• Archives of Plastic Surgery
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• v.37 no.1
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• pp.1-6
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• 2010

Purpose: Diabetic foot infection is one of the most common and severe complications of diabetes mellitus that delays healing of the wound. Deep tissue biopsy is considered to be the gold standard method for antibiotic selection in treating infected chronic diabetic ulcers. However, swab culture or superficial tissue biopsy is often performed for a microbiologic test since deep tissue biopsy has limitations in application. The purpose of this study is to find out whether microbiologic results of swab culture or superficial tissue biopsy could be used for selection of antibiotics in treating diabetic ulcers. Methods: This study involved 42 patients with diabetic foot ulcers with negative results in bone probing test. Tissue samples for microbiologic tests were collected from all the patients by using superficial cotton swab, superficial tissue, and deep tissue. The microbiologic results of deep tissue biopsy were compared with swab culture and superficial tissue biopsy statistically. Results: Microbiology of the deep tissue showed the same results with those of the swab culture and superficial tissue in 67% and 71%, respectively. Statistical analysis demonstrated that the microbiology of the swab culture and superficial tissue does not coincide with that of the deep tissue. Conclusion: These results suggest that the microbiology of the swab culture and superficial tissue is not concordant with that of the deep tissue in infected chronic diabetic ulcers. To select appropriate antibiotic regimen, the speci specimen for the microbiologic test should be obtained from deep tissue.

• Archives of Plastic Surgery
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• v.35 no.5
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• pp.491-494
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• 2008

Purpose: When deciding a treatment plan in diabetic foot ulcer patients, predicting a possibility of healing wounds is important since not a few patients have poor general condition to get successful wound healing. This study was planned to find out if a serum collagen level can be used as a predictor for healing wounds in diabetic foot patients. Methods: Fifty-seven patients, who visited our clinic from January to June, 2007 for treatment of diabetic foot ulcers, were included in this study. Serum levels of type I collagen were checked using carboxy terminal type I propeptide kits. Simultaneously serum levels of vitamin C and iron, cofactors of collagen synthesis, were checked. The patients were divided into two groups; a group of successfully healed wounds and the other of unhealed wounds. Serum levels of the parameters were compared between the 2 groups. Results: The serum level of collagen was $197.65{\pm}86.26ng/ml$ in a healed group and $87.91{\pm}28.76ng/ml$ in the unhealed group(p<0.05). The serum iron and vitamin C levels were did not show significant differences. Conclusion: The serum collagen level may predict healing or nonhealing wounds in diabetic foot ulcers.

• Archives of Plastic Surgery
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• v.33 no.2
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• pp.198-204
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• 2006

Many clinical trials have shown the effectiveness of the platelet releasate or the platelet gel on chronic wounds. However, the patient's own blood had to be aspirated and processed to make the platelet releasate or a platelet gel. The purpose of this study was to assess the effects of platelet concentrates from the blood bank for the treatment of diabetic foot ulcers. To obtain the basic data of the PDGF-BB content in platelet concentrates supplied from the blood bank, enzyme-linked immunosorbent assay quantification was performed. On average, 8.5 pg of the PDGF-BB was released per 1 million platelets. Sixteen patients with diabetic foot ulcers ranging from 1.0 to $18.0cm^2$(mean, $6.1cm^2$) in size were treated. The platelet concentrates was centrifuged and the precipitantte was mixed with 1 ml of fibrinogen. The platelets and fibrinogen mixture was dispersed on to the ulcer lesions. The liquid platelet and fibrinogen mixture was then sealed using 0.3-1.0 ml of thrombin and moisture dressing was performed. The procedure was repeated every one or two weeks until wound closure. Time required for complete healing ranged from 3 to 12 weeks after treatment (mean, 7.3 weeks). Patient satisfaction was also very positive. In this study, the use of platelet concentrates from the blood bank was found to be effective in treating diabetic foot ulcers.

• The Journal of Korean Physical Therapy
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• v.19 no.5
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• pp.51-63
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• 2007

Diabetic foot ulcers result from abnormal mechanical loading of the foot, such as repetitive pressure applied to the plantar aspect of the foot while walking. Diabetic peripheral neuropathy causes changes in foot structure, affecting foot function and subsequently leading to increased plantar foot pressure, which is a predictive risk factor for the development of diabetic foot ulceration. To early identify the insensitive foot makes it possible to prevent diabetic foot ulceration and to protect the foot at risk from abnormal biomechanical loading. Abnormal foot pressures can be reduced using several different approaches, including callus debridement, prescription of special footwear, foot orthosis. injection of liquid silicone, Achilles tendon lengthening, and so forth. Off-loading of the diabetic wound is a key factor to successful wound healing as it is associated with reduced inflammatory and accelerated repair processes. Pressure relief can be achieved using various off-loading modalities including accommodative dressing, walking splints, ankle-foot orthosis, total contact cast, and removable and irremovable cast walkers.

• Archives of Plastic Surgery
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• v.35 no.5
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• pp.495-500
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• 2008

Purpose: Adequate tissue oxygenation is considered as an essential factor for wound healing. In the non-diabetic population, an uncompromised macrocirculation generally leads to adequate tissue oxygenation. On the contrary, the macrocirculation in diabetic patients may not correlate with tissue oxygenation because of structural changes in the capillary basement membrane. Nevertheless, many medical professionals in Korea rely on macrocirculation evaluation when predicting wound healing potential of the diabetic ulcers. The purpose of this study is to compare reliability of two common macrocirculation assessment methods, Doppler probing and CT angiography, on tissue oxygenation in diabetic foot patients. Methods: Doppler and CT angiography scores were given according to the patency of the anterior and posterior tibial arteries. Tissue oxygenation was measured by transcutaneous partial oxygen tension($TcpO_2$). Doppler and CT angiography scores were statistically analyzed against $TcpO_2$ values. Sixty-eight diabetic foot ulcer patients were included in this study. Results: The test was carried out on Doppler score and $TcpO_2$ variables displayed a p-value of 0.0202, and concluded that the two variables were statistically dependent. The test used to determine for linear trends between Doppler scores and $TcpO_2$ variables displayed a p-value of 0.0149, displaying statistical linear trend between the two variables. On the contrary, the tests between CT angiography scores and $TcpO_2$ variables showed p-values of 0.1242 and 0.6590, that means no correlation between CT angiography and $TcpO_2$ scores. Conclusion: Doppler probing is more reliable than CT angiography in predicting tissue oxygenation of diabetic foot ulcers.

• Journal of Korean Foot and Ankle Society
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• v.10 no.2
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• pp.250-254
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• 2006

Purpose: The treatment of diabetic foot ulcers with total contact cast has been reported to be associated with numerous undesirable complications. This study shows that our technique of total contact casting that incorporates high concentration silver coated foam dressing. Materials and Methods: Forty-four diabetic foot ulcers were treated with total contact cast along with high concentration silver coated foam dressing. Complication and healing rates were evaluated. Results: Eighty five percent of the ulcers healed within 6 weeks with an overall complication rate of 7%. There were only two cases (5%) of infection and no recurrent ulceration and no another site new pressure ulcer in our study. Conclusion: Total contact casting incorporates high concentration silver coated foam dressing resulted in fewer complications rate and healing rate that is comparable to other studies.

• Journal of Korean Foot and Ankle Society
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• v.23 no.4
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• pp.208-211
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• 2019

Diabetic foot ulcers can progress to the point where amputation is needed, and so these ulcers require active treatment. Skin grafts or flaps can be performed for coverage of this type of ulcer. Local flap surgery is relatively easy to perform and good results have been previously reported. We performed single-lobed rotation flap on 5 cases of forefoot ulcer around the site of weight bearing. The location of the foot ulcers was the medial part of the first metatarsophalangeal joint in all the patients. The mean size of the defect was 4.70 ㎠. Managing of ulcers, controlling of diabetes and infection, and improving of peripheral blood flow were performed before surgery. In two cases, infection progressed to the articular cartilage and so metatarsophalangeal joint fusions were performed simultaneously. All the cases were completely transplanted. There was no recurrence of the ulcers, and all the patients were able to walk.

• Archives of Plastic Surgery
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• v.36 no.5
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• pp.548-554
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• 2009

Purpose: To evaluate clinical efficacy and safety of hyaluronic acid based autologous dermal fibroblasts (Hyalograft 3D) in the treatment of diabetic foot ulcers. Methods: A total of 28 patients with diabetic ulcers were randomized to either the control group with nonadherent foam dressings(n=14) or the treatment group with autologous tissue - engineered grafts(n=14). Weekly assessment contained vital sign checks, ulcer size measurements, and wound photos. At 12th week, percentages of complete wound healing and mean healing times were compared. Safety was also monitored by adverse events. Results: Complete wound healing was achieved in 84.6% of the treatment group and 23.1% of the control group (p<0.005). The mean times of closures for the treatment versus control groups were 6.1 weeks and 10.9 weeks, respectively. No adverse events related to the study treatment occurred. Conclusion: The use of hyaluronic acid based autologous fibroblast grafts was found to be a safe and effective treatment for diabetic foot ulcers.

• Archives of Plastic Surgery
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• v.49 no.6
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• pp.782-784
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• 2022

Diabetic foot ulcers are a severe complication of diabetes, and their management requires a multidisciplinary approach for optimal management. When treating these ulcers, limb salvage remains the ultimate goal. In this article, we present the "hanging" free flap for the reconstruction of chronic lower extremity diabetic ulcers. This two-staged approach involves standard free flap harvest and inset; however, following inset the "hanging" pedicle is covered within a skin graft instead of making extraneous incisions within the undisturbed soft tissues or tunnels that can compress the vessels. After incorporation, a second-stage surgery is performed in 4 to 6 weeks which entails pedicle division, flap inset revision, and end-to-end reconstruction of the recipient vessel. Besides decreasing the number of incisions on diabetic patients, our novel technique utilizing the "hanging" pedicle simplifies flap monitoring and inset and allows reconstruction of recipient vessels to reestablish distal blood flow.

• Journal of Yeungnam Medical Science
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• v.40 no.4
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• pp.335-342
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• 2023

Diabetic foot ulcers (DFUs) are among the most serious complications of diabetes and are a source of reduced quality of life and financial burden for the people involved. For effective DFU management, an evidence-based treatment strategy that considers the patient's clinical context and wound condition is required. This treatment strategy should include conventional practices (surgical debridement, antibiotics, vascular assessment, offloading, and amputation) coordinated by interdisciplinary DFU experts. In addition, several adjuvant therapies can be considered for nonhealing wounds. In this narrative review, we aim to highlight the current trends in DFU management and review the up-to-date guidelines.