• Archives of Reconstructive Microsurgery
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• v.10 no.2
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• pp.154-162
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• 2001

Diabetic foot ulcer is a serious complication which result from long-standing diabetes. Especially, severe infected diabetic foot ulcer results in unwanted lower extremity amputation. The diabetic patient is considered the relative contraindication for microsurgery because of the severe peripheral vascular disease. Recently, microvascular free tissue transfer technique applied to diabetic foot ulcer. It is well known that free tissue transfer provides immediate soft tissue coverage and control of infection. So it is possible that preservation of the lower extremity through free tissue transfer. A retrospective study of diabetic patients who had infected foot ulcer from 1999 to 2000 with foot defects reconstructed with free tissue transfer were reviewed. Thirteen patients were studied with mean follow-up of 12.7 months. There were two deaths during follow-up period. There were two failures after free flap surgery. All eleven survived patients were ambulatory. There was no recurrence of ulcer. No patient need amputation above the ankle joint. We have found that free tissue transfer for infected diabetic foot ulcer is very effective surgical technique. Careful patient selection and regular follow-up is important.

• Archives of Plastic Surgery
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• v.35 no.2
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• pp.134-138
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• 2008

Purpose: In a diabetic foot ulcer, superficial fungal infection of the foot may disrupt the skin integrity and provide an avenue for bacterial infection. The prevalence of fungal infection in diabetic foot ulcer has been reported as 12-30% in Caucasian patients. However, no data are available for Korean patients. The purpose of the study was to examine the prevalence of fungal infection in diabetic foot patients admitted in our clinic. Methods: This study included consecutive 30 diabetic foot ulcer patients(24 males and 6 females) admitted from May 2007 to July 2007. The mean age was 60.5 years. All patients underwent mycological examination including direct microscopic examination in KOH and culturing on slants and tubes with Sabouraud's glucose agar. Results: Clinical signs of presumed fungal infection, which were examined by dermatologists, were found in all patients included in this study. Direct microscopic examination was positive for the specimens of the skin and the toenails in 28(93.3%) and 25(83.3%) patients, respectively. In addition, culture result was positive for the specimens of the skin and the toenails in 5(16.73%) and 7(23.3%) patients, respectively. Conclusion: The prevalence of fungal infection in diabetic foot ulcer patients admitted in our clinic is much higher than that in Caucasian patients(83.3-93.3% vs 12-30%).

• Journal of Korean Foot and Ankle Society
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• v.26 no.4
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• pp.187-191
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• 2022

The author experienced a case of autologous platelet-rich plasma (PRP) affecting the recovery of a chronic neuropathic diabetic foot ulcer combined with infection. A 65-year-aged male with uncontrolled diabetes presented with a Wagner grade 2 diabetic foot ulcer on his left forefoot of more than 2 weeks duration. Osteomyelitis, gangrene, and ischemia requiring acute intervention were absent. Although infection was controlled to a moderate degree, wound healing was unsatisfactory following surgical debridement and simple dressing. Therefore, intralesional autologous PRP injection was performed 5 times as an adjuvant regeneration therapy, and the recalcitrant ulcer healed in 3 months. Intralesional PRP injections are worthwhile as they promote wound regeneration, are evidence-based, safe, and can be easily performed in ambulatory care facilities.

• Journal of Korean Foot and Ankle Society
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• v.18 no.1
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• pp.1-7
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• 2014

In patients with diabetic foot, ulceration and amputation are the most serious consequences and can lead to morbidity and disability. Peripheral arterial sclerosis, peripheral neuropathy, and foot deformities are major causes of foot problems. Foot deformities, following autonomic and motor neuropathy, lead to development of over-pressured focal lesions causing the diabetic foot to be easily injured within the shoe while walking. Wound healing in these patients can be difficult due to impaired phagocytic activity, malnutrition, and ischemia. Correction of deformity or shoe modification to relieve the pressure of over-pressured points is necessary for ulcer management. Application of selective dressings that allow a moist environment following complete debridement of the necrotic tissue is mandatory. In the case of a large soft tissue defect, performance of a wound coverage procedure by either a distant flap operation or a skin graft is necessary. Patients with a Charcot joint should be stabilized and consolidated into a plantigrade foot. The bony prominence of a Charcot foot can be corrected by a bumpectomy in order to prevent ulceration. The most effective management of the diabetic foot is ulcer prevention: controlling blood sugar levels and neuropathic pain, smoking cessation, stretching exercises, frequent examination of the foot, and appropriate education regarding footwear.

• Journal of Korean Foot and Ankle Society
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• v.18 no.1
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• pp.8-13
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• 2014

Amputation of diabetic foot ulcer and infection is a critical modality for saving a patient's life from life threatening infections or ischemic limbs. However, it can cause serious handicaps or complications, such as lifetime shortening and re-amputation of the other limb. The minimal amputation is the main goal of amputation in diabetic patients. However, insufficient amputation can have a harmful effect on patients. The decision of amputation is very difficult and should be made using multidisciplinary approaches. All aspects of the patient's situation, including vascular status, degree of infection, and medical conditions should be considered. The foot surgeon should keep in mind the notion that proper amputation can lead to a new life for diabetic foot patients.

• Korean Journal of Adult Nursing
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• v.18 no.1
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• pp.81-91
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• 2006

Purpose: The purpose of this study was to investigate foot ulcer risk factors, foot care knowledge, and foot care practice in patients with type 2 diabetes. Method: One hundred fifty type 2 diabetic patients were in and out-patients in a large urban hospital. The data were collected using a self-report questionnaire, chart review and foot examination. The questionnaires were developed by the researchers through the experts consultation and literature review. High risk for foot ulcer was evaluated by peripheral neuropathy(PN), peripheral vascular disease(PVD), and prior foot ulcer. Foot risk scores(FRS) means numbers of present risk factors. Results: 31.3% of subjects show 1 FRS, and 13.3% showed 2 FRS. Mean foot care frequency was 3.5 times per week. There were significant differences in foot care knowledge according to DM education (t=2.96, p=.004) and foot care education (t=3.65, p=.001). There were significant differences in the foot care practice activities according to duration of DM (t=3.48, p=.010) and educational levels. Conclusion: There were high proportion of foot ulcer risk among the patients. It is necessary to screen high risk foot ulcer patients and provide practical education for foot care practice of diabetic patients.

• Journal of muscle and joint health
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• v.28 no.3
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• pp.223-233
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• 2021

Purpose: This study aimed to systematically review the contents and effectiveness of education programs for preventing diabetic foot ulcer among patients with type 2 diabetes mellitus in Korea. Methods: Six electronic databases were searched using search terms, and 748 articles were identified. Ten articles were eligible based on inclusion and exclusion criteria. Article quality was evaluated using a critical evaluation checklist for manuscripts before performing the systematic review. Results: Although education programs for preventing diabetic foot ulcers have been continuously studied for 20 years, the number of studies is small, and to our knowledge, there have been no studies reporting on the subsequent prevalence of foot ulcers or amputations. While the effect of these education programs on knowledge (ES=1.23) and self-management behavior (ES=.96) was shown to be statistically significant, it was not shown to be significant in preventing diabetic foot ulcers (ES=.03). Conclusion: The actual preventive effect on the prevalence of foot ulcers, through education programs for preventing diabetic foot ulcer could not be determined. Our findings highlight a potential need for studies aimed at developing effective programs to improve education on preventing diabetic foot ulcers.

• Archives of Plastic Surgery
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• v.38 no.5
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• pp.585-589
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• 2011

Purpose: Microcirculation of diabetic patients is commonly comporomised, regardless of the condition of the macrocirculation. Therefore, direct tissue oxygenation measurement is recommended in determining tissue viability and predicting wound healing potential. This study was designed to determine cut-off value of the tissue oxygenation in predicting wound healing in diabetic foot patients. Methods: This study included 41 feet of 41 diabetic foot patients who were treated in the Diabetic Wound Center of author's institution between January and June, 2009. Main inclusion criteria were type 1 or 2 diabetes and a foot ulcer (duration > 3 weeks) and ulcer area (from 1 $cm^2$ to 4 $cm^2$). Measurements of the area of diabetic foot ulcer were carried out before treatment. Transcutaneous oxygen pressure ($TcpO_2$) was measured at adjacent site of ulcer. The healing wound was defined as complete wound closure within 12 weeks. Results: Average diabetic foot ulcer areas with healing and nonhealing wounds were $2.67{\pm}0.76$ and $2.59{\pm}0.75\;cm^2$, respectively. There was no significant difference in the wound area between the groups. Average foot $TcpO_2$ in healing and nonhealing wounds were $68.56{\pm}23.07$ and $30.98{\pm}16.66$ mmHg, respectively ($p$ <0.01). The rate of healing wound increased as $TcpO_2$ increased. In particular, $TcpO_2$ lower than 40 mmHg and higher than 40 mmHg showed the most significant difference (wound healing rates of 25% and 71%, respectively). Conclusion: Based on the results of the study, the minimal $TcpO_2$ value thought to be required for adequate wound healing in diabetic wounds (cut-off value) is 40 mmHg.

• Proceedings of the Korean Society of Applied Pharmacology
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• 2000.04a
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• pp.3-5
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• 2000

Of 16 million diabetic patients in the USA, 2.4 millions have experienced diabetic foot ulcer and 67,000 have amputations every year. For treatment of diabetic foot ulcer, Americans spend more than $1 billion each year, including $36,000 per patient for complete treatment and $60,000 for each amputation. Neuropathy and ischemia, two common complications of diabetes mellitus, are the primary underlying risk factors for development of diabetic foot ulcers. Ischemic ulcers develop as a result of low perfusion pressure in the foot with inadequate blood supply, whereas neuropathic ulcers develop from loss of protective sensation. In addition, diabetes also increases the risk of infection by impairing the body's ability to eliminate bacteria. From these circumstances, results are chronic wounds with impaired healing ability.

• Journal of Korean Foot and Ankle Society
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• v.15 no.4
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• pp.232-239
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• 2011

Purpose: Diabetic foot ulcer is one of the most important diabetic complications because it increases the risk of amputations. Moreover, it lowers the quality of patients' life and increases the social medical expenses. Authors analyzed risk factors of intractable diabetic foot ulcer using retrospective study. Materials and Methods: From January 2007 to December 2010, 40 patients who could not achieve complete healing despite more than 12 weeks of proper management among who had been diagnosed and treated as diabetic foot ulcer at our hospital were included and evaluated retrospectively. We compared the risk factors between two groups who were finally treated by amputation and non-amputation. Results: The sample was composed of 31 male patients (77.5%) and 9 female patients (22.5%). Comorbidity including hypertension and hyperlipidemia were 77.5% and 80% each. By Wagner classification, 30 patients (80%) had ulcerative lesion over the grade 3. From bacteriology results, 29 patients (72.5%) had polybacteria infection. 35 patients (87.5%) had neuropathy and 26 patients (65%) had vascular stenosis at least one level. The mean initial ankle-brachial index and toe-brachial index were 0.982 and 0.439. In comparison between amputation group and non-amputation group, ulcer severity, number of stenotic vessel and initial ankle-brachial index/toe-brachial index had statistical significance. Conclusion: The most commonly risk factor of intractable diabetic foot ulcer was peripheral neuropathy reaching 87.5% of cases. In comparison with non-amputation group, ulcer severity according to Wagner classification, number of stenotic vessel and initial ankle-brachial index/toe-brachial index were demonstrated as a risk factor of amputation in intractable diabetic foot ulcer.