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Background: Nearly all amputations in people with diabetes are preceded by a foot ulcer. It has been reported that stress is an important risk factor for slower wound healing and susceptibility to infection. The purpose of this study was to objectively monitor physiological stress response in patients with diabetic foot ulcer (DFU) during a clinical visit for wound dressing change. Methods: Physiological stress was continuously monitored in 20 patients (Age: 56.7±12.2 years) with DFU for duration of approximately 45min including waiting, dressing change and post-dressing period. Stress was quantified using a custom algorithm based on standard deviation of R-R intervals, heart rate variability (HRV). To identify the change in level of stress, change in HRV was compared to baseline HRV. Medium and high-stress periods were defined when HRV was in the range of 60–85% and below 60% of baseline HRV, respectively. Results: During the entire time of visit medium and high stress episodes happened for 28±12.6% and 16±18% of the time respectively. Further analyses of wound dressing time revealed that medium and high stress episodes were experienced for 47±24% and 18.3±27% of dressing time respectively. In addition, the duration of medium stress was significantly increased in average by 66% (difference=21.8%, p =0.002, 95%CI [7.5, 29.5]%) during dressing change compared to entire period of clinic visit. Conclusions: This pilot study shows that patients with DFU experience moderate to high stress while visiting a wound clinic, which may negatively impact wound healing outcomes. In particular, the highest stressful condition was during wound dressing change, which may be related to painful dressing or perception of pain. Further investigation is required to explore association between quantified stress and outcomes of wound healing. In addition, future studies need to explore benefit of stress management in enhancing the outcomes of wound healing in patients with diabetes. [ABSTRACT FROM AUTHOR]

Abstract: Extensive tissue resection often mandates unique approaches to complete a functional reconstruction. While there are numerous options for selecting a donor site for a skin or soft tissue flap, available options for securing a local flap following midfoot amputation are quite limited. Adequate flap fixation is essential to maintain its viability, yet this may be challenging to achieve when there is a substantial residual post debridement requiring coverage and only limited remaining viable surrounding soft tissue available for anchoring. Over thinning the flap may compromise vital circulation to it from plantar (or other pertinent) artery perforators. In our experience, the adjunctive use of Kirschner wire(s) to support external soft-tissue fixation in conjunction with traditional methods has been successful in securing such tenuous fasciocutaneous flaps. To our knowledge, few alternative techniques have been described to fasten flaps in instances of compromised surrounding skin and soft tissue integrity in high-risk patients. This technique offers the surgeon a strong, inexpensive, and versatile solution for soft tissue anchoring. It allows for mechanical creep and ultimately stress relaxation at a potential wound closure site. This manuscript reviews several cases, each using this simple, novel approach to fixate an unsecured flap during the closure of an open amputation. [Copyright &y& Elsevier]

Introduction. Foot disorders such as ulceration, infection, and gangrene which are often due to diabetes mellitus are some major causes of morbidity and high amputation. Aim. This study aims touse a group of methods for the management of diabetic foot ulcers (DFU) in order to salvage the lower limb so as to reduce the rate of high amputations of the lower extremity. Materials and Methods. A group of different advanced methods for the management of DFU such as sharp debridement of ulcers, application of vacuum therapy, and other forms of reconstructive plastic surgical procedures were used. Data collection was done at 3 different hospitals where the treatments were given. Results. Fifty-four patients with type 2 diabetes mellitus were enrolled in the current study: females n = 37 (68.51%) and males n = 17 (31.49%) with different stages of PEDIS classification. They underwent different methods of surgical management: debridement, vacuum therapy (some constructed from locally used materials), and skin grafting giving good and fast results. Only 4 had below knee amputations. Conclusion. Using advanced surgical wound management including reconstructive plastic surgical procedures, it was possible to reduce the rate of high amputations of the lower limb. [ABSTRACT FROM AUTHOR]

Background Disparities in diabetic foot ulcer ( DFU) treatment outcomes are well described, although few studies identify risk factors contributing to disparate healing and amputation rates. In a unique academic center serving urban public, private, and veteran patients, we investigated amputation and healing rates and specific risk factors for disparate treatment outcomes. Methods A retrospective chart review of diabetic patients with a new diagnosis of a foot ulcer at geographically adjacent, but independent public, private, and Veterans Administration ( VA) hospitals was conducted. Healing and lower extremity amputation outcomes were assessed. Results Across the three hospitals, 234 patients met the inclusion criteria. Patients at the VA hospital were older (mean 72.5 years; P < 0.001) and had gangrenous ulcers (mean 14.1%; P < 0.001) compared with patients in the private and public hospitals. Public hospital patients were mostly Hispanic (mean 54%; P < 0.001) with a shorter duration of diabetes (mean 12.8 years; P = 0.02), but were more poorly controlled than VA and private hospital patients ( P ≤ 0.001). Prior amputation (odds ratio [ OR] 1.97; P = 0.016) and non- Caucasian race ( OR 2.42; P = 0.004) increased the risk of amputation on multivariate analysis. Osteomyelitis ( P = 0.0371) and gangrene ( P < 0.001) are independent risk factors for amputation. Across all three hospitals, 42.3% of patients were treated by amputation (6.8% private, 12% public and 23.5% VA; P < 0.001). Conclusion In a single triumvirate health care system where the patient population is stratified primarily by insurance, VA patients have significantly higher amputation rates compared with patients at adjacent private and public hospitals. The VA patients are largely racial minorities with advanced DFU progression to gangrenous ulcers. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 65-year-old woman with FVII deficiency. She was evaluated by hematology in 2010, and no history of bleeding complications despite multiple surgical procedures, including toe amputation, and cardiac stenting. She underwent three-vessel coronary bypass off-pump for severe left main artery disease and reveals that she had no bleeding complications and did not require further doses of FVII replacement.

Transtibial (TT) amputations, or below-knee amputations, are among the most frequently performed major limb removals. To replace the missing limb, numerous prosthetic devices were developed. A study of the state-of-the-art in TT prostheses shows that none of the commercially available devices are capable of mimicking an able-bodied ankle-foot complex. Still on a research level, some powered prosthetic devices have the potential to improve amputee walking experience, but still need heavy and bulky actuators to provide the necessary power of propulsion. With the AMP-Foot 2.0, the authors propose a new concept for an energy efficient, powered transtibial prosthesis. Its design enables the use of a low power actuator which stores energy in springs during the complete stance phase that can be released at push-off. Thanks to this, the size and weight of the actuator can be decreased considerably while the ankle still provides the full power necessary for forward propulsion. A prototype of the AMP-Foot 2.0 has been built and experiments with a transfemural amputee were conducted. The captured data is presented and analyzed throughout this paper. [ABSTRACT FROM AUTHOR]

Study aim: the foot is recognised as a 'functional unit' with two important aims: to support body weight and to serve as a lever to propel the body forward. When it is impaired, the locomotor pattern has to adapt to compensate for the dysfunction. The purpose of this study was to investigate gait kinematics of a man after bilateral partial amputation of the toes. Material and methods: the subject of the study was a young man aged 30 years (body height and mass: 186 cm, 82 kg) who suffered a frostbite injury in the feet while climbing in the severe mountain conditions. After a few months of treatment, the necessary amputation occurred. Three-dimensional lower limb kinematics was collected from motion capture system (Vicon 250) and Golem marker set-up using 5 video-based cameras with infrared strobes. The subject performed over-ground walking at self-selected speed, first barefoot, then wearing athletic shoes. Results: the patient's results are the mean values of sixteen full gait cycles. The spatiotemporal parameters were lower during gait without shoes. In terms of the angular changes of the lower limb joints in sagittal plane, the analysis revealed similar functional patterns and typical trends in both recorded conditions. The differences, however, occurred in their amplitude. A larger range of motion was generally noted in shod conditions. The higher the joint was, the smaller the differences were. Conclusion: changes in gait due to the forefoot dysfunction may be stabilizing adaptations related to fear of falling. Footwear provided more stable conditions. [ABSTRACT FROM AUTHOR]

Although generally considered to be both a durable and functional procedure for limb preservation, the transmetatarsal amputation (TMA) has high rates of complication, failure, revisional operation, and progression to more proximal amputation. The objective of this investigation was to determine the effect of remnant metatarsal parabola structure on healing outcomes following TMA. A retrospective chart review was performed of subjects undergoing a complete TMA with primary closure. We considered 4 patterns of remnant metatarsal parabola structure. TMA pattern type 1 was a normal parabola with the remnant second metatarsal extending furthest distally and slightly longer than the remnant first and third metatarsals with a gradual lateral taper. TMA pattern type 2 was the first metatarsal remnant extending furthest distally with a gradual lateral taper. TMA pattern type 3 was a relatively long fifth metatarsal remnant without the presence of a gradual lateral taper. And TMA pattern type 4 was a relatively short first metatarsal remnant with a relatively long second metatarsal with a gradual lateral taper. Seventy-three transmetatarsal amputations in 73 subjects met selection criteria. Thirty-nine (53.4%) amputations healed primarily at 90 days. No statistically significant differences were observed between groups with respect to the 90-day primary healing rate (p = .571) or 1-year ambulation rate without wound recurrence or reoperation (p = .811). These results might indicate that the remnant metatarsal structure does not have an effect on transmetatarsal amputation outcome. It is our hope that these results add to the body of knowledge and lead to further investigations into outcomes of limb preservation surgical interventions., (Copyright © 2021 the American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

The prevalence of diabetes mellitus, particularly type 2 diabetes, is increasing worldwide. Also, the incidence of both lower limb revascularizations and amputations is increasing. We have less transtibial amputations due to improved diabetes care, but also due to modern treatments, vascular surgery, and development of plastic surgery. With well-planned minor amputations, more limbs can be saved. Minor limb-saving amputations are preferred especially to older diabetes patients, because they have a high-risk contralateral amputations. Losing both limbs causes major problems for patients and their life, risk for lifetime ward is high., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Introduction Burn and traumatic limb injuries with exposed bone/tendon typically require surgical flaps or amputations for healing. Some burn patients are not candidates for these invasive techniques. Placental amniotic membrane has been used as a wound dressing for more than 100 years and may offer an alternative to flaps and/or amputations. Processed dehydrated human amnion/chorion membrane (dHACM), from human placental tissue, contains type 1 human collagen as well as non-viable cells and 285 identified regulatory proteins including growth factors, chemokines, cytokines, metalloproteinases, and other tissue growth and inflammatory mediators. dHACM has been successfully used as a dressing for wound ulcers, burns, donor sites, & surgical debridement. This study reports the use of dHCAM as a limb salvage tool in four patients with severe injuries. Methods This is a retrospective case series of patients suffering severe lower extremity injury with bone/tendon exposure that had applied dHACM/dHCM over or packed (depending on wound depth), then covered with 3% bismuth tribromophenate petrolatum dressing & glycerol/ hydroxyethylcellulose lubricant. Negative pressure wound therapy (NPWT) was initiated; wound re-evaluation occurred in seven days. dHACM/dHCM was reapplied if required (bone still exposed). Results There were 3 males and 1 female with three burns and one NSTI. The mean±sd (median) age was 58±23 (61) years; % total burn surface area 3±3 (2); length of hospital stay 48±30 (40) days; number of tangential excisions & debridements 6.5±1 (6.5); days from admission to product application 49±47 (34) and discharge 24±19 (19) days; negative pressure wound therapy (NPWT) 53±6 (56) days. All four patients continued treatment upon discharge with clinic visits and home NPWT. All recovered with good results and no complications. Treatment may be continued with NPWT therapy at home or in a skilled nursing facility. Patients healed after two to three dHACM/dHCM applications and did not require leg or foot amputations. Conclusions In select limb salvage cases, dHACM/HCM may be a promising alternative to extremity amputations, tissue transfer flaps or other techniques for secondary intention healing of wounds with bone/tendon exposure. [ABSTRACT FROM AUTHOR]

Background and aim of the work: Foot ulcers are a major problem of diabetes for which conventional treatment modalities alone have had limited success in promoting complete wound closure; however, there are large amounts of evidences that exist for the effectiveness of manuka honey as a wound dressing especially in diabetic foot. The aim of this study was to compare the efficacy of Manuka honey combined with conventional modalities to that of conventional treatment alone in the treatment of diabetic foot ulcers. Patients and Methods: This was a prospective double-blind, randomized clinical trial conducted at the King Abdul Aziz Specialist Hospital in Taif, Saudi Arabia. Fifty-nine patients, enrolled from January 2011 to January 2013, were randomized to receive conventional treatment plus manukahoney impregnated dressings (honey treatment group) or conventional treatment alone (control group). Outcomes were; time to eradicate infection, length of hospital stay, percentage of completely healed ulcers after six weeks and six months. Results: The mean time to eradicate infection and the hospital stay were significantly reduced in the honey treatment group compared to control group (51.1% and 53.8% respectively, P<0.05). Percentages of ulcers that were completely healed were significantly greater in the honey group than the control group, at six weeks (61.3% vs. 11.5%; P <0.05) and at six months (87.1% vs. 42.3%; P<0.05). There were less toe amputations in the honey-treated group (9.7% vs. 34.6%; P<0.05). Conclusion: Combination of conventional treatment with manuka honey impregnated dressings is superior to conventional treatment alone in controlling wound infection, promoting the complete healing of diabetic foot ulcers, and decreasing the rate of minor amputations. [ABSTRACT FROM AUTHOR]

Copyright of Revista Ciência & Saúde Coletiva is the property of Associacao Brasileira de Pos-Graduacao em Saude Coletiva and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Highlights: [•] We investigated the effect of a bionic foot in ten transtibial amputees. [•] Motor abilities and the energy cost of walking in different conditions were tested. [•] The differences with the dynamic carbon fiber foot were analysed. [•] The bionic foot allowed for a lower energy cost of walking, particularly on floor. [Copyright &y& Elsevier]

Abstract: Uneven walking surfaces pose challenges to balance, especially in individuals with lower extremity amputation. The purpose of this study was to determine if lateral stability of persons with unilateral transtibial amputation (TTA) is compromised when walking on a loose rock surface. Thirteen TTA and 15 healthy controls walked over level ground and over a loose rock surface at four controlled speeds. Dependent measures, including medial–lateral center of mass (COM) motion, step width variability, lateral arm swing velocity, and mean and variability of the minimum margins of stability (MOSmin), were compared between subject groups and across conditions. TTA had greater average MOSmin than Control subjects (p =0.018). TTA exhibited decreased MOSmin on their prosthetic limbs compared to their intact limbs (p =0.036), while Control subjects did not exhibit side to side differences. Both groups increased MOSmin with increasing walking speed (p ≤0.001). There was no difference in the average MOSmin between walking surfaces (p =0.724). However, the variability of MOSmin was greater on the rocks compared to level ground. Both subject groups increased step width, step width variability, COM range of motion and peak COM velocity when walking on the rock surface. TTA exhibited greater variability of both step width and MOSmin, which suggests that they made larger step-to-step corrective responses, more often, to achieve the same average result. [Copyright &y& Elsevier]

Copyright of Rehabilitation / Rehabilitacija is the property of University Rehabilitation Institute, Republic of Slovenia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims: The purpose of this study was to identify the presence or absence of geographic variation in Medicare spending and mortality rates for diabetic patients with foot ulcers (DFU) and lower extremity amputations (LEA). Methods: Diabetic beneficiaries with foot ulcers (n=682,887) and lower extremity amputations (n= 151,752) were enrolled in Medicare Parts A and B during the calendar year 2007. We used ordinary least squares (OLS) regression to explain geographic variation in per capita Medicare spending and one-year mortality rates. Results: Health care spending and mortality rates varied considerably across the nation for our two patient cohorts. However, higher spending was not associated with a statistically significant reduction in one-year patient mortality (P=.12 for DFU, P=.20 for LEA). Macrovascular complications for amputees were more common in parts of the country with higher mortality rates (Pb.001), but this association was not observed for our foot ulcer cohort (P=.12). In contrast, macrovascular complications were associated with increased per capita spending for beneficiaries with foot ulcers (P=.01). Rates of hospital admission were also associated with higher per capita spending and increased mortality rates for individuals with foot ulcers (Pb.001 for health spending and mortality) and lower extremity amputations (Pb.001 for health spending, P=.01 for mortality). Conclusions: Geographic variation in Medicare spending and mortality rates for diabetic patients with foot ulcers and amputations is associated with regional differences in the utilization of inpatient services and the prevalence of macrovascular complications. [ABSTRACT FROM AUTHOR]

The definitive aim of a minor amputation is limited resection with retention of feet and legs resulting in a completely loadable extremity, in contrast to the lower leg stump. A shift in the amputation level in the sense of a shortening is inevitably accompanied by a reduction in the stand area, an increase in axial pressure and a disruption of muscle equilibrium in the extent of movement of the rest of the foot. This knowledge forms the central issue for further treatment of minor amputations in addition to the subtle treatment of the skin of the sole for coverage of a tension-free tip of the stump. Advantageous are longitudinal partial amputations of the forefoot and midfoot. [ABSTRACT FROM AUTHOR]

Diabetes mellitus has become a significant health problem throughout the world, where it constitutes the underlying cause for 84% of lower limb amputations due to recalcitrant ulcers. The Center for Genetic Engineering and Biotechnology (CIGB) at Havana, Cuba has designed an integrated strategy for preclinical testing, pharmaceutical development, production, clinical trials and business negotiations of an injectable drug for treating diabetic foot ulcers, denominated Heberprot-P®. This product, which uses epidermal growth factor as active ingredient and avoids these amputations, is the only registered drug of its type and has already had considerable medical, social and economic impact in Cuba and other nations, placing national science and the Cuban health system at the forefront of the fight against this disorder. Phase III trials are planned for 2013, pending approval of the Advisory Scientific Council of the European Medicines Agency (EMA), for examining its efficacy and safety in this continent. Research teams at CIGB continue to develop new Heberprot-P® versions, based on advanced controlled release systems employing micro and nanospheres, in order to continuously improve the product and extend its existing intellectual property coverage beyond the year 2030. [ABSTRACT FROM AUTHOR]

Diabetes mellitus has become a significant health problem throughout the world, where it constitutes the underlying cause for 84% of lower limb amputations due to recalcitrant ulcers. The Center for Genetic Engineering and Biotechnology (CIGB) at Havana, Cuba has designed an integrated strategy for preclinical testing, pharmaceutical development, production, clinical trials and business negotiations of an injectable drug for treating diabetic foot ulcers, denominated Heberprot-P®. This product, which uses epidermal growth factor as active ingredient and avoids these amputations, is the only registered drug of its type and has already had considerable medical, social and economic impact in Cuba and other nations, placing national science and the Cuban health system at the forefront of the fight against this disorder. Phase III trials are planned for 2013, pending approval of the Advisory Scientific Council of the European Medicines Agency (EMA), for examining its efficacy and safety in this continent. Research teams at CIGB continue to develop new Heberprot-P® versions, based on advanced controlled release systems employing micro and nanospheres, in order to continuously improve the product and extend its existing intellectual property coverage beyond the year 2030. [ABSTRACT FROM AUTHOR]

Summary: So far a few case reports about laptops causing burns have been published. Now for the first time, we report on a case, in which notebook-induced thermal injuries placed in a patient’s lap resulted in severe second- and third-degree burns. As a consequence, a partial amputation of the left foot had to be performed. Furthermore, we measured maximum temperatures of 12 popular laptops, which were running full load for 3 h. For this experiment air circulation underneath the device was blocked in order to simulate surrounding conditions, which were present when the patient got injured. Although this setting may be the reason for most of all notebook burns, this kind of test has not been part of any scientific publication until now. Patients with lower extremity sensation, altered consciousness or decreased peripheral sensitivity have a higher risk for thermal injuries. [Copyright &y& Elsevier]

Abstract: This study measured tissue properties of different anatomies of heels in amputated lower limbs of diabetic patients before and after hyaluronic acid (HA) or normal saline (NS) injections. Seven amputated lower limbs from six diabetic patients constituted the experimental group and one amputated lower limb from a diabetic patient served as the control. The limbs were placed in a fixation platform. A 5–12 MHz linear-array ultrasound transducer controlled by a stepping motor was used to load and unload tested heels. The loading-unloading velocity was 6 mm/s and the maximum loading stress was 178 kPa. Loading-unloading tests were performed before and after 1 mL HA injections into heels in the experimental group. The control limb underwent the same test before and after 1 mL NS injection. The unloaded thickness and Young‘s modulus of the macrochambers, microchambers and heel pads were determined before and after the interventions. The unloaded thickness of the macrochambers and the heel pad increased significantly (p = 0.012) after HA injection. The Young’s modulus of the macrochambers decreased nonsignificantly after HA injections. Similar thickness and tissue stiffness changes were observed in the control limb. The baseline heel-pad energy dissipation ratio (EDRhp) was 81.3 ± 1.3% and decreased significantly (p = 0.012) to 73.1 ± 1.7% after HA injections. The EDRhp in the control increased after NS injection. Histologic examinations revealed localized HA accumulation in the macrochambers with an extension into the adjacent fibrous septa. Injection of HA can increase tissue thickness and enhance heel-pad tissue resilience. [Copyright &y& Elsevier]

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article compares the different measures of performance and preferences of two crutch designs in elite football players with amputation, one with a traditional elbow crutch and the other spring-assisted crutch. The study involves tests of speed and agility. The authors detected a significant increase in perceived exertion using spring-assisted crutches. Results revealed that participants using traditional crutches were faster for all measures of speed and agility.

A prosthetic swing-phase control mechanism simulates the action of leg musculature, aiding gait function by controlling the duration of swing, extent of heel rise, and by allowing the shank to smoothly decelerate into full knee extension without excessive impact. Nonfluid-based (NBF) mechanisms have the potential to provide a durable and affordable solution as required in many parts of the world, but the design variables that lead to improved performance of NBF swing-phase control technologies are not well established. Seven transfemoral amputees were fitted with a prosthetic knee joint and different NBF swing-phase setups were systematically assessed. Clinical testing included walk tests utilizing a potentiometer (to measure knee flexion angles) and accelerometer (to measure terminal impact decelerations) mounted on the prosthetic limb. As hypothesized, the friction and spring systems improved gait function. This includes an increased walking speed that closely matched high-end hydraulic prosthetic knee joints, decreased and more normal maximum prosthetic knee flexion, decreased flexion duration, and lower terminal impact. Further improvements were obtained using a dual-spring system, two springs in series, over the more conventional single spring system. NBF swing-phase control mechanisms are simple and significantly improve the performance of prostheses. Their application is ideal where size, weight, and cost may be constrained. [ABSTRACT FROM PUBLISHER]

OBJECTIVE--Diabetic foot infection is the predominant predisposing factor to nontraumatic lower-extremity amputation (LEA), but few studies have investigated which specific risk factors are most associated with LEA. We sought to develop and validate a risk score to aid in the early identification of patients hospitalized for diabetic foot infection who are at highest risk of LEA. RESEARCH DESIGN AND METHODS--Using a large, clinical research database (Care-Fusion), we identified patients hospitalized at 97 hospitals in the U.S. between 2003 and 2007 for culture-documented diabetic foot infection. Candidate risk factors for LEA included demographic data, clinical presentation, chronic diseases, and recent previous hospitalization. We fit a logistic regression model using 75% of the population and converted the model coefficients to a numeric risk score. We then validated the score using the remaining 25% of patients. RESULTS--Among 3,018 eligible patients, 21.4% underwent an LEA. The risk factors most highly associated with LEA (P < 0.0001) were surgical site infection, vasculopathy, previous LEA, and a white blood cell count > 11,000 pet mm³. The model showed good discrimination (c-statistic 0.76) and excellent calibration (Hosmer-Lemeshow, P = 0.63). The risk score stratified patients into five groups, demonstrating a graded relation to LEA risk (P < 0.0001). The LEA rates (derivation and validation cohorts) were 0% for patients with a score of 0 and ~50% for those with a score of ≥21. CONCLUSIONS--Using a large, hospitalized population, we developed and validated a risk score that seems to accurately stratify the risk of LEA among patients hospitalized for a diabetic foot refection. This score may help to identify high-risk patients upon admission. [ABSTRACT FROM AUTHOR]

Diabetic foot complications place an enormous burden upon the health economy but, more importantly, are associated with significant morbidity and mortality risks for those affected. It is clear from published data that with good screening programmes, which are integrated with comprehensive and structured foot-care pathways, significant reductions in lower extremity amputations can be achieved and maintained. This article provides simple but effective tools for identifying and stratifying the risk of foot ulceration in people with diabetes and clarifies how to refer people with a diabetic foot condition. [ABSTRACT FROM AUTHOR]

Background: Although the health status of all Americans has improved substantially in the past century, gender and ethnic disparities still persist. Gender and ethnic disparities in diabetic foot management and amputations are an important but largely ignored issue in musculoskeletal health care. Questions/purposes: Our purposes were to (1) clarify where we are now, (2) describe ways to get where we need to go, and (3) suggest solutions for how we get there, with respect to gender and ethnic disparities in diabetic foot management and amputations. Where are we now?: Studies investigating socioeconomic, cultural, racial, and biologic contributing factors on gender and ethnic musculoskeletal healthcare disparities have found no single root cause. Studies into disparities in diabetic foot management and amputation have discordant methodologies and most are retrospective. Effective intervention strategies to eliminate these disparities are nonexistent. Where do we need to go?: The orthopaedic leadership should lead the movement to create a clearly defined strategy and assist young investigators to gain access to large datasets to study this problem. Orthopaedic specialty society leaders should help to create valid outcome tools, especially on peripheral vascular disease and amputations. How do we get there?: The working group proposed a three-pronged strategy of education, research, and advocacy to help address this problem. [ABSTRACT FROM AUTHOR]

Although the microangiopathy of the foot may not be accepted as the primary cause for ulceration, there are morphological and functional changes of microcirculation in diabetes. The aim of our study was to identifying those who are important for the pathogeny of the complicated diabetic foot. Material and Method: We studied 20 diabetic patients (type 1 diabetes = 9 patients, 4 males and 5 females, type 2 diabetes = 11 patients, 7 males and 4 females) with a duration of diabetes between 10 and 20 years. All patients had peripheral neuropathy and distal lesions of the foot (ulcerations, gangrenes) and they were surgically treated (amputations limited at the lower level of the foot). During the surgery there were taken bioptic fragments from areas with tissue that apparently had no macroscopic modifications. We used the CD34 antibody (marker for the vascular endothelium) and the PGP9.5 antibody (pan-axonal marker). We also used the PAS technique to show the basement membranes. Results: The basement membranes of microcirculation were thickened and PAS positive both in the deep dermis, as well as in the superficial dermis. Quantitative ratio between capillary and arterio-venous shunts was different in the dermal papilla; it was also a different degree of expansion of these structures lumens. Marker CD34 showed a decreased number of endoneural capillaries. PGP9.5 showed fragmentation and disruption of the peripheral nerves of dermis as well as the ones of muscular tissue. Conclusions: The morphological modifications shown in our study support the microangiopathic theory of neuropathy, without invalidating the metabolic one. We think that both metabolic (derived from chronic hyperglycaemia) and vascular factors occur in the development and progression of neuropathy, contributing to the nervous disorder, both through the deficient contribution in nutrients and affecting the clearance of the metabolic products. The opening of the arteriovenous shunts, element observed in the anatomo-pathological preparations studied, may support the theory of the functional microangiopathy existing in the neuropathic diabetic foot. [ABSTRACT FROM AUTHOR]

Background. The Diabetic Foot is one the most expensive and disabling chronic events presented in diabetic patients. In México 9% of the population suffers diabetes mellitus. In the Central Military Hospital all minor amputations are performed with open technique is for this reason that realized this study for determined the incidence of complications with minor amputation closed technique in diabetic foot. Material and methods. The procedure of minor amputations with closed technique took place in the vascular's surgery room of the central Military hospital, under the influence of local anesthesia using stererile technique, and the wound were closed using 3-0 nylon, with intravenous antibiotics for five days to assess the presence of complications, then was discharged with oral antibiotics and appointment of vascular surgery. Results. The group operated with minor amputation closed technique complications were observed from 18% with 2 patients (7%) infection other 2 patients (7%) necrosis of the edges surgery and 1 patient (4%) deserves major amputation, the other 23 patients (82%) showed no complication. Conclusions. After performing minor amputations with closed technique in 28 patients the incidence of complications were 5 patients (18%) 3 of them with chronic renal failure aggregated so it's best to exclude patients with this condition added to decrease the rate of complications. [ABSTRACT FROM AUTHOR]

Copyright of Revue Francophone des Laboratoires is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Española de Cirugía Ortopédica y Traumatologia (English Edition) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article examines randomized controlled trials (RCT) describing or reviewing methods to prevent diabetic foot ulcers. Review articles were obtained from Medline and PubMed between January 1, 1960 and April 30, 2010. One study was conducted by J. M. Malone and colleagues which focused on diabetic education to prevent foot amputation. Another study was conducted by L. E. Uccioli and colleagues which focused on the use of therapeutic shoes by patients with previous foot ulceration.

A general affectation of small muscles appears during the progress of diabetes, producing modifications of pressure points that, associated with neuropathy, lead to foot ulcerations. The aim of the study is to identify the changes in striate muscles of diabetic foot. Material and method. The study group consisted of 25 patients ( type 1 diabetes . 9 patients, 5 males and 4 females, type 2 diabetes . 16 patients, 10 males and 6 females), with a history of diabetes between 10 and 30 years. All patients had peripheral diabetic neuropathy and different stages of lesions in feet that needed surgical treatment (amputations limited to the inferior extremity of limbs). Fragments of tissue were processed and examined in usual stains (Haemalaun-Eosine, trichromic Szekely and van Gieson staining). The CD34 marker was used to highlight the vascular endothelium. Results. In van Gieson stain, the edematous aspect of endomysium could be seen. Degenerated muscular tissue was replaced with adipose tissue. By argentic impregnation techniques was proven that endomysium is preserved in case of degenerative changes of striate muscles. In endomysium and perimysium, vascular lumens were noted with CD34 marker in fragments coming from deep ulcers. Conclusions. Diabetic foot associates all modifications produced in nerves, vessels, soft tissues and skeleton, causing biomechanical changes of foot, severe infections, dysfunction and amputations. Muscular modifications are progressive, from distancing fibers, destruction, disorganization, to replacement with adipose tissue. Myositis is present in cases of inflammation. [ABSTRACT FROM AUTHOR]

The article discusses the application of Pirogoff amputation as a surgical technique for necrosis of the forefoot. It explores several procedures in conducting the surgical technique, which include identifying anesthetic considerations, osteotomy of the distal part of the tibia and the lateral and medial malleoli, and wound closure. It also discusses the postoperative management of the patient, wherein pain management and wound healing will be considered as main concerns during the early phase.

Foot and ankle surgeons are frequently challenged by the devastating systemic consequences of diabetes mellitus manifested through neuropathy, integumentary and joint breakdown, delayed healing, decreased ability to fight infection, and fragile tendon/ligaments. Diabetic neuropathic pedal ulcerations lead to amputations at an alarming rate and also carry a high mortality rate. This article will discuss causes of diabetic pedal ulcerations that persist or recur after tendo-Achilles lengthening and will highlight areas that need to be addressed by the practitioner such as infection, vascular and nutritional status, glucose control, off-loading, biomechanics, and patient compliance. [ABSTRACT FROM AUTHOR]

Conservative management of Charcot foot neuroarthropathy remains efficacious for certain clinical scenarios. Treatment of the patient should take into account the stage of the Charcot neuroarthopathy, site(s) of involvement, presence or absence of ulceration, presence or absence of infection, overall medical status, and level of compliance. The authors present an overview of evidence-based non-operative treatment for diabetic Charcot neuroarthropathy with an emphasis on the most recent developments in therapy. [ABSTRACT FROM AUTHOR]

Our aim of this study was to compare the accuracy of three different modalities for testing sensory neuropathy in diabetic patients with and without diabetic foot problems. The three devices used included the pin-prick testing using the Neurotip® (PPT), the Semmes-Weinstein 5.07/10 g monofilament testing (SWMT), and the rapid-current perception threshold (R-CPT) measurements using the Neurometer® testing. Our study population consisted of 54 patients (108 feet) with diabetic foot problems treated at the National University Hospital in Singapore by our multi-disciplinary diabetic foot care team. Our results showed no difference in sensory neuropathy detected by PPT and 5.07/10 g SWMT in both the pathological and normal foot. In the pathological foot, there was significant increase in sensory neuropathy detected by the Neurometer® device at both the big toe and ankle sites as compared to PPT and 5.07/10 g SWMT. In the normal foot, there was a significant increase in sensory neuropathy detected by the Neurometer® device at the big toe site only as compared to PPT and 5.07/10 g SWMT. Finally, the Neurometer® measurements detected a statistically higher proportion of feet with sensory neuropathy as compared to detection by the PPTor 5.07/10 g SWMT. [ABSTRACT FROM AUTHOR]

Objectives: This is a prospective study of the clinical efficacy of the V.A.C. Granufoam Bridge Dressing for the treatment of diabetic foot ulcers. Materials and methods: Five consecutive patients with diabetic foot ulcers were treated with V.A.C. Granufoam Bridge Dressings and studied over a period of 22-48 days. The indications for treatment included diabetic patients with open ray amputation wounds and wounds post-drainage for abscess with exposed deep structures. Clinical outcome was measured in terms of reduction in wound dimensions, presence of wound granulation, microbial clearance, and development of wound complications. Results: Our results showed that with V.A.C. therapy, wound healing occurred in all patients. The number of dressings required ranged from 8 to 10. The baseline average wound size was 23.1 cm2. Wound areas shrunk by 18.4-41.7%. All subjects achieved 100% wound bed granulation with an average length of treatment of 33 days. Microbial clearance was achieved in all cases. All wounds healed by secondary intention in one case and four cases required split-thickness skin grafting. Conclusion: The V.A.C. Granufoam Bridge Dressing is effective in the treatment of diabetic foot ulcers. It promotes reduction of wound area, wound bed granulation, and microbial clearance. By allowing placement of the suction pad outside the foot, it allowed patients to wear protective shoes and to walk non-weight bearing with crutches during V.A.C. therapy. [ABSTRACT FROM AUTHOR]

Objective: To assess the frequency of amputation in diabetic foot with morbidity and mortality. Methods: The study was carried out at the department of Orthopaedic Surgery and traumatology Unit -1, Liaquat University of Medical and Health Sciences Jamshoro from July 2007 to June 2008. The study design was prospective. All type II diabetes patients having foot complications were included and patients with type I diabetes were excluded from the study. All the patients were assessed by the Wagner's grading system of diabetic foot and the most common grade of diabetic foot in this study were grade II and III. Operative procedures were, wound debridement, incision and drainage, small and big toe amputation, below and above knee amputation. Results: Total number of patients was 58; there were 39(67.24%) male and 19(32.75%) female patients with male female ratio of 3:1. Age ranged between 30 to 70 years with average age 52 years. Wound debridement was done in 14(24.15%) patients, below knee amputation 12(20.69%), above knee amputation 09(15.52%), small toe amputation 11(18.96%), big toe amputation in 07(12.06%) and incision and drainage in 5(8.62%) patients. Overall amputation rate in the study was 39(67.24%) patients with minor amputations in 18(31.4 %) patients and 21(36.20 %) major limb amputation. Mortality rate in this study was 08(13.7 %). Mild Phantom pain was reported by 53%. Conclusion: We conclude that diabetic foot is leading cause of amputations resulting in high morbidity and mortality. These complications can be prevented by early detection, adequate glycemic control and timely referral of diabetic foot patients to specialists. Patient's education and training to general practitioners at district level about foot care are the most important measure to curtail disabilities resulting from diabetic foot. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Mycetoma is a chronic disease, which is endemic in tropical and subtropical countries. We report a rare case of mycetoma located on the foot of a patient living in a temperate-climate country followed by a short discussion. Observation: A 50-year-old woman with painless swelling in her left foot. The swelling started after a banal penetrating injury on the sole of her left foot 23 years ago. X-rays images showed multiple osteolytic lesions of the tarsus. The histological analyses identified the fungus madurella mycetomatis. The treatment was radical surgery (amputation). The patient had a tibial prosthesis and recovered an autonomous gait. Discussion: Mycetoma is a chronic granulomatous inflammatory response often with sinus tract formations due to fungal or bacterial organisms. The infection of the forefoot is quite typical. It is a slowly progressing disease affecting the deep dermis and subcutaneous tissues that can extent to the underlying bones. Conclusion: If it is not diagnosed early on, mycetoma can cause functional and esthetical impairments. [Copyright &y& Elsevier]