• 대한족부족관절학회지
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• 제25권2호
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• pp.100-107
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• 2021

Purpose: The present study aimed to develop guidelines regarding initial choice of antibiotics for diabetic foot ulcers (DFU) by investigating bacterial isolates. Materials and Methods: This study included 223 DFU patients that visited a single tertiary hospital and underwent bacterial culture between January 2016 and February 2020. The study was conducted in two parts: 1) to compare bacterial isolates and wound healing according to comorbidities such as chronic kidney disease (CKD) and peripheral artery disease (PAD), and 2) to compare bacterial isolates according to wound depth using the Wagner classification. Results: Of the 223 patients, 43 had CKD (group A), 56 had PAD (group B), 30 had CKD and PAD (group C), and 94 had none of these comorbidities (group D). The isolation rate for multidrug-resistant gram-negative bacteria (MRGNB) and gram-negative to gram-positive bacteria ratio were highest in group C (p=0.018, p=0.038), and the proportion that achieved wound healing was lowest in group C (p<0.001). In the second part of the study, subjects were classified into 5 grades by wound depth using the Wagner classification; 13 grade I, 62 grade II, 60 grade III, 70 grade IV, and 17 grade V. No significant difference was observed between these grades in terms of isolation rates or gram-negative to gram-positive bacteria ratios. Conclusion: This study suggests antibiotics that cover gram-negative bacteria including MRGNB produces better results in the presence of CKD and PAD and that initial antibiotic choice should be based on the presence of CKD and PAD rather than wound depth.

• Archives of Plastic Surgery
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• 제34권5호
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• pp.543-550
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• 2007

Purpose: Diabetic foot ulcer is a representative disease of chronic would with multiple defects of wound healing factors. Many nutrition factors have been known to be essential for wound healing, but objective data are lacking. The purpose of this study is to determine those factors essential for wound healing, and to find out which of those factors are lacking in diabetic foot ulcer patients through this pilot study. Methods: We studied 100 patients who visited our clinic from March 2005 to February 2006 for treatment of diabetic foot ulcers with a duration of more than 6 weeks. We checked serum levels of protein, albumin, vitamin A, C, E, iron, magnesium, zinc, copper and hemoglobin by drawing 23cc blood after 8 hours of fasting. Protein, albumin, iron, magnesium levels were measured by colorimetry; hemoglobin levels were measured by auto analysis. Vitamin levels were measured by high performance liquid chromatography (HPLC), copper and zinc levels were measured by Inductively coupled plasma (ICP). They were compared with normal values. The patients were divided by transcutaneous oxygen pressure levels, age and sex to study the effects of these parameters. Results: 76% and 61% of patients had within-normal range serum protein and albumin levels, respectively. Among vitamins, only the level of vitamin C was low in 55% of the patients. Levels of vitamin A, E were normal or high in 93% and 100% of patients. As for trace elements, levels of iron and zinc were low in 63% and 60% of patients, but levels of magnesium and copper were usually normal or high. Levels of vitamin C, iron and zinc were lower in the low-transcutaneous oxygen pressure group. There were no definite differences according to age and sex. Conclusion: Serum levels of Hb, vitamin C, iron, zinc were low in most diabetic foot ulcer patients. The deficit was very severe in the low-transcutaneous oxygen pressure group.

• 한국방사선학회논문지
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• 제18권4호
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• pp.327-334
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• 2024

본 연구의 목적은 당뇨병 환자의 맞춤형 족부질환 분석 및 관리 시스템 개발로 당뇨병성 족부질환 환자의 발 궤양 예방본 시스템은 영상분석 기술을 활용하여 족압뿐만 아니라, 발목의 변형, 신체의 균형, 발의 상처 여부 등의 다양한 데이터를 통하여 정확한 족부변형 상태 분석이 가능하고, 이를 기반으로 당뇨병성 족부질환 환자의 발의 정확한 변형 상태를 파악하여 맞춤형 인솔 제작을 하였다. 당뇨병 족부질환의 상처를 상태 확인 애플리케이션(App)의 사용 만족도 검사와 당뇨병성 족부질환 환자 및 족부질환 환자의 변성 상태를 파악하여 맞춤형 인솔을 착용하여 인솔 착용 만족도 조사연구이다. 연구 결과로 족저압력 측정 Knee angle은 -0.8 ± 1.3도였으며 최소 -2.4도에서 최대 1.1도의 분포를 보였고, 외반슬은 양쪽 하지 간에 유의미한 차이가 없었다(p = 0.534). 경골 각도는 양쪽 하지에 유의미한 차이가 있었다 (p < 0.001). 발목 각도(Ankle angle)는 왼쪽이 2.6 ± 2.0도였으며 최소 0도에서 최대 6.3도의 분포를 보였고, 오른쪽은 4.5 ± 2.1도였고 최소 1.5도에서 최대 9.1도의 분포를 보였다. 발목 각도는 양쪽 하지에 유의미한 차이가 있었다 (p = 0.011). 족저 압력 측정 애플리케이션에 평균 4.3점의 만족도를 느낀다고 응답하였으며. 맞춤형 인솔 사용에 대해 평균 3.9점의 만족도를 느낀다고 응답하였다.

• 셀메드
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• 제2권3호
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• pp.23.1-23.7
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• 2012

The healing properties of medicinal maggots (larval stage of Lucilia sericata) are widely used in the chirurgical debridement of non-healing wounds including diabetic foot ulcers, venous and pressure ulcers, where classical approaches have failed. Several kinds of wounds are prone to complications coming out of a specific wound bed environment. There are multi-resistant bacterial species present, their pathogenic impact is multiplied by their ability to form a biofilm. Moreover, immunological events in chronic wounds differ from those in acute wounds. Non-healing wounds are cycled in the early inflammation phase with increased levels of inflammation attributes like inflammation cytokines and matrix metalloproteinases produced by inflammation phase cells. Application of larval therapy promotes progress in the healing process to the next stages involving tissue granulation and re-epithelisation. Larval debridement is an effective method of cleaning the wound of cell debris, necrotic tissue and bacterial load. This happens in a mechanical and biological manner, but the whole complex mechanism of the maggot healing activity is still not fully elucidated. Centuries of clinical practice brings noticeable proof of the maggots' beneficial effect in wound healing management. This long history led to the investigation of the bioactive components of the larval body and its extracts in vitro. We introduce a review which describes the immunomodulation impact of maggot body components on the cellular and molecular levels of the wound healing process.

• Archives of Plastic Surgery
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• 제41권6호
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• pp.788-790
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• 2014

• 한방안이비인후피부과학회지
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• 제29권4호
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• pp.14-23
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• 2016

Objectives : One of major complications of diabetes, diabetic ulcer is also one of the main reasons for amputation, and the prevalence rate is 4-10%. Laser therapy is widely used for leg ulcer and diabetic ulcer, and it is known to improve wound epithelialization, cellular content, and collagen deposition. The purpose of this study is to investigate the properties of the laser and the spectrum of laser instruments for diabetic ulcer. Methods : We performed literature search using the PubMed, Cochrane, CINAHL and Web of science for the data in English. In addition, other databases were checked for different languages such as OASIS and NDSL for the literature in Korean, CNKI in Chinese, and CiNii and J-STAGE written in Japanese. We excluded all review article and experimental studies, and only clinical studies using laser or light emitting diode (LED) for diabetic ulcer were selected. Results : A total twenty papers were selected. Different light sources were used as follows: LED, HeNe, InGaAlP, GaAlAs, GaAs, CO2, and KTP. The number of LED studies was 9, and HeNe laser was 7, and InGaAlP and GaAlAs laser was 2, GaAs, CO2, and KTP laser was 1 for each. Various energy density of the clinical study were reported. Conclusions : It is suggested that to select appropriate laser type and give the adequate output power to treat diabetic ulcer. Further evaluation and research for the condition of laser therapy to treat diabetic ulcers are warranted.

• Archives of Plastic Surgery
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• 제45권6호
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• pp.564-571
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• 2018

Background Chronic wounds occur due to failure of the normal healing process, associated with a lack of deposition of cellular components and a suitable microenvironment such as the extracellular matrix (ECM). Acellular dermal matrix (ADM) is viewed as an ECM substitute, and a paste-type ADM has recently been introduced. We hypothesized that CGPaste, an injectable paste-type ADM, could serve as a scaffold and promote wound healing. Methods We retrospectively studied seven patients in whom CGPaste was applied between 2017 and 2018, who had pressure ulcers, necrotizing fasciitis, diabetic foot ulcers, traumatic defects, and osteomyelitis. The goal of applying CGPaste was to achieve complete wound healing with re-epithelialization or growth of granulation tissue, depending upon the wound bed status. CGPaste was injected based on the wound size along with the application of a dressing. Results Four of the seven patients showed granulation tissue on their wound bed, while the other three patients had a bony wound bed. The mean wound area was $453.57mm^2$ and the depth was 10.71 mm. Wound healing occurred in five of the seven patients (71.43%). The mean duration of complete healing was 2.4 weeks. Two patients showed failure due to paste absorption (29.57%); these patients had wound beds comprising bone with relatively large and deep wounds ($40{\times}30$ and $30{\times}20mm^2$ in area and 15 and 10 mm in depth). Conclusions CGPaste is an effective option for coverage of small and deep chronic wounds for which a flap operation or skin grafting is unfeasible.

• Journal of Ginseng Research
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• 제47권6호
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• pp.784-794
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• 2023

Background: ginsenoside Rg5 is a rare ginsenoside with known hypoglycemic effects in diabetic mice. This study aimed to explore the effects of ginsenoside Rg5 on skin wound-healing in the Lepr^db/db mutant (db/db) mice (C57BL/KsJ background) model and the underlying mechanisms. Methods: Seven-week-old male C57BL/6J, SLC7A11-knockout (KO), the littermate wild-type (WT), and db/db mice were used for in vivo and ex vivo studies. Results: Ginsenoside Rg5 provided through oral gavage in db/db mice significantly alleviated the abundance of apoptotic cells in the wound areas and facilitated skin wound healing. 50 μM ginsenoside Rg5 treatment nearly doubled the efferocytotic capability of bone marrow-derived dendritic cells (BMDCs) from db/db mice. It also reduced NF-κB p65 and SLC7A11 expression in the wounded areas of db/db mice dose-dependently. Ginsenoside Rg5 physically interacted with SLC7A11 and suppressed the cystine uptake and glutamate secretion of BMDCs from db/db and SLC7A11-WT mice but not in BMDCs from SLC7A11-KO mice. In BMDCs and conventional type 1 dendritic cells (cDC1s), ginsenoside Rg5 reduced their glycose storage and enhanced anaerobic glycolysis. Glycogen phosphorylase inhibitor CP-91149 almost abolished the effect of ginsenoside Rg5 on promoting efferocytosis. Conclusion: ginsenoside Rg5 can suppress the expression of SLC7A11 and inhibit its activity via physical binding. These effects collectively alleviate the negative regulations of SLC7A11 on anaerobic glycolysis, which fuels the efferocytosis of dendritic cells. Therefore, ginsenoside Rg5 has a potential adjuvant therapeutic reagent to support patients with wound-healing problems, such as diabetic foot ulcers.

• Archives of Plastic Surgery
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• 제35권6호
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• pp.653-658
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• 2008

Purpose: Skin and soft tissue defect is one of the major challenges faced by plastic surgeons. Adipose derived stromal cells, which can be harvested in large quantities with low morbidity, display multilineage mesodermal potential. Therefore, adipose derived stromal cells have been met with a great deal of excitement by the field of tissue engineering. Recently, Adipose derived stromal cells have been isolated and cultured to use soft tissue restoration. In order to apply cultured cells for clinical purpose, however, FDA approved facilities and techniques are required, which may be difficult for a clinician who cultures cells in a laboratory dedicated to research to utilize this treatment for patients. In addition, long culture period is needed. Fortunately, adipose derived stromal cells are easy to obtain in large quantities without cell culture. The purpose of this study is to present a possibility of using uncultured adipose derived stromal cells for wound coverage. Methods: Seven patients who needed skin and soft tissue restoration were included. Five patients had diabetic foot ulcers, 1 patient got thumb amputation, and 1 patient had tissue defect caused by resection of squamous cell carcinoma. The patients' abdominal adipose tissues were obtained by liposuction. The samples were digested with type I collagenase and centrifuged to obtain adipose derived stromal cells. The isolated adipose derived stromal cells were applied over the wounds immediately after the wound debridement. Fibrin was used as adipose derived stromal cells carrier. Occlusive dressing was applied with films and foams and the wounds were kept moist until complete healing. Results: One hundred to one hundred sixty thousand adipose derived stromal cells were isolated per ml aspirated adipose tissue. All patients' wounds were successfully covered with the grafted adipose derived stromal cells in a 17 to 27 day period. No adverse events related to this treatment occurred. Conclusion: The use of uncultured adipose derived stromal cells was found to be safe and effective treatment for wound coverage without donor site morbidity.

• Journal of Microbiology and Biotechnology
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• 제34권4호
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• pp.765-773
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• 2024

Ozone, a highly reactive oxidant molecule, is widely used as a complementary therapy for various skin diseases, including wound healing, pressure ulcers, diabetic foot, and infections. However, there is limited research on the effectiveness of ozone for atopic dermatitis (AD). Ozonated sunflower oil (OSO) is an active ingredient obtained from partially ozonated sunflower oil (SO). OSO markedly reduced the LPS-induced increase in IL-1β and nitric oxide (NO) levels in RAW 264.7 mouse macrophage cells. Oxazolone (OXZ) was applied to hairless mice to induce AD-like skin symptoms and immune response. OSO significantly alleviated the OXZ-induced increases in the number of infiltrating mast cells, epidermal thickness, AD symptoms, thymic stromal lymphopoietin (TSLP), and filaggrin, as well as the serum levels of NO, IgE, IL-1β, and TNF-α. Furthermore, OSO inhibited the IL-4/STAT3/MAPK pathway and the expression of NF-κB. Our results suggest that OSO treatment could relieve AD-mediated skin damage through its anti-inflammatory and antioxidant activities. Therefore, it can be used as a therapeutic agent against AD-related skin diseases.