• 임상간호연구
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• 제21권2호
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• pp.196-206
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• 2015

Purpose: This study was done to use a guideline adaptation process to develop a Korean evidence-based diabetic foot care clinical practice guideline for diabetic foot prevention and management. Methods: The guideline adaptation process was conducted according to the guideline adaptation manual developed by the National Evidence-Based Healthcare Collaborating Agency. The process consists of three main phases, with 9 modules including a total of 23 steps. Results: The newly developed diabetic foot care clinical practice guideline consisted of an introduction, description of diabetic foot, summary of recommendations, recommendations, references, appendices, and glossary. There were 165 recommendations in 4 sections (risk assessment for diabetic foot ulcers, prevention of diabetic foot ulcers, wound assessment of diabetic foot ulcers, and management of the diabetic foot). In grading by recommendations, for A there were 30 (18.2%), B, 8 (4.8%), C, 30 (18.2%) D, 97 (58.8%). Conclusion: This guideline can be used as educational material for healthcare workers and diabetic patients. It can also be utilized as a practice guideline for healthcare workers in the hospital and community setting.

• Experimental and Molecular Medicine
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• 제50권11호
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• pp.13.1-13.15
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• 2018

Wound healing is delayed in diabetic patients. Increased apoptosis and endothelial progenitor cell (EPC) dysfunction are implicated in delayed diabetic wound healing. Melatonin, a major secretory product of the pineal gland, promotes diabetic wound healing; however, its mechanism of action remains unclear. Here, EPCs were isolated from the bone marrow of mice. Treatment of EPCs with melatonin alleviated advanced glycation end product (AGE)-induced apoptosis and cellular dysfunction. We further examined autophagy flux after melatonin treatment and found increased light chain 3 (LC3) and p62 protein levels in AGE-treated EPCs. However, lysosome-associated membrane protein 2 expression was decreased, indicating that autophagy flux was impaired in EPCs treated with AGEs. We then evaluated autophagy flux after melatonin treatment and found that melatonin increased the LC3 levels, but attenuated the accumulation of p62, suggesting a stimulatory effect of melatonin on autophagy flux. Blockage of autophagy flux by chloroquine partially abolished the protective effects of melatonin, indicating that autophagy flux is involved in the protective effects of melatonin. Furthermore, we found that the AMPK/mTOR signaling pathway is involved in autophagy flux stimulation by melatonin. An in vivo study also illustrated that melatonin treatment ameliorated impaired wound healing in a streptozotocin-induced diabetic wound healing model. Thus, our study shows that melatonin protects EPCs against apoptosis and dysfunction via autophagy flux stimulation and ameliorates impaired wound healing in vivo, providing insight into its mechanism of action in diabetic wound healing.

• Journal of Korean Biological Nursing Science
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• 제18권2호
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• pp.78-86
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• 2016

Purpose: Diabetic foot ulcers are significant problems in diabetes mellitus and often result in lower extremity amputation. This study was conducted to evaluate the effects of a self-care management program on Korean patient's self-efficacy, self-care behavior, size of the wound, and wound related pain. Methods: This study was a quasi-experimental study of pre-test and post-test design in a non-equivalent control group. The intervention strategies of the self-care management program consisted of individual intervention (education, practice and demonstration), computer animation, and face-to-face counseling. There were thirty seven patients, and 20 were assigned to the experimental group while the other 17 were assigned to the control group. The experimental group was given a self-care management program. The control group received information on diabetic mellitus care by means of a leaflet. The data was analyzed using descriptive statistics, a chi-square test, an independent t-test, and a Mann-Whitney test. Results: There were significant differences in self-care behavior and wound related pain. Conclusion: A Self-care program is an effective way to increase patient's self-care ability. This program is highly applicable to diabetic foot ulcer patients in various settings.

• Archives of Plastic Surgery
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• 제36권5호
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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.

• 대한족부족관절학회지
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• 제16권4호
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• pp.257-264
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• 2012

Purpose: The diabetic foot lesions are intractable, and aggravation often leads to amputation. None or minor amputation group was treated debridement or toe amputation and major amputation group was treated Ray, Lisfranc, Chopart, Below Knee and Above Knee amputation. We investigate the risk factors for major limb amputations among patients with diabetic foot lesion. Materials and Methods: The subjects were 73 diabetic foot lesion patients (83 diabetic foot lesions) treated at our department from January 2006 to December 2010. Non or Minor amputation group of 44 cases were treated with debridement or toe amputation. Major amputation group of 39 cases were treated with Ray, Lisfranc, Chopart, below or above Knee amputation. We investigated socioeconomic factors, diabetes mellitus related factors and wound related factors and laboratory factors. Statistical analysis was done by Students t-test, Chi-square test, Mann-Whitney's U test. Results: In our analysis, wound size, wound classification (Wagner classification, Brodsky classification), white blood cell counts, polymorphoneuclear neutrophil percentage, hemoglobin, C-reactive protein and albumin were risk factors for major amputation (p<0.05). Conclusion: Low education level, nutritional condition, premorbid activity level and progressed wound condition were observed in major amputation group compared with non or minor amputation group. In the major amputation group, higher white blood cell count, C-reactive protein level and lower albumin level were observed. Together with maintenance of adequate nutritional condition, early detection of lesions and foot care for early treatment is important. Therefore, active investigation with full risk evaluation of vascular complication is also important.

• 한방안이비인후피부과학회지
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• 제34권2호
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• pp.80-85
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• 2021

Objectives : The purpose of this study is to report on the treatment of wound dressing in patients with diabetic foot ulcers in the dermatology clinic of Korean medicine. Methods : First, sufficient marginal resection of the ulcer and necrotic tissue on the foot of a patient with diabetic peripheral neuropathy was performed. Inflammation was treated with Anti-inflammatory pharmacopuncture solution, and dressings were applied for one month using Cornu Cervi Parvum pharmacopuncture solution, and Haeboo ointment for granulation tissue formation and skin regeneration. Results : After 10 days of the treatment, the formation of new granulation tissue was observed in the necrotic tissue area, and the extent of the lesion decreased sharply from the 14th day. On the 40th day, epithelialization progressed so that the treatment was terminated, and complete keratinization of the site was observed at follow-up 3 weeks after the end of the treatment. Conclusions : In the treatment of wound dressings in diabetic foot ulcer patients, marginal resection treatment with the application of pharmacopuncture solution and herbal ointment showed good effect.

• The Korean Journal of Physiology and Pharmacology
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• 제27권5호
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• pp.437-448
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• 2023

Diabetic ulcer is usually seen in people with uncontrolled blood sugar. Reportedly, many factors such as impaired glucose metabolism, and macrovascular and microvascular diseases caused angiogenesis disorders and delayed the healing of diabetic ulcers, thus affecting the body's metabolism, nutrition, and immune function. This study aimed to explore the effect of paeonol on skin wound healing in diabetic rats and the related mechanism. A rat model of diabetic ulcer was established. High glucose-treated mouse skin fibroblasts were co-cultured with M1 or M2-polarized macrophages treated with or without paeonol. H&E and Masson staining were used to reveal inflammatory cell infiltration and collagen deposition, respectively. Immunohistochemistry visualized the expression of Ki67, CD31, and vascular endothelial growth factor (VEGF). Western blot was used to detect interleukin (IL)-1β, tumor necrosis factor (TNF)-α, IL-4, IL-10, CD31, VEGFA, and collagen I/III. The expression of iNOS and arginase 1 was revealed by immunofluorescence staining. Paeonol treatment augmented collagen deposition and the expression of Ki67, CD31, VEGF, and macrophage M2 polarization markers (IL-4 and IL-10) and reduced wound area, inflammatory cell infiltration, and macrophage M1 polarization markers (IL-1β and TNF-α) in the ulcerated area. In vitro, paeonol treatment promoted M2-polarization and repressed M1-polarization in macrophages, thereby improving the repair of cell damage induced by high glucose. Paeonol accelerates the healing of diabetic ulcers by promoting M2 macrophage polarization and inhibiting M1 macrophage polarization.

• 대한족부족관절학회지
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• 제28권2호
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• pp.41-47
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• 2024

Negative pressure wound therapy (NPWT) has emerged as a valuable tool for managing complex wounds within the foot and ankle field. This review article discusses the expanding applications of NPWT in this specialized field. Specifically, it discusses the efficacy of NPWT for various wound types, including diabetic foot wounds, traumatic wounds, surgical wounds, and wounds involving exposed bone or soft tissue defects. NPWT demonstrates versatile utility for foot and ankle wound management by promoting healing, potentially reducing the need for secondary surgery, improving diabetic and neuropathic ulcer healing times and outcomes, and optimizing the healing of high-risk incisions. In addition, this review explores the underlying mechanisms through which NPWT might enhance wound healing. By synthesizing current evidence, this review provides a comprehensive overview of the role of NPWT in foot and ankle surgery and offers valuable insights to clinicians navigating the complexities of wound care in this challenging anatomical area.

• 대한족부족관절학회지
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• 제8권1호
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• pp.26-30
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• 2004

감염된 당뇨병성 족부궤양의 병실내 벽매립형 중앙 흡인 장치를 이용한 창상 밀봉관리로 빠른 창상의 호전을 얻을 수 있었다. 이 창상관리 방법은 빠른 창상의 호전 외에도 비용을 획기적으로 줄일 수 있으며 환자의 동통을 줄이고 병실내 세균 전파의 위험이 적으며 필요 인력 축소 등의 장점이 있으나 말기신장부전 환자에서의 적용은 추가의 연구가 필요할 것으로 사료된다.

• Vascular Specialist International
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• 제34권4호
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• pp.109-116
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• 2018

Purpose: Diabetic foot wound (DFW) is known as a major contributor of nontraumatic lower extremity amputation. We aimed to evaluate overall amputation rates and risk factors for amputation in patients with DFW. Materials and Methods: From January 2014 to December 2017, 141 patients with DFW were enrolled. We determined rates and risk factors of major amputation in DFW and in DFW with peripheral arterial occlusive disease (PAOD). In addition, we investigated rates and predictors for amputation in diabetic foot ulcer (DFU). Results: The overall rate of major amputation was 26.2% in patients with DFW. Among 141 DFWs, 76 patients (53.9%) had PAOD and 29 patients (38.2%) of 76 DFWs with PAOD underwent major amputation. Wound state according to Wagner classification, congestive heart failure, leukocytosis, dementia, and PAOD were the significant risk factors for major amputation. In DFW with PAOD, Wagner classification grades and leukocytosis were the predictors for major amputation. In addition, amputation was performed for 28 patients (38.4%) while major amputation was performed for 5 patients (6.8%) of 73 DFUs. Only the presence of osteomyelitis (OM) showed significant difference for amputation in DFU. Conclusion: This study represented that approximately a quarter of DFWs underwent major amputation. Moreover, over half of DFW patients had PAOD and about 38.2% of them underwent major amputation. Wound state and PAOD was major predictors for major amputation in DFW. Systemic factors, such as CHF, leukocytosis, and dementia were identified as risk factors for major amputation. In terms of DFU, 38.4% underwent amputation and the presence of OM was a determinant for amputation.