• 대한족부족관절학회지
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• 제23권2호
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• pp.58-66
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• 2019

Purpose: To evaluate the efficacy of antibiotic-loaded cement spacers (ALCSs) for the treatment of diabetic foot infections with osteomyelitis as a salvage procedure and to analyze the risk factors of treatment failure. Materials and Methods: This study reviewed retrospectively 39 cases of diabetic foot infections with osteomyelitis who underwent surgical treatment from 2009 to 2017. The mean age and follow-up period were $62{\pm}13years$ and $19.2{\pm}23.3months$, respectively. Wounds were graded using the Wagner and Strauss classification. X-ray, magnetic resonance imaging (or bone scan) and deep tissue cultures were taken preoperatively to diagnose osteomyelitis. The ankle-brachial index, toe-brachial index (TBI), and current perception threshold were checked. Lower extremity angiography was performed and if necessary, percutaneous transluminal angioplasty was conducted preoperatively. As a surgical treatment, meticulous debridement, bone curettage, and ALCS placement were employed in all cases. Between six and eight weeks after surgery, ALCS removal and autogenous iliac bone graft were performed. The treatment was considered successful if the wounds had healed completely within three months without signs of infection and no additional amputation within six months. Results: The treatment success rate was 82.1% (n=32); 12.8% (n=5) required additional amputation and 5.1% (n=2) showed delayed wound healing. Bacterial growth was confirmed in 82.1% (n=32) with methicillin-resistant Staphylococcus aureus being the most commonly identified strain (23.1%, n=9). The lesions were divided anatomically into four groups; the largest number was the toes: (1) toes (41.0%, n=16), (2) metatarsals (35.9%, n=14), (3) midfoot (5.1%, n=2), and (4) hindfoot (17.9%, n=7). A significant difference in the Strauss wound score and TBI was observed between the treatment success group and failure group. Conclusion: The insertion of ALCSs can be a useful treatment option in diabetic foot infections with osteomyelitis. Low scores in the Strauss classification and low TBI are risk factors of treatment failure.

• Advances in Traditional Medicine
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• 제4권4호
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• pp.261-266
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• 2004

Wound swabs and pus samples were collected from diabetic foot ulcers, and control pus samples from non-diabetic cases. In 144 diabetic cases screened, Pseudomonas aeruginosa was isolated from 78 cases, in which 10.59% of the isolates were multidrug resistant (MDR), whereas the 60 control cases were not MDR. The isolated bacteria were decreasingly resistant to 6 clinically administrated antimicrobics such as ceftazidime, gentamicin, ciprofloxacin, tobramycin, piperacillin and amikacin. Therefore, it is demanded that new and more effective antimicrobials of phytochemical origins are sought after. Among 11 isoflavones (YS11-YS21) isolated from Sophora and Euchresta (Leguminosae; pea plant family), 2 (YS19 and YS21) prominently exhibited the high antibacterial activity both in vitro and in vivo. By the preliminary results, the object of this paper is to evaluate the in vitro antibacterial effect of YS19 and YS21 on the clinically isolated bactera of Ps. Aeruginosa in hospitals. All the isolates were sensitive to YS19 and YS21 and for both, minimum inhibitory concentration (MIC) values ranged from $2\;to\;50\;{\mu}g/mL$. The $MIC_{90}$ values of YS19 and YS21 were $50\;{\mu}g/mL$. It is suggested that these isoflavones might consist a basis phytochemical prevention and therapy for diabetic foot infections caused by pseudomonads.

• 한국재료학회:학술대회논문집
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• 한국재료학회 2011년도 추계학술발표대회
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• pp.2.1-2.1
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• 2011

Biomedical applications of electrospun nanofibrous meshes have been receive tremendous attentions because of their unique structures and versatilities as novel biomaterials. Incorporation of growth factors in fibrous meshes can be performed by surface-modification and encapsulation. Those growth factors stimulate differentiation and proliferation of specific types of cells and thus lead tissue regenerations of specific cell types. Topographical cues of electrospun nanofibrous meshes also increase differentiation of specific cell types according to alignments of fibrous structures. Wound healing treatments of diabetic ulcers were performed using nanofibrous meshes encapsulating multiple growth factors. Aligned nanofibrous meshes and those with random configuration were compared for differentiating mesenchymal stem cells into neuronal cells. Thus, nanofibrous meshes can be applied to novel drug delivery carriers and matrix for promoting cellular proliferation.

• Archives of Plastic Surgery
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• 제35권4호
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• pp.400-406
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• 2008

Purpose: Since ancient times, larval therapy has been applied to help wound healing. Its use has recently been rediscovered, and the interest in this therapy has been increased in clinical practice, as well as in research. The objective of this study is to assess the efficacy of maggot therapy for the treatment of intractable, chronic wounds. Methods: Twenty patients, suffering mostly from chronic wounds were treated using maggots of greenfly (Phaenicia sericata). Sterile maggots were administered to the wound twice a week. The causes of the development of wounds were diabetic foot(14), trauma(3), plate exposure(1), and unknown origin(2). Results: Complete debridement was achieved in 10 wounds; in 8 wounds, the debridement was partially achieved; 2 patients escaped. Four patients were healed without any additional surgical procedures but fourteen patients were treated with skin graft. Pain, reported by six patients, was relatively well controlled with oral analgesics. Conclusion: We found larval therapy to be effective for chronic wounds. Maggot therapy is a relatively rapid and effective treatment, particularly in necrotic wounds or the wounds resistant to conventional treatment.

• 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.

• Nutrition Research and Practice
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• 제4권5호
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• pp.362-368
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• 2010

Oral administration of royal jelly (RJ) promotes wound healing in diabetic mice. Concerns have arisen regarding the efficacy of RJ on the wound healing process of normal skin cells. In this study, a wound was created by scratching normal human dermal fibroblasts, one of the major cells involved in the wound healing process. The area was promptly treated with RJ at varying concentrations of 0.1, 1.0, or 5 mg/ml for up to 48 hrs and migration was analyzed by evaluating closure of the wound margins. Furthermore, altered levels of lipids, which were recently reported to participate in the wound healing process, were analyzed by HPTLC and HPLC. Migration of fibroblasts peaked at 24 hrs after wounding. RJ treatment significantly accelerated the migration of fibroblasts in a dose-dependent manner at 8 hrs. Although RJ also accelerated the migration of fibroblasts at both 20 hrs and 24 hrs after wounding, the efficacy was less potent than at 8 hrs. Among various lipid classes within fibroblasts, the level of cholesterol was significantly decreased at 8 hrs following administration of both 0.1 ug/ml and 5 mg/ml RJ. Despite a dose-dependent increase in sphinganines, the levels of sphingosines, ceramides, and glucosylceramides were not altered with any concentration of RJ. We demonstrated that RJ enhances the migration of fibroblasts and alters the levels of various lipids involved in the wound healing process.

• 대한족부족관절학회지
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• 제17권3호
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• pp.209-214
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• 2013

Purpose: To evaluate correlation between the clinical results and causative bacteria in diabetic foot patients with lower extremity amputation. Materials and Methods: One hundred twenty nine patients(131 feet) of diabetic foot amputations were followed for more than one year. Wound cultures were done by deep tissue or bone debris at first visit to our clinics. Retrospective analysis was performed using chart review and interview with the patients. Depending on the culture result, level of amputation, reinfection, duration of treatment, death rate, patient satisfaction and admission dates were evaluated. Results: Microorganisms were confirmed in 114 cases. In the other 17 cases, there were no cultured microorganisms. In bacterial growth group, Methicillin-sensitive Staphylococcus aureus was the most common pathogen and accounted for 34 cases. As other common pathogens, there were Methicillin-resistant Staphylococcus aureus(24 cases) and mixed infection(14 cases). Mortality is no difference in each infected group. Mixed bacterial infected patients have higher reinfection, longer hospital day and duration of treatment, but there is no difference in patients satisfaction and pain at last follow up. Conclusion: The most common pathogen in diabetic foot patients with lower extremity amputation was Methicillin-sensitive Staphylococcus aureus, and mixed bacterial infected patients have higher reinfection rate, longer admission date and duration of treatment than other bacterial infected patients.

• 대한족부족관절학회지
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• 제15권1호
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• pp.7-12
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• 2011

Purpose: To evaluate the incidence and risk factors of ipsilateral reamputation after lower limb amputation in the patient with diabetic foot lesions. Materials and Methods: Between May 2005 and June 2009, 88 patients who underwent lower limb amputation were analyzed. Group 1 consisted of 73 patients who didn't have a ipsilateral reamputation after lower limb amputation and group 2 consisted of 15 patients who underwent reamputation. We compared several factors between two groups, such as age, gender, BMI, ABI, Wagner classification, wound culture, site of amputation, vascular surgery, the period of diabetes mellitus, chronic renal failure. Results: Fifteen (17%) of 88 patients had a ipsilateral limb reamputation and 13 patients (87%) of them underwent reamputation within 6 months. When we compared the two groups, average age was 59.3 (range, 48-74 years); 62.9(range, 44-78 years). Age was significantly associated with reamputation rate (p=0.02) and no reamputation after initial amputation above ankle joint was found. Other factors did not show statistically difference between both groups. Conclusion: There were no significant difference between diabetic limb amputation and reamputation group in our concerned risk factors except age and amputation level. There should be careful consideration when determine level of amputation in diabetic foot lesions especially in elder patients.

• Archives of Plastic Surgery
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• 제40권4호
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• pp.403-408
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• 2013

Background For patients with neuropathy, vasculopathy, and impairment of wound healing, treatment of a diabetic foot ulcer poses many challenges. A large number of dermal analogues have been invented in an effort to overcome these challenges. Matriderm, a dermal analogue, is made from bovine collagen and elastin. This study was conducted in order to evaluate the effectiveness of Matriderm for treatment of diabetic foot ulcers, in comparison with skin grafting. Methods Sixty patients with diabetic foot ulcer were included in this prospective study. The average age of the patients, who had type II diabetes mellitus, was 58 years old. The patients were allocated to an experimental or control group with their consents. The patients were selected with their consent for inclusion in an experimental group and a control group. Patients in the experimental group received a Matriderm appliance and a split-thickness skin graft, while those in the control group received only a split-thickness skin graft. Results A shorter hospitalization period (7.52 weeks) was observed in the experimental group than in the control group (9.22 weeks), and a shorter period of time (8.61 weeks) was required for complete healing, compared with the control group (12.94 weeks), with statistical significance (P<0.05). A higher elasticity ratio of the affected side to the non-affected side was observed in the experimental group, compared with the control group (P<0.01). Conclusions Matriderm enables effective healing and improves elasticity in treatment of patients with diabetic foot ulcer.

• Archives of Plastic Surgery
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• 제33권2호
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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.