tissue envelopes with good outcomes, and we challenge the dogma that maximal debridement of soft tissue must accompany debridement of necrotic and infected bone.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2019-09-26T10:44:19Z
      DOI: 10.1177/1534734619876841
       
  • Broad-Ranging Nutritional Deficiencies Predict Amputation in Diabetic Foot
           Ulcers
    • Authors: John Deakin Lees Brookes, Joseph Swaminadan Jaya, Henley Tran, Ashish Vaska, Keagan Werner-Gibbings, Andre C. D’Mello, Jennifer Wong, Chris N. Lemoh, Alan C. Saunder, Ming Kon Yii
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Diabetic foot ulcers present across the spectrum of nonhealing wounds, be it acute or many months duration. There is developing literature highlighting that despite this group having high caloric intake, they often lack the micronutrients essential for wound healing. This study reports a retrospective cohort of patients’ micro- and macro-nutritional state and its relationship to amputation. A retrospective cohort was observed over a 2-month period at one of Australia’s largest tertiary referral centers for diabetic foot infection and vascular surgery. Patient information, duration of ulcer, various biochemical markers of nutrition and infection, and whether the patient required amputation were collected from scanned medical records. A cohort of 48 patients with a broad-spectrum of biochemical markers was established. Average hemoglobin A1c (HbA1c) was 8.6%. A total of 58.7% had vitamin C deficiency, including 30.4% with severe deficiency, average 22.6 Ł} 5.8 μmol/L; 61.5% had hypoalbuminemia, average albumin 28.7 Ł} 2.5 g/L. Average vitamin B12 was 294.6 Ł} 69.6 pmol/L; 57.9% had low vitamin D, average 46.3 Ł} 8.3 nmol/L. Basic screening scores for caloric intake failed to suggest this biochemical depletion. There was a 52.1% amputation rate; biochemical depletion was associated with risk of amputation with vitamin C (P < .01), albumin (P = .03), and hemoglobin (P = .01), markedly lower in patients managed with amputation than those managed conservatively. There was no relation between duration of ulceration and nutrient depletion. Patients with diabetic foot ulceration rely on multidisciplinary care to optimize their wound healing. An important but often overlooked aspect of this is nutritional state, with micronutrients being very important for the healing of complex wounds. General nutritional screening often fails to identify patients at risk of micronutrient deficiency. There is a high prevalence of vitamin deficiency in patients with diabetic foot ulcers. This presents an excellent avenue for future research to assess if aggressive nutrient replacement can improve outcomes in this cohort of patients.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2019-09-24T10:54:57Z
      DOI: 10.1177/1534734619876779
       
  • Further Data on Wound Healing Rates After Application of Lucilia sericata
    • Authors: Zbigniew Szczepanowski, Andrzej Tukiendorf, Grzegorz Krasowski
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Maggot therapy has recently received a special medical and public attention, and according to the specialists’ opinion, it takes us to the future of a wound care. Simultaneously, as new biomechanisms were discovered, statistical analyses of wound healing rates were conducted usually adopting simple parametric and nonparametric tests. In this study, based on a set of statistical methods, we performed an advanced analysis of wound surface reduction using Lucilia sericata larvae in different clinical aspects: status of diabetes mellitus, maggots’ density, and pain intensity. Particularly, we employed these factors because, in our statistical analysis, they are easy to obtain and they proved to be the possible risk factors of wound regeneration. Furthermore, these factors represent different clinical, biological, and neurological spectra of knowledge. In our study, we have found further and statistically significant correlations between the analyzed variables and skin regeneration together with different time periods of the healing rate using maggot therapy in patients with lower limb ulceration.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2019-09-19T09:12:44Z
      DOI: 10.1177/1534734619876840
       
  • Combinatorial Drug Therapy for Controlling Pseudomonas aeruginosa and Its
           Association With Chronic Condition of Diabetic Foot Ulcer
    • Authors: Prakhar Srivastava, Karthikeyan Sivashanmugam
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Diabetic foot ulcer (DFU) is a major complication of diabetes mellitus, major observations of DFU cases have reported on amputation of foot region, and microbial bioburden during DFU is a major cause that affects healing of the wound regions. Pathogenic microbes are routinely isolated from these wound regions, especially Staphylococcus, Pseudomonas, Klebsiella, and Escherichia coli have been reported, whereas higher prevalence of Pseudomonas species during chronic condition in the deeper part of the wound, when left untreated, leads to gangrene. Multiple drug-resistant Pseudomonas strains are a new threat because of their biofilm-forming ability, making it more potent and incurable. Acyl homoserine lactones (AHL) are a group of signaling molecules that can regulate biofilm growth, and Las and Rhl operon generally work in tandem to initiate biofilm formation by Pseudomonas species. These signaling molecules also initiate virulence factors that correlates upregulation of inflammatory responses, and AHL can be a therapeutic target in order to prevent the efficacy of multiple drug-resistant strains that form biofilm and also can be an alternative solution against control of multiple drug-resistant strains.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2019-09-19T09:10:25Z
      DOI: 10.1177/1534734619873785
       
  • Therapeutic Effect of a Traditional Chinese Medicine on the Treatment of
           Painful Leg Ulcer
    • Authors: Xuya Lu, Qiang Xu, Pinchuan Li, Zhaohui Zhang
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      This study aimed to investigate the therapeutic effect of a traditional Chinese medicine on the treatment of painful leg ulcer. Twelve cases of painful leg ulcer were recruited and their characteristics (etiology, size, Visual Analog Scale score, and duration) were recorded. Then, an herbal medicine–oriented treatment protocol combining Zhi Tong Sheng Ji powder (ZTSJ) and SJXP (Sheng Ji Xiang Pi plaster) was applied to these patients. The results suggested that this therapeutic protocol contributed to pain relief and promoted wound healing simultaneously. Specifically, 2 days after applying ZTSJ on wounds, the intensity of pain reduced substantially, and the difference between pre- and post-treatment Visual Analog Scale scores (46 mm vs 23 mm, P < .001) was statistically significant. Epithelialization varied according to ulcer depth. If the wound was deep to the fascia, islands of epithelia did not form within wounds, but rather formed at the edge of wounds, generating island of epithelial cells (IECs) or newly formed epithelial tissue. If the wound was superficial and the dermis remained, scattered IECs appeared within ulcers and merged eventually. Furthermore, as wound pain decreased, IECs appeared, expanded, and merged, or epithelial proliferation and migration occurred in wound margin, eventually healing wounds. No infection spread, topical rashes, itching, or other allergies occurred in these 12 cases, and the time for recovery ranged from 16 to 163 days. ZTSJ is effective for the treatment of painful leg ulcers, but the specific mechanism is not clear.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2019-09-09T10:04:30Z
      DOI: 10.1177/1534734619873786
       
  • A Comparative Study of Chitosan Gel and Soframycin in the Management of
           Wounds
    • Authors: Kushagra Khanna, Deeksha Sharma, Roop Krishen Khar, Ritu Karwasra, Nitin Sharma, Dhruv Kumar Nishad, Aseem Bhatnagar, Harvinder Popli
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Wounds and related injuries remain a major cause of death and disability. Healing of wound is a complex, highly regulated process that includes cellular, molecular, biochemical, and physiological events that permit living organisms to repair accidental lesions. Therefore, dealing with wounds has always been a subject of concern to the world, and demand for products in wound management had increased to $9.3 trillion worldwide in the health care industry, affecting economic growth. The present work aimed to assess the wound healing effect of chitosan, and a comparative profile with soframycin is established in experimental animals. Enormous research reports, the wound healing properties of chitosan, but the protective mechanism implicated in wound healing activity of chitosan is unknown. In addition to this, we evaluated the anatomical, macroscopical, and histopathological alterations in wounds of experimental rats. Collagenase activity was performed to determine the granulation tissue formation and epithelialization of wounds treated with untainted chitosan. Wounds treated with glycerated chitosan gel, that is, GCG-3 (high degree of deacetylation), showed faster healing with highest percentage of contraction as compared with the soframycin-treated group. The healing of wounds was found to be 85% in GCG-3 on the sixth day of treatment, showing significant (P < .001) improvement in epithelial tissue. The collagenase activity in GCG-3 was 192 unit/mg of protein. Wound reepithelialization was found to be to 94 ± 4% in case of the GCG-3-treated group and 87 ± 5% in the soframycin-treated group. Higher degree of deacetylation in the chitosan, GCG-3, warrants its use in the treatment and management of dermal wounds.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2019-09-09T10:04:29Z
      DOI: 10.1177/1534734619870086
       
  • Ground-Level Falls at Skilled Nursing Facilities Are Associated With More
           Serious Lower Extremity Injuries Compared With Home
    • Authors: Bima J. Hasjim, Areg Grigorian, Catherine M. Kuza, Sebastian Schubl, Cristobal Barrios, Theresa L. Chin, Jeffry Nahmias
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Ground-level falls (GLFs) are the number one cause of injury and death in the older adult population. We compared injury profiles of GLFs at SNFs to those at homes, hypothesizing that GLFs at SNFs would lead to higher risks for serious (AIS ≥ 3) traumatic brain injury (TBI) and lower extremity (LE) injuries compared to GLFs at home. The 2015-2016 Trauma Quality Improvement Program was used to compare patients sustaining GLFs at home and SNFs. From 15,873 patients sustaining GLFs, 14,306 (90.1%) occurred at home while 1,567 (9.9%) at SNFs. More patients with GLFs at SNFs were female, older, and had greater incidence of congestive heart failure, end-stage renal disease, and dementia (p < 0.001) compared to those at home. Although, GLF SNF patients had lower injury severity scores (9 vs. 10, p < 0.001) and incidence for TBI (28.0% vs 33.4%, p < 0.001), they had a higher rate of femur fractures (55.1% vs. 38.9%, p < 0.001). After controlling for female, end stage renal disease, smoking, dementia, diabetes mellitus, chronic obstructive pulmonary disease, congestive heart failure, and stroke, patients falling at SNFs had an increased risk of sustaining serious LE injury AIS (OR 1.64, p < 0.001), but not serious TBI AIS (OR 0.89, p = 0.073). In conclusion, compared to GLFs at home, those at SNFs have a higher risk for serious LE injury, with femur fractures being the most common. However, GLFs at SNFs and homes had no significant difference in risk for serious TBI. Future studies are warranted to evaluate preventative measures to reduce LE injuries at SNFs.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2019-09-09T10:04:06Z
      DOI: 10.1177/1534734619870393
       
  • Periulcer Foam Sclerotherapy Injection in Chronic Venous Leg Ulcers Using
           Near-Infrared Laser for Vein Visualization
    • Authors: Adel Hussieny Kamhawy, Ahmed Husseiny Elbarbary, Mohamed Ahmed Elhenidy, Ahmed Mohamed Morsy Elwagih
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      High recurrence and high costs of treatment are the main problems with venous ulcer management. Therefore, it is of utmost importance to target the exact pathological cause. The role of cutaneous microvalves reflux in the pathogenesis of these ulcers has been confirmed. In this study, 20 chronic venous leg ulcers were prospectively subjected to foam sclerotherapy injection into periulcer veins using direct visualization by AccuVein AV400. Patients having infected ulcers, acute deep vein thrombosis, hypercoagulability, Ankle-Brachial Index
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2019-09-09T10:03:43Z
      DOI: 10.1177/1534734619870680
       
  • Changes in Skin Perfusion Pressure After Hyperbaric Oxygen Therapy
           Following Revascularization in Patients With Critical Limb Ischemia: A
           Preliminary Study
    • Authors: Hideharu Nakamura, Takaya Makiguchi, Daisuke Atomura, Yukie Yamatsu, Ken Shirabe, Satoshi Yokoo
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Hyperbaric oxygen (HBO) therapy promotes wound healing in patients with ischemic disease; however, HBO-induced changes in skin peripheral circulation have not been evaluated in clinical practice. Here, we investigated these changes in patients with critical limb ischemia (CLI), with a focus on the angiosome of crural blood vessels with blood flow improved by endovascular therapy (EVT). Six patients with CLI and ulcers who were treated with HBO after EVT (7 limbs; 1 patient had ulcers in the bilateral limbs) and 3 healthy subjects (6 limbs) were enrolled. HBO therapy was performed at 2 atm under 100% oxygen for 90 min per session. Skin perfusion pressure (SPP) was measured in the dorsum and sole of the foot 1 hour before (pre-SPP) and after (post-SPP) HBO therapy. ΔSPP was calculated as post-SPP minus pre-SPP. SPP measurement regions were divided into those that did (direct region) and did not (indirect region) correspond to the vascular angiosome in which angiography findings of the crus were improved after EVT; i.e., when the anterior tibial artery was effectively treated with EVT, the dorsum was the direct region and the sole was the indirect region, and vice versa when the posterior tibial artery was treated. In the direct, indirect, and healthy subject groups, the ΔSPPs were 20.5±8.7 (p=0.002), –6.4±10.9, and –15.1±18.1 (p=0.014), respectively; that of the direct group was significantly greater than that of the other groups. These results suggest that short-term improvement of the peripheral circulation by HBO therapy was significant in patients with successful revascularization.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2019-09-03T11:08:01Z
      DOI: 10.1177/1534734619868925
       
  • Topical Application of Teucrium polium Can Improve Wound Healing in
           Diabetic Rats
    • Authors: Hasan Fallah Huseini, Amir Hossein Abdolghaffari, Maryam Ahwazi, Eghbal Jasemi, Maryam Yaghoobi, Mojtaba Ziaee
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Diabetic foot ulcer is one of the major complications among diabetic patients. Several studies have shown that the extract of Teucrium polium (T. polium) is effective in the treatment of diabetic and non-diabetic wounds, as well as burn wounds. The aim of current study was to assess the wound healing activity of T. polium extract ointment in diabetic rats. Sixty-four male Wistar rats were induced diabetes with alloxan injection (125 mg/kg) and surgical wound induced. The rats were divided into 8 groups of eight rats each: control group, eucerin group, phenytoin group, 2%, 3%, 4%, 5% and 10% T. polium groups. The ointment was dressed on the wound twice a day. The process of wound healing was screened by macroscopy and digitalization on days 14 and 21 and until complete wound healing. There was no infection in the wounds of rats in any groups. The process of wounds healing of the 2%, 3%, 4%, 5%, and 10% T. polium ointments, with phenytoin ointment and base ointment (eucerin) on day 14 and 21, showed that the significant difference between the treatment groups with 4% (P = 0.003), 5% (P = 0.001), 10% (P = 0.001) T. polium ointment and phenytoin ointment group (P = 0.001) compared to eucerin group. The results of this study showed that T. polium extract ointment with a 10% ointment accelerates the wound healing process in diabetic rats and is comparable to the phenytoin group.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2019-09-03T11:06:41Z
      DOI: 10.1177/1534734619868629
       
  • Associations of Serum Lipids and Deep Venous Thrombosis Risk After Total
           Knee Arthroplasty in Patients With Primary Knee Osteoarthritis
    • Authors: Xiaoyu Dai, Wenge Ding, Huan Li, Peng Xu, Zhihui Huang, Wenjun Zhu, Jinbo Liu
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Deep venous thrombosis (DVT) of the lower extremities is a common complication after total knee arthroplasty (TKA). This study aimed to investigate the potential associations between serum lipids and the risk of DVT after TKA in patients with primary knee osteoarthritis (OA). A total of 431 patients who received TKA caused by primary knee OA were randomly enrolled. According to the results of the color Doppler ultrasound of bilateral lower extremities deep veins on the third day postoperatively, patients were divided into DVT and non-DVT groups. Comparisons of preoperative serum levels of triglycerides, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1, and apolipoprotein B were then performed by the Student’s t test, χ2 test, and multivariate logistic regression analysis. For females, DVT patients had a higher serum LDL-C level at baseline (P = .043) compared with non-DVT patients. A higher LDL-C value was significantly associated with an elevated DVT risk following TKA in female patients (P = .037). In female patients with primary knee OA, preoperative serum LDL-C level may have an association with DVT risk after TKA. The relatively small male sample size may limit the accuracy of the findings.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2019-08-14T07:24:56Z
      DOI: 10.1177/1534734619868123
       
  • Limb Salvage Using Combined Linking Perforator Free Flaps
    • Authors: Youn Hwan Kim, Gyeong Hoe Kim, Georgios Pafitanis, Rob Miller, Sang Wha Kim
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Microsurgical free tissue transfer is the most effective method for extensive reconstruction of lower limb defects. The purpose of this report is to describe our experience of using microsurgically fabricated combined linking perforator flaps for one-stage reconstruction of extensive lower limb defects. Between April 2008 and November 2016, 16 cases of extensive lower defects were reconstructed using combined linking flaps. Of the patients, 10 were males, and the mean age was 45.3 years (range = 20-76 years). The flaps used were thoracodorsal artery perforator flaps together with deep inferior epigastric artery perforator flaps or anterolateral thigh flaps. There were no total flap failures; however, 3 anterolateral thigh flaps were partially lost and required skin grafts. One wound disruption healed conservatively. Donor site healing was achieved primarily without any dehiscence. The follow-up period was 15.4 months (range = 8-24 months). The use of combined linking perforator flaps for lower limb defects is uncommon; however, in cases of extensive limb defects these flaps can salvage limbs by means of one-stage operations.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2019-07-17T09:23:50Z
      DOI: 10.1177/1534734619864240
       
  • Effective Salvage Surgery of a Severely Congested Propeller Perforator
           Flap Using a Postoperative Delay Technique and Negative-Pressure Wound
           Therapy
    • Authors: Naohiro Ishii, Tomoki Kiuchi, Takahiro Uno, Yuichiro Uoya, Kazuo Kishi
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Wound edge–based propeller perforator flaps have often been applied to soft tissue reconstruction of sacral pressure sores. Although this flap often causes necrosis due to overtension and twisting of the perforators, salvage surgery using a postoperative delay technique has not been reported thus far. In this article, we present a case in which we successfully reconstructed a sacral pressure sore using a wound edge–based propeller perforator flap. The flap caused severe congestion, which had a concern due to the potential wide-ranging flap loss; it was subsequently salvaged by an emergent delay procedure and negative-pressure wound therapy on day 2 postoperatively.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2019-07-15T11:02:54Z
      DOI: 10.1177/1534734619863513
       
  • Pitfalls and Misconducts in Medical Writing
    • Authors: Miltos K. Lazarides, Evangelia Gougoudi, Nikolaos Papanas
      First page: 350
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      The objective of medical research is the quest for scientific truth, as well as the communication of new knowledge to the medical society through publication of novel results. Journals publishing these results rely on the trust that all persons involved (authors, peer reviewers, editors, and publishers) remain honest, following the rules and ethics of scientific integrity. Unfortunately, this is not always the case and a wide spectrum of pitfalls and misconducts may occur, ranging from less serious violations of ethical rules to most serious ones. In ascending order of severity, these include borderline questionable practices (HARKing [Hypothesizing After the Results are Known] and hyping), redundant publications, authorship misconducts, plagiarism, and all types of fraud (data falsification or fabrication). Awareness of all these fraudulent practices is essential to mitigate misconduct in academic writing.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2019-08-29T11:30:12Z
      DOI: 10.1177/1534734619870083
       
  • Diabetic Foot Ulcer as a Cause of Significant Decline in the Renal
           Function Among South Indian Population With Type 2 Diabetes: Role of
           TGF-β1 and CCN Family Proteins
    • Authors: T. P. Smina, M. Rabeka, Vijay Viswanathan
      First page: 354
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      In the present study, a total of 428 South Indian subjects were divided into four different groups, consisting of individuals with type 2 diabetes without any other complications (T2DM), T2DM subjects with stage 2 and 3 diabetic kidney disease (CKD), T2DM subjects with grade 2 or 3 diabetic foot ulcer (DFU) and T2DM subjects having both diabetic kidney disease and diabetic foot ulcer (CKDDFU). The study was conducted ambispectively by comparing the changes in renal function among two consecutive periods, i.e., the period prior to the development of grade 2 and 3 diabetic foot ulcer (retrospectively) and after the development of DFU (prospectively). A gradual and uniform reduction of eGFR was observed throughout the study period in the subjects affected with either CKD or DFU alone. Whereas in subjects with both CKD and DFU, there was a sharp decline in the eGFR during the six months prior to the baseline, i.e., the period in which the development of ulcer and its progression to grade 2 or 3 happened. Remarkable elevations in the levels of TGF-β1 and CCN2 (CTGF), as well as a significant reduction in the level of CCN3 (NOV), were observed in the serum of CKDDFU group subjects, compared to the other groups. Increased production of TGF-β1 in response to the inflammatory stimulus from multiple sites in CKDDFU subjects caused a subsequent down-regulation of CCN3, followed by the activation of a large quantity of CCN2.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2019-07-15T11:00:33Z
      DOI: 10.1177/1534734619862704
       
  • Influence of Patient Setting and Dedicated Limb Salvage Efforts on
           Outcomes in Charcot-Related Foot Ulcer
    • Authors: Brian M. Schmidt, Crystal M. Holmes
      First page: 362
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Charcot neuroarthropathy is a devastating consequence of diabetes mellitus and peripheral neuropathy. Because of its rarity, the condition is often misdiagnosed or poorly managed. When misadventure occurs, patients with Charcot neuroarthropathy can suffer ulceration, infection, amputation, and death. When patients have Charcot-related foot ulcers, the risks are amplified. Utilizing advanced electronic medical record analysis, a 30-month investigation was undertaken to determine if patients with diabetes mellitus and a concomitant diagnosis of Charcot-related foot ulcer were at greater risk of complications because of location setting of initial treatment for their condition. Charcot foot–related ulcers that are diagnosed in the outpatient setting had established foot specialist care. The outpatient management of the condition lead to a significant reduction in the amount of admissions to a higher acuity setting. However, patient outcomes did not vary once established and dedicated limb salvage efforts were employed. In this large contemporary population managed in a tertiary health system, patients with Charcot-related foot ulcer had negative outcomes when they were initially treated in an inpatient setting and had a significantly greater likelihood of readmission as compared with individuals who had established focused limb salvage care.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2019-07-15T10:58:13Z
      DOI: 10.1177/1534734619861571
       
  • Principles of STAGE Management for Diabetic Foot Ulcers Based on the
           Wagner and Texas Classification Systems
    • Authors: Chaojun Zhu, Bing Zhou, Jiakang Lü, Ping Yue, Xianzhou Liu, Lei Huo, Yue Shi, Tingting Liu, Zhaohui Zhang
      First page: 367
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      The current Wagner and Texas classifications of diabetic foot ulcers (DFUs) are used worldwide to assess the extent of foot lesions, but wound treatment principles based on both the classification systems are lacking. We have summarized the STAGE principles of wound treatment for clinical practice based on the Wagner and Texas classification systems. The STAGE principles refer to the principles of surgical intervention during wound treatment of DFUs and emphasize that “based on anatomical layers, the management focuses on blood supply and includes layer-by-layer incision to the infected area, maintenance of effective wound drainage, and step-by-step treatment of the wound.” During treatment, microcirculation improvement and microvascular angiogenesis (A) are essential for granulation tissue formation in the bone (skeleton, S) and tendons (T) and healing of the wound with reepithelialization (E). We defined the above mentioned steps as the STAGE principles, namely, layer-by-layer incision and step-by-step management (Phase A is essential for the treatments in Phases S-T and G-E). Ulcers or gangrene formed during Phases S-T or T should be treated according to the STAGE or TAGE principles, respectively. Similar treatment principles are applied in the other phases. However, treatments at each phase are not isolated and can be performed simultaneously. The STAGE principle can be combined with the tissue, infection, moisture, and wound edge (TIME) and TIME-H chronic wound treatment principles to eliminate the shortcomings of a single principle in wound management.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2019-07-17T09:20:11Z
      DOI: 10.1177/1534734619863914
       
  • Perforator Flap Reconstruction for the Distal Third of Lower Extremity
           Defects: Clinical Application and Guideline Recommendation
    • Authors: Chairat Burusapat
      First page: 376
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      A distal third of lower extremity defect is challenging for plastic surgeons. The standard for treatment is microsurgery. Recently, perforator flap has been reported for small to medium defects. The objective was to analyze the outcomes of perforator flaps for distal third of lower extremity defects and to establish surgical guidelines. A retrospective review of patients with defects in distal third of lower extremities was conducted. Patients with multiple levels of lower extremity defects were excluded. A total of 8 patients with distal third of lower extremity defects were included. Seven patients were male. Overall mean age was 35.3 (18-60) years. Patients had 3 anterior, 3 lateral, and 2 medial defects. Lateral and anterior defects in 6 patients were closed using a peroneal-based propeller perforator flap with an angle of rotation of 90° to 160°. Medial defects in 2 patients were closed using a posterior tibial-based perforator advancement flap. Three patients (37.5%) developed venous congestion. No complications occurred for patients with medial defect closure using an advancement posterior tibial-based perforator flap. No total flap loss was observed. The perforator flap provides a similar texture to the skin at recipient area and a wide range of rotation. Perforator flaps should be the first choice for defects reconstruction in distal third lower extremities. Perforator flaps can be used for small to large defects, and can be moved by propeller or advancement depending on the perforator location. A guideline for perforator flaps reconstruction of the distal third of lower extremity defects was established.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2019-07-15T10:56:27Z
      DOI: 10.1177/1534734619861018
       
  • A Rare Case of Recurrent Lower Extremity Ulcer
    • Authors: Wei Zhu, Huapei Song
      First page: 389
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Venous leg ulcers are a manifestation of lower extremity chronic venous disorder. Venous hypertension caused by abnormal venous blood flow is considered to be the primary mechanism of venous ulcers. The etiology of lower extremity venous ulcer is complicated, and it is difficult to be treated. At present, it has achieved a certain effect for venous leg ulcers through the combination of drugs, pressure therapy, and surgical treatment. Budd-Chiari syndrome is a rare syndrome characterized by portal hypertension and/or inferior vena cava syndrome. Treatment of Budd-Chiari syndrome includes anticoagulation, thrombolysis, angioplasty, stenting, transjugular intrahepatic portosystemic shunt, and liver transplantation. This article reports an elderly female patient with recurrent ulceration of both lower extremities that healed poorly after long-term dressing and skin grafting. During further examination, she was found to have Budd-Chiari syndrome. Through multidisciplinary treatment, which includes removing the inferior vena cava stenosis and implanting the ulcer wound, the ulcer wounds then healed.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2019-08-29T11:31:51Z
      DOI: 10.1177/1534734619870098
       
 
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