Subjects -> EDUCATION (Total: 2539 journals)
    - ADULT EDUCATION (24 journals)
    - COLLEGE AND ALUMNI (10 journals)
    - E-LEARNING (37 journals)
    - EDUCATION (2178 journals)
    - HIGHER EDUCATION (155 journals)
    - INTERNATIONAL EDUCATION PROGRAMS (4 journals)
    - ONLINE EDUCATION (41 journals)
    - SCHOOL ORGANIZATION (14 journals)
    - SPECIAL EDUCATION AND REHABILITATION (40 journals)
    - TEACHING METHODS AND CURRICULUM (36 journals)

EDUCATION (2178 journals)            First | 1 2 3 4 5 6 7 8     

Showing 801 - 857 of 857 Journals sorted alphabetically
İnönü Üniversitesi Eğitim Fakültesi Dergisi     Open Access  
İnönü University Journal of the Graduate School of Education     Open Access  
INOPENDAS : Jurnal Ilmiah Kependidikan     Open Access   (Followers: 2)
Inspiramatika     Open Access  
Instructional Science     Hybrid Journal   (Followers: 14)
Integral Transforms and Special Functions     Hybrid Journal  
Interacções     Open Access  
InterActions: UCLA Journal of Education and Information     Open Access   (Followers: 16)
Interchange     Hybrid Journal   (Followers: 1)
Intercultural Education     Hybrid Journal   (Followers: 10)
Interdisciplinaridade. Revista do Grupo de Estudos e Pesquisa em Interdisciplinaridade     Open Access  
Interdisciplinary Journal of e-Skills and Lifelong Learning     Open Access   (Followers: 4)
Interdisciplinary Journal of Information, Knowledge, and Management     Open Access   (Followers: 12)
Interdisciplinary Journal of Problem-based Learning     Open Access   (Followers: 4)
Interdisciplinary Research in Education     Open Access   (Followers: 1)
Interdyscyplinarne Konteksty Pedagogiki Specjalnej     Open Access  
Interespe. Interdisciplinaridade e Espiritualidade na Educação     Open Access  
Interface - Comunicação, Saúde, Educação     Open Access   (Followers: 1)
Interfaces : Revista de Extensão da UFMG     Open Access  
Interfaces da Educação     Open Access  
International Developments     Open Access   (Followers: 3)
International e-Journal of Educational Studies     Open Access  
International Education     Open Access   (Followers: 10)
International Education Research     Open Access   (Followers: 8)
International Education Studies     Open Access   (Followers: 10)
International Educational Research     Open Access  
International Electronic Journal of Environmental Education     Open Access   (Followers: 1)
International Journal for 21st Century Education     Open Access  
International Journal for Educational and Vocational Guidance     Hybrid Journal   (Followers: 9)
International Journal for Educational Integrity     Open Access   (Followers: 3)
International Journal for Research in Vocational Education and Training     Open Access   (Followers: 8)
International Journal for Talent Development     Open Access  
International Journal for the Scholarship of Teaching and Learning     Open Access   (Followers: 9)
International Journal of Academic Research in Education     Open Access   (Followers: 1)
International Journal of Accounting     Hybrid Journal   (Followers: 1)
International Journal of Active Learning     Open Access  
International Journal of Advanced Multidisciplinary Research and Review     Open Access  
International Journal of Advancement in Education and Social Sciences     Open Access   (Followers: 1)
International Journal of Aquatic Research and Education     Hybrid Journal  
International Journal of Art & Design Education     Hybrid Journal   (Followers: 26)
International Journal of Assessment Tools in Education     Open Access   (Followers: 7)
International Journal of Bilingual Education and Bilingualism     Hybrid Journal   (Followers: 19)
International Journal of Bullying Prevention     Hybrid Journal  
International Journal of Child Care and Education Policy     Open Access   (Followers: 3)
International Journal of Chinese Education     Hybrid Journal   (Followers: 1)
International Journal of Christianity & Education     Full-text available via subscription   (Followers: 5)
International Journal of Cognitive Research in Science, Engineering and Education     Open Access   (Followers: 7)
International Journal of Community Service Learning     Open Access   (Followers: 1)
International Journal of Construction Education and Research     Hybrid Journal   (Followers: 3)
International Journal of Contemporary Educational Research     Open Access   (Followers: 1)
International Journal of Continuing Engineering Education and Life-Long Learning     Hybrid Journal   (Followers: 5)
International Journal of Critical Pedagogy     Open Access   (Followers: 3)
International Journal of Curriculum and Instruction (IJCI)     Open Access   (Followers: 5)
International Journal of Cyber Ethics in Education     Full-text available via subscription   (Followers: 4)
International Journal of Designs for Learning     Open Access   (Followers: 6)
International Journal of Development Education and Global Learning     Open Access   (Followers: 6)
International Journal of Disability, Development and Education     Hybrid Journal   (Followers: 35)
International Journal of Distance Education and E-Learning     Open Access   (Followers: 3)
International Journal of Distance Education Technologies     Full-text available via subscription   (Followers: 7)
International Journal of Early Childhood     Hybrid Journal   (Followers: 14)
International Journal of Early Years Education     Hybrid Journal   (Followers: 11)
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: 7)
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: 7)
International Journal of Educational and Psychological Researches     Open Access   (Followers: 4)
International Journal of Educational Development     Hybrid Journal   (Followers: 17)
International Journal of Educational Methodology     Open Access  
International Journal of Educational Psychology     Open Access   (Followers: 17)
International Journal of Educational Research     Hybrid Journal   (Followers: 29)
International Journal of Educational Technology     Open Access   (Followers: 4)
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: 12)
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 Holistic Early Learning and Development     Open Access   (Followers: 2)
International Journal of Inclusive Education     Hybrid Journal   (Followers: 25)
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 Education     Open Access   (Followers: 1)
International Journal of Language Teaching and Education     Open Access   (Followers: 1)
International Journal of Leadership in Education: Theory and Practice     Hybrid Journal   (Followers: 24)
International Journal of Learning Analytics and Artificial Intelligence for Education (iJAI)     Open Access   (Followers: 4)
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 Nursing Student Scholarship     Open Access   (Followers: 2)
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 Practice-based Learning in Health and Social Care     Open Access   (Followers: 2)
International Journal of Public Legal Education     Open Access   (Followers: 1)
International Journal of Qualitative Studies in Education     Hybrid Journal   (Followers: 39)
International Journal of Quantitative Research in Education     Hybrid Journal   (Followers: 5)
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: 20)
International Journal of Research in Education Methodology     Open Access   (Followers: 12)
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   (Followers: 1)
International Journal of School Social Work     Open Access   (Followers: 3)
International Journal of Science and Mathematics Education     Hybrid Journal   (Followers: 25)
International Journal of Science and Technology Education Research     Open Access   (Followers: 10)
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: 9)
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: 4)
International Journal of Technology Enhanced Learning     Hybrid Journal   (Followers: 21)
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 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: 7)
International Review of Qualitative Research     Full-text available via subscription   (Followers: 33)
International Review of Research in Open and Distance Learning     Open Access   (Followers: 26)
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  
Investigating the Child’s World     Open Access   (Followers: 2)
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)
Iseedu : Journal of Islamic Educational Thoughts and Practices     Open Access   (Followers: 2)
Islamic Counseling : Jurnal Bimbingan Konseling Islam     Open Access   (Followers: 1)
Issues and Trends in Educational Technology     Open Access  
Issues in Informing Science and Information Technology     Open Access   (Followers: 2)
Issues in Language Instruction     Open Access   (Followers: 2)
Istanbul Journal of Innovation in Education     Open Access  
Istawa : Journal of Islamic Education     Open Access  
Italiano a scuola     Open Access   (Followers: 1)
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: 4)
JALIE : Journal of Applied Linguistics and Islamic Education     Open Access   (Followers: 1)
JAMP : Jurnal Administrasi dan Manajemen Pendidikan     Open Access   (Followers: 1)
JEKPEND : Jurnal Ekonomi dan Pendidikan     Open Access   (Followers: 2)
Jendela Olahraga     Open Access  
JET (Journal of English Teaching)     Open Access  
JIKAP PGSD : Jurnal Ilmiah Ilmu Kependidikan     Open Access   (Followers: 2)
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)

  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  [1089 journals]
  • The Summer Issue: We Shall Overcome
    • Authors: Nikolaos Papanas, Massimo Papi, Kittipan Rerkasem
      Pages: 109 - 110
      Abstract: The International Journal of Lower Extremity Wounds, Volume 19, Issue 2, Page 109-110, June 2020.

      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-06-20T05:39:52Z
      DOI: 10.1177/1534734620927675
      Issue No: Vol. 19, No. 2 (2020)
       
  • Bacterial Profile, Antimicrobial Susceptibility Pattern, and Associated
           Risk Factors Among Patients With Wound Infections at Debre Markos Referral
           Hospital, Northwest, Ethiopia
    • Authors: Masresha Shimekaw, Abiye Tigabu, Belay Tessema
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Wound infections are associated with morbidity and mortality in developing countries. Thus, this study aimed to assess bacterial profile, antimicrobial susceptibility pattern and risk factors among wound infection suspected patients. A hospital-based cross-sectional study was conducted on 201 participants at Debre Markos referral hospital from January to May 2019. Sociodemographic data were collected using pre-designed questionnaire and swabs from different types of wounds were collected, and inoculated onto mannitol salt agar, blood and MacConkey agar plate for isolation and identification. Antimicrobial susceptibility tests were done using modified Kirby-Bauer disk diffusion technique. Out of 201 swabs analyzed, 72.6% were culture positive and 10.9% of them had co-infections, and 162 bacterial isolates obtained from 146 swab samples. Staphylococcus aureus was the most frequently isolated which accounted for 32.1% of isolates followed by Pseudomonas aeruginosa, 15.4%. The susceptibility patterns of ciprofloxacin, gentamycin and ceftriaxone were 77.8%, 69.1%, and 68.5%, respectively. The MDR rate of gram positive and gram negative isolates were 69.7% and 82.3%, respectively. Anatomically located wounds near a site of potential contamination, inadequate management of moisture, exudate or edema, mechanism of wound production, presence of predisposing condition and being urban in residence significantly associated with wound infections. S. aureus and P. aeruginosa were the predominant causes of wound infections. Ciprofloxacin, gentamycin and ceftriaxone were the most effective antimicrobials. Periodic surveillance of isolates involved in wound infection and their antimicrobial susceptibility is recommended for effective management of patients.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-06-29T04:21:41Z
      DOI: 10.1177/1534734620933731
       
  • An Application of a Negative-Pressure Wound Dressing for Partial- or
           Full-Thickness Burn Wounds
    • Authors: Yulong Cheng, Zengding Zhou, Huan Hu, Wenbo Li, Yi Liu, Zihuan Xia, Chenliang Deng, Guangyu Mao, Lei Yi, Xiangdong Liu, Songlin Yang, Jianghong Zheng, Feng Guo
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Negative-pressure wound therapy is widely used in burn populations. Traditionally, negative-pressure devices use persistent vacuum suction, requiring a longer hospital stay. In this study, we applied a novel negative-pressure wound dressing for burn wounds, which eliminates the hospital stay. The medical records of 39 patients with partial-/full-thickness burns treated by negative-pressure wound dressing were retrospectively analyzed. The average burn area, burn degree, healing duration, cost, and incidents during treatment were determined and compared with previous data for conventional therapies. In conclusion, for patients diagnosed with partial-thickness or full-thickness burns and a burn area
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-06-29T04:20:02Z
      DOI: 10.1177/1534734620933439
       
  • Curcumin Nanoparticles Improved Diabetic Wounds Infected With
           Methicillin-Resistant Staphylococcus aureus Sensitized With HAMLET
    • Authors: Saeed Taghavifar, Fatemeh Afroughi, Maryam Saadati Keyvan
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Accurately orchestrated course of events normally observed in healing are not followed in diabetic wounds, and bacterial colonization/infection further messes up the process. Novel therapeutic options for treatment of infections caused by multidrug-resistant Staphylococcus aureus are urgently needed. HAMLET (human α-lactalbumin made lethal to tumor cells) has been reported to be able to sensitize bacterial pathogens to traditional antimicrobial agents. The aim was to assess the wound healing activity of curcumin nanoparticles in diabetic wounds infected with methicillin-resistant Staphylococcus aureus (MRSA) sensitized with HAMLET. Fifty male rats were randomized into 5 groups of 10 animals each. In CONTROL group, 0.1-mL sterile saline 0.9% solution was added to the wounds with no infection. In MRSA group, the wounds were infected with MRSA and only treated with 0.1-mL sterile saline 0.9% solution. In MRSA/HAMLET group, infected wounds were treated with HAMLET (100 µg). In MRSA/CNP group, animals with infected wounds were treated with 0.1 mL topical application of 1 mg/mL curcumin nanoparticles. In MRSA/CNP/HAMLET group, animals with infected wounds were treated with topical application of 0.1 mL solution of curcumin nanoparticles (1 mg/mL) and HAMLET (100 µg). All test formulations were applied for 10 days, twice a day, starting from first treatment. Microbiological examination; planimetric, biochemical, histological, and quantitative morphometric studies; immunohistochemical staining for angiogenesis; determination of hydroxyproline levels; and reverse transcription polymerase chain reaction for caspase 3, Bcl-2, and p53 showed that there was significant difference between animals in MRSA/CNP/HAMLET group compared with other groups (P < .05). Curcumin nanoparticles improved diabetic wounds infected with MRSA sensitized with HAMLET and had the potential to offer more attention to this safer agent for topical use in infected diabetic wounds.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-06-29T04:18:02Z
      DOI: 10.1177/1534734620933079
       
  • Limb Salvage in Patients With Severe Critical Limb Ischemia (CLI) After
           Referral for a Second Opinion to a Dedicated CLI Center
    • Authors: Theodosios Bisdas, Nikolaos Patelis, Georgia Argyrakopoulou, Dimitrios Tsiachris, Aristotelis Kurtis, Panagiotis Gargalianos-Kakoliris, Christodoulos Stefanadis
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      The complexity of critical limb ischemia (CLI) requires dedicated multidisciplinary teams of different care providers, who will supervise the full cycle of CLI care. Until CLI treatment is fully centralized, such dedicated teams may work as second-opinion tools before major amputation is undertaken in CLI patients. The aim of the study is to assess the effectiveness of a well-timed referral to a dedicated CLI-center of patients scheduled to major amputation elsewhere. A retrospective analysis of all CLI-patients treated in our department between January 2019 and March 2020 was conducted. Only patients scheduled for a major amputation elsewhere and referred to our clinic were included. Primary endpoint was amputation-free survival, whereas technical success, limb salvage, minor amputation rate, re-admission at 30 days, and frequency of medication change from other disciplines were the secondary endpoints. Sixteen patients with 19 treated limbs were identified and included in this analysis. The WIfI (wound, infection and foot ischemia) clinical stage on admission was 2 in 4 limbs (21%), 3 in 5 limbs (26%), and 4 in 10 limbs (53%). All patients underwent advanced endovascular revascularization. Minor amputation was performed in 8 patients (42%). Amputation-free survival at 6 months was 93% with limb salvage rate of 100%. Technical success and re-admission rates at 30 days was 95% and 6%, respectively. There was a medication adjustment from other specialties in 13 (81%) patients. Patients in severe stages of CLI scheduled to major amputation reached high limb salvage and survival rate, since they are referred for a second opinion to a dedicated multidisciplinary CLI team.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-06-29T04:13:02Z
      DOI: 10.1177/1534734620933069
       
  • A Comparison Between Diabetic Foot Classifications WIfI, Saint Elian, and
           Texas: Description of Wounds and Clinical Outcomes
    • Authors: Gabriela Verónica Carro, Ruben Saurral, Elsa Carlucci, Fernando Gette, María de los Ángeles Llanos, Pablo Salvador Amato
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Several wound classification systems are used to assess diabetic foot wounds. The recommendations for their use depend on the authors and foot associations. In this study, we compared Saint Elian score system, WIfI classification and Texas in 101 patients with foot wounds, and we followed them for a median of 149 days, finding differences both in the assigned risk and in the association with major amputation and wound healing. Saint Elian and WIfI scores match when Saint Elian is low or high risk but not when it is moderate. WIfI stages correlate with major amputation and wound healing. Saint Elian III correlates with major amputation. Prevalence of major amputations was 41% for WIfI 4 and 83% for Saint Elian III. WIfI 1 and 2 and Saint Elian I had a rate of wound healing of 80% to 85%. Stages 1 and 2 of WIfI score behave similar with regard to wound healing, 82% and 80% (P = .71), and major amputation, 0% and 10% (P = .68). Stages I and II of Saint Elian have the same rates of major amputation, 0% and 8% (P = .66), but not of wound healing, 85% and 51% (P < .05). The optimal cut point for detecting major amputation in Saint Elian is 18, with a sensitivity of 90.9 and specificity of 84.9, but there is no recommended cut point for wound healing. These classifications are validated for their use in diabetic foot wounds and to assess amputation risk, helping physicians make decisions and talk to the patients about prognosis.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-06-29T04:08:46Z
      DOI: 10.1177/1534734620930171
       
  • Early Advanced Therapy for Diabetic Foot Ulcers in High Amputation Risk
           Veterans: A Cohort Study
    • Authors: Margaret Doucette, Kattie M. Payne, Walter Lough, Alison Beck, Kristi Wayment, John Huffman, Laura Bond, Aurora Thomas-Vogel, Susan Langley
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Veterans with diabetic foot ulcers (DFUs) represent the highest percentage of lower extremity amputations (LEAs) within the Veterans Affairs (VA) population. Many veterans have additional risk factors for amputation. Few studies focus on advanced therapies for this population. This study explores the impact of early application of dehydrated human amniotic membrane allograft (DAMA) with comprehensive care on preventing amputation. This prospective, single-center cohort study (ClinicalTrials.gov Identifier NCT02632929) was conducted through Boise VA Medical Center. Patients with DFUs were objectively stratified for LEA risk. Those with moderate to high amputation risk could participate. Participants received comprehensive care and weekly application of DAMA. Primary endpoint was avoidance of major LEA. Secondary endpoint was wound epithelialization. Monitoring continued 4 months. Between July 2015 and March 2017, 20 patients (mean age 67.2 years) with 24 DFU classified as moderate (12 wounds) to high risk (12 wounds) for amputation were enrolled. Wound volumes ranged from 0.072 cm3 to 56.4 cm3. Risk factors included neuropathy (20 patients), osteomyelitis (16 wounds), exposed tendon/ligament/bone (19 wounds), Charcot (5 patients), and peripheral arterial disease (13 wounds). All subjects avoided amputation within the study period, all 24 wounds achieved re-epithelialization within 4 to 33 weeks; mean healing time 13.2 weeks. Cost for the DAMA tissue ranged from $750 to $38 150. Estimated cost for LEA ranges from $30 000 to $50 000. No treatment-related adverse events during the study period were reported. The results suggest that early and frequent application of DAMA with comprehensive care may help prevent amputation. Additional research will help inform third-party payors and clinicians.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-06-22T10:56:34Z
      DOI: 10.1177/1534734620928151
       
  • Mini Invasive Floating Metatarsal Osteotomy for Diabetic Foot Ulcers Under
           the First Metatarsal Head: A Case Series
    • Authors: Eran Tamir, Yossi Smorgick, Guy Zvi Ron, Ron Gilat, Gabriel Agar, Aharon S. Finestone
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Diabetic foot ulcers under the first metatarsal head are difficult to treat and prevent recurrence. The aim of this study is to summarize the results of a distal first metatarsal minimally invasive floating osteotomy for ulcers under the first metatarsal head in patients with diabetic neuropathy. We reviewed files of patients with diabetic neuropathy undergoing a floating first metatarsal osteotomy. Demographic and clinical data were collected and analyzed to determine success and complications. We found records for 21 patients (mean age 64) with University of Texas 1A ulcers. The ulcer’s mean age was 11.2 months. Following surgery, the ulcer completely resolved after a mean of 3.7 (2 to 11) weeks in 19 patients. During the first year, there were 4 complications related to the surgery (including 3 infections). At latest follow-up, 17/21 (81%) patients had healed with satisfactory results. Minimal invasive floating distal osteotomy of the first metatarsal can cure and prevent recurrence of diabetic foot ulcers under the first metatarsal head in 80% of the patients, but the ability to provide close follow-up and prompt response are prerequisites.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-06-19T08:30:47Z
      DOI: 10.1177/1534734620934579
       
  • Impact of Diabetes Foot Care Education on Amputation Rate in the
           University of Abuja Teaching Hospital, Nigeria
    • Authors: Felicia O. Anumah, Rifkatu Mshelia-Reng, Odiase S. Omonua, Jamda Mustapha, Ramatu A. Shuaibu, Kenechukwu C. Odumodu
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Ulceration of the foot is a major problem for people with diabetes. In a developing country like Nigeria, huge challenge is caused by diabetes foot problems. The aim of this study was to determine the impact of diabetic foot care education of patients and health care staff on the outcome of diabetic foot complications in our hospital. This was a pre and post design carried out from April 2013 to March 2014 on 155 diabetes patients. Patient education was carried out by diabetes nurses and doctors, at diagnosis and re-enforced at follow-up clinics. At the end of 1 year, the impact of education was assessed. Descriptive statistics were generated as appropriate. A total of 155 patients, 64 (41%) males and 91 (59%) females, were studied with mean age of 49 ± 3 years and mean duration of diabetes 6 ± 2.6 years. At the onset of the program, 70% of the patients had no knowledge of foot care education. Only 13.5% knew that diabetes mellitus foot ulcer could be related to long duration of diabetes, nerve damage, blood vessel blockage, foot deformity, and uncontrolled blood glucose. Ninety-two percent of the patients preferred home remedies, herbal treatment, or chemist in the event of an ulcer. After the program, 77% would seek hospital care as first option, and amputation rate decreased from 50% in 2009 to 10% by 2017. Our experience has shown that education is the cheaper option for the prevention of lower limb amputation in a resource-poor setting like ours.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-06-19T08:22:46Z
      DOI: 10.1177/1534734620934578
       
  • Photodynamic Topical Antimicrobial Therapy for Infected Diabetic Foot
           Ulcers in Patients With Diabetes: A Case Series
    • Authors: Enrico Brocco, Vincenzo Curci, Roberto Da Ros, Cesare Miranda, Giovanni Boschetti, Sara Barone, Anna Tedeschi, Elisabetta Salutini, Roberto Anichini
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Diabetic foot ulcers (DFUs) are common, complex, costly complications, associated with frequent recurrences and increased morbidity and mortality. DFUs can be prevented and their healing can be mostly influenced by appropriately and aggressively managing any infection, but the role of antiseptic therapies in reducing healing time lacks sufficient evidence. Several therapeutic interventions have been developed based on the principles of photomedicine to overcome the issue of poor drug circulation in infected areas, with the aim of killing microbial agents while leaving the surrounding host cells unharmed. Such techniques use absorption of photons by specific chromophores. Among these, RLP068 is a tetracationic Zn(II) phthalocyanine derivative activated by exposure to red light, used as a topical treatment for superficial bacterial and fungal infections. The photoactivation of RLP068 results in the production of singlet oxygen and other reactive oxygen species, able to affect a range of cellular targets, including cell membrane and/or wall, cytoplasm, and cellular components, resulting in a rapid, broad range, bactericidal and fungicidal effect. The phase IIa study showed that photoactivated RPL068 is capable of inducing a dose-dependent reduction in total and pathogen microbial load in infected diabetic foot ulcers. In this article, a case series of 22 DFU treated with photoactivated RLP068 at 5 different centers in Italy is presented. Considering microbial agents reduction, ulcer healing facilitation, healing rate (9 DFUs out of 22), and amputation rate (only 1 case over 22), the decrease in the cost of DFU seems to be a point in favor of RLP068 and its cost-effectiveness.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-06-19T08:07:30Z
      DOI: 10.1177/1534734620929889
       
  • Erythrocyte Sedimentation Rate Combined With the Probe-to-Bone Test for
           Fast and Early Diagnosis of Diabetic Foot Osteomyelitis
    • Authors: Jun Xu, Fang Cheng, Yanming Li, Jinghang Zhang, Shuhong Feng, Penghua Wang
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      This study aimed to investigate the erythrocyte sedimentation rate (ESR) optimal cutoff point in Chinese patients with diabetic foot osteomyelitis (DFO) and to evaluate the screening value of ESR combined with probe-to-bone (PTB) test for a fast diagnosis of DFO in early stage. A total of 204 diabetic inpatients with foot infection were tested for white blood cell count, neutrophil %, C reactive protein, and ESR at admission within 24 hours. All patients were performed PTB test. Patients with DFO (111) were confirmed by bone biopsy, the other patients (86) had only soft tissue infection. Although white blood cell count, neutrophil %, C-reactive protein, and ESR were different between the 2 groups, only area under curve of ESR was 0.832, with the value as a diagnostic indicator. The best cut point of ESR was>43 mm/h; the sensitivity, specificity, positive predictive value (+PV), and negative predictive value (−PV) were 82.9%, 70.5%, 0.78, and 0.77, respectively. ESR combined with PTB test (serial test), the sensitivity, specificity, +PV, −PV, positive likelihood ratio (+LR), and negative LR (−LR) were 63.56%, 98%, 0.97, 0.67, 31.75, and 0.37, respectively. ESR combined with PTB test (parallel test), the sensitivity, specificity, +PV, −PV, +LR, and −LR were 96%, 65.7%, 0.78, 093, 2.8, and 0.06, respectively, combined with PTB test is simple, favorable for application, and can early fast screening patients with DFO in high-risk patients.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-06-15T10:41:46Z
      DOI: 10.1177/1534734620923278
       
  • Effect of Family Empowerment on HbA1c Levels and Healing of Diabetic Foot
           Ulcers
    • Authors: Rasnah Appil, Elly Lilianty Sjattar, Saldy Yusuf, Kasmawati Kadir
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Objective. To evaluate the effectiveness of family empowerment through educational interventions against HbA1c level and healing progress of diabetic foot ulcers. Method. A quasi-experimental design was employed involving 33 participants from 4 wound care clinics in Makassar, eastern Indonesia. The intervention group consisted of 17 participants and their families; the control group was composed of 16 participants who received nonstructural education. Family empowerment was measured by the Indonesian version of the Family Empowerment Scale instrument. Glycemic control was evaluated with HbA1c levels, and the wound healing process was evaluated on the Diabetic Foot Ulcers Assessment Scale. Result. After 3 months, Family Empowerment Scale scores improved, particularly in the subdomain of family knowledge (16.59 ± 3.92 vs 13.38 ± 1.26; P = .005) and attitude (3.65 ± 0.93 vs 2.75 ± 0.45; P = .002). After 3 months of intervention, HbA1c decreased (from 10.47 ± 2.44% to 8.81 ± 1.83%), compared with the control group (P = .048). Meanwhile, an independent t test further revealed that the wound healing process tended to be better with the intervention group (4.71 ± 7.74) compared with the control group (17.25 ± 17.06), with P = .010 at the third month. Conclusion. Family-based education intervention creates family empowerment to control HbA1c levels and accelerate wound healing of diabetic foot ulcer.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-06-12T06:43:23Z
      DOI: 10.1177/1534734620930120
       
  • The Incidence of Depression in Patients With Diabetic Foot Ulcers: A
           Systematic Review and Meta-Analysis
    • Authors: Fu-Hui Jiang, Xiao-Man Liu, Hai-Rong Yu, Yan Qian, Hong-Lin Chen
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Some patients with diabetic foot ulcers (DFUs) may suffer from depression, but the latest information regarding the incidence of depression in patients with DFUs is limited. This review aimed to provide up-to-date information concerning the incidence of depression in patients with DFUs. We searched the literature in PubMed and Web of Science databases, limited to English publications. 11 eligible studies with a total of 2117 participants were included in this review. A random-effects model was applied due to high heterogeneity. The incidence of depression in patients with DFUs ranged from 26% (95% confidence interval [CI] = 19% to 33%) to 85% (95% CI = 78% to 92%), and was 47% (95% CI = 36% to 58%) after systematically summarizing. Subgroup analyses suggested that the incidence of depression were 49% (95%CI = 35% to 63%) in Europe, 37% (95% CI = 23% to 51%) in Asia, 62% (95% CI = 48% to 76%) in North America. Additionally, the incidence of depression were 40% (95% CI = 29% to 50%) in prospective studies, 55% (95% CI = 28% to 82%) in retrospective studies, 40% (95% CI = 29% to 50%) in cross-sectional studies. Furthermore, the incidence of depression were 43% (95% CI = 25% to 60%), 49% (95% CI = 35% to 63%), 68% (95% CI = 35% to 102%), 32% (95% CI = 26% to 38%), and 28% (95% CI = 18% to 38%) in patients with DFUs assessed by the Hospital Anxiety and Depression Scale, EuroQol 5-Dimension Questionnaire, Geriatric Depression Scale, Diagnostic and Statistical Manual of Mental Disorders, 4th edition, and the Center for Epidemiologic Studies Depression Scale, respectively. The estimates were robust in the sensitivity analysis. According to the meta-regression analyses, diabetes mellitus duration (t = 0.93, P = .422), publication years (t = −0.72, P = .488), and age of subjects (t = 0.01, P = .989) were not the sources of high heterogeneity. Our meta-analysis showed nearly half of patients with DFUs had depression problems.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-06-12T06:41:03Z
      DOI: 10.1177/1534734620929892
       
  • Meta-Analysis of the Role of Intermittent Pneumatic Compression of the
           Lower Limbs to Prevent Venous Thromboembolism in Critically Ill Patients
    • Authors: Tarek Haykal, Yazan Zayed, Harsukh Dhillon, Muhammad Shah Miran, Josiane Kerbage, Areeg Bala, Varun Samji, Smit Deliwala, Ghassan Bachuwa
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Critically ill patients (patients treated in a medical or surgical intensive care unit) are at high risk of venous thromboembolism (VTE) development (deep vein thrombosis [DVT] and/or pulmonary embolism). Multiple thromboprophylaxis strategies have been used for the prevention of VTE in this population with various outcomes. Therefore, we aimed to evaluate the efficacy of intermittent pneumatic compression (IPC) prophylaxis in the lower limb compared with no treatment, anticoagulant use, or their combinations in reducing risk. A comprehensive electronic database search was conducted for all randomized clinical trials (RCTs) comparing the clinical outcomes of IPC versus anticoagulants or no treatment or their combinations for the prevention of VTE for critically ill patients. The primary outcome was VTE. The secondary outcome was DVT. We performed a Bayesian network meta-analysis to calculate odds ratios (ORs) and 95% credible intervals (CrIs). We included 5 RCTs with 3133 total patients, represented by a mean age of 49.61 ± 18 years, while 60.28% were male. There was a significant reduction of the primary outcome (incidence of VTE events) when no treatment was compared with IPC (OR = 0.36; 95% CrI = 0.18-0.71), anticoagulation alone (OR = 0.30; 95% CrI = 0.12-0.68), or anticoagulation with IPC (OR = 0.34; 95% CrI = 0.13-0.81). In addition, there was a significant reduction in DVT when no treatment was compared with IPC (OR = 0.45; 95% CrI = 0.21-0.9), anticoagulation alone (OR = 0.16; 95% CrI = 0.03-0.66), or anticoagulation with IPC (OR = 0.18; 95% CrI = 0.03-0.84). However, there were no significant differences between other comparisons (IPC vs anticoagulation alone, anticoagulation alone vs anticoagulation with IPC, or anticoagulation with IPC vs IPC alone) regarding VTE or DVT incidence. Among critically ill patients, IPC alone, anticoagulation alone, and IPC with anticoagulation were associated with a significant reduction of VTE and DVT incidence compared with no treatment. However, there was no significant difference between these modalities when compared together. Therefore, further larger studies comparing those different thromboprophylaxis modalities and their combinations are needed to provide more robust results for future clinical recommendations.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-06-12T06:38:03Z
      DOI: 10.1177/1534734620925391
       
  • Maggot Debridement Therapy in Malaysia
    • Authors: Harikrishna K. R. Nair, Nazni Wasi Ahmad, Chien Huey Teh, Han Lim Lee, Sylvia Syin Ying Chong
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Maggot therapy, also known as maggot debridement therapy, larval therapy, biodebridement, or biosurgery, is a type of biotherapy involving the intentional application of live, disinfected fly larvae or maggots into the nonhealing wound of a human or animal to debride the necrotic wound, reduce bacterial contamination of the wound as well as enhance the formation of healthy granulation tissue and stimulate healing in nonhealing wounds. In addition, van der Plas et al reported that the use of the medicinal larvae as natural remover of necrotic and infected tissue had prevented amputation in 11 selected patients. In Malaysia, Aaron et al had demonstrated prevention of amputation in 25 patients.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-06-11T11:33:34Z
      DOI: 10.1177/1534734620932397
       
  • A Systematic Review on Classification, Identification, and Healing Process
           of Burn Wound Healing
    • Authors: Morteza Abazari, Azadeh Ghaffari, Hamid Rashidzadeh, Safa Momeni Badeleh, Yaser Maleki
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Because of the intrinsic complexity, the classification of wounds is important for the diagnosis, management, and choosing the correct treatment based on wound type. Generally, burn injuries are classified as a class of wounds in which injury is caused by heat, cold, electricity, chemicals, friction, or radiation. On the other hand, wound healing is a complex process, and understanding the biological trend of this process and differences in the healing process of different wounds could reduce the possible risk in many cases and greatly reduce the future damage to the injured tissue and other organs. The aim of this review is to provide a general perspective for the burn wound location among the other types of injuries and summarizing as well as highlighting the differences of these types of wounds with emphasizing on factors affecting thereof.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-06-11T11:28:57Z
      DOI: 10.1177/1534734620924857
       
  • Reconstruction of Sacral Pressure Ulcer Using a Modified Parasacral
           
    • Authors: Hyun Woo Kyung, Geonil Ko, Seung Han Song, Sang-Ha Oh, Yooseok Ha
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Background. Many different operative options have been used to cover sacral defects. Perforator flap enables wide defect reconstruction with long pedicle and a large arc of rotation while preserving gluteus maximus muscle, but the risk of vessel injury can jeopardize flap survival. Perforator-based flap, the flap transposed without skeletonization of the perforator, requires much experience to be perfect in flap design to achieve tension-free closure. Methods. Fourteen modified parasacral perforator-based flap procedures were carried out on 14 patients. The records of patients at Chungnam National University Hospital from February 2017 to January 2020 were retrospectively reviewed. Results. All 14 flaps survived completely. One patient developed localized hematoma, and another presented with latent seroma. No donor or recipient site dehiscence or recurrence occurred during follow-up. Conclusion. We present our experience of a parasacral perforator-based flap with modified design of bilobed flaps. It could be performed easily and safely with less wound dehiscence and serve as a good practice model for young surgeons to cover small to moderately sized defects.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-06-11T11:23:52Z
      DOI: 10.1177/1534734620923457
       
  • Health Economic Indicators in Patients With Diabetic Foot: Outpatient
           Multidisciplinary Management
    • Authors: Min Peng, Qiuhong Zhou, Xiaoai Fu, Ling Yu, Jingcan Xu, Liaofang Wu, Rong Xu, Furong Yang
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      The purpose of this study is to investigate the influence of an outpatient multidisciplinary diagnosis and treatment model on the health economic indices of diabetic foot patients. We included 142 diabetic foot patients who received treatment in 2 target hospitals from January to April 2018 in this prospective cohort study. According to their exposure factors, the patients were divided into a MDT group and a control group, with 71 patients in each group. The patients’ baseline data were collected. The follow-up period was 12 months; all patients were followed up to April 30, 2019. Health economic indicators were collected when the patients were discharged from the hospital. The prognosis of each group was followed every month. If a wound healed, a major amputation occurred, or the patient died within 12 months, the follow-up was stopped. A total of 129 patients were followed, and their baseline data were comparable. During the follow-up period, the healing rate of the 2 groups was significantly different (P = .034). The healing rate of Wagner grade 4 patients was significantly better than Wagner grade 2 and grade 3 patients (P = .001). Health economic indicators demonstrated significant differences in bed waiting time (P = .038), transfer time (P = .001), surgery waiting time (P = .003), length of hospital stay (P = .047), and hospitalization expenses (P = .011). In conclusion, an outpatient multidisciplinary diagnosis and treatment model for diabetic foot can support cost-effective patient management.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-06-11T11:12:39Z
      DOI: 10.1177/1534734620923439
       
  • Do’s and Don’ts for a Good Reviewer of Scientific Papers: A
           Beginner’s Brief Decalogue
    • Authors: Miltos K. Lazarides, George S. Georgiadis, Nikolaos Papanas
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Peer review has been the principal way of evaluating scientific articles, ensuring that publications meet standards of methodology, integrity, and ethics. Occasionally, however, reviews are suboptimal, especially those by inexperienced reviewers. Therefore, this article offers suggestions on how to review a scientific article. Some of the most important suggestions include submitting the review in a timely fashion without undue delay, not breeching confidentiality, focusing mainly on the methodology, following specific format, and avoiding embarrassing comments to the authors.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-06-11T06:16:06Z
      DOI: 10.1177/1534734620924349
       
  • Effectiveness and Tolerability of Natural Herbal Formulations in the
           Prevention of Radiation-Induced Skin Toxicity in Patients Undergoing
           Radiotherapy
    • Authors: Georgios Koukourakis, Georgios Pissakas, Christos G. Ganos, Gregory Sivolapenko, Dimitrios Kardamakis
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      The aim of this study is to investigate the preventive role of 3 herbal formulation products on reducing the incidence of radiation-induced dermatitis in patients undergoing radiotherapy for either breast or head and neck cancer. A total of 59 patients participated in the study. The novel herbal products, a combination of beeswax, olive oil, Calendula and Hypericum oils and Aloe gel, were daily and regularly being used by the patients during radiotherapy and 2 weeks after treatment end. Acute skin toxicity was scored weekly during radiotherapy and after treatment for a further 4-week follow-up period. Demographic data were analyzed by descriptive statistics. Statistical analyses of the study objectives were based on an intent-to-treat principle. Most of the patients presented with grade I (RTOG/EORTC) toxicity in the first weeks of radiotherapy, progressed to grade II but reverted to grade I toxicity up until the study end. A total of 94.9% of the patients had Dermatology Life Quality Index up to 1, and 66.1% remained in this scale. The application of the novel natural product combinations proved to be statistically significantly effective in reducing the intensity of radiation dermatitis, positively affecting the quality of life of the patients.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-06-11T06:14:56Z
      DOI: 10.1177/1534734620923912
       
  • Bacterial Isolates and Their Antibiotics Susceptibility Pattern Among
           Patients Admitted With Chronic Lower Limb Ulcers at Kilimanjaro Christian
           Medical Centre Northern Zone Referral Hospital, Tanzania
    • Authors: Wilson Marco Hape, Mujuni Josephat Magambo, James Samwel Ngocho, Victor Mosha, Sia E. Msuya, Beatrice John Leyaro
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Objective. To identify the bacterial isolates and their antibiotics susceptibility pattern among patients with lower limb ulcers admitted at a tertiary hospital in northern Tanzania. Methodology. A cross-sectional study was conducted between April and July 2018 at the Kilimanjaro Christian Medical Centre. Questionnaire was used to obtain the demographics and clinical information of participants. Wound samples were collected and culture method used to identify the bacteria and their susceptibility patterns. Results. Out of 65 participants, 55 (84.6%) had positive aerobic bacterial growth. Twelve (18 %) participants had more than one bacterium. Fifty-nine (88.1%) were gram-negative bacteria. Proteus vulgaris (13, 19.9%), Pseudomonas spp (10, 14.8%), and Staphylococcus aureus (8, 11.7%) were the common isolates. Out of 59 gram-negative bacterial, 47 (78%) were sensitive to amikacin. Staph were sensitive to oxacillin (75%; n = 8) and vancomycin (50%; n = 8). Gram-negative were common isolates and were resistant to amoxicillin/clavulanic acid but sensitive to amikacin. Conclusion. The observed resistance to antibiotics calls for continuous monitoring of the resistance pattern to guide the empirical management of patients with leg ulcer.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-06-11T06:13:16Z
      DOI: 10.1177/1534734620923455
       
  • Surgery Versus Nonsurgical Methods in Treating Neuropathic Plantar
           Forefoot Ulcers: A Meta-Analysis of Comparative Studies
    • Authors: Kaissar Yammine, Chahine Assi
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      The treatment of diabetic foot ulcers (DFUs) is usually based on local debridement, topical agents, and nonsurgical off-loading. When compared with nonsurgical methods, a number of articles reported better results with surgery. The aim of this meta-analysis was to collate quantitative evidence on the outcomes of surgery versus nonsurgical treatment (NST) of DFUs. Databases were searched from inception to September 2019. PRISMA guidelines were followed, and the Joanna Briggs Institute critical appraisal tools were used to appraise studies’ quality. Nine studies were included totalizing 436 ulcers (216 treated with surgery and 220 DFUs with NST). The primary outcome was the healing rate. The secondary outcomes were time to heal, recurrence rate, transfer rate, infection rate, and amputation/revision surgery rate. The risk differences (RDs) between the healing rates following surgery and NST for infected and noninfected ulcers were 17% (95% confidence interval [CI] = 0.012-0.328, P = .03) and 19.2% (95% CI = 0.050-0.334, P = .008), respectively, in favor of surgery. The amputation/revision surgery rate was significantly better following surgery for both types of ulcers. Noninfected ulcers demonstrated significantly lesser time to heal, recurrence, and infection rates following surgery. This meta-analysis demonstrated that surgery was superior to NST in treating infected and noninfected neuropathic plantar wounds.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-06-11T04:57:23Z
      DOI: 10.1177/1534734620923425
       
  • Regular Use of FlowAid FA100 SCCD Reduces Pain While Increasing Perfusion
           and Tissue Oxygenation in Contralateral Limbs of Amputees With Diabetic
           Neuropathy and Peripheral Arterial Disease: Results of an Open, Pre-Post
           Intervention, Single-Center Study
    • Authors: Suganya Ramar, Seena Rajsekar, Bamila Selvaraj, Vijay Viswanathan, Raj Mani
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Patients with diabetic neuropathy and peripheral arterial disease often suffer pain, develop foot wounds, and go on to lose limbs leaving them with a painful limb. Electrical stimulation is one possibility open to physicians. In this study, the effects of the FlowAid FA100 SCCD, a sequential contraction compression device, were tested. The FA100 device is noninvasive; it uses 4 electrodes to sequentially stimulate the calf muscles in a modified intermittent pneumatic compression manner. A total of 14 patients with diabetic neuropathy, peripheral arterial disease, unilateral amputation, and a painful limb were treated with FlowAid FA100 (FlowAid Medical Technologies Corporation, New York, NY) with prior ethical approval. The study design was open, pre-post intervention comparison, and nonrandomized. Pain perceived was measured using Visual Analogue Scale (VAS) scores. Assessments of ankle brachial index (ABI), ultrasound color Duplex, and tissue oxygen using the transcutaneous oxygen technique were done at baseline and 2 successive follow-ups 4 weeks apart. Three out of 14 patients dropped out on account of distances involved in traveling to the clinic. Eleven out of 14 patients experienced statistically significant reduction in pain mean VAS scores (7.5 ± 0.93 to 5.8 ± 1.47, P = .002) associated with increase in ABI (0.64 ± 0.06 to 0.69 ± 0.04, P < .001) and transcutaneous oxygen tension measured on the dorsum (29.4 ± 4.03 to 33.2 ± 5.26 in mm Hg, P = .005). When pain scores were regressed against ABI and transcutaneous oxygen tension values, there was a significant association between these (r = 0.8, P = .002). The reduction in pain following regular use of FlowAid was accompanied by beneficial and statistically significant increases in perfusion and oxygenation.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-06-11T04:54:03Z
      DOI: 10.1177/1534734620917918
       
  • Denatured Collagen Could Increase the Autophagy Level and Inhibit
           Apoptosis of Fibroblasts to Help Cell Survival and Influence Wound Healing
           
    • Authors: Yidan Su, Min Li, Xiqiao Wang, Zhiyong Wang, Lei Yi
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      When exposed to thermal factors, collagen in the dermis denatures, which could affect the biological behavior of cells. Previous studies have demonstrated that denatured collagen could influence the activity of fibroblasts and induce fibroblasts differentiate into myofibroblasts. However, information on the regulation of fibroblasts by denatured collagen-modulated autophagy and apoptosis during the wound healing process is limited. In this article, we researched the effect of denatured collagen-modulated autophagy and apoptosis on fibroblasts. An in vitro model comprising fibroblasts and denatured collagen was established to identify the potential ability of denatured collagen to modulate autophagy and apoptosis. Western blotting, quantitative polymerase chain reaction, transmission electron microscopy, TUNEL assay, and immunofluorescence staining were used to examine the changes induced by denatured collage. Protein and mRNA levels of LC3 and beclin-1 were significantly increased after stimulated by denatured collagen, while those of caspase-3 were reduced. Unlike stimulation with normal collagen, denatured collagen enhanced autophagy and inhibited apoptosis of fibroblasts. After blocking autophagy using 3-methyladenine, the apoptotic function was increased. Denatured collagen could increase autophagy and inhibit apoptosis of the fibroblasts to promote cell survival and influence wound healing.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-06-10T08:35:44Z
      DOI: 10.1177/1534734620925942
       
  • Application of Easy Wet Healing Therapy for Chronic Noninfectious Wounds
           in Limbs
    • Authors: Zhimin Ni, Jiachen Sun, Shiling Qi
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Chronic wounds in limbs without infection are common. This study was to identify an economical, simple, and useful wet healing therapy for patients with chronic noninfectious wounds in the limbs, especially for low-income patients. In total, 56 patients with chronic limb wounds without infection from April 2018 to March 2019 were included. They underwent wound cleaning by iodine and wound covering by recombinant human epidermal growth factor gel, zinc oxide ointment, and erythromycin eye ointment at a 1:1:1 ratio and thickness of 0.8 cm. After applying the drug, a slight-pressure dressing was applied to the wound with a cotton pad and bandage, and the dressing was changed every 3 days. All the wounds completely healed within 12 to 45 days (26.2 ± 11.9 days). The healing time showed a positive correlation with the area of the wound (r = 0.328, P < .05) and the course of disease (r = 0.485, P < .01). The healing time of deep second-degree wounds was 17.2 ± 3.3 days, which was shorter than that of deep third-degree wounds (34.8 ± 8.4 days; P < .05). There was no significant difference in the healing time according to sex. Upper limb wounds healed faster than lower limb wounds (16 ± 2.7 days versus 31.7 ± 9.7 days, P < .05). The simple therapy required a low cost of 0.07 dollars per square centimeter for each dressing change. This wet healing therapy is easy, effective, relatively safe, and affordable, with no obvious side effects.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-06-10T08:33:49Z
      DOI: 10.1177/1534734620924260
       
  • Hybrid Treatment Combining Lymphaticovenous Anastomoses and the Oriental
           Herbal Medicine Bofutsushosan for Obesity-Associated Lower Leg
           Elephantiasis Nostras Verrucosa: A Case Report
    • Authors: Keisuke Shimbo, Yukako Okuhara, Kazunori Yokota
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Elephantiasis nostras verrucosa (ENV) is a rare dermatological disease associated with chronic lymphedema caused by obesity, soft tissue infection, or chronic venous insufficiency. Although surgical debridement may be sufficient to treat the skin manifestations of ENV, treatment of ENV should focus on reducing lymph stasis to improve the skin changes and prevent recurrence. In this case report, we present the case of a 79-year-old woman who developed obesity-associated ENV in the lower leg. She was successfully treated by a combination of lymphaticovenous anastomoses and the oriental herbal medicine Bofutsushosan. To our knowledge, this is the first reported obesity-associated ENV case in which skin pathology was not only healed, but both edema relief and weight loss were successful. A treatment combining both surgery and the herbal medicine could be a potential therapeutic candidate for obesity-associated ENV.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-06-10T02:33:57Z
      DOI: 10.1177/1534734620932802
       
  • Pilot Experience on the Use of S54P4 Bioactive Glass in the Surgical
           Management of Diabetic Foot Osteomyelitis
    • Authors: Elisabetta Iacopi, Letizia Pieruzzi, Chiara Goretti, Alberto Piaggesi
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      To test safety and efficacy of bioactive glass, a novel material used to replace bone, able to completely bond itself to the host tissues on patients treated for osteomyelitis (OM) complicating a diabetic foot (DF). We evaluated a group of patients consecutively admitted in our department between September and December 2018, who underwent surgical DF procedures for OM and in whom the use of bioactive glass could limit the demolition phase of surgical procedure. Patients were treated with bioactive glass S53P4 on top of standard treatment directly in operating room. The patients were weekly controlled for 6 months or until complete healing. During follow-up, we analyzed primarily healing rate and secondarily time of healing, need for further debridement procedures, recurrences, and adverse or hypersensitivity reactions to study treatment. Ten DF patients were enrolled (male/female 6/4; mean age 56 ± 11 years; mean duration of diabetes 10.5 ± 4.7 years, mean hemoglobin A1c 7.2 ± 0.9%). Patients underwent surgical procedure during which, after an accurate debridement, bioactive glass was applied. A healing rate of 80% in a mean time of 34 ± 2 days, with only 1 patient who needed a second surgical look, was observed. Neither recurrences nor adverse events during follow-up were observed in treated patients. This pilot experience demonstrated that bioactive glass can be considered a useful tool for the surgical treatment of DF-related OM.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-06-08T08:54:45Z
      DOI: 10.1177/1534734620926003
       
  • Dalbavancin for the Treatment of Complicated Gram-Positive Skin and Soft
           Tissue Infections
    • Authors: Vasilios Petrakis, Periklis Panagopoulos, Nikolaos Papanas
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      New antimicrobial agents have been developed to treat infections caused by methicillin-resistant Staphylococcus aureus and other multidrug-resistant pathogens. Dalbavancin is a novel semisynthetic lipoglycopeptide antibiotic, particularly active against methicillin-resistant Staphylococcus aureus. Due to its unique pharmacological characteristics and longer half-life, it can be administered once-weekly or every 15 days and in outpatient setting. Currently, it is indicated for complicated skin and soft tissue infections, but accumulating evidence points to its off-label efficacy in osteomyelitis and endocarditis. Further experience is still needed to increase our knowledge on the role of dalbavancin in a wider range of Gram-positive infections requiring prolonged antimicrobial treatment.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-06-05T12:10:42Z
      DOI: 10.1177/1534734620921677
       
  • Development and Characterization of Squalene-Loaded Topical Agar-Based
           Emulgel Scaffold: Wound Healing Potential in Full-Thickness Burn Model
    • Authors: T. S. Shanmugarajan, N. Kalai Selvan, Varuna Naga Venkata Arjun Uppuluri
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Full-thickness burns pose a major challenge for clinicians to handle because of their restricted self-healing ability. Even though several approaches have been implemented for repairing these burnt skin tissue defects, all of them had unsatisfactory outcomes. Moreover, during recent years, skin tissue engineering techniques have emerged as a promising approach to improve skin tissue regeneration and overcome the shortcomings of the traditional approaches. Although previous literatures report the wound healing effects of the squalene oil, in the current study, for the first time, we developed a squalene-loaded emulgel-based scaffold as a novel approach for potential skin regeneration. This squalene-loaded agar-based emulgel scaffold was fabricated by using physical cross-linking technique using lecithin as an emulsifier. Characterization studies such as X-ray diffraction, Fourier-transform infrared spectroscopy, and field emission scanning electron microscopy revealed the amorphous nature, chemical interactions, and cross-linked capabilities of the developed emulgel scaffold. The squalene-loaded emulgel scaffold showed excellent wound contraction when compared with the agar gel and negative control. In case of the histopathology and recent immunohistochemistry findings, it was clearly evidenced that squalene-loaded emulgel promoted faster rate of the revascularization and macrophage polarization in order to enhance the burn wound healing. Moreover, the findings also revealed that the incorporation of squalene oil into the formulation enhances collagen deposition and accelerates the burnt skin tissue regeneration process. Finally, we conclude that the squalene-loaded emulgel scaffold could be an effective formulation used in the treatment of the burnt skin tissue defects.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-06-05T10:06:58Z
      DOI: 10.1177/1534734620921629
       
  • Wound Healing Activities of Gundelia tournefortii L Extract and Milk-Cream
           Ointment on Second-Degree Burns of Rat Skin
    • Authors: Setareh Javanmardi, Iman Safari, Faranak Aghaz, Mozafar Khazaei
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Skin burn is a major health problem in the community and seeking new and suitable treatment is suggested. In this regard, traditional remedies were consider in many countries. Regarding clinical application of herbal medicine in the healing of burn wounds, the present study was designed to evaluate the effect of Gundelia (Gundelia tournefortii L) extract with milk-cream on the healing of second-degree burn in a rat model. Thirty-six male Wistar rats (220 ± 30 g) were divided into 3 groups (n = 12), after establishment of second-degree burn: group1, were left without any intervention; group 2, were treated topically with silver sulfadiazine; and group 3, were treated with Gundelia tournefortii L extract composite with milk-cream once a day for 21 days. Macroscopically and histological examinations were conducted on 7, 14, and 21 days of therapy. Data analyses were done using 1-way analysis of variance and post hoc Tukey tests. Macroscopically, evaluation of wounds’ sizes on the 14th and 21st days indicated that the wound surface was reduced significantly (P < .001) in group 3 compared with groups 1 and 2. Histological findings also showed that burn healing was significantly improved in group 3 compared with the other groups. Gundelia tournefortii L extract composite with milk-cream has an effective role on healing of second-degree burn in rat skin and it could a complementary and/or alternative medicine in wound healing.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-06-05T10:06:57Z
      DOI: 10.1177/1534734620921589
       
  • Turkish Adaptation of Diabetic Foot Ulcer Scale–Short Form
    • Authors: İsmail Toygar, Sadık Hançerlioğlu, Selden Gül, Tülün Utku, Ilgın Yıldırım Şimşir, Şevki Çetinkalp
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      The purpose of this study was to evaluate the validity and reliability of the Turkish version of the Diabetic Foot Scale–Short Form (DFS-SF). The study was cross-sectional and conducted between January and October 2019 in a diabetic foot council of a university hospital. A total of 194 diabetic foot patients participated in the study. A Patient Identification Form and DFS-SF were used for data collection. Forward and backward translations were used in language validity. Expert opinions were obtained to determine the Content Validity Index. To determine construct validity, exploratory factor analysis and confirmatory factor analysis were used. Cronbach’s α internal consistency coefficient, item-scale correlation, and test-retest reliability were used to evaluate reliability. It was found that Content Validity Index was 0.97 (0.86-1.00), the factor loading of scale varied from 0.378 to 0.982, Cronbach’s α value varied from 0.81 to 0.94, and item-total correlations were between 0.30 and 0.75. The Turkish version of the DFS-SF was found valid and reliable to measure the quality of life of diabetic foot patients.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-06-03T09:43:50Z
      DOI: 10.1177/1534734620921036
       
  • Perforator Free Flap Coverage of Chronic Lower Extremity Ulcers in
           Patients With Autoimmune Diseases Under Immunosuppression
    • Authors: Sang Wha Kim
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Objectives. Lower extremity ulcers are quite common in patients with autoimmune diseases. Due to chronic use of immunosuppressants, these wounds may develop into deeper wounds resulting in exposure of bone or tendon, which in turn may require free tissue transfers for coverage. The author reviewed perforator free flap transfers performed in this group of patients and analyzed the results. Methods. A retrospective review was performed on all patients who underwent perforator free flap transfer for coverage of lower extremity ulcers without trauma, over a 10-year period. Patient demographics, administered immunosuppressants, and flap and donor site complications were analyzed. Results. Twenty-two perforator free flap transfers were performed in patients with autoimmune diseases, including 18 thoracodorsal perforator flaps, 2 anterolateral thigh flaps, and 2 deep inferior epigastric artery flaps. There was no total flap loss, but there was a high rate of partial flap necrosis (40.9%) and wound dehiscence (40.9%). Intake of corticosteroids was significantly associated with postoperative complications (P < .05). Conclusion. As partial loss of flap and wound dehiscence is much more common in this group of patients, treatment may take longer, and a fully informed consent should be obtained preoperatively. Surgeons should not avoid performing perforator free flap transfers in patients with autoimmune diseases under immunosuppression; instead, much more preparation and caution are required.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-05-18T06:39:47Z
      DOI: 10.1177/1534734620919611
       
  • A Systematic Review and Meta-Analysis of the Effects of Low-Level Laser
           Therapy in the Treatment of Diabetic Foot Ulcers
    • Authors: Cristiana Maria dos Santos, Rebeca Barbosa da Rocha, Fuad Ahmad Hazime, Vinicius Saura Cardoso
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Diabetic foot ulcers (DFUs) are considered one of the most aggressive and expensive complications of diabetes. Low-level laser therapy (LLLT) has been highlighted as a potential modality of treatment to accelerate the healing of ulcers. This systematic review and meta-analysis aimed to investigate the efficacy of LLLT in the treatment of DFU and identify the LLLT application parameters recommended for the treatment of DFU over the past 10 years. A systematic search was conducted in PubMed, BVS, PEDro, Scopus, Web of Science, and CINAHL up to March 31, 2019. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines, randomized controlled trials (RCTs) that assessed the effect of LLLT on the treatment of DFU were included. Thirteen RCTs with a total of 361 participants were included in this review. Three RCTs reported a reduction in the percentage size of the ulcers and were included in the meta-analysis. The meta-analysis of the percentage size difference demonstrated a significant reduction in ulcer size in the LLLT group compared with controls (22.96 [95% confidence interval = 18.22-27.69; z = 9.51, P < .0001]). Treatment with 632.8 to 685 nm, 50 mW/cm2, 3 to 6 J/cm2, and irradiation for 30 to 80 seconds, 3 times weekly for a month is of benefit to patients with DFU. LLLT is effective and safe for the treatment of DFU. Additionally, well-designed, high-quality studies are needed to allow its ideal parameterization for clinical practice.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-05-12T10:01:39Z
      DOI: 10.1177/1534734620914439
       
  • Multimodal Conservative Treatment of Complicated Open Wound After Total
           Knee Replacement Arthroplasty in Patients With Comorbidities
    • Authors: Sang Oon Baek, Jeonghwan Shin, Jong Keun Song, Jun Yong Lee
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Total knee replacement arthroplasty is a common procedure and postoperative wound complications are sometimes inevitable. Although invasive reconstructive surgery may be an option for nonhealed wounds, such procedures can limit early rehabilitation, adversely affecting the range of joint motion. Patients can achieve a wider range of motion if they undergo early rehabilitation with a conservative approach. From 2015 to 2017, 5 patients with comorbidities who underwent total knee replacement arthroplasty were referred to the reconstructive surgery department for nonhealed open wounds. Depending on their comorbidities and conditions, the patients underwent negative-pressure wound therapy based on multimodal conservative treatment. During the treatment, the patients continued rehabilitation. In the 5 patients, the mean duration of complete wound healing was 65.2 days (range = 57-81), during which all open wounds were well healed. For final wound closure, the patients underwent skin grafting, dermatotraction, or collagen dressing. Four patients achieved ranges of joint motion over 100 degrees after treatment. We believe that early coverage is important for open wounds. For complicated open wounds after total knee replacement arthroplasty in patients with comorbidities, less invasive multimodal treatment along with early rehabilitation may be more effective to achieve adequate final range of joint motion.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-05-08T06:44:22Z
      DOI: 10.1177/1534734620919315
       
  • Efficacy of Maggot Debridement Therapy on Refractory Atypical Diabetic
           Foot Ulcers: An Open-Label Study
    • Authors: Mansour Siavash, Ali Najjarnezhad, Nader Mohseni, Seyed Mohammad Abtahi, Azadeh Karimy, Mohammad Hosein Sabzevari
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Atypical or refractory diabetic foot ulcers (DFUs) are still a major health problem. Maggot debridement therapy (MDT) by larva of Lucilia sericata is an ancient and a modern option for wound healing. It works by debridement, stimulation of wound healing, and disinfection. In this study, we aimed to evaluate the efficacy of MDT for healing atypical and refractory DFUs. Patients with atypical DFUs were selected and further evaluated for some predefined differential diagnoses like atypical fungal, parasitic, or bacterial infections, malignancy, trauma, and so on. Multiple MDT sessions were carried out. Ulcer size was measured before every MDT session. Complete wound healing, time to heal, and adverse effects were recorded as well. Forty-two DFU patients (26 men, 16 women) with 42 nonhealing atypical ulcers participated in this study. Complete wound healing was achieved in 35 patients (83.3%) by MDT. Complete debridement and then healing of the wounds happened in less than 1.79 ± 0.8 months. Four ulcers persisted, and 3 (7.1%) were eventually amputated. MDT may be considered as an effective treatment for atypical DFUs, which are unresponsive to conventional therapies.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-05-06T05:00:05Z
      DOI: 10.1177/1534734620920403
       
  • Admission Time Deep Swab Specimens Compared With Surgical Bone Sampling in
           Hospitalized Individuals With Diabetic Foot Osteomyelitis and Soft Tissue
           Infection
    • Authors: Ana Belen Manas, Surabhi Taori, Raju Ahluwalia, Hani Slim, C. Manu, Hisham Rashid, Venu Kavarthapu, Michael Edmonds, Prashanth R. J. Vas
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Whether deep swab cultures taken at admission reliably identify pathogens compared to surgical bone specimens in hospitalized individuals with diabetic foot osteomyelitis and soft tissue infection is unclear. Comparison of microbiological isolates between a deep wound swab (DWS) taken at the time of admission through the actively infected, discharging ulcer probing to the bone and the subsequent surgical bone sample (SBS) taken during surgical debridement was made. A total of 63 subjects (age 60.8 ± 13.5 years, 75% male, 80% Type 2 diabetes, HbA1C 8.9%±2.2%) were included. The proportion of Gram-positive (DWS 49% v SBS 52%) and Gram-negative (DWS 60% v SBS 60%) isolates was similar between the techniques. However, the overall concordance of isolates between the two techniques was only fair (κ=0.302). The best concordance was observed for Staphylococcus aureus (κ=0.571) and MRSA (κ=0.644). There was a correlation between number of isolates in SBS with prior antibiotic therapy of any duration (r= -0.358, p=0.005) and with the duration of ulceration (r=0.296, p=0.045); no clinical correlations were found for DWS. Prior antibiotic therapy (p=0.03) and duration of ulceration
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-05-06T04:55:25Z
      DOI: 10.1177/1534734620916386
       
  • Accurate Noninvasive Arterial Assessment of the Wounded Lower Limb: A
           Clinical Challenge for Wound Practitioners
    • Authors: Peta Ellen Tehan, Alex Louise Barwick, Sarah Louise Casey, Sean Michael Lanting, Vivienne Helaine Chuter
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Arterial investigations are an essential part of lower extremity wound assessment. The results of these investigations assist the wound clinician to determine the etiology of the wound, predict healing capacity, and inform further management. There are a number of noninvasive testing methods available to practitioners, all with varying levels of reliability and accuracy. Clinical wound assessment guidelines give varied recommendations when it comes to lower limb vascular assessment in the presence of a wound. This leaves clinicians with little guidance on how to choose the most appropriate test, and uncertainty remains about which tests provide the most accurate information in different patient-specific contexts. Conditions such as advanced age, diabetes, and renal disease are known to affect the accuracy of some commonly used lower limb arterial assessment methods, and alternate testing methods should be considered in these cases. This seminal review discusses the reliability and accuracy of lower limb vascular assessment methods used to guide lower limb arterial assessment in the presence of wounds.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-05-06T04:52:09Z
      DOI: 10.1177/1534734620913705
       
  • Ecchymosis and Coldness in Peripheral Varicose Vein Patients: Observations
           From VEIN-TURKEY Study
    • Authors: Selcuk Ozturk, Kagan Turker Akbaba, Suleyman Kilic, Tufan Cicek, Levent Peskircioglu, Izzet Tandogan, Ahmet Gurlek, Ozbay Aydemir, Mehmet Ileri, Ertan Yetkin
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      The purpose of this subgroup analysis is to investigate and analyze the venous leg symptoms including sense of coldness and sign of ecchymosis in patients with or without peripheral varicose veins (PVVs) from VEIN-TURKEY study population. A total of 600 patients, who were enrolled to VEIN-TURKEY study recently, were included in this subgroup analysis. Patients were examined clinically for the presence and severity of PVV and varicocele. Patients were asked to answer the VEINES-Sym questionnaire consisting of 10 parts and questions about ecchymosis and coldness in their legs. Frequency of symptoms present in the VEINES-Sym instrument, coldness (16.6%, 6.5%, P = .002, respectively), and ecchymosis (16.6%, 2.7%, P < .001, respectively) were significantly higher in patients with PVV compared to patients without PVV. Mean score of each symptom was significantly lower in PVV (+) patients including scores of ecchymosis and coldness. Total VEINES-Sym score was also correlated with the scores of ecchymosis (r = 0.18, P < .001) and coldness (r = 0.35, P < .001). Logistic regression analysis revealed that heavy legs, aching legs, night cramps, and ecchymosis are significantly and independently associated with PVV. In conclusion, sign of ecchymosis and coldness are significantly higher in patients with PVV compared to patients without PVV in a population recruited from the urology clinics. In clinical evaluation, presence or sign of ecchymosis and coldness in legs should be considered to be compatible with PVV in the absence of trauma, hematologic pathologies including antiplatelet treatment, and arterial stenosis or obstruction.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-05-01T10:05:46Z
      DOI: 10.1177/1534734620917911
       
  • Granulox—The Use of Topical Hemoglobin to Aid Wound Healing: A
           Literature Review and Case Series From Singapore
    • Authors: Clement Loh, Qian Ying Tan, Diane L. K. Eng, Stewart R. Walsh, Tze Tec Chong, Tjun Yip Tang
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Chronic wounds are an increasing burden on health care globally, and tissue hypoxia is a common issue in such wounds. Granulox (SastoMed GmbH, Georgsmarienhütte, Germany) is designed to provide wound bases with supplemental oxygen through facilitated diffusion and aid the physiological wound-healing process. It is a topical hemoglobin wound spray that is applied after wound cleaning and debridement to ensure continuous oxygen supplementation for up to 72 hours. Compared with other forms of topical oxygen therapy that require portable devices, Granulox is a spray-on application and the patient experience is similar to the use of a conventional dressing. Current clinical evidence suggests that Granulox aids with both wound healing and with symptom relief in chronic wounds, but current literature is limited by small study populations and further larger studies are required.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-04-30T04:20:43Z
      DOI: 10.1177/1534734620910318
       
  • Microvascular Control Mechanism of the Plantar Foot in Response to
           Different Walking Speeds and Durations: Implication for the Prevention of
           Foot Ulcers
    • Authors: Fu-Lien Wu, Wendy T. Wang, Fuyuan Liao, Yang Liu, Jiacong Li, Yih-Kuen Jan
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Physical activity has been recommended by the American Diabetes Association (ADA) as a preventive intervention of diabetes complications. However, there is no study investigating how microvascular control mechanism respond to different walking intensities in people with and without diabetes. The purpose of this study was to assess microvascular control mechanism of the plantar foot in response to various walking speeds and durations in 12 healthy people using spectral analysis of skin blood flow (SBF) oscillations. A 3×2 factorial design, including 3 speeds (3, 6, and 9 km/h) and 2 durations (10 and 20 minutes), was used in this study. Plantar SBF was measured using laser Doppler flowmetry over the first metatarsal head. Borg Rating of Perceived Exertion (RPE) scale and heart rate maximum were used to assess the walking intensity. Wavelet analysis was used to quantify regulations of metabolic (0.0095-0.02 Hz), neurogenic (0.02-0.05 Hz), myogenic (0.05-0.15 Hz), respiratory (0.15-0.4 Hz), and cardiac (0.4-2 Hz) controls. For 10-minute walking, walking at 9 km/h significantly increased the ratio of wavelet amplitudes of metabolic, neurogenic, myogenic, respiratory, and cardiac mechanisms compared with 3 km/h (P < .05). For 20-minute walking, walking at 6 km/h significantly increased the ratio of wavelet amplitudes of metabolic, myogenic, respiratory, and cardiac compared with 3 km/h (P < .05). RPE showed a significant interaction between the speed and duration factors (P < .01). This is the first study demonstrating that different walking speeds and durations caused different plantar microvascular regulations.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-04-24T06:08:20Z
      DOI: 10.1177/1534734620915360
       
  • Effect of Light-Emitting Diode Irradiation on Chronic Nonhealed Wound
           After Below-Knee Amputation
    • Authors: Haitham Amin Elessawy, Wafaa Hussein Borhan, Nasser Ahmed Ghozlan, Samah Hosny Nagib
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Chronic nonhealed wound after below-knee amputation is a serious problem that is faced by the health care team; therefore, there is a need to find an adjuvant therapy to address this problem. The aim of the study is to evaluate the therapeutic efficacy of light-emitting diode (LED) irradiation on chronic nonhealed wound after below-knee amputation using a digitalized method of evaluation by Adobe Photoshop CS5 aided by magnetic lasso tool. Thirty patients with chronic nonhealed wound (≥4 weeks) after below-knee amputation were randomly divided into 2 equal groups, with 15 participants in each. Group A received the LED irradiation for 24 sessions (3 sessions per week) in addition to the standard medical treatment, and the second experimental group (group B) received the standard medical treatment for 8 weeks. Methods of evaluation included the wound surface area: for tracing the wound perimeter using a computerized software. Results showed that both LED irradiation therapy and standard medical treatment were effective in healing the chronic nonhealed wound, but the LED was more effective than standard medical treatment alone. A clear improvement in the results of wound healing surface area was found in group A, with an improvement percentage of 50.63%, when compared with group B, which used the standard medical treatment alone, with an improvement percentage of 43.96%.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-04-20T05:22:06Z
      DOI: 10.1177/1534734620915108
       
  • Preserving the Blood Flow of the Recipient Artery in Cross-Leg Free Flap
           Procedure for Lower Extremity Reconstruction
    • Authors: Zulfukar Ulas Bali, Berrak Karatan, Yavuz Tuluy, Yavuz Kececi, Levent Yoleri
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      When there is no suitable vessel in the injured leg for microsurgical transfer, cross-leg free flaps can be considered for lower extremity reconstruction. This report describes patients who experienced lower extremity trauma and underwent reconstruction with cross-leg free flaps with preserved blood flow in the recipient artery. Anterolateral thigh flap is preferred for small to moderate defects. The descending branch of the lateral femoral circumflex artery was dissected 2 cm proximally and distally and was prepared in a T-shape. The branches of the T were anastomosed to the recipient artery in the contralateral leg in the first session of the cross-leg free flap procedure. After 3 weeks, the flap artery was separated from the bifurcation. For large defects, the latissimus dorsi flap was chosen. The thoracodorsal artery was anastomosed to the contralateral posterior tibial artery in the first session. After 3 weeks, to provide recipient vessel integrity, the thoracodorsal artery was transected from the flap and anastomosed to the distal stump of the posterior tibial artery. Between January 2017 and January 2019, 8 defects were reconstructed using an anterolateral thigh flap; the remaining 4 defects were reconstructed using a latissimus dorsi flap. All flaps survived without complications. Anterograde flow distal to the anastomosis was confirmed in all recipient arteries via Doppler ultrasound. In cross-leg free flaps, the continuity of the recipient artery can be established to prevent diminished blood flow to the recipient extremity.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-04-20T05:17:26Z
      DOI: 10.1177/1534734620913414
       
  • Evaluation of ROCEN on Burn Wound Healing and Thermal Pain: Transforming
           Growth Factor-β1 Activation
    • Authors: Ramin Goudarzi, Maryam Eskandary Nasab, Partow Mirzaee Saffari, Golnaz Zamanian, Chong Deok Park, Alireza Partoazar
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      The present study aimed to evaluate the effect of liposomal arthrocen 2% (ROCEN) on the healing of burn wound and pain alleviation of thermal stimuli in a rat model of the second-degree burn. The results showed that ROCEN formulation significantly improved the main parameters of burn wound healing in a short period of time (7 days). The percentage of wound surface was also reduced significantly compared with the control group following once daily application of ROCEN for 14 days. The level of TGF (transforming growth factor)-β1 cytokine was also elevated significantly in the burn tissue treated with ROCEN almost the same as zinc oxide cream. Also, ROCEN showed a significant analgesic effect evaluated by 2 models of acute thermal pain, tail-flick and hotplate tests, which suggested that the formulation may act as a pain reliever in burn injuries. In conclusion, the application of the topical formulation of ROCEN may have benefits in the acceleration of the wound healing process and alleviation of the pain due to burn injuries.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-04-20T05:13:09Z
      DOI: 10.1177/1534734620915327
       
  • Understanding Stress-Strain Behavioral Change in Fabrics for Compression
           Bandaging
    • Authors: Wan Syazehan Ruznan, Raechel M. Laing, Bronwyn J. Lowe, Cheryl A. Wilson, Timothy J. Jowett
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Bandages are common in many health-related treatments, including management of edema of the lower limb where they may remain in place for several days. The behavior of 2 bandage fabrics was investigated after exposure for up to 5 days to a multiaxial extension laboratory setup on a tensile tester in compression mode. The fabrics were extended 20% and remained under that machine setting. Stress-relaxation over time was determined by analyzing the rate of change over 24 hours and over 5 days. Most change, a rapid drop in force, occurred during the first 15 minutes; thereafter, for the next 12-hour period, a slower rate of decrease was observed. Both fabrics continued to relax gradually during the next 12 hours and continued to do so for up to 5 days. Little further change was evident during the last 12 hours or so. This phenomenon suggests that rewrapping may be appropriate (albeit not practical) after 12 hours of compression therapy to optimize the compression given to the lower leg. Relaxation behavior of these 2 fabrics can be explained using the generalized Maxwell-Wiechert model.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-04-06T07:32:23Z
      DOI: 10.1177/1534734620912093
       
  • A Biomechanical Examination of Prefabricated Total Contact Cast Kits:
           Relevance to Patients With Diabetic Neuropathy
    • Authors: Ali Ersen, Lawrence A. Lavery, Aakshita Monga, Mike Richardson, Brandy Schwarz, Myles U. Quiben, Alan G. Garrett, Mike Flyzik, Dane K. Wukich, Metin Yavuz
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      The traditional Total Contact Cast (TCC) is considered the gold standard for treating plantar diabetic ulcers. A number of prefabricated TCC kits have been introduced, which offer a user-friendly casting process for health care providers. Our objective was to evaluate pressure reduction and gait characteristics after application of a TCC kit (TCC-EZ) and traditional TCC. Fifteen individuals (9 males, 6 females; median age of 51.5 years [range = 40.5-71.2 years]) completed 30-m walking trials while fitted with TCC-EZ and TCC in a randomized order. A pair of automated wireless photogate sensors captured time to traverse the distance and pedobarographic insoles measured and recorded plantar pressures. Paired t tests were used to compare peak pressure, gait speed, and cast weights across the 2 modalities. Peak pressure and cast weight were significantly lower in the TCC-EZ arm (169.6 ± 41.3 kPa vs 214.9 ± 63.2 kPa, P = .0048; and 1.79 ± 0.17 kg vs 2.11 ± 0.25 kg, P = .0004). Contact area and gait speed were not significantly different between the 2 modalities (140.4 ± 25.8 cm2 vs 126.9 ± 37.8 cm2, P = .0228, Cohen’s d = 0.40; and 0.94 ± 0.19 m/s vs 0.83 ± 0.26 m/s, P = .0532, Cohen’s d = .48). TCC-EZ was found to provide more favorable pressure distributions compared with TCC. TCC-EZ is also lighter and may be a preferred treatment modality for patients. More research is necessary to reveal the clinical effectiveness of prefabricated total contact kits.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-03-30T04:24:01Z
      DOI: 10.1177/1534734620914440
       
  • Who Tweets About Diabetic Foot on Twitter and Which Tweets Are More
           Attractive'
    • Authors: İrfan Karahan, Aybüke Yürekli, Ömer Recep Özcömert, Birhan Oktaş, Aydın Çifci
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Diabetic foot is a serious problem for health care systems. Twitter can provide communication between people and it might be an informative tool for health care management. The purpose of this study is detecting the people or organizations that tweet about diabetic foot and analyze the interactions of these tweets on Twitter. All tweets containing the keyword “diabetic foot” in April 2019 were collected. The users were separated into 7 groups: patients with diabetes, health care providers, nongovernmental organizations, information sites and communication media, private companies, medical students, and others. Health care professionals and nonprofessionals were evaluated in likes, mentions, and retweets. The major group was health care providers. By 2-group comparisons of professionals and nonprofessionals, all likes, mentions, and retweets were significantly different (P = .02, P = .04, P < .001, respectively). We concluded that the tweets of health care professionals get more interaction than others. Twitter might be a useful tool to distinguish accurate information about diabetic foot. Also, health care professionals should use for making people aware of the diabetic foot and shed light on society.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-03-24T04:04:09Z
      DOI: 10.1177/1534734620912942
       
  • Polyethylene Glycol–Based Nanocerium Improves Healing Responses in
           Excisional and Incisional Wound Models in Rats
    • Authors: Tara Kardan, Rahim Mohammadi, Saeed Taghavifar, Marzieh Cheraghi, Ashkan Yahoo, Kianoush Mohammadnejad
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Applications of nanotechnology have gained progressive interest for regeneration of injured wound tissue. The aim of the present study was to evaluate effects of polyethylene glycol (PEG)-based nanocerium on excisional and incisional wound models in rats. For excisional wound healing model, 24 male white Wistar rats were randomized into 4 groups of 6 rats each: control group with creation of wounds and no treatment, PEG group with creation of wounds and dressing the wound with PEG, NanoCer group with application of 1 mL nanocerium on the wound, and PEG/NanoCer group with dressing the wound with PEG-based nanocerium. Wound size was measured on days 6, 9, 12, 15, 18, and 21 postsurgery. For incisional wound healing model, 24 healthy male Wistar rats were randomized into 4 groups of 6 rats each the same way in the excisional wound model. Reduction in wound area, hydroxyproline contents, and biomechanical parameters indicated that there was a significant difference (P> .05) between PEG/NanoCer and other groups. Biomechanical testing was performed on day 9 postsurgery in the incisional model. Biochemical and quantitative histological studies demonstrated that there was a significant difference (P> .05) between PEG/NanoCer and other groups. PEG/NanoCer offered potential advantages in wound healing acceleration and improvement through angiogenesis stimulation, fibroblast proliferation, and granulation tissue formation on early days of healing phases. Acceleration in wound repair was associated with earlier wound area reduction and enhanced tensile strength of damaged area by rearrangement of granulation tissue and collagen fibers. PEG-based nanocerium could have therapeutic benefits in wound healing.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-03-24T03:59:52Z
      DOI: 10.1177/1534734620912102
       
  • Abstracts
    • Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.

      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-03-13T04:32:52Z
      DOI: 10.1177/1534734620907019
       
  • Combined Use of Autologous Stromal Vascular Fraction Cells and
           Platelet-Rich Plasma for Chronic Ulceration of the Diabetic Lower Limb
           Improves Wound Healing
    • Authors: Shilu Yin, Xin Yang, Hongsen Bi, Zhenmin Zhao
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      The discovery of stromal vascular fraction cells and platelet-rich plasma in promoting tissue regeneration has prompted a new idea for the treatment of chronic diabetic ulcer of the lower limb. The study aim was to evaluate the clinical efficacy of a new method that applied stromal vascular fraction cells and platelet-rich plasma together in the treatment of recalcitrant chronic diabetic ulcer. We conducted a single-center, prospective, open, noncontrolled study. Four patients (5 ulcers in total) who had received standard treatment for diabetic ulcer for at least 3 months that failed to heal was enrolled. All patients were treated with surgical debridement, cell suspension (stromal vascular fraction cells suspended by platelet-rich plasma) injection into the wound, and platelet-rich plasma gel coverage. Wounds were measured every week after treatment using a 2-dimensional digital camera and a 3-dimensional wound measurement device. All patients were followed-up for 4 months after the treatment. Four of the 5 ulcers healed completely within a mean of 71.75 ± 29.57 days. The average proportion of granulation tissue achieved 100% within 4 weeks for all cases. The wound size decreased to less than half of the original size for all cases 4 weeks after the treatment. Findings revealed that the new treatment is efficient to achieve wound healing in patients with recalcitrant chronic diabetic ulcer of lower limb.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-03-05T05:33:58Z
      DOI: 10.1177/1534734620907978
       
  • Comparative Evaluation of Clinical Efficacy and Safety of Collagen
           Laminin–Based Dermal Matrix Combined With Resveratrol Microparticles
           (Dermalix) and Standard Wound Care for Diabetic Foot Ulcers
    • Authors: Şevki Çetinkalp, Evren Homan Gökçe, IlgınYıldırım Şimşir, Sakine Tuncay Tanrıverdi, Fatma Doğan, Çığır Biray Avcı, İpek Eroğlu, Tülün Utku, Cumhur Gündüz, Özgen Özer
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      This is an open, prospective, comparative parallel-arm medical device clinical study of Dermalix (Dx) in diabetic foot wounds. Dx is a 3-dimensional collagen-laminin porous-structured dermal matrix prepared and additionally impregnated with resveratrol-loaded hyaluronic acid and dipalmitoylphosphatidylcholine-based microparticles. The aim was to evaluate the efficacy and safety of Dx, an investigational medical device, in Wagner 1 and 2 wounds in comparison to a standard wound care (SWC) that consists of irrigation and cleaning with sterile saline solution. Forty-eight patients were randomized to receive either SWC or SWC + Dx. A 4-week treatment period was followed by a 2-month follow-up without treatment. The wound area measurement, total collagen, vascular epidermal growth factor, tumor necrosis factor, interleukin 1, caspase 3, glutathione, reduced/oxidized glutathione, and lipid peroxidation levels were evaluated. At the end of 4 weeks, the percentage closures of wounds were determined as 57.82% for Dx, and 26.63% for SWC groups. Dx had a significant effect on tumor necrosis factor, caspase 3, and reduced/oxidized glutathione levels. Dx provided 2 times faster wound healing and decreased oxidative stress. Application of Dx in the first phase of wound would help the wound area heal faster with a safe profile.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-03-05T05:28:41Z
      DOI: 10.1177/1534734620907773
       
  • The Association Between Elevated Foot Skin Temperature and the Incidence
           of Diabetic Foot Ulcers: A Meta-Analysis
    • Authors: Javier Ena, Juani Carretero-Gomez, Jose Carlos Arevalo-Lorido, Carmen Sanchez-Ardila, Antonio Zapatero-Gaviria, Ricardo Gómez-Huelgas
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Prior to the appearance of any foot ulcer, there is an increase in the local temperature due to the presence of an underlying inflammatory process. The use of thermometry to identify inflammation could make patients increase preventive measures until the inflammation disappears. We carried out a meta-analysis to determine the effectiveness of the daily measurement of the foot temperature in 6 points to prevent the occurrence of foot ulcers in patients with diabetes. Patients with temperature differences>4°F (2.2°C) between left and right corresponding sites should reduce activity and increase preventive measures until temperature is normalized. We searched the literature in MEDLINE, EMBASE, Cochrane Library, Web of Knowledge, and clinicaltrials.gov. We have only included randomized clinical trials where individuals were assigned to receive enhanced care (temperature measurement and standard care) versus standard care (education, self-care practices, and periodic clinical visits). We found 4 trials comprising 462 patients from the United States and Norway that met our inclusion criteria. The duration of follow-up varied from 4.5 to 15 months. Overall, 18 (7.9%) subjects in the enhanced foot care group and 53 (22.6%) in the standard foot care group developed foot ulcers (pooled risk ratio = 0.37; 95% confidence interval = 0.21-0.66; P = .0008; percentage of heterogeneity [I2], 25%; P = .26). The number needed to treat was 7 (95% confidence interval = 5-11). The results were robust after analysis by subgroups according to the potential risk of bias in the studies and the duration of follow-up.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-02-28T10:05:45Z
      DOI: 10.1177/1534734619897501
       
  • Effects of Preconditioning Local Vibrations on Subsequent Plantar Skin
           Blood Flow Response to Walking
    • Authors: Xiaotong Zhu, Fu-Lien Wu, Ting Zhu, Fuyuan Liao, Yuanchun Ren, Yih-Kuen Jan
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Weight-bearing exercise such as walking may increase risk of foot ulcers in people with diabetes mellitus (DM) because of plantar ischemia due to repetitive, high plantar pressure. Applications of local vibrations on plantar tissues as a preconditioning intervention before walking may reduce plantar tissue ischemia during walking. The objective of this study was to explore whether preconditioning local vibrations reduce reactive hyperemia after walking. A double-blind, repeated-measures, and crossover design was tested in 10 healthy participants without DM. The protocol included 10-minute baseline, 10-minute local vibrations (100 Hz or sham), 10-minute walking, and 10-minute recovery periods. The order of local vibrations was randomly assigned. Skin blood flow (SBF) was measured over the first metatarsal head during baseline and recovery periods. SBF responses were characterized as peak SBF, total SBF, and recovery time of reactive hyperemia. SBF was expressed as a ratio of recovery to baseline SBF to quantify the changes. Peak SBF in the vibration protocol (6.98 ± 0.87) was significantly lower than the sham control (9.26 ± 1.34, P < .01). Total SBF in the vibration protocol ([33.32 ± 7.98] × 103) was significantly lower than the sham control ([48.09 ± 8.9] × 103, P < .05). The recovery time in the vibration protocol (166.08 ± 32.71 seconds) was not significantly different from the sham control (223.53 ± 38.85 seconds, P = .1). Local vibrations at 100 Hz could reduce walking-induced hyperemic response on the first metatarsal head. Our finding indicates that preconditioning local vibrations could be a potential preventive intervention for people at risk for foot ulcers.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-02-26T04:41:34Z
      DOI: 10.1177/1534734620905744
       
  • Heel Reconstruction With Bipedicled Flap: A Salvage Procedure
    • Authors: Alper Burak Uslu, Ramazan Erkin Ünlü
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Reconstruction of the heel region poses great challenge to plastic surgeons not only due to calcaneal bone lying just deep to the subdermal fat pad but also due to easily exposed Achilles tendon. In order to achieve permanent closure of the heel defect, exposed bone or tendon—or both—should be covered with durable, preferably sensate, well-vascularized, thin skin flaps. Even though fasciocutaneous free flaps remain the gold standard in the reconstruction of heel defects with exposed bone or tendon, a significant number of these patients are older individuals with multiple comorbidities such as diabetes mellitus, hypertension, atherosclerosis, and peripheral vascular disease. In this study, with a clinic series consisting of 6 patients (1 female, 5 males), we present a new technique of reconstruction with a bipedicled flap as a safe, reliable, and efficient reconstructive modality in the treatment of heel defects in cases where free flaps and other more sophisticated reconstructive options are either not feasible or have failed. Achieving complete reconstruction of defects in all 6 patients, this technique proves to be successful as a salvage procedure in reconstruction of heel defects.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-02-24T05:20:24Z
      DOI: 10.1177/1534734620905738
       
  • 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
       
  • 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
       
  • COVID-19 and Diabetic Foot: Will the Lamp Burn Bright'
    • Authors: Nikolaos Papanas, Stella Papachristou
      First page: 111
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.

      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2020-04-22T05:28:09Z
      DOI: 10.1177/1534734620921382
       
  • 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
      First page: 165
      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
       
  • 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
      First page: 180
      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
      First page: 205
      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
       
 
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