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https://www.readbyqxmd.com/read/28216809/healing-ulcers-and-preventing-their-recurrences-in-the-diabetic-foot
#1
S Raja Sabapathy, Madhu Periasamy
Fifteen percent of people with diabetes develop an ulcer in the course of their lifetime. Eighty-five percent of the major amputations in diabetes mellitus are preceded by an ulcer. Management of ulcers and preventing their recurrence is important for the quality of life of the individual and reducing the cost of care of treatment. The main causative factors of ulceration are neuropathy, vasculopathy and limited joint mobility. Altered bio-mechanics due to the deformities secondary to neuropathy and limited joint mobility leads to focal points of increased pressure, which compromises circulation leading to ulcers...
September 2016: Indian Journal of Plastic Surgery: Official Publication of the Association of Plastic Surgeons of India
https://www.readbyqxmd.com/read/28202074/exendin-4-in-combination-with-adipose-derived-stem-cells-promotes-angiogenesis-and-improves-diabetic-wound-healing
#2
Eunhui Seo, Jae Soo Lim, Jin-Bum Jun, Woohyuk Choi, In-Sun Hong, Hee-Sook Jun
BACKGROUND: Diminished wound healing is a major complication of diabetes mellitus and can lead to foot ulcers. However, there are limited therapeutic methods to treat this condition. Exendin-4 (Ex-4), a glucagon-like peptide-1 receptor agonist, is known to have many beneficial effects on diabetes. In addition, mesenchymal stem cells are known to have wound healing effects. We investigated the effects of Ex-4 in combination with human adipose tissue-derived stem cells (ADSCs) on diabetic wound healing in a diabetic animal model...
February 15, 2017: Journal of Translational Medicine
https://www.readbyqxmd.com/read/28152328/a-comparison-of-axial-circumference-between-superficial-circumflex-iliac-artery-perforator-flap-and-other-workhorse-flaps-in-dorsal-foot-reconstruction
#3
Yujin Myung, Sangjun Yim, Baek-Kyu Kim
BACKGROUND: Management and reconstruction of dorsal foot defects present various difficulties and challenges. The main purpose of this article is to discuss experiences of using superficial circumflex iliac perforator (SCIP) flap in various defects of the dorsal foot region. METHODS: From August 2012 to February 2015, a total of 13 patients - nine males and four females - received a reconstruction operation for dorsal foot defects using SCIP flaps (the SCIP group)...
February 2, 2017: Journal of Plastic Surgery and Hand Surgery
https://www.readbyqxmd.com/read/28031030/outcome-after-protected-full-weightbearing-treatment-in-an-orthopedic-device-in-diabetic-neuropathic-arthropathy-charcot-arthropathy-a-comparison-of-unilaterally-and-bilaterally-affected-patients
#4
Niklas Renner, Stephan Hermann Wirth, Georg Osterhoff, Thomas Böni, Martin Berli
BACKGROUND: Charcot neuropathic arthropathy (CN) is a chronic, progressive, destructive, non-infectious process that most frequently affects the bone architecture of the foot in patients with sensory neuropathy. We evaluated the outcome of protected weightbearing treatment of CN in unilaterally and bilaterally affected patients and secondarily compared outcomes in protected versus unprotected weightbearing treatment. METHODS: Patient records and radiographs from 2002 to 2012 were retrospectively analyzed...
December 29, 2016: BMC Musculoskeletal Disorders
https://www.readbyqxmd.com/read/27935900/-thromboangiitis-obliterans-buerger-s-disease-state-of-the-art
#5
REVIEW
D D Zerbino, E A Zimba, N N Bagry
Thromboangiitis obliterans (Buerger's disease) is systemic vasculitis with predominant development of thrombotic occlusions of small-to-medium diameter arteries of distal portions of both upper and lower limbs. A distinctive feature of Buerger's disease from other vasculitides is the involvement of the venous bed into the pathological process in the form of migrating thrombophlebitis. The disease is encountered more often in young adult males, predominantly tobacco smokers. The clinical pattern is presented by symptoms of increasing insufficiency of blood supply of tissues of extremities...
2016: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
https://www.readbyqxmd.com/read/27923212/comparison-of-diabetic-charcot-patients-with-and-without-foot-wounds
#6
Dane K Wukich, David Sadoskas, Nicholas J Vaudreuil, Mitchell Fourman
BACKGROUND: The primary aim of this study was to evaluate the outcomes of a series of patients with Charcot neuroarthropathy (CN) who were evaluated in a tertiary care setting. We hypothesized that those patients with CN who presented with a Charcot-related foot wound would have lower rates of successful limb salvage than patients who presented without a wound. METHODS: Two hundred forty-five patients (280 feet) were identified with diabetic CN during the time period from January 1, 2005, to June 1, 2015...
February 2017: Foot & Ankle International
https://www.readbyqxmd.com/read/27865319/circular-external-fixation-as-a-primary-or-adjunctive-therapy-for-the-podoplastic-approach-of-the-diabetic-charcot-foot
#7
REVIEW
Daniel J Short, Thomas Zgonis
Numerous techniques have been described for surgical management of the diabetic Charcot foot. External fixation has become a main surgical tool for the reconstructive foot and ankle surgeon when dealing with the ulcerated diabetic Charcot foot. In the presence of an open wound and/or osteomyelitis, staged reconstruction with circular external fixation becomes ideal for salvage of the diabetic lower extremity. Also, circular external fixation can provide simultaneous compression and stabilization, correct the underlying osseous or soft tissue deformities, and surgically offload the diabetic Charcot foot...
January 2017: Clinics in Podiatric Medicine and Surgery
https://www.readbyqxmd.com/read/27865317/revisional-surgery-of-the-diabetic-charcot-foot-and-ankle
#8
REVIEW
Patrick R Burns, Spencer J Monaco
Charcot neuroarthropathy (CN) is a difficult problem for the foot and ankle surgeon. If surgery is required, little is known or available regarding the best methods and timing. When the initial attempt of reconstruction fails, revision of CN is even more demanding. One must take in to account all aspects, including nutrition, vascular status, infection control, short- and long-term blood glucose management, as well as other factors requiring laboratory monitoring and consult services. Once optimized, the biomechanics of the deformity can be addressed and decisions can be made on fixation devices...
January 2017: Clinics in Podiatric Medicine and Surgery
https://www.readbyqxmd.com/read/27865316/soft-tissue-reconstruction-pyramid-for-the-diabetic-charcot-foot
#9
REVIEW
Claire M Capobianco, Thomas Zgonis
Foot and ankle ulcerations in patients with diabetic Charcot neuroarthropathy (DCN) occur frequently and can be challenging to address surgically when conservative care fails. Patients with acute or chronic diabetic foot ulcers (DFU) are at continued risk for development of osteomyelitis, septic arthritis, gas gangrene, and potential lower extremity amputation. Concurrent vasculopathy and peripheral neuropathy as well as uncontrolled medical comorbidities complicate the treatment approach. In addition, pathomechanical forces left untreated may contribute to DFU recurrence in this patient population...
January 2017: Clinics in Podiatric Medicine and Surgery
https://www.readbyqxmd.com/read/27865314/surgical-treatment-options-for-the-diabetic-charcot-midfoot-deformity
#10
REVIEW
Yousef Alrashidi, Thomas Hügle, Martin Wiewiorski, Mario Herrera-Perez, Victor Valderrabano
Management of diabetic Charcot midfoot deformity is one of the most demanding aspects of foot and ankle surgery. Its treatment should aim at reducing the rate of complications, including foot and ankle amputations or limb loss. Attempting reconstruction at Eichenholtz stages I and II carries the risk of infection and loss of fixation. It is advisable to limit surgical reconstruction to Eichenholtz stage III in the absence of any evidence of infection or vascular insufficiency. Achilles lengthening or gastrocnemius-soleus release is an essential initial step in surgery...
January 2017: Clinics in Podiatric Medicine and Surgery
https://www.readbyqxmd.com/read/27694302/combination-of-open-subtotal-calcanectomy-and-stabilization-with-external-fixation-as-limb-salvage-procedure-in-hindfoot-infected-diabetic-foot-ulcers
#11
Luca Dalla Paola, Anna Carone, Giulio Boscarino, Giuseppe Scavone, Lucian Vasilache
Diabetic hindfoot ulcers, complicated by osteomyelitis, are associated with a high risk of major amputation. Partial calcanectomy, preceded by an effective management of the infection and of the eventual peripheral artery disease, can be considered as valid therapeutic option. We have evaluated a therapeutic protocol for diabetic hindfoot ulcers complicated by osteomyelitis, which, besides an adequate surgical debridement, considers a reconstructive pathway assisted by the positioning of a circular external fixator...
September 29, 2016: International Journal of Lower Extremity Wounds
https://www.readbyqxmd.com/read/27681806/treatment-of-large-complex-non-healing-wounds-with-cryopreserved-amniotic-suspension-allograft-a-case-series
#12
B Marcus
OBJECTIVE: Cryopreserved amniotic suspension allograft (CASA) is a regenerative tissue suspension containing amniotic membrane and amniotic fluid components used for soft-tissue repair, replacement, and reconstruction. The aim of this case series is to examine its effects in different wound types. METHOD: In a retrospective series CASA was applied to chronic non-healing wounds. All patients were treated at a single center between June 2013 and December 2014. The criterion for application of CASA was lack of progress toward wound healing despite standard treatments and adjuvant therapies...
October 2016: Journal of Wound Care
https://www.readbyqxmd.com/read/27673541/a-new-approach-for-reconstruction-of-diabetic-foot-wounds-using-the-angiosome-and-supermicrosurgery-concept
#13
Hyun Suk Suh, Tae Suk Oh, Ho Seung Lee, Seung Hwan Lee, Yong Pil Cho, Joong Ryul Park, Joon Pio Hong
BACKGROUND: Major vessels in the diabetic foot are often calcified and inadequate for use as recipient vessels. Thus, a supermicrosurgery technique using small branches or perforators from other collateral vessels with an adequate pulse may be an alternative method. This study evaluated outcome using the supermicrosurgery concept and the risk factors involved. METHODS: Ninety-five cases of diabetic foot reconstruction were reviewed; the average patient age was 57 years; average follow-up was 43...
October 2016: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/27556759/what-role-does-function-play-in-deciding-on-limb-salvage-versus-amputation-in-patients-with-diabetes
#14
Dane K Wukich, Katherine M Raspovic
BACKGROUND: Patients with diabetic foot disease are at an increased risk for lower extremity amputation (LEA), premature mortality, and reduced health-related quality of life. In the setting of chronic infection, significant tissue loss, and/or an unstable deformity, limb salvage may not be possible, and major amputation is necessary. METHODS: The primary goal of this study was to review the literature with an emphasis on the functional aspects associated with successful limb salvage versus major LEA...
September 2016: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/27524708/neuropathic-minimally-invasive-surgeries-nemesis-percutaneous-diabetic-foot-surgery-and-reconstruction
#15
REVIEW
Roslyn J Miller
Patients with peripheral neuropathy associated with ulceration are the nemesis of the orthopedic foot and ankle surgeon. Diabetic foot syndrome is the leading cause of peripheral neuropathy, and its prevalence continues to increase at an alarming rate. Poor wound healing, nonunion, infection, and risk of amputation contribute to the understandable caution toward this patient group. Significant metalwork is required to hold these technically challenging deformities. Neuropathic Minimally Invasive Surgeries is an addition to the toolbox of management of the diabetic foot...
September 2016: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/27336348/-lower-limb-critical-ischaemia-in-patients-of-a-pyoseptic-surgery-unit
#16
A V Maksimov, K A Koreiba, R M Nuretdinov, R R Sadykov, S M Khizriev
The authors retrospectively analysed therapeutic results of treatment in a total of 749 patients of the Pyoseptic Surgery Unit with signs of lower limb critical ischaemia. Of these, 101 (13.5%) patients were found to have a pronounced septic process (successfully arrested in 88 patients). A further 86 (11.5%) patients were diagnosed with extended trophic alterations making revascularization unpromising. The incidence rate of "major" amputations in this group amounted to 34.2%, with a lethality rate of 5.9%...
2016: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
https://www.readbyqxmd.com/read/27036309/society-for-vascular-surgery-limb-stage-and-patient-risk-correlate-with-outcomes-in-an-amputation-prevention-program
#17
Marlin W Causey, Ayman Ahmed, Bian Wu, Warren J Gasper, Alex Reyzelman, Shant M Vartanian, Jade S Hiramoto, Michael S Conte
OBJECTIVE: Clinical decision making and accurate outcomes comparisons in advanced limb ischemia require improved staging systems. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System (Wound extent, Ischemia, and foot Infection [WIfI]) was designed to stratify limb outcomes based on three major factors-wound extent, ischemia, and foot infection. The Project or Ex-Vivo vein graft Engineering via Transfection III (PREVENT) III (PIII) risk score was developed to stratify patients by expected amputation-free survival (AFS) after surgical revascularization...
June 2016: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/27015337/combination-of-vascular-intervention-surgery-and-free-tissue-transfer-for-critical-diabetic-limb-salvage
#18
Chieh Chou, Pao-Jen Kuo, Yen-Chou Chen, Shu-Hung Huang, Chih-Hau Chang, Yi-Chia Wu, Su-Shin Lee, Cheng-Sheng Lai, Sin-Daw Lin, Kao-Ping Chang, Yur-Ren Kuo
BACKGROUND: Complex, nontraumatic diabetic foot ulcers with peripheral vascular compromise often lead to extensive lower-limb amputation. The aim of this study is to determine the outcome of combined vascular intervention and free tissue transfer for critical diabetic limb salvage. MATERIALS AND METHODS: A total of 26 consecutive diabetic patients with 28 legs with diabetic foot ulcers who underwent limb salvage with a combination of revascularization (bypass surgery or endovascular angioplasty) and free flap transfers were reviewed...
February 2016: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/26910652/microsurgical-reconstruction-of-plantar-ulcers-of-the-insensate-foot
#19
Dinesh Kadam
Background Plantar, neuropathic, or trophic ulcers are often found in patients with decreased sensation in the foot. These ulcers can be complicated by infection, deformity, and increased patient morbidity. Excision results in wider defects and local tissues are often insufficient for reconstruction Methods Total 26 free flaps were used in 25 patients to reconstruct plantar ulcers between years 2007 and 2013. The etiology included diabetic neuropathy (n = 13), leprosy (n = 3), spinal/peripheral nerve injury (n = 7), spina bifida (n = 1), and peripheral neuropathy (n = 1)...
June 2016: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/26866804/skin-grafting-and-tissue-replacement-for-treating-foot-ulcers-in-people-with-diabetes
#20
REVIEW
Trientje B Santema, Paul P C Poyck, Dirk T Ubbink
BACKGROUND: Foot ulceration is a major problem in people with diabetes and is the leading cause of hospitalisation and limb amputations. Skin grafts and tissue replacements can be used to reconstruct skin defects for people with diabetic foot ulcers in addition to providing them with standard care. Skin substitutes can consist of bioengineered or artificial skin, autografts (taken from the patient), allografts (taken from another person) or xenografts (taken from animals). OBJECTIVES: To determine the benefits and harms of skin grafting and tissue replacement for treating foot ulcers in people with diabetes...
2016: Cochrane Database of Systematic Reviews
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