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Chinaroonchai K. Oxygen Therapy to Enhance Wound Healing After Revascularization. INT J LOW EXTR WOUND 2024; 23:49-54. [PMID: 38311897 DOI: 10.1177/15347346231215201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Oxygen is one of the important factors for wound healing and infection control. The revascularization procedure is amended to correct the tissue hypoxia problem by increasing the blood flow to obtain an adequate amount of oxygen. Hypoxic wounds are still the issue in the cases of unsuccessful or incomplete revascularization. The issue needs to be clarified and confirmed by proper methods for management to achieve wound healing and prevent limb loss. Oxygen therapy may benefit in the case of remaining hypoxia or wound infection in postrevascularization.
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Affiliation(s)
- Kusuma Chinaroonchai
- Trauma Surgery Division, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Moon KC, Cha JH, Han SK, Son JW. Developing a Practical Tool for Predicting Wound Healing Outcomes of Patients with Diabetic Forefoot Ulcers: Focus on Vasculopathy and Infection. Adv Skin Wound Care 2024; 37:95-101. [PMID: 38241452 DOI: 10.1097/asw.0000000000000090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
OBJECTIVE To develop a preliminary risk scoring system to predict the prognosis of patients with diabetic forefoot ulcers based on the severity of vasculopathy and infection, which are the major risk factors for amputation. METHODS Forefoot was defined as the distal part of the foot composed of the metatarsal bones and phalanges and associated soft tissue structures. The degree of vasculopathy was graded as V0, V1, or V2 according to transcutaneous partial oxygen tension values and toe pressure. The degree of infection was graded as I0, I1, or I2 according to tissue and bone biopsy culture results. The risk scores were calculated by adding the scores for the degree of vasculopathy and infection and ranged from 0 to 4. Wound healing outcomes were graded as healed without amputation, minor amputation, or major amputation. The authors evaluated wound healing outcomes according to risk scores. RESULTS As the risk score increased, the proportion of patients who underwent both major and minor amputations increased (P < .001). In the multivariate logistic analysis, the odds ratios of amputation also increased as the risk score increased. Patients with a risk score of 4 were 75- and 19-fold more likely to undergo major and minor amputations, respectively, than patients with a risk score of 0 (P = .006 and P < .001). CONCLUSIONS The risk score can be used as an indicator to predict the probability of amputation in patients with diabetic forefoot ulcers.
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Affiliation(s)
- Kyung-Chul Moon
- At Korea University Medical Center, Seoul, South Korea, Kyung-Chul Moon, MD, PhD, is Clinical Associate Professor, Department of Plastic Surgery; Ji-Hwan Cha, MD, is Plastic Surgery Resident; Seung-Kyu Han, MD, PhD, is Professor, Department of Plastic Surgery; and Ji-Won Son, RN, is Plastic Surgery Nurse
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Normahani P, Khosravi S, Sounderajah V, Aslam M, Standfield NJ, Jaffer U. The Effect of Lower Limb Revascularization on Flow, Perfusion, and Systemic Endothelial Function: A Systematic Review. Angiology 2020; 72:210-220. [PMID: 33143447 PMCID: PMC7859678 DOI: 10.1177/0003319720969543] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Peripheral arterial disease (PAD) is associated with reduced lower limb blood flow and tissue perfusion. The consequent reduction in vessel wall shear stress as well as ischemia-reperfusion injury has also been associated with systemic endothelial dysfunction and inflammation. We aimed to explore the impact of lower limb revascularization on (1) lower limb blood flow, (2) tissue perfusion, and (3) systemic endothelial function. We performed a systematic literature search using the MEDLINE, Embase, and Web of Science databases. Eligible studies measured changes in lower limb blood flow, perfusion, or systemic endothelial function following revascularization for the treatment of symptomatic PAD. We found 19 eligible studies, which were limited by considerable heterogeneity. Current evidence suggests that revascularization has a positive effect on flow, perfusion, and systemic endothelial dysfunction. Any changes may take a number of weeks to become apparent. There is a need for well-designed studies to explore the association between flow, perfusion, and endothelial dysfunction.
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Affiliation(s)
- Pasha Normahani
- Imperial Vascular Unit, 4615Imperial College NHS Healthcare Trust, Paddington, London, UK
| | - Sodabeh Khosravi
- Imperial Vascular Unit, 4615Imperial College NHS Healthcare Trust, Paddington, London, UK
| | - Viknesh Sounderajah
- Imperial Vascular Unit, 4615Imperial College NHS Healthcare Trust, Paddington, London, UK
| | - Mohamed Aslam
- Imperial Vascular Unit, 4615Imperial College NHS Healthcare Trust, Paddington, London, UK
| | - Nigel J Standfield
- Imperial Vascular Unit, 4615Imperial College NHS Healthcare Trust, Paddington, London, UK
| | - Usman Jaffer
- Imperial Vascular Unit, 4615Imperial College NHS Healthcare Trust, Paddington, London, UK
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Leenstra B, Wijnand J, Verhoeven B, Koning O, Teraa M, Verhaar MC, de Borst GJ. Applicability of Transcutaneous Oxygen Tension Measurement in the Assessment of Chronic Limb-Threatening Ischemia. Angiology 2020; 71:208-216. [PMID: 31387360 PMCID: PMC6987479 DOI: 10.1177/0003319719866958] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Transcutaneous oxygen tension measurement (TcPO2) is widely applied for the evaluation of chronic limb-threatening ischemia (CLTI). Nevertheless, studies that focused on the clinical value of TcPO2 have shown varying results. We identified factors that potentially play a role in TcPO2 measurement variation such as probe placement, probe temperature, and the use of a reference probe. In this review of the current literature, we assessed the application of these factors. A systematic search was conducted. Parameters that were assessed were probe placement, probe temperature, and mentioning and/or use of a reference probe. In total, 36 articles were eligible for analysis. In 24 (67%) studies, probes were placed on specific anatomical locations. Seven (19%) studies placed probes, regardless of the location of the ulcer, adjacent to an ischemic lesion or ulcer (perilesion). Selected temperature setting of the probe differed; in 18 (50%), a default probe temperature of 44°C was selected, and in 13 (36%), a different temperature was selected. In 31 (84%) studies, the use of a reference probe was not reported. Transcutaneous oxygen tension measurement is applied diversely in patients with CLTI. Homogeneity in TcPO2 protocols is warranted for reliable clinical application and to compare future TcPO2 research.
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Affiliation(s)
- Bernard Leenstra
- Department of Vascular Surgery, UMC Utrecht, CX Utrecht, the
Netherlands
| | - Joep Wijnand
- Department of Vascular Surgery, UMC Utrecht, CX Utrecht, the
Netherlands
| | - Bart Verhoeven
- Department of Vascular Surgery, Jeroen Bosch Ziekenhuis, Henri Dunantstraat,
GZ ‘s-Hertogenbosch, the Netherlands
| | - Olivier Koning
- Department of Vascular Surgery, Jeroen Bosch Ziekenhuis, Henri Dunantstraat,
GZ ‘s-Hertogenbosch, the Netherlands
| | - Martin Teraa
- Department of Vascular Surgery, UMC Utrecht, CX Utrecht, the
Netherlands
- Department of Vascular Surgery, Jeroen Bosch Ziekenhuis, Henri Dunantstraat,
GZ ‘s-Hertogenbosch, the Netherlands
- Department of Nephrology and Hypertension, UMC Utrecht, Heidelberglaan, CX
Utrecht, the Netherlands
| | - Marianne C. Verhaar
- Department of Nephrology and Hypertension, UMC Utrecht, Heidelberglaan, CX
Utrecht, the Netherlands
| | - Gert J. de Borst
- Department of Vascular Surgery, UMC Utrecht, CX Utrecht, the
Netherlands
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Moon KC, Kim KB, Han SK, Jeong SH, Dhong ES. Risk Factors for Major Amputation on Hindfoot Ulcers in Hospitalized Diabetic Patients. Adv Wound Care (New Rochelle) 2019; 8:177-185. [PMID: 31737413 DOI: 10.1089/wound.2018.0814] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 11/26/2018] [Indexed: 12/19/2022] Open
Abstract
Objective: The purpose of this study was to investigate the risk factors for major amputation in patients hospitalized with diabetic foot ulcers involving the hindfoot. Approach: Between January 2003 and October 2017, a total of 1,657 diabetic patients were admitted to the diabetic wound center of Korea University Guro Hospital, for the management of foot ulcers. Among the admitted patients, 117 diabetic patients with hindfoot ulcers were included in this study. One hundred and four patients (89%) healed without major amputation, while 13 patients (11%) healed with major amputation. Data related to 88 potential risk factors, including demographics, ulcer condition, vascularity, bioburden, neurology, and serology, were collected from patients in these two groups for comparison. Results: Among the 88 potential risk factors, 15 showed statistically significant differences between the two groups. In univariate analysis of 88 potential risk factors, nine showed statistically significant differences. In stepwise multiple logistic regression analysis, three of the nine risk factors remained statistically significant. Multivariate-adjusted odds ratios for pulmonary disorders, erythrocyte sedimentation rate (ESR) levels, and total iron-binding capacity (TIBC) levels were 38.525, 1.047, and 0.976, respectively. Innovation: Compared with forefoot and midfoot ulcers, diabetic foot ulcers involving the hindfoot are at increased risk of major amputation because infection may spread proximal to the ankle. However, large-scale cohort studies that specifically discuss the outcomes and characteristics of diabetic hindfoot ulcers are not widely available. Conclusion: Risk factors for major amputation in patients hospitalized with diabetic hindfoot ulcers include pulmonary disorders, high levels of ESR, and decreased TIBC levels.
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Affiliation(s)
- Kyung-Chul Moon
- Department of Plastic Surgery, Korea University Guro Hospital, Seoul, South Korea
| | - Ki-Bum Kim
- Department of Plastic Surgery, Korea University Guro Hospital, Seoul, South Korea
| | - Seung-Kyu Han
- Department of Plastic Surgery, Korea University Guro Hospital, Seoul, South Korea
| | - Seong-Ho Jeong
- Department of Plastic Surgery, Korea University Guro Hospital, Seoul, South Korea
| | - Eun-Sang Dhong
- Department of Plastic Surgery, Korea University Guro Hospital, Seoul, South Korea
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Skin Hydration Level as a Predictor for Diabetic Wound Healing: A Retrospective Study. Plast Reconstr Surg 2019; 143:848e-856e. [PMID: 30676507 DOI: 10.1097/prs.0000000000005474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND In the diabetic foot, the skin may crack and develop fissures, potentially increasing vulnerability to ulceration and infection. Therefore, maintaining adequate skin hydration may be crucial for diabetic wound healing. However, no clinical study has addressed this issue. This study aimed to determine and compare the effect of the skin hydration level on diabetic wound healing with that of the tissue oxygenation level, which is recognized as the most reliable parameter in predicting diabetic wound healing. METHODS This retrospective study included 263 diabetic patients with forefoot ulcers. Skin hydration and transcutaneous oxygen pressure data collected before and after percutaneous transluminal angioplasty were analyzed. Skin hydration and tissue oxygenation were graded as poor, moderate, or acceptable. Wound healing outcomes were graded as healed without amputation, minor amputation, or major amputation. Wound healing outcomes were compared using four parameters: skin hydration at baseline, transcutaneous oxygen pressure at baseline, post-percutaneous transluminal angioplasty skin hydration, and post-percutaneous transluminal angioplasty transcutaneous oxygen pressure. RESULTS Each of the four parameters exhibited statistically significant correlations with wound healing outcomes. In the concurrent analysis of both skin hydration and transcutaneous oxygen pressure, skin hydration was a dominant parameter (p = 0.0018) at baseline, whereas transcutaneous oxygen pressure was a dominant parameter (p < 0.0001) following percutaneous transluminal angioplasty. CONCLUSIONS Skin hydration level might be a useful predictor for diabetic wound healing. In particular, the skin hydration level before recanalization was found to be superior to transcutaneous oxygen pressure in predicting wound healing. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Moon KC, Chung HY, Han SK, Jeong SH, Dhong ES. Possibility of Injecting Adipose-Derived Stromal Vascular Fraction Cells to Accelerate Microcirculation in Ischemic Diabetic Feet: A Pilot Study. Int J Stem Cells 2019; 12:107-113. [PMID: 30836733 PMCID: PMC6457712 DOI: 10.15283/ijsc18101] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/04/2019] [Accepted: 01/14/2019] [Indexed: 12/25/2022] Open
Abstract
Background and Objectives Beneficial effects of human adipose-derived stromal vascular fraction (SVF) cell injection on microcirculation have been recently reported in in vitro and in vivo studies. However, no clinical studies have reported its effect in diabetic patients who commonly experience compromised tissue perfusion, regardless of the status of intravascular blood flow. The present piloting study was designed to clinically examine the possibility of SVF cell injection to accelerate microcirculation, particularly in ischemic diabetic feet. Methods Ten diabetic feet were included to receive subcutaneous injection of SVF cells around wounds. Transcutaneous partial oxygen pressure (TcPO2) and cutaneous microvascular blood flow were measured before and every four weeks after cell injection until the 12th week visit. Results TcPO2 values increased from 31.3±7.4 before injection to 46.4±8.2 mmHg at 12 weeks after SVF injection (1.5-fold, p<0.05). Cutaneous microvascular blood flow levels increased from 34.0±21.1 before injection to 76.1±32.5 perfusion unit at 12 weeks after SVF injection (2.2-fold, p<0.05). There were no adverse events related to SVF cell injection. Conclusions Results of this study demonstrate that adipose-derived SVF cell injection have the possibility to provide beneficial effects on microcirculation in ischemic diabetic feet.
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Affiliation(s)
- Kyung-Chul Moon
- Department of Plastic Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Ha-Yoon Chung
- Department of Plastic Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Seung-Kyu Han
- Department of Plastic Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Seong-Ho Jeong
- Department of Plastic Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Eun-Sang Dhong
- Department of Plastic Surgery, Korea University Guro Hospital, Seoul, Korea
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Namgoong S, Yang JP, Yoo KH, Han SK, Rha SW, Lee YN. Comparison of perfusion values after percutaneous transluminal angioplasty according to the severity of ischaemia in the diabetic foot. Int Wound J 2018; 16:176-182. [PMID: 30311727 DOI: 10.1111/iwj.13008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 09/14/2018] [Accepted: 09/16/2018] [Indexed: 11/30/2022] Open
Abstract
Percutaneous transluminal angioplasty (PTA) is now more frequently used to improve tissue perfusion in ischemic diabetic feet. However, there are concerns about its feasibility and effectiveness in severely ischaemic feet. This study aimed to compare the perfusion values after PTA according to the ischaemic degree of diabetic feet. This study included 133 ischaemic diabetic feet. The foot transcutaneous oxygen pressure (TcPO2 ) and toe pressure were measured before the procedure and every second postoperative week for 6 weeks. The patients were divided into three groups according to ischaemic severity on the basis of TcPO2 and toe pressures. In the "severely ischaemic" group, the TcPO2 increased from 7.5 ± 4.9 to 40.3 ± 11.3 mm Hg (5.4-fold) 6 weeks after the PTA (P < 0.001). The toe pressure increased from 8.5 ± 8.8 to 42.2 ± 19.3 mm Hg (5.0-fold, P < 0.001). In the "mild" group, the TcPO2 increased from 35.4 ± 2.5 to 41.8 ± 12.4 mm Hg (1.2-fold, P = 0.003), and the toe pressure increased from 45.7 ± 12.3 to 54.3 ± 31.3 mm Hg (1.2-fold, P > 0.05). Results of the "intermediate" group were in between. The most severely ischaemic group had the most dramatic increase of tissue perfusion after PTA. As such, PTA can be an effective method for increasing tissue perfusion even in the severely ischaemic diabetic feet.
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Affiliation(s)
- Sik Namgoong
- Diabetic Wound Center, Korea University Guro Hospital, Seoul, South Korea
| | - Jong-Phil Yang
- Diabetic Wound Center, Korea University Guro Hospital, Seoul, South Korea
| | - Ki-Hyun Yoo
- Diabetic Wound Center, Korea University Guro Hospital, Seoul, South Korea
| | - Seung-Kyu Han
- Diabetic Wound Center, Korea University Guro Hospital, Seoul, South Korea
| | - Seung-Woon Rha
- Diabetic Wound Center, Korea University Guro Hospital, Seoul, South Korea
| | - Ye-Na Lee
- Diabetic Wound Center, Korea University Guro Hospital, Seoul, South Korea
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Abstract
OBJECTIVE Negative-pressure wound therapy (NPWT) has become a common wound care treatment modality for a variety of wounds. Several previous studies have reported that NPWT increases blood flow in the wound bed. However, NPWT might decrease tissue oxygenation in the wound bed because the foam sponge of NPWT compresses the wound bed under the influence of the applied negative pressure. Adequate tissue oxygenation is an essential consideration during diabetic foot management, and the foot is more sensitive to ischemia than any other region. Furthermore, the issue as to whether NPWT reduces or increases tissue oxygenation in diabetic feet has never been correctly addressed. The aim of this study was to evaluate the influence of NPWT on tissue oxygenation in diabetic feet. PARTICIPANTS Transcutaneous partial oxygen pressures (TcPO2) were measured to determine tissue oxygenation levels beneath NPWT dressings on 21 feet of 21 diabetic foot ulcer patients. DESIGN A TcPO2 sensor was fixed at the tarsometatarsal area of contralateral unwounded feet. A suction pressure of -125 mm Hg was applied until TcPO2 reached a steady state. The TcPO2 values for diabetic feet were measured before, during, and after NPWT. MAIN RESULTS The TcPO2 levels decreased significantly after applying NPWT in all patients. Mean TcPO2 values before, during, and after therapy were 44.6 (SD, 15.2), 6.0 (SD, 7.1), and 40.3 (SD, 16.4) mm Hg (P < .01), respectively. CONCLUSION These results show that NPWT significantly reduces tissue oxygenation levels in diabetic feet.
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Tissue Oxygenation and Negative-Pressure Wound Therapy When Applied to the Feet of Persons With Diabetes Mellitus: An Observational Study. J Wound Ostomy Continence Nurs 2018; 44:517-523. [PMID: 29117076 DOI: 10.1097/won.0000000000000378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE Our group has reported that negative-pressure wound therapy (NPWT) decreases tissue oxygenation by 84% in the foot of diabetic patients because the pad of the connecting drainage tube and foam sponge of the NPWT system compress the wound bed. The purpose of this study was to determine whether an NPWT modified dressing application reduces tissue oxygenation in the feet of persons with diabetes mellitus. DESIGN A prospective, clinical, observational study. SUBJECTS AND SETTING We enrolled 30 patients with diabetic mellitus; their mean age was 63.9 ± 11.2 years (mean ± standard deviation). All were cared for at the diabetic wound center at an academic tertiary medical center in South Korea between 2014 and January 2015. METHODS Transcutaneous partial oxygen pressures (TcpO2) were measured to determine tissue oxygenation levels beneath modified NPWT dressings. A TcpO2 sensor was fixed at the tarsometatarsal area of the contralateral unwounded foot. A negative pressure of -125 mm Hg was applied until TcpO2 reached a plateau state; values were measured before, during, and after the modified NPWT. The Wilcoxon' and Mann-Whitney U tests were used to compare differences between these measurements. RESULTS TcpO2 levels decreased by 26% during the modified NPWT. Mean TcpO2 values before, during, and after turning off the therapy were 54.3 ± 15.3 mm Hg, 41.6 ± 16.3 mm Hg, and 53.3 ± 15.6 mm Hg (P < .05), respectively. CONCLUSION Applying NPWT without the pad of the connecting drainage tube significantly reduces the amount of tissue oxygenation loss beneath foam dressings on the skin of the foot dorsum in diabetic patients.
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Wang Z, Hasan R, Firwana B, Elraiyah T, Tsapas A, Prokop L, Mills JL, Murad MH. A systematic review and meta-analysis of tests to predict wound healing in diabetic foot. J Vasc Surg 2016; 63:29S-36S.e1-2. [DOI: 10.1016/j.jvs.2015.10.004] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 10/08/2015] [Indexed: 12/13/2022]
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Wang Y, Ye C, Su H, Wang J, Wang Y, Wang H, Zhao A, Huang N. Layer-by-layer self-assembled laminin/fucoidan films: towards better hemocompatibility and endothelialization. RSC Adv 2016. [DOI: 10.1039/c6ra02070d] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The laminin/fucoidan multilayer film is prepared on glass via layer-by-layer self-assembly technique and monitored the assembled process by QCM-D. This film can inhibit platelets adhesion and improve ECs and EPCs adhesion.
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Affiliation(s)
- Yan Wang
- Key Laboratory of Advanced Materials Technology of Ministry of Education
- Department of Materials Science and Engineering
- Southwest Jiaotong University
- Chengdu 610031
- China
| | - Changrong Ye
- Key Laboratory of Advanced Materials Technology of Ministry of Education
- Department of Materials Science and Engineering
- Southwest Jiaotong University
- Chengdu 610031
- China
| | - Hong Su
- Key Laboratory of Advanced Materials Technology of Ministry of Education
- Department of Materials Science and Engineering
- Southwest Jiaotong University
- Chengdu 610031
- China
| | - Juan Wang
- Key Laboratory of Advanced Materials Technology of Ministry of Education
- Department of Materials Science and Engineering
- Southwest Jiaotong University
- Chengdu 610031
- China
| | - Yanan Wang
- Key Laboratory of Advanced Materials Technology of Ministry of Education
- Department of Materials Science and Engineering
- Southwest Jiaotong University
- Chengdu 610031
- China
| | - Haohao Wang
- Key Laboratory of Advanced Materials Technology of Ministry of Education
- Department of Materials Science and Engineering
- Southwest Jiaotong University
- Chengdu 610031
- China
| | - Ansha Zhao
- Key Laboratory of Advanced Materials Technology of Ministry of Education
- Department of Materials Science and Engineering
- Southwest Jiaotong University
- Chengdu 610031
- China
| | - Nan Huang
- Key Laboratory of Advanced Materials Technology of Ministry of Education
- Department of Materials Science and Engineering
- Southwest Jiaotong University
- Chengdu 610031
- China
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Namgoong S, Jung S, Han SK, Jeong SH, Dhong ES, Kim WK. Risk factors for major amputation in hospitalised diabetic foot patients. Int Wound J 2015; 13 Suppl 1:13-9. [PMID: 26478562 DOI: 10.1111/iwj.12526] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 09/15/2015] [Accepted: 09/20/2015] [Indexed: 12/30/2022] Open
Abstract
Diabetic foot ulcers are the main cause of non-traumatic lower extremity amputation. The objective of this study was to evaluate the risk factors for major amputation in diabetic foot patients. Eight hundred and sixty diabetic patients were admitted to the diabetic wound centre of the Korea University Guro Hospital for foot ulcers between January 2010 and December 2013. Among them, 837 patients were successfully monitored until complete healing. Ulcers in 809 patients (96·7%) healed without major amputation and those in 28 patients (3·3%) healed with major amputation. Data of 88 potential risk factors including demographics, ulcer condition, vascularity, bioburden, neurology and serology were collected from patients in the two groups and compared. Among the 88 potential risk factors, statistically significant differences between the two groups were observed in 26 risk factors. In the univariate analysis, which was carried out for these 26 risk factors, statistically significant differences were observed in 22 risk factors. In a stepwise multiple logistic analysis, six of the 22 risk factors remained statistically significant. Multivariate-adjusted odds ratios were 11·673 for ulcers penetrating into the bone, 8·683 for dialysis, 6·740 for gastrointestinal (GI) disorders, 6·158 for hind foot ulcers, 0·641 for haemoglobin levels and 1·007 for fasting blood sugar levels. The risk factors for major amputation in diabetic foot patients were bony invasions, dialysis, GI disorders, hind foot locations, low levels of haemoglobin and elevated fasting blood sugar levels.
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Affiliation(s)
- Sik Namgoong
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Suyoung Jung
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Seung-Kyu Han
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Seong-Ho Jeong
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Eun-Sang Dhong
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Woo-Kyung Kim
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, South Korea
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Braun L, Kim PJ, Margolis D, Peters EJ, Lavery LA. What's new in the literature: an update of new research since the original WHS diabetic foot ulcer guidelines in 2006. Wound Repair Regen 2015; 22:594-604. [PMID: 25139424 DOI: 10.1111/wrr.12220] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 05/15/2014] [Indexed: 12/15/2022]
Abstract
The objective of the paper was to update the diabetic foot ulcer guidelines that were previously published in 2006. We performed a key word search using MEDLINE and Cochrane reviews for publication between January 2006 and January 2012. Articles that fit the inclusion criteria were reviewed and the previous guidelines were updated.
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Affiliation(s)
- Liza Braun
- Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, Florida
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Benitez E, Sumpio BJ, Chin J, Sumpio BE. Contemporary assessment of foot perfusion in patients with critical limb ischemia. Semin Vasc Surg 2014; 27:3-15. [PMID: 25812754 DOI: 10.1053/j.semvascsurg.2014.12.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Significant progress in limb salvage for patients with peripheral arterial disease and critical limb ischemia has occurred in the past 2 decades. Improved patient outcomes have resulted from increased knowledge and understanding of the disease processes, as well as efforts to improve revascularization techniques and enhance patient care after open and endovascular procedures. An imaging modality that is noninvasive, fast, and safe would be a useful tool for clinicians in assessing lower-extremity perfusion when planning interventions. Among the current and emerging regional perfusion imaging modalities are transcutaneous oxygen monitoring, hyperspectral imaging, indocyanine green dye-based fluorescent angiography, nuclear diagnostic imaging, and laser Doppler. These tests endeavor to delineate regional foot perfusion to guide directed revascularization therapy in patients with critical limb ischemia and foot ulceration.
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Affiliation(s)
- Erik Benitez
- Department of Vascular Surgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510
| | - Brandon J Sumpio
- Department of Vascular Surgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510
| | - Jason Chin
- Department of Vascular Surgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510
| | - Bauer E Sumpio
- Department of Vascular Surgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510.
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Abstract
In covering wounds, efforts should include utilization of the safest and least invasive methods with goals of achieving optimal functional and cosmetic outcome. The recent development of advanced wound healing technology has triggered the use of cells to improve wound healing conditions. The purpose of this review is to provide information on clinically available cell-based treatment options for healing of acute and chronic wounds. Compared with a variety of conventional methods, such as skin grafts and local flaps, the cell therapy technique is simple, less time-consuming, and reduces the surgical burden for patients in the repair of acute wounds. Cell therapy has also been developed for chronic wound healing. By transplanting cells with an excellent wound healing capacity profile to chronic wounds, in which wound healing cannot be achieved successfully, attempts are made to convert the wound bed into the environment where maximum wound healing can be achieved. Fibroblasts, keratinocytes, adipose-derived stromal vascular fraction cells, bone marrow stem cells, and platelets have been used for wound healing in clinical practice. Some formulations are commercially available. To establish the cell therapy as a standard treatment, however, further research is needed.
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Affiliation(s)
- Hi-Jin You
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, Korea
| | - Seung-Kyu Han
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, Korea
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New Treatments for Infrapopliteal Disease: Devices, Techniques, and Outcomes So Far. Cardiovasc Intervent Radiol 2012; 35:715-24. [DOI: 10.1007/s00270-012-0412-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 04/20/2012] [Indexed: 11/25/2022]
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