Subjects -> EDUCATION (Total: 2346 journals)
    - ADULT EDUCATION (24 journals)
    - COLLEGE AND ALUMNI (10 journals)
    - E-LEARNING (38 journals)
    - EDUCATION (1996 journals)
    - HIGHER EDUCATION (140 journals)
    - INTERNATIONAL EDUCATION PROGRAMS (4 journals)
    - ONLINE EDUCATION (42 journals)
    - SCHOOL ORGANIZATION (14 journals)
    - SPECIAL EDUCATION AND REHABILITATION (40 journals)
    - TEACHING METHODS AND CURRICULUM (38 journals)

EDUCATION (1996 journals)            First | 1 2 3 4 5 6 7 8 | Last

Showing 601 - 800 of 857 Journals sorted alphabetically
Frühe Bildung     Hybrid Journal   (Followers: 3)
Ganesha Journal     Open Access  
Gazi Üniversitesi Gazi Eğitim Fakültesi Dergisi     Open Access  
Gelanggang Pendidikan Jasmani Indonesia     Open Access  
Geographical Education     Full-text available via subscription   (Followers: 2)
Georgia Educational Researcher     Open Access  
Georgia Journal of College Student Affairs     Open Access  
Gestión de la educación     Open Access  
Gifted Child Quarterly     Hybrid Journal   (Followers: 6)
Gifted Education International     Hybrid Journal   (Followers: 7)
Global Education Review     Open Access   (Followers: 3)
Global Journal of Educational Research     Full-text available via subscription   (Followers: 2)
Global Journal of Educational Studies     Open Access  
Global Studies of Childhood     Full-text available via subscription   (Followers: 2)
Globalisation, Societies and Education     Hybrid Journal   (Followers: 12)
Góndola, Enseñanza y Aprendizaje de las Ciencias. (Bogotá, Colombia)     Open Access  
Graduate School Journal Chiang Rai Rajabhat University     Open Access  
Greater Faculties: A Review of Teaching and Learning     Open Access  
Grief Matters : The Australian Journal of Grief and Bereavement     Full-text available via subscription   (Followers: 12)
GSTF Journal on Education     Open Access  
Hachetetepé. Revista científica de Comunicación y Educación     Open Access   (Followers: 1)
HAMUT'AY     Open Access  
Harvard Educational Review     Full-text available via subscription   (Followers: 22)
HCU Journal     Open Access  
Headteacher Update     Full-text available via subscription   (Followers: 12)
Health Education & Behavior     Hybrid Journal   (Followers: 14)
Health Education Research     Hybrid Journal   (Followers: 18)
Health Professions Education     Open Access   (Followers: 2)
Herausforderung Lehrer_innenbildung     Open Access  
High Ability Studies     Hybrid Journal   (Followers: 3)
High School Journal     Full-text available via subscription   (Followers: 4)
Higher Education     Hybrid Journal   (Followers: 153)
Higher Education Abstracts     Full-text available via subscription   (Followers: 18)
Higher Education in Europe     Hybrid Journal   (Followers: 13)
Higher Education Policy     Hybrid Journal   (Followers: 31)
Higher Education Quarterly     Hybrid Journal   (Followers: 140)
Higher Education Research & Development     Hybrid Journal   (Followers: 142)
Hikma : Journal of Islamic Theology and Religious Education     Hybrid Journal  
Histoire de l'éducation     Open Access   (Followers: 5)
História & Ensino     Open Access  
Historical and Social-educational Ideas     Open Access  
Historical Studies in Education / Revue d'histoire de l'éducation     Open Access   (Followers: 3)
History of Education Quarterly     Hybrid Journal   (Followers: 11)
History of Education Review     Hybrid Journal   (Followers: 10)
History of Education: Journal of the History of Education Society     Hybrid Journal   (Followers: 39)
HONAI : International Journal for Educational, Social, Political & Cultural Studies     Open Access  
Hoosier Science Teacher     Open Access  
Horyzonty Wychowania     Open Access  
HOW Journal     Open Access  
HSE - Social and Education History     Open Access  
Human Studies: a collection of scientific articles of the Drohobych Ivan Franko State Pedagogical University. Series of “Pedagogy”     Open Access  
Humanidades : Revista de la Universidad de Montevideo     Open Access  
Huria : Journal of the Open University of Tanzania     Full-text available via subscription   (Followers: 2)
i.e. : inquiry in education     Open Access  
IALLT Journal of Language Learning Technologies     Open Access   (Followers: 1)
Ibriez : Jurnal Kependidikan Dasar Islam Berbasis Sains     Open Access  
IE Revista de Investigación Educativa de la REDIECH     Open Access  
IEEE Potentials     Full-text available via subscription   (Followers: 42)
IEEE Revista Iberoamericana de Tecnologias del Aprendizaje     Hybrid Journal  
IEEE Transactions on Education     Hybrid Journal   (Followers: 11)
IJ-ATL (International Journal of Arabic Teaching and Learning)     Open Access   (Followers: 1)
IJEE (Indonesian Journal of English Education)     Open Access  
IJEM - International Journal of Educational Leadership and Management     Open Access   (Followers: 13)
IJERI : International Journal of Educational Research and Innovation     Open Access   (Followers: 1)
IJLRES : International Journal on Language Research and Education Studies     Open Access  
IJOLTL : Indonesian Journal of Language Teaching and Linguistics     Open Access  
Ilmu Pendidikan: Jurnal Kajian Teori dan Praktik Kependidikan     Open Access  
Imagens da Educação     Open Access  
Impact : The Philosophy of Education Society of Great Britain     Free   (Followers: 4)
Impacting Education : Journal on Transforming Professional Practice     Open Access   (Followers: 1)
Improvement : Jurnal Ilmiah Untuk Peningkatan Mutu Manajemen Pendidikan     Open Access  
Improving Schools     Hybrid Journal   (Followers: 6)
Indian Journal of Continuing Nursing Education     Open Access   (Followers: 3)
Indivisa. Boletin de Estudios e Investigacion     Open Access  
INDONESIA : Jurnal Pembelajaran Bahasa dan Sastra Indonesia     Open Access  
Indonesia Performance Journal     Open Access  
Indonesian Basic Education Journal     Open Access  
Indonesian Journal Of Civil Engineering Education     Open Access  
Indonesian Journal of Contemporary Education     Open Access  
Indonesian Journal of Curriculum and Educational Technology Studies     Open Access   (Followers: 2)
Indonesian Journal of Early Childhood Education Studies     Open Access   (Followers: 2)
Indonesian Journal of Educational Review     Open Access   (Followers: 1)
Indonesian Journal of Educational Studies     Open Access  
Indonesian Journal of Guidance and Counseling     Open Access  
Indonesian Journal of Learning Education and Counseling     Open Access  
Indonesian Journal of Pharmaceutical Education     Open Access  
Indonesian Journal of Science and Mathematics Education     Open Access   (Followers: 2)
Indonesian Journal of Sociology and Education Policy     Open Access   (Followers: 1)
Indonesian Journal on Learning and Advanced Education     Open Access  
Industrial Management & Data Systems     Hybrid Journal   (Followers: 8)
Industry and Higher Education     Full-text available via subscription   (Followers: 10)
Infancia y Aprendizaje : Journal for the Study of Education and Development     Hybrid Journal  
Infancias Imágenes     Open Access  
Inferensi : Jurnal Penelitian Sosial Keagamaan     Open Access  
INFORMS Transactions on Education     Open Access  
Innoeduca. International Journal of Technology and Educational Innovation     Open Access  
Innovación educativa     Open Access  
Innovaciones Educativas     Open Access  
Innovation in Language Learning and Teaching     Hybrid Journal   (Followers: 35)
Innovations in Education and Teaching International     Hybrid Journal   (Followers: 24)
Innovations in Practice     Open Access  
Innovative Higher Education     Hybrid Journal   (Followers: 85)
Innovative Journal of Curriculum and Educational Technology     Open Access   (Followers: 6)
İnönü Üniversitesi Eğitim Fakültesi Dergisi     Open Access  
İnönü University Journal of the Graduate School of Education     Open Access  
INOPENDAS : Jurnal Ilmiah Kependidikan     Open Access  
Inspiramatika     Open Access  
Instructional Science     Hybrid Journal   (Followers: 13)
Integral Transforms and Special Functions     Hybrid Journal  
Interacções     Open Access  
InterActions: UCLA Journal of Education and Information     Open Access   (Followers: 11)
Interchange     Hybrid Journal   (Followers: 2)
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 Education Research     Open Access   (Followers: 3)
Interdisciplinary Journal of Information, Knowledge, and Management     Open Access   (Followers: 12)
Interdisciplinary Journal of Problem-based Learning     Open Access   (Followers: 5)
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 Studies     Open Access   (Followers: 7)
International Educational Research     Open Access   (Followers: 1)
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: 7)
International Journal for Educational Integrity     Open Access   (Followers: 2)
International Journal for Lesson and Learning Studies     Hybrid Journal   (Followers: 2)
International Journal for Research in Vocational Education and Training     Open Access   (Followers: 7)
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: 2)
International Journal of Active Learning     Open Access  
International Journal of Advanced Multidisciplinary Research and Review     Open Access  
International Journal of Aquatic Research and Education     Hybrid Journal  
International Journal of Art & Design Education     Hybrid Journal   (Followers: 24)
International Journal of Assessment Tools in Education     Open Access   (Followers: 3)
International Journal of Bilingual Education and Bilingualism     Hybrid Journal   (Followers: 20)
International Journal of Bullying Prevention     Hybrid Journal   (Followers: 1)
International Journal of Business, Humanities, Education and Social Sciences     Open Access   (Followers: 1)
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: 2)
International Journal of Cognitive Research in Science, Engineering and Education     Open Access   (Followers: 8)
International Journal of Comparative Education and Development     Hybrid Journal  
International Journal of Construction Education and Research     Hybrid Journal   (Followers: 2)
International Journal of Contemporary Educational Research     Open Access   (Followers: 1)
International Journal of Continuing Engineering Education and Life-Long Learning     Hybrid Journal   (Followers: 4)
International Journal of Critical Pedagogy     Open Access   (Followers: 5)
International Journal of Culture and Modernity     Open Access  
International Journal of Curriculum and Instruction (IJCI)     Open Access   (Followers: 3)
International Journal of Cyber Ethics in Education     Full-text available via subscription   (Followers: 2)
International Journal of Designs for Learning     Open Access   (Followers: 6)
International Journal of Disability, Development and Education     Hybrid Journal   (Followers: 34)
International Journal of Distance Education Technologies     Full-text available via subscription   (Followers: 7)
International Journal of Early Childhood     Hybrid Journal   (Followers: 12)
International Journal of Early Years Education     Hybrid Journal   (Followers: 9)
International Journal of Education     Open Access   (Followers: 16)
International Journal of Education and Development using Information and Communication Technology     Open Access   (Followers: 9)
International Journal of Education and Literacy Studies     Open Access   (Followers: 7)
International Journal of Education in Mathematics, Science and Technology     Open Access   (Followers: 11)
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: 14)
International Journal of Educational Psychology     Open Access   (Followers: 18)
International Journal of Educational Reform     Full-text available via subscription  
International Journal of Educational Research     Hybrid Journal   (Followers: 29)
International Journal of Educational Research Open     Open Access  
International Journal of Educational Technology     Open Access   (Followers: 11)
International Journal of Electrical Engineering Education     Hybrid Journal   (Followers: 5)
International Journal of Emerging Technologies in Learning     Open Access   (Followers: 10)
International Journal of English Language Education     Open Access   (Followers: 13)
International Journal of English Language Teaching     Open Access   (Followers: 4)
International Journal of Ethics Education     Hybrid Journal   (Followers: 1)
International Journal of Evaluation and Research in Education     Open Access   (Followers: 5)
International Journal of Foreign Language Teaching and Research     Open Access   (Followers: 3)
International Journal of Health Administration and Education Congress (Sanitas Magisterium)     Open Access  
International Journal of Health Promotion and Education     Hybrid Journal   (Followers: 11)
International Journal of Holistic Early Learning and Development     Open Access   (Followers: 1)
International Journal of Inclusive Education     Hybrid Journal   (Followers: 30)
International Journal of Indonesian Education and Teaching     Open Access   (Followers: 1)
International Journal of Information and Operations Management Education     Hybrid Journal   (Followers: 6)
International Journal of Innovation in Education     Hybrid Journal   (Followers: 8)
International Journal of Innovative Research in Education     Open Access   (Followers: 1)
International Journal of Instructional Technology and Educational Studies     Open Access   (Followers: 1)
International Journal of Knowledge and Learning     Hybrid Journal   (Followers: 4)
International Journal of Language Teaching and Education     Open Access  
International Journal of Leadership in Education: Theory and Practice     Hybrid Journal   (Followers: 23)
International Journal of Learning and Development     Open Access   (Followers: 3)
International Journal of Learning and Intellectual Capital     Hybrid Journal   (Followers: 1)
International Journal of Lifelong Education     Hybrid Journal   (Followers: 12)
International Journal of Lower Extremity Wounds     Hybrid Journal   (Followers: 4)
International Journal of Management Education     Hybrid Journal   (Followers: 11)
International Journal of Management in Education     Hybrid Journal   (Followers: 6)

  First | 1 2 3 4 5 6 7 8 | Last

Similar Journals
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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  [1174 journals]
  • Autumn’s Golden Leaves

    • Free pre-print version: Loading...

      Authors: Nikolaos Papanas, Massimo Papi, Kittipan Rerkasem
      Pages: 205 - 206
      Abstract: The International Journal of Lower Extremity Wounds, Volume 21, Issue 3, Page 205-206, September 2022.

      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-07-19T12:15:57Z
      DOI: 10.1177/15347346221113220
      Issue No: Vol. 21, No. 3 (2022)
       
  • Bentonite Nanoparticles and Honey Co-Administration Effects on Skin Wound
           Healing: Experimental Study in the BALB/c MICE

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      Authors: Masoumeh Askari, Mohammad Afshar, Ali Naghizadeh, Mohsen Khorashadizadeh, Mahmoud Zardast
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      In recent years, nanotechnology and the subsequent production of nanoparticles have developed excellent methods for medical applications, including wound healing. One of these nanoparticles is bentonite nanoparticles (BNPs) which show high ability in tissue engineering. But our knowledge of its effectiveness in wound healing is based on little data. Therefore, the main purpose of this study was to evaluate the wound healing ability of BNPs and in the next step the suitability of honey as a solvent for these nanoparticles. Methods: In this experimental study, an excisional wound injury model was developed in adult male BALB/c mice (n = 60) by creative two equal-sized wounds (5 mm) on either side of their back midline. The animals were allocated into five groups (n = 12 each) as untreated control (U), honey (H), polyethylene glycol (P), and (BNPs) dissolved in honey or polyethylene glycol (H + BNPs, P + BNPs). Animals have received their relative topical treatments twice per day for 14 consecutive days. Tissue sampling was carried out on days 4, 7, 10, and 14. The tissue sections were stained with hematoxylin and eosin and Trichrome-Masson staining methods. The histomorphological parameters including inflammatory cells infiltration, fibroblasts, re-epithelialization, granulation formation, and collagenases were evaluated in all tissue sections. Data were analyzed by SPSS 16 software. Comparison between the groups was performed by one-way analysis of variance following Tukey's post-hoc test. Compared to the control group, BNPs showed significant wound healing activities with lower inflammatory cells infiltration, higher fibroblastosis and new epithelium thickness, and greater granulation area and collagen fibers density in the ulcer bed. In addition, honey as a solvent synergistically increased the wound healing activity of the studied nanoparticle. These results for the first time are clearly showing that BNPs have a promising wound healing activity, especially when applied with honey concurrently.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-08-11T12:21:58Z
      DOI: 10.1177/15347346221118497
       
  • Catalytic Nanomedicine – A new Approach and Solution for Chronic
           Ulcers: Case Series

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      Authors: Tessy López-Goerne, Paola Ramírez, Alba Arévalo, Mireya Huantes, Francisco J. Padilla-Godínez
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Chronic ulcers are a major public health problem, due to their chronic nature, their poor response to treatment, the high frequency of recurrences, and their affection to the patient’s quality of life. Even with the development of new therapies in the field of chronic wound care, chronic ulcers remain a clinical problem. As a novel branch of research, Catalytic Nanomedicine has offered promising results in disinfection and treatment of chronic wounds through the use of bionanocatalysts, organically functionalized mesoporous nanostructured materials with catalytic properties. Particularly, Cu/TiO2-SiO2 mixed oxide bionanocatalysts have shown favorable results for chronic ulcer healing. In this work, we present the treatment of 15 patients (8 females and 7 males, mean age of 69.59 ± 12.07 years old) affected with chronic ulcers (wound age ranging from 4 months to 10 years old, mean size of 12.94 ± 18.20 cm2) by the administration of Cu/TiO2-SiO2 bionanocatalysts embedded in a nanoemulsion matrix. In all cases, complete epithelialization and healing of the lesions was achieved (healing time from 3 to 35 weeks), without the appearance of side effects. Wound healing time was analyzed in the context of initial wound size, wound’s age, patient’s age, and concomitant conditions, being wound size and patient’s age the main factor affecting the duration of the treatment with the bionanocatalysts.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-08-09T07:54:40Z
      DOI: 10.1177/15347346221119006
       
  • Prospective Validation of the Value of Adding Osteomyelitis to Moderate
           and Severe Categories of Diabetic Foot Infections

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      Authors: Javier Aragón-Sánchez, Gerardo Víquez-Molina, María Eugenia López-Valverde, José María Rojas-Bonilla
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      We aimed to validate the value of adding osteomyelitis (OM) to moderate and severe categories of diabetic foot infections (DFIs) classification. We conducted a prospective study of a cohort of 200 patients with moderate and severe infections. Variables associated with prognosis were need for any amputation, major amputation, need for hospitalization, length of hospitalization, length of antibiotic therapy, reinfection rate and infection-related mortality. Infections were moderate in 111 cases (55.5%) and severe in 89 (44.5%). OM was diagnosed in 114 cases (57%), 73 presented as moderate (36.5%) and 41 as severe (20.5%). Overall, 129 patients (64.5%) were admitted for a median of 15 days (IQR 13) and 71 (35.5%) were treated as outpatients (day-surgery). Ninety-four patients (47%) were exclusively treated with intravenous antibiotics, 35 (17.5%) with intravenous and then shifting to oral, 16 (8%) exclusively with oral antibiotics, and 55 (27.5%) without antibiotics. Definitive surgery that led to the arrest of the infection was as follows: 117 patients (58.5%) underwent surgical debridement without amputation, and 69 (34.5%) underwent minor and 14 (7%) major amputation. Patients with OM presented as severe had a higher rate of amputations, major amputations, hospitalizations and need for antibiotic therapy when compared with OM presented as moderate. OM is strongly recommended to be added to the moderate and severe categories of the Infectious Diseases Society of America/International Working Group on Diabetic Foot severity system, as recommended by the International Working Group on Diabetic Foot 2019 guidelines.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-08-04T07:21:23Z
      DOI: 10.1177/15347346221116740
       
  • Adherence to at-Home Monitoring of Foot Temperatures in People with
           Diabetes at High Risk of Ulceration

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      Authors: F.J. Rovers, J.J. Van Netten, T.E. Busch-Westbroek, W.B. Aan de Stegge, S.A. Bus
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      We aimed to investigate adherence to at-home monitoring of foot temperature and its association with patient-, disease- and behavior-related factors, in people with diabetes at high risk of ulceration. We analyzed 151 participants in the enhanced therapy arm of the DIATEMP trial (all at high diabetes-related foot ulcer risk) who aimed to perform and log foot temperatures daily for 18 months or until ulceration. Adherence was the proportion of measurement days covered (PDC), with being adherent defined as PDC≥70%. If a hotspot was recorded, adherence to subsequently reducing ambulatory activity was assessed. Multivariate logistic regression analysis was performed to investigate associations with adherence. We found ninety-four participants (62.3%) adherent to measuring foot temperatures. This was higher in months 1-3 versus months 4-18: 118 (78.1%) versus 78 (57.4%; P 
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-07-16T03:13:03Z
      DOI: 10.1177/15347346221114565
       
  • Does Obstructive Sleep Apnoea Syndrome Influence the Development and
           Treatment of Diabetic Foot' A Brief Narrative Review

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      Authors: Evanthia Gouveri, Paschalis Steiropoulos, Nikolaos Papanas
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Both obstructive sleep apnoea syndrome (OSAS) and diabetes mellitus (DM) are common conditions that often coexist and share many similar risk factors. Diabetic foot is a common complication of DM, which may lead to lower-limb amputation. OSAS is considered a risk factor for type 2 DM (T2DM). There is also evidence that OSAS may be linked with the development, as well as the healing of diabetic foot. Multiple mechanisms triggered by sleep fragmentation and intermittent hypoxaemia in OSAS could contribute to the development of diabetic foot ulcers (DFUs). More interestingly, emerging evidence implies a favourable impact of continuous positive airway pressure (CPAP) treatment on DFU healing. Healing DFUs and minimising recurrence rates remains a challenge for health care professionals. In this context, management of OSAS might prove a useful therapeutic adjunct for DFUS. However, data is still limited and randomised controlled trials are needed to further explore this interesting potential.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-07-14T08:09:52Z
      DOI: 10.1177/15347346221113992
       
  • Polarized Light Therapy in the Treatment of Wounds: A Review

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      Authors: Nesma M. Allam, Hadaya Mosaad Eladl, Marwa M. Eid
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      The most prevalent type of photo therapies are low-level laser therapy (LLLT) and ultraviolet (UV) treatments, which are distinguished by the physical properties of the light employed. However, in latest years, it has been suggested that polarization and an extensive light band including all light spectra are essential aspects in light treatment. Light waves are filtered to align and vibrate in a single plane, resulting in polarized light (PL). Light that has been polarized can penetrate tissues more deeply than light that has not been polarized. The visible light spectrum is very broad. PL varies from other types of light therapy in that it uses a considerably wider spectrum of wavelengths than LLLT or UV. As a result, PLT devices are often less expensive and simple to operate. Since the late 1960s, light therapy has been used to treat anything from neonatal jaundice to psoriasis and vitiligo. Fenyö created a PL source and found that it can stimulate wound healing in a similar way to the low-energy laser. In comparison to the laser, this source of light had numerous gains: lesser prices, fewer hazards, a greater area to be treated, and no sophisticated user expertise. Despite several findings from fundamental research (in vitro, in vivo, and animal trials), practitioners continue to have reservations regarding PL's potency and utility in treating musculoskeletal problems. It is even largely believed that the commercial use of these therapies is validated by a sufficient amount of scientific evidence based on reliable clinical papers. The major goal of this study is to gather information on the use of PL for treatment of various wound types in animal and human investigations.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-07-14T08:09:34Z
      DOI: 10.1177/15347346221113991
       
  • At-home Topical Sevoflurane Added to the Conventional Analgesic Treatment
           for Painful leg Ulcers Greatly Improved the Analgesic Effectiveness and
           Reduced Opioid Consumption in a Single-Center Retrospective Comparative
           Study with one-Year Follow-up

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      Authors: Manuel Cortiñas-Sáenz, F. Dámaso Fernández-Ginés, Carmen Selva-Sevilla, Manuel Gerónimo-Pardo
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      The general anesthetic sevoflurane is being repurposed as a topical analgesic for painful chronic wounds. This study was aimed to compare the analgesic effectiveness and safety of systemic analgesics alone or plus at-home topical sevoflurane for the management of patients with painful nonrevascularizable leg ulcers who were referred to a Pain Clinic by their attending vascular surgeons. We reviewed charts of patients treated in a single Pain Clinic with analgesic Standard of Care either alone (group SoC) or plus at-home topical sevoflurane (group SoC + Sevo), according to safety criteria. The area under the curve of pain over a year (AUC-Pain) was the primary outcome for analgesic effectiveness. Opioids were converted into Oral Morphine Milligram Equivalents. Groups SoC (n = 26) and SoC + Sevo (n = 38) were similar in baseline characteristics. Compared to SoC, median values [interquartile range] of area under the curve of pain for one-year follow-up were markedly lower for SoC + Sevo (54 [35-65] vs. 15 [11-23]; p 
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-07-14T08:09:28Z
      DOI: 10.1177/15347346221111418
       
  • Is in-Shoe Microclimate a Neglected Contributor in the Pathway to Diabetic
           Foot Ulceration'

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      Authors: S. Mizzi, I. Swaine, K. Springett
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      The identification of the key contributing factors which predispose the foot to ulceration, increasing the risk of recurrence and slow wound healing in diabetes mellitus (DM), has led to some significant research studies over the last 30 years, providing valuable insight into the mechanism leading to diabetic foot ulceration (DFU). Although, these contributory factors are similar to those identified in pressure ulceration occurring in other parts of the body (such as “bed pressure sores’) where magnitude and/or duration of mechanical stress in the presence of sensory deficits are key causal factors, research investigating pressure ulceration has also included measurement of temperature and relative humidity at the interface between the skin and supporting surface. The possible influence of these parameters (in-shoe temperature and humidity) does not appear frequently in diabetic foot ulceration research. Referred to as “microclimate”, this has an important role in the pathway to tissue breakdown evidenced in pressure ulcer research and may be particularly relevant in countries with warm and humid climates. As the microclimate is influential in the ulceration pathway for other body sites, its role in the DFU causal pathway justifies further investigation.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-07-06T06:49:54Z
      DOI: 10.1177/15347346221112257
       
  • Sarcopenia, Frailty and Diabetic Foot: A Mini Narrative Review

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      Authors: Nikolaos D. Karakousis, Elisavet E. Pyrgioti, Petros N. Georgakopoulos, Nikolaos Papanas
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      The aim of this narrative mini review was to investigate the potential association of the diabetic foot (DF) with sarcopenia and frailty. Data is still limited, but it appears that DF patients may be more prone to frailty. In addition, patients with DF and sarcopenia exhibit more frequently foot ulcers and amputations, as well as increased mortality rates post-operatively. Further studies are now needed to see how these realizations may be used in clinical practice, aiming to improve DF outcomes.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-07-06T06:49:25Z
      DOI: 10.1177/15347346221111420
       
  • Full Diabetic Foot Ulcer Healing and Pain Relief Based on
           Platelet-Rich-Plasma gel Formulation Treatment and the Involved Pathways

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      Authors: Krissia Caroline Leme, Guilherme Martins Neri, Gabriel Gaspar Biscaro, Andreia Afaz Bulgareli, Nelson Duran, Maria Candida Ribeiro Parisi, Ângela Cristina Malheiros Luzo
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Diabetic foot ulcer is a severe Diabetic Mellitus-associated complication. It is induced by poor glycemic control, which leads to peripheral neuropathy and vascular diseases. Platelet-rich plasma could be beneficial for healing processes due to its active biomolecules that promotes immunomodulation, angiogenesis, cell proliferation and analgesia.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-07-04T05:41:36Z
      DOI: 10.1177/15347346221109758
       
  • Foot Self-Care Behaviour among People with Type 2 Diabetes mellitus Living
           in Rural Underserved Area of North India: A Community-Based
           Cross-Sectional Study

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      Authors: Saurabh Kumar Gupta, Ashu Rastogi, Manmeet Kaur, Sunita Malhotra, P.V.M. Lakshmi
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      The objective of this study was to ascertain the foot self-care behaviour and its associated factors among people with type 2 diabetes mellitus (T2DM) living in the rural resource-constrained health setting of Punjab, North India. A community based cross sectional study was undertaken in the randomly selected underserved rural area of District Fatehgarh Sahib, Punjab, North India. A pre-validated Nottingham Assessment of Functional Footcare (NAFF) scale was administered to assess foot self-care behaviour, and participants were classified based on the percentage of a maximum possible score of 84 on the scale, as poor, if the score was 70% good foot self-care behaviour. A total of 700 participants’ responses were recorded. The study results revealed that 84% (588) of the respondents had poor, 16% (112) had satisfactory, and none were following good foot self-care behaviour. An outcome of multivariable logistics regression suggested satisfactory foot self-care behaviour was significantly associated with foot self-care education, with an adjusted odds ratio (aOR) of 2.83 (95%, CI:1.62 - 4.93; p 
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-06-27T06:53:16Z
      DOI: 10.1177/15347346221110074
       
  • Epidemiology of Diabetes Foot Amputation and its Risk Factors in the
           Middle East Region: A Systematic Review and Meta-Analysis

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      Authors: Fatemeh Bandarian, Mostafa Qorbani, Ensieh Nasli-Esfahani, Mahnaz Sanjari, Camelia Rambod, Bagher Larijani
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      This study aimed to review epidemiology of diabetic foot (DF) amputation and provide a pooled estimation of DF amputation rate in the region. A comprehensive search was performed in Web of Science, PubMed, Scopus and EMBASE databases using appropriate search term. Obtained records were entered endnote software and after removing duplicats were screened by title, abstract and full text. Data was extracted from the remained documents. Random effect meta-analysis was used to pool the estimated prevalence rate due to sever heterogeneity between studies. Finally 17 articles in diabetes, 20 in patients with DFU (diabetic foot ulcer) and two in both remained after screening and included in meta-analysis. Overall pooled amputation rate in diabetes was 2% (95% CI: 1%-3%) which was not significantly different between countries. The pooled prevalence of amputation rate in DFU patients was 33% (24%-43%) and the pooled prevalence in Saudi Arabia was significantly higher than in other countries. The estimated rate of foot amputation in diabetes patients and those with DFUs in the Middle East region is approximately high, which may indicate low quality of preventive foot care, low socioeconomics and low patients awareness or education in countries with high amputation rate.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-06-22T06:55:23Z
      DOI: 10.1177/15347346221109057
       
  • Antibiotic-loaded Bone Cement Combined with Vacuum-assisted Closure
           Facilitating Wound Healing in Wagner 3-4 Diabetic Foot Ulcers

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      Authors: Yan-Wei Sun, Liang Li, Zhi-Hua Zhang
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      This study explored the clinical effectiveness of antibiotic-loaded bone cement (ALBC) combined with vacuum-assisted closure (VAC) on the treatment of Wagner 3-4 diabetic foot ulcers (DFUs). This is a retrospective study, including 32 patients with Wagner 3-4 DFUs who had undergone treatment between August 2019 and June 2021. Patient age, sex, Hemoglobin A1c (HbA1c), body mass index (BMI), ankle brachial index (ABI), white blood cells (WBC), C-reactive protein (CRP) levels, comorbidities and wound closure methods were recorded. Patients were divided into the study group and control group according to the treatment modality. Patients in the study group received the combination treatment of ALBC and VAC, while patients in the control group received single VAC treatment. Clinical endpoints were assessed and compared between the two groups, including wound complete healing time and complications after operation. All patients were followed-up 6 months postoperation. Results showed that the mean healing time of the study group (44.20 ± 16.72 days) was shorter than that of the control group (64.00 ± 29.85 days) (P 
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-06-16T06:03:28Z
      DOI: 10.1177/15347346221109045
       
  • The Leg Subcutaneous Tissue Calcification and Venous Ulcer-a Case Series

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      Authors: Zhoupeng Wu, Yukui Ma, Xiaorong Wen
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Ultrasonography of patients with venous ulcers showed subcutaneous tissue calcification (STC)in some patients. However, calcification is rarely included in venous ulcer-related changes. The aim of this study was to evaluate the prevalence and morphological changes of STC in patients with ultrasonographically diagnosed with venous ulcers. A total of 80 legs of 40 patients with venous ulcers (28 women and 12 men, mean age 48 years, range 18-83 years) were included in this study. After ultrasonographic evaluation of the patient's deep, superficial, and perforating veins, continue to use ultrasonography to examine the patient's subcutaneous tissue for the presence of STC. According to the CEAP (Clinical, Etiological, Anatomical, Pathophysiological) classification of Group C, 18 legs were classified as C5 and 62 as C6. STC was present in 38 of the 80 legs, most of which were patients classified as C6.STC are easily detected by ultrasound, especially in the injured area of the leg in C6 patients. STC may be associated with chronic inflammation of the subcutaneous tissue. It is recommended to remove it from the ulcer bed to promote ulcer healing and prevent recurrence. Further studies are needed to determine its prognostic significance and other possible clinical implications.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-06-06T04:59:14Z
      DOI: 10.1177/15347346221106578
       
  • Cinnamon Nanoparticles Loaded on Chitosan- Gelatin Nanoparticles Enhanced
           Burn Wound Healing in Diabetic Foot Ulcers in Rats

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      Authors: Amirreza Hajati Ziabari, Mostafa Asadi Heris, Seyed Mohammad Doodmani, Alireza Jahandideh, Kave Koorehpaz, Rahim Mohammadi
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      The objective of this work was to investigate impact of Cinnamon nanoparticles loaded on chitosan- gelatin nanoparticles on burn wound healing in diabetic foot ulcers in rat. We included sixty male rats into four groups. There were 15 animals in each group as follow: DFU group: We treated the burn wounds with normal saline (0.1 mL). DFU/SSD group: In this group, the wounds were with silver sulfadiazine 1% ointment. DFU/CGNP: In this group, the burn wounds were treated with chitosan-gelatin nanoparticles based ointment (0.05 mg/mL). DFU/CNP-CGNP group: In this group, the wounds were treated with CN-CGNPs (0.05 mg/mL). Wound area reduction measurements, biochemistry, histomorphometrical studies, hydroxyproline levels and reverse transcription polymerase chain reaction for caspase 3, Bcl-2, and p53 showed significant difference between rats in DFU/CNP-CGNP group in comparison with other groups (P 
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-06-06T04:59:05Z
      DOI: 10.1177/15347346221101245
       
  • The Ability of Clinical Decision Rules to Detect Peripheral Arterial
           Disease: A Narrative Review

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      Authors: Amaraporn Rerkasem, Rawee Nopparatkailas, Sothida Nantakool, Rath Rerkasem, Chayatorn Chansakaow, Poon Apichartpiyakul, Arintaya Phrommintikul, Kittipan Rerkasem
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Peripheral arterial disease (PAD) is a common cause of lower extremity wound. Consequently, PAD leads to a cause of leg amputation nowadays, especially in diabetic patients. In general practice (GP), confrontation with PAD prevention is a challenge. In general, ankle-brachial index (ABI) measurement can be used as a PAD diagnostic tool, but this takes some time. The tool is not generally available and this need to train healthcare workers to perform. Multiple independent predictors developed the diagnostic prediction model known as clinical decision rules (CDRs) to identify patients with high-risk PAD. This might therefore limit the number of patients (only high-risk patients) to refer for ABI evaluation. This narrative review summarized existing CDRs for PAD.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-05-31T03:29:47Z
      DOI: 10.1177/15347346221104590
       
  • Local Ozone Therapy in Complex Treatment of Venous Leg Ulcers: Ozone
           therapy for venous leg ulcers

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      Authors: Jarosław Pasek, Sebastian Szajkowski, Grzegorz Cieślar
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      A significant health problem in many countries of the world is the occurrence of hard to heal leg ulcers. In recent years modern methods of physical medicine in comprehensive treatment have been used often including ozone therapy. The study included 54 patients, 25 male and 29 female in age between 39 and 87 years (mean age: 66.7 ± 11.9 years) with venous leg ulcers who underwent a cycle of local ozone therapy. The progress in wound healing was evaluated by computerized planimetry and pain intensity was assessed with use a visual analog scale (VAS) . As a result of the applied local ozone therapy a statistically significant reduction of the ulcer area was achieved from median 7.1 (5.6-9.4) cm2 to 4.4 (3-7) cm2 (P = .000001), which was on median 38.74 (27.27-51.42)% compared to the baseline values ​​before the start of the therapy. In 2 patients (3.7%) the ulcers were completely healed. 18 patients (33.3%) achieved a reduction in ulcer area of ​​more than 50% of the baseline value and the remaining 34 patients (63%) also achieved a reduction in ulcer area. A statistically significant in the percentage of surface area was observed in the group of 19 patients suffering from> 5 years of age compared to the group of 35 patients suffering from ≤5 years (median 50 (32.03-67.16)% versus 33.96 (23.71-45); P = .033178), while percentage changes in ulcer surface area did not differ significantly between all other subgroups of patients. There was also a statistically significant reduction in the intensity of pain in VAS scale in all patients, median 6 (5-7) points before treatment versus 4.4 (3-7) points after treatment, P = .000001). Local ozone therapy of venous leg ulcers accelerate the healing process of ulcers in objective planimetric assessment and reduce the intensity of pain ailments.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-05-31T02:18:32Z
      DOI: 10.1177/15347346221104611
       
  • Clinical and Histological Outcomes of Negatively Charged Polystyrene
           Microspheres Applied Daily Versus Three Times per Week in Hard-to-Heal
           Diabetic Foot Ulcers: A Randomized Blinded Controlled Trial

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      Authors: José Luis Lázaro-Martínez, Marta García-Madrid, Mateo López-Moral, Aroa Tardáguila-García, Francisco Javier Álvaro-Afonso, Yolanda García-Álvarez
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Negatively charged polystyrene microspheres (NCMs) have been demonstrated as a novel and effective therapy for managing hard-to-heal diabetic foot ulcers (DFUs). However, one limitation of this therapy is that the protocol is based on daily application, which sometimes does not fit local protocols of wound care. Thus, we aimed to analyze the safety and efficacy of a new dose regimen. We conducted a randomized blinded controlled trial in a specialized diabetic foot unit between May 2019 and February 2021 with a total of 30 patients who had neuropathic or neuroischemic DFUs that had not responded after four weeks of standard treatment. Patients were randomized consecutively into a group that received daily application (control) or one that received applications three times per week (experimental). The clinical outcomes were evaluated using the Wollina score and wound-area reduction (WAR) weekly during a treatment period of 28 days. The histological outcomes were assessed using a soft-tissue punch biopsy (3 mm) at 0, 14, and 28 days to evaluate cellular proliferation. The Wollina scores were higher at the end of treatment by week 4 in both groups, but the differences were not significant between groups. The averages were 6 (5, 7) points in Experimental group (EG) and 6 (6,7) points in Control group (CG) (p = 0.848). Wound area reduction at day 28 was 53.57 [37.43, 79.16] % in the CG and 79.37 [42.74, 93.57] % in the EG, without differences among groups (p = 0.305). Cellular proliferation was similar in both groups at day 28. Application three times per week showed similar clinical and histological outcomes to those of daily application, both dose regimens demonstrated significant improvement of granulation tissue formation and WAR during the treatment.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-05-30T06:22:50Z
      DOI: 10.1177/15347346221104946
       
  • Fatal Cutaneous Mucormycosis Caused by Apophysomyces elegans: A Case
           Report and Review of Literature

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      Authors: Munesh k Gupta, Vivek K Katiyar, Pooja Sharma, Rajesh kumar, Satyanam Kumar Bhartiya, Ragini Tilak
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Primary cutaneous mucormycosis is a consequence of environmental Mucorales spores inoculation at the abraded skin. In a diabetic patient, these spores germinate quickly and disseminate hematogenously to the surroundings. Cutaneous mucormycosis is a rare but aggressive, invasive, and life-threatening fungal infection. Its presentation is nonspecific, but it rapidly results in necrosis of underneath tissues. Diagnosis can be readily made by KOH wet mount of excise tissue. However, a prompt diagnosis with multidisciplinary management is a prerequisite for a better outcome. We present a case of fatal cutaneous mucormycosis caused by Apophysomyces elegans, in a diabetic patient who succumbed to death despite extensive debridement and antifungal treatment.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-05-25T07:00:53Z
      DOI: 10.1177/15347346221103387
       
  • Bioactive Glass in a Multi Drug Resistance Osteomyelitis in Diabetic Foot:
           Case Report

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      Authors: Andrea Panunzi, Laura Giurato, Marco Meloni, Luigi Uccioli
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Diabetic foot osteomyelitis (DFO) is a clinical problem with high risk of amputation. The treatment of DFO is still an unsolved challenge. Surgical therapy, antibiotic therapy or conservative treatment are still debated for the timing and the consequences. Long antibiotic therapies expose the selection of multidrug-resistant bacteria. Nowadays the use of new bone substitutes aims to support the load of the bone segments and to ensure the eradication of the infectious process after surgical treatment. A case report of digital osteomyelitis due to a multidrug resistant bacteria was treated with a conservative treatment and use of bioglass (Bonalive) that has the ability to inhibit bacterial growth. A long follow-up shows the resolution of infectious process, no ulcer recurrence and persistent recovery of its ability to walk. Our results agree with literature data and suggest that bioglass may be considered a useful option to manage DFO and achieve healing with a very conservative approach.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-05-19T04:27:53Z
      DOI: 10.1177/15347346221102643
       
  • The Fascinating History of Wound Healing Through Fine Arts

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      Authors: Massimo Papi, Ersilia Fiscarelli
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Visual art images narrate the evolution of humankind including different and specific wound managing strategies. Through the observation of some notable art works we explore the empiric historical progress in wound healing and the main reasons they may have been represented. We briefly examine the cultural, symbolic, magical or religious beliefs that have conditioned the approach to a fundamental vital need of humanity: to heal a wound.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-05-19T04:27:25Z
      DOI: 10.1177/15347346221102642
       
  • A Call to Encourage Participation in the Reviewing Process: The REFEREE
           Acrostic

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      Authors: Nikolaos Papanas, Dimitri P. Mikhailidis
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.

      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-05-17T05:06:37Z
      DOI: 10.1177/15347346221102645
       
  • Resistant Chronic Venous Leg Ulcers: Effect of Adjuvant Systemic
           Hyperbaric Oxygen Therapy Versus Venous Intervention Alone

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      Authors: Amr M Elsharnoby, Ahmed H El-Barbary, Ali E Eldeeb, Hassan A Hassan
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      The aim of this study was to assess the adjuvant efficacy of adding systemic hyperbaric oxygen therapy (HBOT) to definitive venous intervention for healing of resistant chronic venous leg ulcers (VLUs). From 97 chronic VLUs, 63 were subjected to a pre-study standard wound care. Thirty three ulcers failed to achieve 50% size reduction, after the 4-weeks standard care, and were allocated to be treated with: HBOT plus venous intervention (n = 17), or venous intervention alone (n = 16). Primary outcomes were the change in ulcer area, complete healing frequency and time, as well as ulcer recurrence. There was a history of recurrent ulcer (82.3% vs. 69%) in HBOT versus venous intervention groups, respectively. The comparison between both groups with regard to area change showed non-significant difference after 3 months of therapy, while there was a significant difference at 6 and 12 months. A significant positive correlation was found between the HBO sessions numbers (20-40) and the rate of ulcer size reduction. Ulcer complete closure after 3 months was observed in (41.7%) of HBOT group, versus (23%) in venous intervention group; (p = 0.33). After 12 months, complete closure was observed in (83.3%) of HBOT group, versus (53.8%) in venous intervention group; (p = 0.02). The mean time of complete closure was significantly shorter in HBOT group, (p = 0.001). HBOT may be effective as adjuvant to venous intervention in treatment of chronic resistant VLUs, it should be reserved for persistent ulcer. Randomized controlled trials with larger numbers is still needed to elucidate its exact role and specific indications.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-05-17T05:06:21Z
      DOI: 10.1177/15347346221100891
       
  • Health Professionals’ Opinions About Secondary Prevention of
           Diabetes-Related Foot Disease

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      Authors: Aaron Drovandi, Leonard Seng, Benjamin Crowley, Malindu E Fernando, Jonathan Golledge
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      This study explored health professionals’ perceptions of current issues and opportunities for the secondary prevention of diabetes-related foot disease (DFD), and potential strategies for improving DFD care. From May to October 2020, relevant Australian health professionals completed an online survey which used ordinal scales, ranking questions, and open text fields to assess perceptions about the importance of aspects of secondary prevention for DFD and elements for a prevention program. Quantitative data were summarised and compared between professions using non-parametric tests, and qualitative data was analysed using conceptual content analysis to identify emerging themes. Perceptions from 116 health professionals with experience in managing patients with DFD were obtained, including 69 podiatrists, 21 vascular surgeons, 16 general practitioners, and ten nurses. Access and adherence to appropriate offloading footwear was perceived as a key element for effective DFD care, and believed to be affected by social and economic factors, such as the cost of footwear, as well as patient-related factors, such as motivation to wear footwear and adhere to other medical therapies. In addition to a lack of patient motivation and financial limitations, health professionals also believed patients lacked an understanding of the likelihood and severity of DFD recurrence. Several elements of care were perceived as missing from practice, including psychological support and ways to improve footwear adherence, with health professionals identifying several strategies for the design and implementation of an effective secondary prevention program. Prospective trials evaluating secondary prevention programs are required to determine the most effective means for preventing DFD recurrence.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-05-17T05:05:33Z
      DOI: 10.1177/15347346221099798
       
  • Characterization of the Skin Bacteriome and Histology Changes in Diabetic
           Pigs

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      Authors: Meirong Li, Jifang Yuan, Qian Hou, Yali Zhao, Lingzhi Zhong, Xin Dai, Hua Chen, Xiaobing Fu
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Chronic wound is one of the most common complications that are associated with diabetes. The cutaneous microbiome is known to play essential roles in the regulation of barrier function and protecting against potential assault. Thus, it is necessary to gain a better understanding of the relationship between microbial community and skin structures in unwounded diabetic skin to explore possible preventive strategies. To achieve the same, a pig diabetic model was built in the present study. Further,16S rDNA sequencing was used to characterize the skin bacteriome. It was observed that the pigs showed skin bacteriome similar to humans in the non-diabetes group, while it varied in the case of diabetes. Further, the β-diversity analysis showed that the bacterial community was significantly different under the diabetes group. More species differences were identified between the two groups at genus level. The predictive function analysis also showed the involvement of significantly different pathways of microbial gene function in diabetes. In agreement with this, skin histology analysis also showed signs of reduced epidermal thickness and rete ridges in diabetic skin. Less proliferation of keratinocytes and impaired TJ barrier was also detected. This evidence suggested that pigs might serve as the best surrogate for cutaneous microbiome studies. Altogether, the present study reported that the skin bacteriome and histology changed significantly in unwounded diabetic skin, which provided a theoretical basis for the regulation of disordered skin bacteriome. The findings of the study would assist in the improvement of the skin environment and prevention of skin infection and chronic wounds.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-05-12T12:49:51Z
      DOI: 10.1177/15347346221100887
       
  • Faster Than Projected Healing in Chronic Venous and Diabetic Foot Ulcers
           When Treated with Intact Fish Skin Grafts Compared to Expected Healing
           Times for Standard of Care: An Outcome-Based Model from a Swiss Hospital

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      Authors: Thomas Zehnder, Marlise Blatti
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Purpose: Inadequate response to wound management is defined as a reduction in the wound area of 50% sooner and as early as
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-05-12T12:49:39Z
      DOI: 10.1177/15347346221096205
       
  • The Role of Autoflorescence Imaging Device in the Evaluation of Bacteria
           Burden Control

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      Authors: Agata Janowska, Giulia Davini, Michela Iannone, Cristian Fidanzi, Riccardo Morganti, Marco Romanelli, Valentina Dini
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      MolecuLight i:X is a autofluorescence, portable device that allows an assessment of wound area, perimeter, width and length and an evaluation in real time of wound surface bacteria (>104 CFU/g). Primary objective of our study was to evaluate the reduction of bacterial load associated to 3 different therapeutic approaches: dressings and multicomponent bandages (Group1), sharp debridement, dressings and multicomponent bandages (Group 2), and 10 patients treated with zinc oxide bandage (Group 3). Secondary objective was NRS pain scale, Wound Bed Score (WBS) and Quality of Life (QoL) assessment. Despite the improvement of bacterial load, WBS, Qol and NRS was evident in all 3 groups, the analysis of our results demonstrates that the application of zinc oxide bandage, directly in contact with the wound bed and/or the perilesional skin, resulted in a higher improvement and a significant reduction of WBS and bacterial load. Fluorescence imaging can help the specialist in a more targeted assessment and management of infection. Sharp debridement and antiseptic dressings are classically used to reduced bacteria burden. Zinc oxide directly on the wound is an interesting cost-effective option to control different types of bacteria.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-05-11T07:31:05Z
      DOI: 10.1177/15347346221098514
       
  • Correlation Between Bacteria Count Using a Rapid Bacterium Counting System
           and Changes in Wound Area on Diabetic Foot Ulcers in Indonesia: A
           Prospective Study

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      Authors: Haryanto Haryanto, Suriadi Jais, Supriadi Supriadi, Imran Imran, Kazuhiro Ogai, Makoto Oe, Mayumi Okuwa, Junko Sugama
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      This study aimed to clarify the correlation between changes in bacterial number and wound area in diabetic foot ulcers (DFUs). This study used a prospective longitudinal cohort design. A total of 30 participants met the inclusion criteria. Changes in bacterial number and wound area were evaluated weekly until week 4. The chi-square test indicated no significant correlation between biofilm formation and wound area (p = 0.32) but a significant correlation between bacterial count and wound area (p = 0.05). Logistic regression analysis showed a significant correlation between bacterial count and changes in wound area (odds ratio, 0.60; 95% confidence interval [CI], 0.372-0.997; p = 0.04). The receiver operating characteristic analysis showed an area under the curve of 0.660 (95% CI, 0.52-0.79; p = 0.03) with a sensitivity of 97% and specificity of 88%. The present prospective longitudinal cohort study demonstrated the correlation between bacterial count changes and wound area in DFUs. Our results suggest that changes in bacterial count could help wound healing evaluations.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-05-06T11:33:59Z
      DOI: 10.1177/15347346221098515
       
  • Major Amputation In Non-Healing Ulcers: Outcomes and Economic Issues. Data
           from a Cohort of Patients with Diabetic Foot Ulcers

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      Authors: Matteo Monami, Benedetta Ragghianti, Besmir Nreu, Valentina Lorenzoni, Marco Pozzan, Antonio Silverii, Giuseppe Turchetti, Edoardo Mannucci
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Background: Foot ulcers have a relevant economic impact on Health Care Systems and the cost-effectivenesseffectiveness of options is not clear. The aim of this study was the assessment of costs for ulcers treatment after 6, 12, and 18 months of follow-up, compared to those for major amputation. Methods: A retrospective study was carried out on 196 types 2 diabetic patients with foot ulcers. The principal endpoints were 1) the proportion of recovered patients among those with ulcers not healed after 6 and 12 months; 2) the assessment of direct costs for treatment of ulcers 6, 12, and 18 months of follow-up, as compared to the cost of major amputation. The economic evaluation was performed considering the perspective of the local health system. Results: Out of 196 patients, 85(46.2%), 131(71.6%), and 140(85.9%) healed within 6, 12, and 18 months, respectively. The average health cost during the 18-month follow-up was 5402€ per patient. We calculated hypothetical costs for three different scenarios, in which patients who did not heal within 6 months underwent a major amputation at 6, 1,2, or 18 months. Costs for the standard of care for all these scenarios (6,094, 7,256, and 7649€ for 6, 12, or 18 months, respectively) were significantly lower than that for major amputations (21,065€). Conclusions: A conservative approach appears more convenient than major amputations in ulcers not healing after 6 months, irrespective of the estimated risk of individual patients.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-04-28T07:32:07Z
      DOI: 10.1177/15347346221097283
       
  • Comparison of Three Methods for Preparation of Autologous Cells for Use in
           

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      Authors: Jitka Husakova, Robert Bem, Alexandra Jirkovska, Andrea Nemcova, Vladimira Fejfarova, Karol Sutoris, Michal Kahle, Edward B. Jude, Michal Dubsky
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Autologous cell therapy (ACT) is a new therapeutic approach for diabetic patients with no-option chronic limb-threatening ischemia (NO-CLTI). The aim of our study was to quantify cell populations of cell therapy products (CTPs) obtained by three different isolation methods and to correlate their numbers with changes in transcutaneous oxygen pressure (TcPO2). CTPs were separated either from stimulated peripheral blood (PB) (n = 11) or harvested from bone marrow (BM) processed either by Harvest SmartPReP2 (n = 50) or sedimented with succinate gelatin (n = 29). The clinical effect was evaluated by the change in TcPO2 after 1, 3 and 6 months. TcPO2 increased significantly in all three methods at each time point in comparison with baseline values (p 
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-04-25T06:06:32Z
      DOI: 10.1177/15347346221095954
       
  • PRP Versus Standard of Care for Venous leg Ulcers: A Systematic Review and
           Meta-Analysis of Prospective Comparative Studies

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      Authors: Kaissar Yammine, Joe Ghanimeh, Sira Jil Agopian, Chahine Assi, Fady Hayek
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Venous leg ulcers (VLUs) are chronic and recalcitrant lower limb wounds that affect millions of patients annually, severely reducing their quality of life, and causing a significant burden on the health care system. Recently, Platelet rich plasma (PRP) has been used to improve healing of VLUs. This systematic review aimed at evaluating the effectiveness of PRP versus the standard of care commonly used to treat VLUs. Ten prospective studies (8 randomized) met the inclusion criteria comprising 451 patients with 527 VLUs. Results were as follows: a) the weighted Odds Ratio (OR) of the mean healing rate was 2.84 (95% CI = 1.160 to 5.056, I2 = 41.4%, p = 0.0004), b) the mean healed ulcer areas were 79.2 ± 19% for the PRP group and 51.7 ± 36% for the control group (p = 0.007) in favor of the PRP group, and c) the weighted infection OR showed no significant difference between both groups. Additionally, negative correlations were found between healing rate and duration of VLUs and initial size of the ulcers. This meta-analysis demonstrated significant beneficial effects of PRP versus standard of care on healing rate, reduction in surface, and reduction in healing time of VLUs. Infection and other complications were similar to standard of care. Therefore, our analytical data would support the use of PRP as a safe and effective treatment for VLUs.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-04-15T05:50:08Z
      DOI: 10.1177/15347346221094424
       
  • High Versus Low Frequency Transcutaneous Electric Nerve Stimulation On
           Chronic Venous Lower Limb Ulceration Randomized Controlled Trial

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      Authors: Ahmed M. Elfahl, Amal M. Abd El Baky, Mohamed T. Yousef, Hany M. Elgohary
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      The major objective of the current paper is to trace and investigate which method is more effective whether the high or the low Transcutaneous electric Nerve Stimulations (TENS) on venous ulcers. A single-blinded, randomized, and controlled trial was done successfully. Sixty venous ulcer patients were divided randomly into three groups; Group (A): control group, Group(B): High-TENS group, and Group(C): Low-TENS group. Group (A), contains twenty participants who received routine medical care and dressing. As for group (B), includes twenty participants who obtained high-frequency TENS; Frequency (80-120) HZ, Intensity (15 - 30 amp), Pulse duration 250 Micro sec, 60 min per session with routine medical care and dressing. The third group (c) L-TENS, encompasses twenty participants who received low-frequency TENS (1-5) HZ; Intensity (30 −80 amp), Pulse duration 250 Micro sec, 60 min per session with routine medical care and dressing. All the participants were examined before and after two months of intervention; four weeks (post1), then after eight weeks (post2). Participants were examined by using (image j) to measure the ulcer area. Saline was used for measuring the ulcer volume, and a visual analog scale was adopted to evaluate pain. After drawing a comparison among the three groups after four weeks and after eight weeks of treatment, a statistically significant decrease (P
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-04-15T05:49:46Z
      DOI: 10.1177/15347346221093860
       
  • Comparative Clinical Outcomes of Patients with Diabetic Foot Infection
           Caused by Methicillin-Resistant Staphylococcus Aureus (MRSA) or
           Methicillin-Sensitive Staphylococcus Aureus (MSSA)

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      Authors: Francisco Javier Álvaro-Afonso, Esther García-Morales, Mateo López-Moral, Luis Alou-Cervera, Raúl Molines-Barroso, José Luis Lázaro-Martínez
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Few studies have addressed the interaction of specific pathogens with clinical outcomes in patients with diabetic foot infection (DFI). Our study aim was to compare the clinical outcomes among patients with DFI caused by methicillin-resistant Staphylococcus aureus (MRSA) with cases caused by methicillin-sensitive Staphylococcus aureus (MSSA). We gathered the data of 75 consecutive patients admitted at specialized outpatients diabetic with mild or moderate DFI in which S. aureus was isolated from bone or soft tissue specimens in pure or as a part of the polymicrobial culture. Patients were divided into two groups: those with MRSA infection and those with MSSA infection. Patients with MRSA diabetic foot infections were significantly associated with male gender (86% vs. 64%, P = .029), higher SINBAD Classification Score (3.6 ± 0.99 points vs. 2.8 ± 1.06 points, P = .001), longer mean wound evolution [17.8 (3;29.5) weeks versus 9.1 (1;12) weeks, P = .008], bone involvement [18 (50%) versus 9 (23.1%), P = .015] and longer mean healing time [18.2(8;28) weeks versus 9.1 (1;12) weeks, P = .008]. In addition, male gender (OR 8.81, 95% CI 2.00-38.84) and SINBAD Classification Score (OR 2.70, 1.46-5.00) were identified as independent risk factors for MRSA DFI. Significant differences in the number of surgical procedures to resolve infection [15 (41.7%) versus 13 (33.3%), P = .456] or in the mean healing time after surgical treatment [10.5 weeks (6.7;16.5) versus 6.1 weeks (3;8.7), P = .068] were not observed among groups, suggesting that when treatment is based on early and surgical debridement, MRSA infections are not associated with worse prognosis. In conclusion MRSA DFI has importance in clinical outcomes such as time to healing. We propose that recent lines of research regarding the genetic virulence of strains of S. aureus could provide new insights into our results.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-04-13T07:10:07Z
      DOI: 10.1177/15347346221094994
       
  • Multifaceted Strategy Improves Outcomes of Patients Hospitalized with a
           Diabetic Foot Infection

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      Authors: Elad Keren, Abraham Borer, Tali Shafat, Lior Nesher, Yaniv Faingelernt, Orli Sagi, Orly Shimoni, Lisa Saidel-Odes
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Diabetic foot infections (DFIs) are associated with major morbidity, reduced quality of life and increased mortality. Osteomyelitis is a leading cause of lower-extremity amputation in diabetic patients. We aimed to examine whether a multifaceted strategy for treating hospitalized patients with a DFI effectively influenced microbiological culture results and outcomes. A retrospective cohort-study in a 1100-bed, tertiary-care university hospital was conducted. Adult patients with a DFI admitted to the orthopedics department between 2015 and 2019 were included. During the pre-intervention period (2015-2016), one general orthopedic department was in operation. In the post-intervention period (2017-2019), a second department was created with a designated “complicated wound unit". The multifaceted strategy included revising local guidelines for DFI culturing emphasizing bone cultures, correct sample handling, and adjusting antibiotic treatment to culture results. Additionally, a weekly multidisciplinary-team grand round was instigated and post-discharge outpatient follow-up was scheduled. 652 patients with DFIs were included; 101 during the pre-intervention period and 551 during the post-intervention period. Compared to the pre-intervention, during the post-intervention period mainly bone or deep-tissue cultures were performed (9.7% vs. 98.2%, P 
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-04-11T02:16:23Z
      DOI: 10.1177/15347346221093463
       
  • Global, Regional, and National Levels and Trends in the Burden of Pressure
           Ulcer from 1990 to 2019: A Systematic Analysis for the Global Burden of
           Disease 2019

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      Authors: Aobuliaximu Yakupu, Hanqi Wang, Lifang Huang, Jingqi Zhou, Fangyi Wu, Yong Lu, Shuliang Lu
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Pressure ulcer (PU) is a type of chronic ulcer, placing a high burden not only on patients’ families but also on national healthcare systems globally. To determine the level, trends, and burden of PU worldwide and to provide an essential foundation for building targeted public policies on PUs at the national, regional, and global levels, data on PU were obtained from the Global Burden of Disease (GBD) 2019 Study. The incidence, disability-adjusted life years (DALYs), and deaths of PUs in 204 countries and regions from 1990 to 2019 were calculated and stratified by sex, age, geographical location, and sociodemographic index (SDI). The estimated annual percentage change (EAPC) of incidence, DALYs, and deaths was calculated to evaluate the temporal trends. A total of 3,170,796 new cases (95% uncertainty interval (UI), 3,499,729–2,875,433 cases) of PU were identified globally in 2019, more than 55% of which were among male individuals, and most of the new cases were concentrated in those 75–90 years of age. The burden of PU measured in DALYs was 481 423 (95% UI, 583 429-374 334) in 2019, 73% and 27% of which could be attributed to years of life lost (YLLs) and years lived with disability (YLDs), respectively. The burden increased gradually from 1990 to 2019 (from 267 846 [360 562-211 024] to 481 423 [95% UI, 583 429-374 334]). A total of 24 389 deaths were attributed to PU (95% UI, 31 260.82-17 299). The EAPC of incidence, DALYs, and deaths were negative in most regions, the age-standardized rate (ASR) of incidence, DALYs, and deaths were considered to be decreasing in most of the regions, and the EAPCs were negatively correlated with the SDI levels, universal health coverage (UHC), and gross domestic product (GDP), which shows that the ASRs of PU decreased as the economy developed and countries’ healthcare system performances improved.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-04-05T07:00:09Z
      DOI: 10.1177/15347346221092265
       
  • Association of PVL Gene in MSSA and MRSA Strains among Diabetic Ulcer
           Patients from Odisha, India

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      Authors: Swatishree Pany, Bayasis M. Sharma, Shibani K. Sen, Bibhuti B. Pal
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Staphylococcus aureus has emerged as an important pathogen among diabetic foot ulcers in patients with diabetes. Infections with S. aureus in diabetic ulcers need surveillance of resistant microbial profile to provide the basis for empirical therapy for the reduction of lower extremities amputation. Panton valentine leucocidin (PVL) is considered as one of the major virulence gene of S. aureus which is responsible for destruction of white blood cells and tissue necrosis. This pore forming cytotoxin gene is carried out by both methicillin-susceptible S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA) strains. The present study described the prevalence of PVL gene in MSSA and MRSA strains isolated from diabetic ulcer patients treated during November, 2019 to January, 2021 from a tertiary care hospital, Odisha. Infected tissue and blood samples from these patients were collected aseptically and sub-cultured using different media and standard techniques. The isolated genomic DNA of MSSA and MRSA strains were subjected to PCR assay for the detection of PVL gene. Two hundred ten S. aureus out of 402 diabetic ulcer patients were isolated having 59.52% MSSA and 40.47% MRSA strains. Wagner's grade III and grade IV ulcers were most prevalent in these ulcer patients. The prevalence of PVL gene in MSSA strains was more in comparison to MRSA strains. Forty five resistance patterns were observed from the antibiogram profiles of S. aureus. The present study highlighted that PVL gene could not be a marker for the detection of MRSA and MSSA strains in diabetic ulcer patients.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-04-05T06:38:31Z
      DOI: 10.1177/15347346221091355
       
  • Care and Treatment for an Antiphospholipid Syndrome-Related Lower Limb
           Skin Ulcer Unhealed for 7 Years: A Case Report

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      Authors: Min Wei, Yan Xu, Dongyun Xia, Jian Li, Shan Dong
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Antiphospholipid syndrome (APS) is a group of rare autoimmune diseases caused by antiphospholipid antibodies that is mainly associated with arterial or venous thrombosis and/or complications during pregnancy. Skin lesions occur in approximately 30% of APS patients as initial manifestations. However, previous studies have primarily focused on the treatment of APS rather than the management of skin lesions. Here, the authors report a case of an APS-related lower limb skin ulcer that had remained unhealed for more than 7 years. The difficulties in this case were the diagnosis of APS, the risk of bleeding during debridement, wound infection, biofilm formation, reduced venous return from the lower limbs, and compliance with compression therapy and follow-up. A three-step wound care regimen based on a multidisciplinary team approach resulted in effective control of APS and healing of the ulcer to the lower leg in 95 days. Over two follow-ups, there was no recurrence of the ulcer.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-04-01T06:20:00Z
      DOI: 10.1177/15347346221090079
       
  • Diabetic Foot Ulcer in Malaysia: Consensus on Treatment Patterns, Health
           Care Utilization and Cost

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      Authors: Harikrishna K. R. Nair, P. Norlizah, MN. Mariam, Syed A L Alsagoff, Kam Ming Long, KR Anantha, Ngoh Chin Liew, Nizam Ali Husien
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Healthcare resource utilization for Diabetic foot ulcers (DFUs) in Malaysia needs to be clarified. This modified Delphi panel study aimed to describe the clinical pathways for diabetic foot ulcer in Malaysia and to define the healthcare resources used and their costs. A systematic review of the literature was carried out on the management of diabetic foot ulcer in Malaysia. A modified Delphi panel involving 7 local experts was organized to validate the statements, in order to arrive at a consensus on the resources used for the treatment of DFU patients in Malaysia and their costs. A Markov model was then used to estimate the financial burden of DFU patients in Malaysia.The total cost per patient per annum was MYR 5981 in public and MYR 8581 in private setting. In the public setting, outpatient visits costs represent 50% of the overall cost, followed by medical devices which represent 38% of total costs. In the private setting, as in the public, outpatient visits and devices contribute the most to overall costs with 51% and 21%, respectively. However, hospital inpatient costs are higher in private setting and represent 14% of the total costs versus 5% in public setting.These findings may prove useful for clinicians and decision makers in understanding the economic implications of managing DFUs in Malaysia and the need for innovative therapies to reduce the burden for patients but also for the society.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-03-29T07:50:13Z
      DOI: 10.1177/15347346221090096
       
  • Denervation Affected Skin Wound Healing in a Modified Rat Model

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      Authors: Lu Lu, Dandan Liu, Jianghui Ying, Zuochao Yao, Qiang Hou, Hui Wang, Fazhi Qi, Wenjie Luan, Hua Jiang
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Introduction: Lacking of normal innervation increases the chance of chronic wounds and recurrence of ulceration. Various rodent models are designed to reveal nerve-wound relationship but present many limitations to mimic human wound which heals primarily by re-epithelialization rather than contraction in rodents. This article tested a modified rat model of denervated wound healing to better mimic clinical common denervated wounds. Material and Methods: The wounds formed on right hind paws of 18 SD rats served as the experimental (denervated) group and the left side as contra-lateral control (non-denervated). The denervation was achieved through sciatic and femoral nerve co-transection and the control side underwent sham-surgery 3 days prior to a skin punch wound formation on both sides. Wound closure rate was calculated under digital photographing. Loss of innervation and affected healing process was confirmed by histological analyses. Results: Truncation of the sciatic and femur nerve successfully denervated the skin of the hind paw and resulted in a significantly declined healing rate, prolonged inflammation, weakened dermal contraction, hindered macrophage recruitment, retarded re-epithelialization and collagen deposition, decreased angiogenesis and epidermal proliferation, and persisted epidermal apoptosis compared to the innervated contra-lateral control. Conclusion: Wound on denervated dorsal pedis in rats can be used to study denervated skin healing in multiple histological process. We believe that this model will assist in understanding the underlying mechanism of nerve-wound relationship and identifying new treatment strategies that can be more rapidly translated into clinical practice.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-03-28T07:49:42Z
      DOI: 10.1177/15347346221090758
       
  • Significant in-Vitro and in-Vivo Antimicrobial and Antibiofilm Activity of
           Colloidal Silver Nanoparticles (cAgNPs) in Chronic Diabetic Foot Ulcers

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      Authors: Aradhana Singh, Swati Sharma, Tuhina Banerjee, Arvind Pratap, Vijay Kumar Shukla
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Infection is a foremost challenge in the cases of wound care, especially in cases of chronic wounds. The present study was conducted to determine the antimicrobial and antibiofilm activity of the colloidal silver nanoparticles (cAgNPs) on Gram positive organisms and to evaluate the in-vivo response of cAgNPs on patients of chronic diabetic foot ulcers (DFUs). cAgNPs were tested against selected Gram-positive organisms like methicillin-sensitive and resistant Staphylococcus aureus (MSSA, MRSA), Enterococcus faecalis and vancomycin resistant enterococci (VRE) using microbroth dilution assay to estimate minimum inhibitory/bactericidal concentration (MIC/MBC). Biofilm inhibition capacity and time kill assay was performed. Further, the in-vivo response of topical application of cAgNPs was evaluated on patients of DFUs. The susceptibility testing demonstrated the MIC and MBC values of the cAgNPs ranging from 0.5μg/ml to 1.0 μg/ml and 1.0 μg/ml to 8 μg/ml against the tested organisms respectively. The cAgNPs showed inhibition of biofilm formation in the low, medium and high biofilm producers by 91%, 83% and 75% respectively at the highest concentration (52ppm). The time kill kinetics showed significant reduction in the number of viable cells (p 
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-03-24T09:39:24Z
      DOI: 10.1177/15347346221088690
       
  • Polypharmacy is Associated with Diabetic Foot Ulcers in Type 2 Diabetes
           mellitus

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      Authors: Eren Imre, Erdi Imre
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Objectives: This observational study aimed to investigate the relationship between polypharmacy and the existence of diabetic foot ulcers in patients with type 2 diabetes. Methods: Patients with T2DM with and without diabetic foot ulcers who presented to the endocrinology outpatient clinic between August 2020 and November 2021 were involved in the study. Overall, five hundred and twelve patients with T2DM (293 patients with diabetic foot ulcer and 219 patients without diabetic foot ulcer) were included. The exclusion criteria were pregnancy, lactation, type 1 diabetes, patients under 18 years and over 65 years of age, and history of malignancy. The information of drugs administered, demographic and clinical data were obtained from the patient files. The Wagner score was used to evaluate the severity of ulcers. Results: The comparison of the two groups revealed that patients with diabetic foot ulcers had significantly higher rates of diabetic retinopathy (p = 0.017). The patients with diabetic foot ulcers who had polypharmacy had significantly higher rates of hypertension, ischaemic heart disease, diabetic retinopathy, and complaints of diabetic neuropathy (P 
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-03-24T04:28:03Z
      DOI: 10.1177/15347346221090756
       
  • Narrative Experiences of Individuals with Lower Limb Amputation: A
           Qualitative Study

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      Authors: Gülhan Küçük Öztürk, Hatice Yüceler Kaçmaz, Ramazan İlter Öztürk
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Aim: The present study aimed to determine the narrative experiences of individuals undergoing lower limb amputation. Method: This study was a qualitative study conducted using the phenomenological pattern. Using purposive sampling, 13 individuals with lower limb amputation were selected and interviewed. Data were collected using semi-structured interviews and analyzed using the content analysis method. Results: The mean age of the 13 individuals was 51.17 ± 8.7 years. Five of the individuals were female and eight of them were male. A main theme and four sub-themes were identified. This main theme together with sub-themes were Dead End (Process of Loss, Negative Feelings, Change, Adapting to New Life). The individuals expressed mostly negative feelings and thoughts while also emphasizing the rehabilitation process (positive sides). Conclusions: Individuals with lower limb amputations stated there were positive factors affecting the rehabilitation process while emphasizing negative thoughts and feelings during the amputation process. These results can be used in planning for training, counseling and therapeutic interviews to protect the psychosocial health of individuals with lower limb amputation.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-03-21T06:38:26Z
      DOI: 10.1177/15347346221087497
       
  • Effectiveness of Sucrose Octasulfate Dressing in the Treatment of
           Neuro-Ischaemic Diabetic Foot Heel Ulcers: A Retrospective Single arm
           Study

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      Authors: Marco Meloni, Laura Giurato, Andrea Panunzi, Alfonso Bellia, Serge Bohbot, Davide Lauro, Luigi Uccioli
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      The study aimed to evaluate the effectiveness of the use of sucrose octasulfate impregnated dressing (TLC-NOSF [Technology Lipido-Colloid-Nano-OligoSaccharide Factor]) in the management of persons with neuro-ischaemic heel diabetic foot ulcers (DFUs). Consecutive patients who referred for an active non-infected neuro-ischaemic heel DFU belonging to grade IC (superficial) or IIC (deep to tendons, muscle or capsule) according to Texas University Classification were included. All patients were managed by a pre-set limb salvage protocol in the respect of International guidelines and the TLC-NOSF dressing was used as primary and specific dressing. Patients were evaluated any 2 to 4 weeks until wound healing or different outcomes. Primary outcome was the rate of complete wound healing after 24 weeks of follow-up. The secondary outcomes assessed the healing time, the rate of wound regression, the re-ulceration in the case of complete healing and the safety. Thirty patients were included. The mean age was 67 ± 11 years, 17 (56.7%) were male, all of them were affected by type 2 diabetes with a mean duration of 18 ± 7 years. Twenty patients (66.7%) showed deep ulcers (grade 2 of Texas University Classification); the mean TcPO2 at the inclusion was 42 ± 7 mm Hg. Twenty-two patients (73.3%) healed by Week 24. The mean time of healing was 84 ± 32 days, 2 (6.7%) patients had ulcer relapse after healing, 28 (93.3%) had wound regression>50%, 2 (6.7%) had mild infection, 1 (3.3%) reported major amputation. No serious adverse events related to TLC-NOSF dressing or local reactions were reported. This current study showed the potential benefit of sucrose octasulfate for treating neuro-ischaemic heel DFUs in addition to the standard of care.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-03-15T08:48:26Z
      DOI: 10.1177/15347346221087499
       
  • Skin Graft Donor Site Healing among Elderly Patients with Dermatoporosis
           – A Case Series

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      Authors: Toni Seppälä, Vahur Grünthal, Virve Koljonen
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      We reviewed donor site wound healing among morbid ≥65-year-old patients after split-thickness skin graft (STSG) harvesting. Patients were treated for a pretibial laceration or hematoma in Kymenlaakso Central Hospital, Finland, between 2015 and 2019. Twelve morbid patients with a mean Charlson Comorbidity Index of 7.1 (range 4-12) and a mean age of 80.6 years (range 69-91) were studied. Nine patients were female. Eight had a chronic cutaneous fragility syndrome, eg, dermatoporosis. All donor site areas were located on the thigh and were less than 2% TBSA. One donor site infection occurred. STSG integration on the pretibial wound bed was successful with all patients, and none of the patients needed further operative treatment. Graft thickness varied between 0.010 to 0.014 inches. STSG donor sites healed within the normal range of 21 days in 50% of patients. Among two patients, healing took 25 days, and among four, 37 to 97 days. All donor sites healed via local wound care without the need for regrafting. 4Our study indicates that harvesting STSG from elderly and morbid patients with poor skin condition is safe and does not result in significant complications. Prolonged donor site healing can occur, which can be managed with regular local wound care.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-03-15T08:47:25Z
      DOI: 10.1177/15347346221087081
       
  • The Effect of Topical Cow's Milk on the Healing of Diabetic Foot Ulcers: A
           Randomized Controlled Pilot Clinical Trial

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      Authors: Somayeh Shabib, Rasool Soltani, Farzin Khorvash, Azade Taheri, Mehdi Shahbazi Azad
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Diabetic foot ulcer (DFU) is a very serious side effect among the diabetic patients with substantial clinical and economic consequences. The aim of this study was to investigate the efficacy of cows’ milk topical ointment, as an available and cost-effective natural product, on accelerating the healing of DFU. In this randomized controlled clinical trial, patients with grade 1 or 2 DFU were randomly divided into two groups of intervention (n = 50) and control (n = 49). For patients of intervention group, cows’ milk 20% topical ointment was applied on the ulcer once daily for two weeks, while a type of novel dressing was used for control group with the same frequency and duration. Both groups received usual standard wound care measures. The percentage of change in the ulcer size and the number of cases with complete wound healing (>90% reduction in the ulcer size) were recorded in the both groups. The ulcer size significantly reduced in both groups on the seventh and 14th days of intervention; however, the percentage of reduction was significantly higher in the intervention (milk) group compared to control at both time points (44.64 ± 15.98 vs. 24.95 ± 12.78, P 
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-03-15T08:46:43Z
      DOI: 10.1177/15347346221084788
       
  • The Role of Puerarin in Chronic Wounds: A Review of its Mechanism of
           Action and Potential Novel Applications

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      Authors: Noor Anvery, Abdulhafez Selim, Amor Khachemoune
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Chronic wounds have a high disease burden and significantly influence patient quality of life. The development of chronic wounds is multifactorial and thus adequate management and care is often difficult to achieve. Chronic diseases, malnutrition, smoking, immune dysregulation, and age contribute to chronic wound development. Treatment options include adequately addressing underlying conditions and selecting appropriate topical preparations which enhance and promote healing of different wounds based on an understanding of wound healing pathophysiology. Puerarin, a naturally occurring flavinoid, may offer therapeutic potential for addressing etiologies as well as managing wound beds due to its anti-inflammatory, anti-oxidative, pro-angiogenic, and anesthetic properties.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-03-11T02:25:47Z
      DOI: 10.1177/15347346221086687
       
  • Efficacy and Safety of Topical Solution of Diperoxochloric Acid for
           Neuropathic Diabetic Foot Ulcer: Results from a Phase 3, Multicentre,
           Randomized, Active-controlled, Parallel-group Study

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      Authors: Arun Bal, Sudhir Kumar Jain, Jagannath, Kailash Chandra Mohapatra, Shilpa Rao, Neeta Deshpande, Renuka Munshi, Rajeshkumar Mahey, Subhankar Chowdhury, M.M. Bhaskar, Sapam Opendro Singh, Gauri Damle, Ashok Damir, Smita Phal, Mukund Zarapkar
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Diabetic foot ulcer (DFU), if untreated, accounts for lower-limb amputations affecting patients’ quality-of-life. Diperoxochloric acid (DPOCL) is known to heal DFU by its antibacterial and fibroblast stimulating activity. This was a phase 3, multicentre, randomized, double-blind, active-controlled, parallel-group study conducted to evaluate the efficacy and safety of topic solution of DPOCL compared with isotonic sodium chloride solution (ISCL). Adult patients with type 1 or 2 diabetes with random blood glucose levels of
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-03-11T02:25:38Z
      DOI: 10.1177/15347346221076625
       
  • Alice through the Looking-glass: Can We Improve Peer Review'

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      Authors: Nikolaos Papanas, Dimitri P. Mikhailidis
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Peer review is an essential component for the evaluation of material submitted to medical and scientific journals. This process usually involves single blind, double blind or open peer review. In the present Editorial, we discuss the advantages and disadvantages of these peer review options. Our comments are influenced by our experience as Editors-in-Chief. We also outline new developments in the field of peer review.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-03-07T11:16:34Z
      DOI: 10.1177/15347346221084784
       
  • Exacerbated Psoriasis as a Rare Trigger of Multilocular Pyoderma
           Gangrenosum: A Case Report of a Rare Coincidence

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      Authors: Wiebke Sondermann, Laura Fischer, Eva Hadaschik, Joachim Dissemond
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.

      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-02-28T09:01:01Z
      DOI: 10.1177/1534734621990297
       
  • Role of Dipeptidyl Dipeptidase 4 Inhibitors in the Management of Diabetic
           Foot

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      Authors: Wen-hui Yu, Tong Zhang, Heng Xu
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Background: Patients with diabetes mellitus face difficulties in wound healing. It is important to explore therapeutic options for diabetic complications such as ulcers. This study evaluates the role of dipeptidyl dipeptidase 4 inhibitors (DPP4i) in the management of diabetic foot. Methods: Literature search was conducted in electronic databases (Google Scholar, Ovid, PubMed, Science Direct, and Springer) and studies were selected for inclusion if they reported the incidence rate of diabetic foot ulcer during DPP4i treatment or evaluated the effect of DPP4i on wound healing. Incidence rates of foot ulcer, amputation and peripheral vascular disease were pooled to achieve overall estimates. Meta-analyses of odds ratios were performed to evaluate the risk of foot ulcer, amputation, and peripheral vascular disease with DPP4i, and to examine the effect of DPP4i treatment on ulcer healing. Results: Ten studies (532354 DPP4i and 2092010 non-DPP4i treated diabetes patients) were included. Incidence rates of foot ulcer, amputation, and peripheral vascular disease were 3.80 [95% confidence interval (CI): 0.22, 7.39], 0.82 [95%CI: 0.60, 1.05], and 22.33 [95%CI: 9.14, 35.53] per 1000 person-years respectively in patients treated with DPP4i and 3.60 [95%CI: 1.77, 5.39], 0.76 [95%CI: 0.58, 0.94], and 20.9 [95%CI: 16.04, 25.81] per 1000 person-years respectively in patients treated with non-DPP4i drugs. Risk of ulcer or amputation with DPP4i was not consistent across studies. Odds of non-healing of ulcer were significantly lower with DPP4i in comparison with controls (odds ratio: 0.27 [95%CI: 0.10, 0.71]; p = 0.008). Conclusion: Incidence rates of diabetic foot and amputation are found to be similar with DPP4i and non-DPP4i drugs. DPP4i improved wound healing of diabetic foot in 3-month randomized trials.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-02-28T03:36:01Z
      DOI: 10.1177/15347346221082776
       
  • LRG1 Accelerates Wound Healing in Diabetic Rats by Promoting Angiogenesis
           via the Wnt/β-Catenin Signaling Pathway

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      Authors: Ping Yang, Shiyan Li, Hao Zhang, Xiaofeng Ding, Qian Tan
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Patients with diabetic wounds may end with lower extremity amputation or death. Leucine-rich α-2-glycoprotein 1 (LRG1) is an effective regulator of angiogenesis and essential for timely wound healing. However, its role in regulating angiogenesis in diabetic wounds remains unclear. This study aimed to investigate the pro-angiogenic function of exogenous LRG1 in diabetic wound healing and explore possible mechanisms. LRG1 expression patterns following injury in normal and diabetic wounds were determined by western blotting. Local injection of LRG1 was used to verify the effects on angiogenesis and wound healing in diabetic rats. Immunohistochemical staining for CD31 was used to analyze the vessel density. Human umbilical vein endothelial cells (HUVECs) cultured in hyperglycemia were used to explore how LRG1 promotes angiogenesis in diabetic wound healing. We found that the expression peak of LRG1 around the wounds was delayed in diabetic rats compared with that in normal rats. Exogenous administration of LRG1 significantly accelerated the wound closure rate and promoted angiogenesis in diabetic rats. In addition, exogenous LRG1 effectively restored the proliferation, migration, and tube formation ability of HUVECs under hyperglycemia. Mechanistically, LRG1 promoted angiogenesis and diabetic wound healing mainly by activating the Wnt/β-catenin pathway, which is inhibited in diabetic wounds. This research suggests that LRG1 promotes angiogenesis and wound closure in diabetic rats by improving angiogenesis via activation of the Wnt/β-catenin pathway. Hence, LRG1 may be a possible therapeutic strategy for diabetic foot treatment.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-02-21T04:21:48Z
      DOI: 10.1177/15347346221081610
       
  • Wound Healing Effects of Chitosan Nanosheets/Honey Compounds in Male
           BALB/c Mice

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      Authors: Masoumeh Askari, Mohammad Afshar, Mohsen Khorashadizadeh, Mahmoud Zardast, Ali Naghizadeh
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Background and aim: Up to now, proper wound care management has remained as an important clinical challenge. Chitosan nanosheets (CNSs) showed a great potential in tissue engineering, but our knowledge about their wound healing effectiveness is based on very limited data. Thus, the aim of this research was to evaluate the wound healing potential of CNSs and honey as a vehicle for these nanoparticles. Methods: The skin excisional wound injury model was made in adult male BALB/c mice (n = 60) by creating two identical sized wounds (5mm) on either side of their dorsal midline. The animals were divided into five groups (n = 12 each) as untreated control, honey, polyethylene glycol, and CNSs dissolved either in honey or polyethylene glycol. Animals were received their relative topical treatments twice per day for 14 consecutive days. Tissue sampling was carried out on days 4, 7, 10, and 14 post wounding. The histological parameters including inflammatory cells infiltration, fibroblast proliferation, re-epithelialization, granulation formation, and collagen formation were evaluated in all studied time points. Results: Compared to the control group, CNSs showed significant wound healing activities with lower inflammatory cells infiltration, higher fibroblastosis and new epithelium thickness, and greater granulation area and collagen fibers density in the ulcer bed. In addition, honey synergistically increased the wound healing activity of the studied nanoparticles. Conclusion: These results showed that CNSs have promising wound healing activity specially when dissolved with honey concurrently.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-02-21T04:19:00Z
      DOI: 10.1177/15347346221074583
       
  • Necrotizing Fasciitis Caused by Mucormycosis: A Case Report and Literature
           Review

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      Authors: Chuanwei Geng, Kai Yu, Feng Li
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      We present a rare case of Necrotizing fasciitis (NF) caused by mucor. The limb was debrided multiple times and the patient received antifungal treatment. The clinical manifestations and laboratory test results of mucor infections, which were significantly different from those caused by common bacteria, are of great value.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-02-15T05:42:32Z
      DOI: 10.1177/15347346221080940
       
  • Psychological Stress on Wound Healing: A Silent Player in a Complex
           Background

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      Authors: Somprakas Basu, Aakansha Giri Goswami, Lena Elizabeth David, Elizabeth Mudge
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Stress is hard to define and is further complicated by varied perceptions in the population and differing responses in different situations. Psychological stress brings about certain physiological changes through manipulation of the neural, humoral and immunological systems. Observational studies have showed that fear and anxiety before surgery can complicate normal wound healing. Two different pathways appear to be involved: one directly through hypothalamic-pituitary-adrenal axis and sympathetic-adrenomedullary axis, and another indirectly through negative psychological stressors such as anxiety, depression and social isolation. The pathogenesis includes decreased expression of pro-inflammatory cytokines, resulting in poor angiogenesis, matrix regeneration and delayed healing. Prolonged immunological activation in itself is a stressor and can precipitate a sickness behaviour syndrome manifested by disturbed sleep, anorexia, reduction in activity, increased responsiveness to pain and addiction to alcohol and tobacco. It has been observed that cortisol release suppresses pro-inflammatory cytokine release, while down-regulation of cortisol causes unabated inflammatory response. In individuals with chronic wounds, on the other hand, it is thought that physical stress has different effects such as foul odor, pain, exudate and social and familial isolation, which may act independently as psychological stressors. This article attempts to appraise the influence of psychological stress on the immunological system and its effect on wound healing.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-02-01T12:36:49Z
      DOI: 10.1177/15347346221077571
       
  • Efficacy of Belt Electrode Skeletal Muscle Electrical Stimulation in the
           Postoperative Rest Period in Patients with Diabetes who Have Undergone
           minor Amputations: A Randomized Controlled Trial

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      Authors: Shinsuke Imaoka, Genki Kudou, Kohei Tsugiyama, Shohei Minata, Taisuke Teroh, Mikiko Ootsuka, Masahide Furukawa, Toshio Higashi, Minoru Okita
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      This study aimed to investigate whether belt electrode skeletal muscle electrical stimulation (B-SES) would improve postoperative lower limb function and walking ability in patients with diabetes who have undergone minor amputations. Diabetic patients who had undergone minor amputations were assigned randomly to a B-SES or control group. The B-SES group underwent conventional physical therapy for 20 min and B-SES for 20 min. The control group underwent only the 20-min conventional physical therapy. In both groups, rehabilitation was introduced by the physical therapists for 14 days from postoperative day 1. The outcome measures were range of motion in the ankle joint, knee extension muscle strength, ambulation status, and quality of life score. All these were evaluated before the intervention and 2 and 4 weeks after the intervention. From the 84 patients initially assessed, 32 were assigned to either the B-SES (N = 16) or control (N = 16) group. Preoperatively, there were no significant differences in all endpoints. The B-SES group showed significant improvement in the ankle dorsiflexion angle at 2 weeks postoperatively and knee joint extension strength at 4 weeks postoperatively. Postoperative B-SES with standard physical therapy might improve the range of motion of dorsiflexion of the ankle joint and extensor strength of the knee joint in patients with diabetes who have undergone minor amputations. B-SES is a useful tool to improve postoperative physical function in diabetic patients who have undergone minor amputations. A multicenter study is needed to determine the effective B-SES combined with regular physiotherapy for minor amputation.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-02-01T12:36:45Z
      DOI: 10.1177/15347346221077491
       
  • A Rare Cause of Chronic Leg Ulcer in Childhood: Parkes-Weber Syndrome

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      Authors: Kübra Yüce Atamulu, Sevgi Yaşar Durmuş, Tuğba Uylar Seber
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Parkes Weber syndrome is a rare congenital vascular disease characterized by capillary venous, arterio-venous and lymphatic malformations accompanied by bone or soft tissue hypertrophy in the affected body area. Lymphatic insufficiency and venous ulcers may occur as a result of increased venous pressure, caused by arterio-venous shunts. Parkes Weber syndrome is an infrequent cause of leg ulcers in childhood. Since arterio-venous malformations can lead to serious complications, it is important to recognize and start treatment immediately.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-01-31T11:16:29Z
      DOI: 10.1177/15347346221077581
       
  • Chronic Leg Ulcer Associated with Cutaneous IgG4-Related Disease

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      Authors: Yi-Jye Chen, Chih-Yi Hsu, Chih-Hsun Lin
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Chronic leg ulcer occurs in up to 13% of the general population and leads to economic and health care burdens. Approximately 20% of chronic nonhealing wounds are related to autoimmune diseases or vasculitis. Of these, chronic wounds associated with IgG4-related disease, a group of fibroinflammatory disorders that can have cutaneous and systemic involvement, are rarely reported. This case report describes a chronic leg ulcer associated with cutaneous IgG4-related disease. In addition to disease control with anti-inflammatory agents, following the principles of wound management and providing adjuvant wound treatment (eg, debridement, dressing, photobiomodulation therapy, or hyperbaric oxygen therapy) can promote the wound healing process.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-01-24T12:43:58Z
      DOI: 10.1177/15347346221075873
       
  • Nutrients with Antioxidant Properties and Their Effects on Lower-Limb
           Ulcers: A Systematic Review

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      Authors: Thamiris de Souza, Jessyca Dias Cardoso Monteiro, Cintia Chaves Curioni, Cláudia Cople-Rodrigues, Marta Citelli
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Chronic lower-limb ulcers (LLUs) are ulcers that fail to proceed through an orderly and timely process to produce anatomic and functional integrity. LLUs reduce the quality of life of affected individuals and are a public health problem. The treatment options include medications or surgery. Nutrition therapy is an important adjunct to improve the clinical picture and healing of LLUs. Considering that nutrients with antioxidant properties can improve the process of tissue healing, this systematic review aimed to evaluate the efficacy of antioxidant nutrient supplementation in the treatment of LLUs through randomized clinical trials. This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses and the Cochrane Handbook for Systematic Reviews of Interventions. The guiding question was—can antioxidant nutrients help in the treatment of chronic LLUs' In total, 1184 articles were found when searching for antioxidant nutrients associated with the most common causes of LLUs. Fourteen articles were included in this review after removing duplicates, studies with topical and/or venous use of antioxidants, and articles published in other languages, except English. Omega-3 fatty acids, magnesium, zinc, vitamins A, C, D, and resveratrol along with probiotics positively improved the ulcer healing. These effects were more significant when there was initially a deficiency of the respective supplemented nutrients. Therefore, correcting and maintaining an adequate nutritional status can improve ulcer healing and contribute to the clinical treatment of patients with LLUs.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-01-24T03:42:55Z
      DOI: 10.1177/15347346221074861
       
  • Phosphaturic Mesenchymal Tumor Along the Hallux side Inducing a Chronic
           non-Healing Wound: A Case Report with Literature Review

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      Authors: Xiaofang Sun, Pengwen Ni, Ting Xie, Shaohan Wu
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Phosphaturic mesenchymal tumor (PMT) is a rare paraneoplastic syndrome characterized by renal phosphate wasting, hypophosphatemia, and bone calcification disorders. Complete surgical resection of the tumor is believed to be the most effective treatment measure. However, the diagnosis of PMT is very difficult because of its insidious and small size, especially, when it appears in subcutaneous tissue with a chronic non-healing wound. We report a rare case of a 38-year-old man with a chronic non-healing wound on the left hallux for approximately eight months. Plain radiographic images and magnetic resonance imaging (MRI) revealed a cystic radiolucent shadow in the left distal phalanx. Bone scan observations also showed increased uptake in the same location. Histologically, this tumor was composed of numerous spindle cells with clusters of giant cells. The serum FGF23 level was significantly higher before surgery, with higher FGF23 levels closer to the tumor. Reverse transcription polymerase chain reaction and immunohistochemistry further confirmed the high expression of FGF23 in tumors. These data suggest that FGF23 may be a potential causative factor of PMT. The serum FGF23 levels might be useful for the diagnosis of PMT and localization of the tumor. The tumor was CD56- and D2 to 40-positive and CD31-negative. The non-healing wound caused by PMT might be attributed to the invasive growth of the tumor, destruction of intercellular junctions, and decrease in the number of endothelial cells.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-01-19T11:25:30Z
      DOI: 10.1177/15347346221074163
       
  • The Effect of Plantago major Hydroalcoholic Extract on the Healing of
           Diabetic Foot and Pressure Ulcers: A Randomized Open-Label Controlled
           Clinical Trial

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      Authors: Mustafa Ghanadian, Rasool Soltani, Alireza Homayouni, Farzin Khorvash, Soroush Mohammadi Jouabadi, Moein Abdollahzadeh
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Aims: Diabetic foot ulcer (DFU) and pressure ulcer (PU) both are common types of ulcers worldwide. The wound healing effect of Plantago major leaves has been shown in a few animal studies. This study aimed to evaluate the clinical efficacy of P. major hydroalcoholic extract on DFU and PU healing. Methods: In this clinical trial, patients with DFU or PU who met the inclusion criteria were randomly assigned to drug (P. major) or control groups. For patients in the drug group, Plantago extract 10% topical gel was applied on the wound once daily concurrent with dressing and routine wound care for two weeks, while for the control group, an appropriate novel dressing was used along with routine wound care for the same duration. The percentage of wound size reduction at the end of the seventh and 14th days of intervention was recorded and compared between the groups. Results: Fifty and 44 patients in drug and control groups, respectively, completed the interventions. Plantago extract gel significantly resulted in more reduction in the wound size compared to control at the end of the first (64.90 ± 29.75% vs. 33.11 ± 26.55%; P 
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-01-19T03:05:06Z
      DOI: 10.1177/15347346211070723
       
  • Study on Blood Serum Levels of Heavy and Trace Metals in Chronic
           Non-Healing Wounds

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      Authors: Ruhi Dixit, Naveen Kumar Chaudhary, Pradeep Kumar Mishra, Pradeep Srivastava, Satyanam Kumar Bhartiya, Arvind Pratap, Somprakas Basu, Vijay Kumar Shukla
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Wound healing is a complex, highly regulated process that is important in sustaining the skin barrier function. The etiologic relation of specific metals is not adequately described for chronic non-healing wounds. The aim of this study was to estimate heavy and trace metals in chronic non-healing wound and their association with wound healing. The levels of zinc, selenium, copper, magnesium, chromium, cadmium, iron, and lead were estimated in serum of chronic non-healing wound patients using atomic absorption spectrophotometry. The tests were carried out in 50 patients with chronic non-healing wound and thirty healthy volunteers as control. The serum levels of elements namely zinc, selenium, copper, magnesium, and chromium were significantly reduced in chronic non-healing wounds (P 
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-01-17T01:07:21Z
      DOI: 10.1177/15347346221074161
       
  • Bizarre Cutaneous Ulcers due to Self-Administered Intravenous
           Dexketoprofen Trometamol

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      Authors: Neslihan Akdogan, Gonca Elcin, Sedat Kiraz
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Systemic non-steroidal anti-inflammatory drug use may result in various cutaneous complications including maculopapular rash, fixed drug eruption, urticaria, and angioedema most frequently. However extensive cutaneous ulcers in relation to intravenous dexketoprofen trometamol use has not been identified before although cutaneous ulcers have been described in association with several opioids. Herein, we would like to present a 27-year-old male with a 1-year history of progressive deep cutaneous ulcers due to long term abusive intravenous use of dexketoprofen trometamol.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-01-17T01:06:42Z
      DOI: 10.1177/15347346221074158
       
  • Dialysis Treatment is an Independent Risk Factor for Foot Morbidity

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      Authors: Nathalie Schembri, Cynthia Formosa
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Aim: To determine the prevalence of foot morbidity among patients with ESRD on dialysis. Methods: A prospective, non-experimental, quantitative time series design was employed. Forty-seven participants were recruited in the study. Medical records were reviewed followed by non-invasive foot assessments which included: Neurological, Arterial, Biomechanical, and Dermatological Assessment. Participants were assessed twice during the study. Results: Foot morbidity was found to be high among participants with ESRD on dialysis. 95.74% of participants presented with foot deformities, 76.60% had skin and nail conditions. 15% of participants had a history of ulceration and amputation. Moreover, active ulceration and history of revascularisation were also observed. Findings demonstrated overall poor foot health and footcare behavior within this population with 40.43% of participants having inappropriate footwear. The majority of participants did not check feet regularly, did not attend to podiatry appointments, and were unable to reach their feet for self-care. The Toe Brachial Pressure Index (TBPI), Spectral Doppler Waveform Analysis, and the Quantitative Sensory Testing (QST) were re-measured at each visit. Monophasic continuous doppler waveforms increased while triphasic waveforms decreased during the study period. Protective sensation did not decrease during the study period. The mean TBPI decreased during the study period. The relationship between the TBPI and duration of dialysis was found to be significant. Both DM and dialysis duration were identified as significant predictors of reduction in TBPI. Conclusion: This study demonstrates a high prevalence of foot morbidity among patients with ESRD on dialysis. This study highlighted the importance of expanding practice by introducing a podiatry service within the renal unit to provide foot screening, foot assessments, and foot care education, with the aim to reduce severe foot complications.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-01-17T01:06:35Z
      DOI: 10.1177/15347346221074111
       
  • Autologous Fat Grafting – A Step Forward in Wound Management

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      Authors: Komal Saeed, Farid Ahmad Khan, Saad Bin Abdul Qudus, Sundas Javed
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Autologous fat grafting (AFG) is an emerging therapeutic option for wounds that are not ready for grafting. The regenerative potential of autologous fat lies in the adipose derived stem cells (ADSCs) contained within the stromal vascular fraction (SVF), which are capable of differentiating into multiple cell lineages. However to date, there has been no comprehensive evaluation of its efficacy in acute complicated wounds. This study aims to critically evaluate the efficacy and safety of AFG in cutaneous wound healing. Materials and Methods: This prospective, quasi experimental study was conducted in the Department Of Plastic Surgery, SIMS, Lahore, between June 2020 and June 2021. Thirty patients with pale granulation, not ready for grafting with no vital structure exposed were included in the study after detailed history, examination and were photographed pre and postoperatively. The procedure was performed under local anaesthesia. 40 to 80 ml fat was harvested from lower abdomen and after emulsification, placed over the wound wrapped in sufra tulle dressing. The dressing was changed on third postoperative day and outcome was assessed on clinical grounds. Results: Thirty patients (M:F Ratio 1.75:1) with mean age 30 years (Range 13-45 years) were included in this study with post traumatic (n = 23) and post infective (n = 7). Of 27 patients who completed their follow up, all had healthy granulation tissue which was later on grafted. Mean number of fat dressing sessions were 2 (Range 1-3). Conclusion: Autologous fat grafting has shown promising results for cutaneous wounds without any unacceptably high complication rates reported so far. Randomised controlled trials should be done on a larger scale to prove its efficacy in the management of complicated wounds.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-01-12T11:54:34Z
      DOI: 10.1177/15347346211073388
       
  • Evaluation of Effect of Biologically Synthesized Ethanolic Extract of
           Propolis-Loaded Poly(-Lactic-co-Glycolic Acid) Nanoparticles on Wound
           Healing in Diabetic Rats

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      Authors: Reza Tayfeh-Ebrahimi, Amir Amniattalab, Rahim Mohammadi
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Wound healing is interaction of a complex cascade of cellular/biochemical actions leading to restoration of structural and functional integrity with regain of injured tissues strength. This study was aimed at evaluation of application of ethanolic extract of propolis-loaded poly(-lactic-co-glycolic acid) nanoparticles (EEP-PLGA NPs) on wound healing in diabetic rats. Sixty rats were randomized into four groups of 15 rats each: In control group (Control) diabetic wound was treated with normal saline. In Carrier 1 group diabetic wound was treated with PLGA nanoparticles based solution. In Carrier 2 group the diabetic wound was treated with EEP. In Treatment group animals received EEP-PLGA NPs on the wound. Wound size was measured on 7, 14 and 21 days after surgery. The expression of p53, bcl-2, Caspase III, were evaluated using reverse-transcription PCR and Immunohistochemical staining. The Treatment group had significantly reduced the wound size compared to other groups (P = 0.001). histological and morphometric studies, and mean rank of the qualitative studies demonstrated that there was significant difference between Treatment group and other groups (P 
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-01-10T01:06:09Z
      DOI: 10.1177/15347346211073224
       
  • Biological Therapy on Infected Traumatic Wounds: A Case-Control Study

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      Authors: Satyanam Kumar Bhartiya, Rina Prasad, Sumit Sharma, VijayKumar Shukla, Gopal Nath, Rajesh Kumar
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Background:Traumatic wound is a great challenging issue to surgeons, because of large in size, heavily contaminated, infected and unscenic. Infection proceeded to progressive tissue necrosis, septicemia, organ failure or even death. Majority has polymicrobial infections. Bacteriohage therapy will have revolutionized in the treatment of wound. The present study was planned to evaluate the efficacy of topical bacteriophage therapy on large traumatic wounds in comparison with conventional therapy. Methods:The Study conducted from Sept. 2018 to July 2020. Samples between 12- 60 years was taken into study. Customized bacteriophage applied over the wound after serial debridement in case and conventional dressing in control. Fifty four wounded person met the clinical inclusion criteria; 27 in each group. Wound swab and tissue biopsy was taken for bacterial isolation. Isolated specific phage was applied over the wound on alternate day till the wound become sterile and fit for further definitive management. Results: A significant and rapid improvement was observed in wound healing in cases then control group. Average number of day required for complete granulation of wound and attaining sterility was half in cases then control. The hospital stay of the patients on BT was half (20days) than those on CT (40 days). The financial analysis also favours the BT over CT as only 1/third expenditure incurred in BT group as compared to CT Conclusion:Topical Bacteriophage therapy is efficient, effective to clearing the infection in shorter length of time and cost effective for infected traumatic wounds as compared to conventional dressing.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-01-05T02:27:46Z
      DOI: 10.1177/15347346211072779
       
  • Omentin-1 and diabetic foot

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      Authors: Tsvetan Gatev, Viktoriya Byalkova, Ivan Poromanski, Tsvetelina Velikova, Dobrin Vassilev, Zdravko Kamenov
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Introduction: Diabetic foot disease is an advanced complication of diabetes mellitus, which is associated with severe invalidization and high mortality rate among affected people. Many factors are involved in its pathogenesis but not all of them are fully elucidated. Objectives: Adipose tissue and its hormones – adipokines, are related to diabetic complications and metabolic disorders. Until now, there are limited data on their role in diabetic foot. The aim of this cross-sectional study is to determine the levels of the adipokine omentin-1 in people with and without diabetic foot disease and to look for its potential involvement in this complication. Methods: Eighty patients with type 2 diabetes and mean age of 60.8±10.5 years were included in this study. They were divided into two groups: with (n=36) and without (n=44) diabetic foot disease. Standard antrometric, clinical and laboratory tests were made. Body composition was analyzed by bioelectrical impedance based device. Serum omentin-1 was measured using ELISA method. Results: Levels of omentin-1 were significantly higher among people with diabetic foot disease (700.2±345.1 ng/ml), compared to the other group (560.2±176.7 ng/ml). This difference remained significant even after adjusting for potential confounders. In a regression model omentin-1 proved its predictive value for development of diabetic foot. Conclusion: Adipokines, and particularly omentin-1, might be included in the pathogenesis of diabetic foot disease.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-01-05T02:27:26Z
      DOI: 10.1177/15347346211069813
       
  • Incidence of Recurrent Venous Ulcer in Patients Treated at an Outpatient
           Clinic: Historical Cohort

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      Authors: Michele Neves Brajão Rocha, Carol Viviana Serna Gonzalez, Eline Lima Borges, Vera Lúcia Conceição de Gouveia Santos, Soraia Assad Nasbine Rabeh, Paula Cristina Nogueira
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      The recurrence of venous ulcers is the wound reopening after a period of completed epithelisation of a previous ulcer due to exposure to causal factors and lack of prevention. Venous ulcers have a high recurrence rate that may increase through the years. Epidemiological evidence on its incidence and risk factors is scarce due to the lack of patient follow-up in outpatient clinics and adherence to treatment after healing. The objective was to analyze the incidence of venous ulcers recurrency in outpatients and the risk factors for its occurrence. It is an observational historical cohort with retrospective data collection, performed through electronic medical records. Setting: private health insurance outpatient clinic. The participants were adult patients with healed venous ulcers. Incidence of venous ulcer recurrence was calculated within individuals with healed ulcers from 2014 and 2018 with a follow-up of at least one year. Bivariate analysis and logistic regression were used to explore risk factors considering demographic, clinical, and wound-related variables. As a result, sixty-five (65) of the 134 patients with healed venous ulcers had a recurrence, leading to an incidence of 48.5%, with a mean onset time of 230.1 (SD 267) days. Patients with recurrent venous ulcers were primarily women (39/48.1%), with a mean age of 64 (SD 15.5) years, 57 (50.8%) had some comorbidity, with systemic arterial hypertension as the most frequent (47/51%). Obesity (15/88.2%) increased the risk of venous ulcers recurrence by 8.7 (OR 95% CI 2.1-60.8; P = .009) times. In conclusion, venous ulcers recurrence incidence was 48.5%, with obesity as a risk factor. This study demonstrates that the clinical approach of people with venous ulcers should not finish when the wound is healed. For ulcer recurrence prevention interventions addressing systemic factors, besides topical management of the wound, are essential.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-01-04T03:49:40Z
      DOI: 10.1177/15347346211065929
       
  • The Effect of Foot Care Education for Patients with Diabetes on Knowledge,
           Self-Efficacy and Behavior: Systematic Review and Meta-Analysis

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      Authors: Elif Yıldırım Ayaz, Berna Dincer, Aytekin Oğuz
      First page: 234
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      This systematic review and meta-analysis aimed to synthesize randomized controlled trials on the impact of foot care education on knowledge, self-efficacy and behavior in patients with diabetes. A search was made using PubMed, Web of Science, Science Direct, Google Scholar, YOK National Thesis Center and Google Scholar electronic databases for studies published between March 2003-January 2022. The search medical subject headings (MeSH) terms were diabetic foot, knowledge, self-efficacy, and behavior. Studies suitable for the systematic review and the meta-analysis met the following criteria (PICOS): target participants would be diagnosed with diabetes (population), diabetic foot education (intervention), comparison of the group receiving diabetic foot care education and routine care education, and the control group receiving only routine care education (comparison), studies evaluating the levels of knowledge, self-efficacy and behavior (outcome), randomized controlled trials (study design). Twenty-six studies were included in systematic review. Three studies for knowledge, 5 studies for behavior, 8 studies for self-efficacy were included in the meta-analysis (total sample: 2534, experiment: 1464, control: 1071). All of the studies had low reporting bias. The mean duration of educations for knowledge was 5.2 months. This duration was 4.8 months for behavior and 4.5 months for self-efficacy. In the random effect (since the homogeneity test: P 
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-06-17T06:03:42Z
      DOI: 10.1177/15347346221109047
       
  • A Study on Pressure Ulcer: Influencing Factors and Diagnostic Techniques

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      Authors: G. Annie Nancy, R. Kalpana, S. Nandhini
      First page: 254
      Abstract: The International Journal of Lower Extremity Wounds, Ahead of Print.
      Pressure ulcer (PU) is one of the most common occurrences in bedridden subjects. Despite the standard of care, there is a huge challenge in monitoring immobile subjects in all the bodily pressure points. This increases the chance of onset of PU which in turn increases the expenditure for treating and managing the PU. Hence, we made a study on the biological and physiological factors that are responsible for the formation of PU and also on various techniques used for diagnosis. Thus, we have summarised the efficacy of various advanced diagnostic procedures with their limitations. Though there are advanced imaging techniques, risk assessment tools based on the visual inspection are widely followed in hospitals. Based on our observation, we here have identified three major areas; one being the development of mathematical modeling, the second is towards the development of non-invasive devices and finally to automate cot facility. We have also provided possible suggestions as to solutions that could be useful to researchers and for society. Thus, this review covers the present difficulty faced by bedridden subjects and respective care-takers along with the knowledge gap and a few suggestions as to future scope.
      Citation: The International Journal of Lower Extremity Wounds
      PubDate: 2022-02-21T04:19:08Z
      DOI: 10.1177/15347346221081603
       
 
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