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Xing DL, Zhu YQ, Sun W, Fang X, Zhuang ZW, Qiu L, Chen XL. Use of carbon dioxide fractional laser in the management of lower limb ischemia in patients with diabetes: a case report : CO 2 fractional laser in the treatment of diabetic foot. J Int Med Res 2024; 52:3000605241253759. [PMID: 38853406 PMCID: PMC11163927 DOI: 10.1177/03000605241253759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 04/23/2024] [Indexed: 06/11/2024] Open
Abstract
Treatment of lower limb ischemia in patients with diabetes is challenging because of the location of the ulcers and the complexity of their pathogenesis. Carbon dioxide fractional laser (CO2FL) therapy in conjunction with tibial periosteum distraction could become a substitute for conventional methods. We herein describe a patient diagnosed with ischemic diabetic foot with a complex ulcer in the upper third of the tibia. Laser irradiation (Deep FX mode with 30 mJ of energy and 10% density) was applied to the entire region of skin below the knee after surface anesthesia, and this treatment was performed twice a week until the ulcer healed. Computed tomography angiography showed successful establishment of a blood supply to the back of the right foot after treatment. Skin grafting was successfully performed, with only a few wounds remaining on the foot 8 months after treatment. The pain score was significantly decreased at the last follow-up. No complications occurred. This case report provides guidance for the performance of CO2FL, a fast, easy, accurate treatment in patients with diabetes. CO2FL can target lower limb arterial occlusive disease accompanied by refractory ulcers, addressing the underlying vascular occlusion and dysfunction as well as promoting microcirculation and wound healing.
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Affiliation(s)
- Dan-Lei Xing
- Department of Burns, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yuan-Qiang Zhu
- Department of Burns, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Wei Sun
- Department of Radiology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xiao Fang
- Department of Burns, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Zhi-Wei Zhuang
- Department of Burns, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Le Qiu
- Department of Burns, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xu-Lin Chen
- Department of Burns, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
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Wang K, Wang Y, Shi W, Shen K, Tao K, Ling R, Huang Y, Fu X, Hu D. Diagnosis and treatment of diabetic foot ulcer complicated with lower extremity vasculopathy: Consensus recommendation from the Chinese Medical Association (CMA), Chinese Medical Doctor Association (CMDA). Diabetes Metab Res Rev 2024; 40:e3776. [PMID: 38402455 DOI: 10.1002/dmrr.3776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 11/29/2023] [Accepted: 12/20/2023] [Indexed: 02/26/2024]
Abstract
Diabetic foot ulcer complicated with lower extremity vasculopathy is highly prevalent, slow healing and have a poor prognosis. The final progression leads to amputation, or may even be life-threatening, seriously affecting patients' quality of life. The treatment of lower extremity vasculopathy is the focus of clinical practice and is vital to improving the healing process of diabetic foot ulcers. Recently, a number of clinical trials on diabetic foot ulcers with lower extremity vasculopathy have been reported. A joint group of Chinese Medical Association (CMA) and Chinese Medical Doctor Association (CMDA) expert representatives reviewed and reached a consensus on the guidelines for the clinical diagnosis and treatment of this kind of disease. These guidelines are based on evidence from the literature and cover the pathogenesis of diabetic foot ulcers complicated with lower extremity vasculopathy and the application of new treatment approaches. These guidelines have been put forward to guide practitioners on the best approaches for screening, diagnosing and treating diabetic foot ulcers with lower extremity vasculopathy, with the aim of providing optimal, evidence-based management for medical personnel working with diabetic foot wound repair and treatment.
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Affiliation(s)
- Kejia Wang
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Yunchuan Wang
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Wenlong Shi
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Kuo Shen
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Ke Tao
- Department of Wound Repair, Wound Repair and Regenerative Medicine Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Rui Ling
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Yuesheng Huang
- Department of Wound Repair, Institute of Wound Repair and Regeneration Medicine, Southern University of Science and Technology Hospital, Southern University of Science and Technology School of Medicine, Shenzhen, China
| | - Xiaobing Fu
- Research Center for Tissue Repair and Regeneration Affiliated to the Medical Innovation Research Department and 4th Medical Center, PLA General Hospital and PLA Medical College, Beijing, China
| | - Dahai Hu
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
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Berchiolli R, Bertagna G, Adami D, Piaggesi A, Iacopi E, Giangreco F, Torri L, Troisi N. Peripheral Interventional Strategy Assessment (PISA) for Diabetic Foot Ulcer Revascularization: Preliminary Outcomes of a Multidisciplinary Pilot Study. Diagnostics (Basel) 2023; 13:2879. [PMID: 37761246 PMCID: PMC10528535 DOI: 10.3390/diagnostics13182879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/28/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Digital subtraction angiography (DSA) still represents the gold standard for anatomical arterial mapping and revascularization decision-making in patients with chronic limb-threatening ischemia (CLTI), although DUS (Doppler Ultrasound) remains a primary non-invasive examination tool. The Global Vascular Guidelines established the importance of preoperative arterial mapping to guarantee an adequate in-line flow to the foot. The aim of this study was to evaluate the accuracy of DUS in guiding therapeutic vascular treatments on the basis of Global Vascular Guidelines without the need of a second-level examination. METHODS Between January 2022 and June 2022, all consecutive patients with CLTI to be revascularized underwent clinical examination and DUS without further diagnostic examinations. Primary outcomes assessed were technical success, and 30-day mortality. Secondary outcomes were 1-year amputation free survival, and time between evaluation and revascularization. RESULTS Sixty-eight patients with a mean age of 73.6 ± 8.5 years underwent lower limb revascularization. Technical success was 100%, and the 30-day mortality rate was 2.9%. Mean time between evaluation and revascularization was 29 ± 17 days. One-year amputation free survival was 97.1%. CONCLUSIONS DUS without further diagnostic examinations can accurately assess the status of the vascular tree and foot runoff, providing enough information about target vessels to guide revascularization strategies.
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Affiliation(s)
- Raffaella Berchiolli
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (R.B.); (G.B.); (D.A.); (L.T.)
| | - Giulia Bertagna
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (R.B.); (G.B.); (D.A.); (L.T.)
| | - Daniele Adami
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (R.B.); (G.B.); (D.A.); (L.T.)
| | - Alberto Piaggesi
- Diabetic Foot Section, Department of Medicine, University of Pisa, 56126 Pisa, Italy; (A.P.); (E.I.); (F.G.)
| | - Elisabetta Iacopi
- Diabetic Foot Section, Department of Medicine, University of Pisa, 56126 Pisa, Italy; (A.P.); (E.I.); (F.G.)
| | - Francesco Giangreco
- Diabetic Foot Section, Department of Medicine, University of Pisa, 56126 Pisa, Italy; (A.P.); (E.I.); (F.G.)
| | - Lorenzo Torri
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (R.B.); (G.B.); (D.A.); (L.T.)
| | - Nicola Troisi
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (R.B.); (G.B.); (D.A.); (L.T.)
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Zaottini F, Picasso R, Pistoia F, Perez MM, Bianco D, Simone R, Rossi G, Macciò M, Pansecchi M, Tovt L, Martinoli C. Ultrasound of the plantar foot: a guide for the assessment of plantar intrinsic muscles. J Ultrason 2023; 23:e151-e160. [PMID: 37732108 PMCID: PMC10508328 DOI: 10.15557/jou.2023.0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 05/29/2023] [Indexed: 09/22/2023] Open
Abstract
Plantar intrinsic muscles play a pivotal role in posture control and gait dynamics. They help maintain the longitudinal and transverse arches of the foot, and they regulate the degree and velocity of arch deformation during walking or running. Consequently, pathologies affecting the plantar intrinsic muscles (for instance, acquired and inherited neuropathies) lead to foot deformity, gait disorders, and painful syndromes. Intrinsic muscle malfunctioning is also associated with multifactorial overuse or degenerative conditions such as pes planus, hallux valgus, and plantar fasciitis. As the clinical examination of each intrinsic muscle is challenging, ultrasound is gaining a growing interest as an imaging tool to investigate the trophism of these muscular structures and the pattern of their alterations, and potentially to follow up on the effects of dedicated rehabilitation protocols. The ten plantar intrinsic muscles can be dived into three groups (medial, central and lateral) and four layers. Here, we propose a regional and landmark-based approach to the complex sonoanatomy of the plantar intrinsic muscles in order to facilitate the correct identification of each muscle from the superficial to the deepest layer. We also summarize the pathological ultrasound findings that can be encountered when scanning the plantar muscles, pointing out the patterns of alterations specific to certain conditions, such as plantar nerves mononeuropathies.
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Affiliation(s)
- Federico Zaottini
- Department of Radiology, IRCCS Policlinico San Martino, Genoa, Italy
| | - Riccardo Picasso
- Department of Radiology, IRCCS Policlinico San Martino, Genoa, Italy
| | - Federico Pistoia
- Department of Radiology, IRCCS Policlinico San Martino, Genoa, Italy
| | - Maribel Miguel Perez
- Unit of Human Anatomy and Embryology, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences (Bellvitge Campus), University of Barcelona, Barcelona, Spain
| | - Deborah Bianco
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Rinaldi Simone
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Gabriele Rossi
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Marta Macciò
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Michelle Pansecchi
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Luca Tovt
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Carlo Martinoli
- Department of Radiology, IRCCS Policlinico San Martino, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
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Cost-effectiveness of Diagnostic Tools to Establish the Presence of Peripheral Arterial Disease in People With Diabetes. Ann Surg 2023; 277:e184-e191. [PMID: 33630439 DOI: 10.1097/sla.0000000000004815] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of point-of-care duplex ultrasound (PAD-scan) and other bedside tests for the diagnosis of peripheral arterial disease (PAD) in people with diabetes. BACKGROUND PAD is a risk factor for cardiovascular disease, diabetic foot ulceration (DFU), and amputation in diabetic patients. Diagnosis enables optimization of therapies to manage these risks. PAD-scan can be performed by frontline staff and has been shown to be the most accurate bedside test. However, its cost-effectiveness has not been investigated. METHODS A Markov model was constructed to estimate the health outcomes and costs over 5 years of different testing strategies applied to a cohort of diabetic patients. Bedside tests investigated were PAD-scan, ankle-brachial pressure index, toe-brachial pressure index, audible and visual Doppler, transcutaneous pressure of oxygen, and pulse palpation. Health outcomes were incidence of new DFU, major cardiovascular events, amputation, death, and DFU healing rates. Sensitivity analyses were performed. RESULTS PAD-scan was the most cost-effective bedside test with an incremental cost-effectiveness ratio of £11,391/quality-adjusted life years. PADscan had the highest probability (78.7%) of having the greatest net benefit at a willingness to pay threshold of £20,000 per quality-adjusted life years. It reduced the number of amputations by 24% and the number of cardiovascular deaths by 10% over 5 years, compared to toe-brachial pressure index (next best alternative). PAD-scans superiority in incremental cost-effectiveness ratio occurred at a PAD prevalence threshold of 0.24. DISCUSSION PAD-scan is a cost-effective test for the detection of PAD in patients with diabetes.
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Impact of type 2 diabetes mellitus on hemodynamic and morphology of foot arteries: A duplex ultrasound evaluation. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2022. [DOI: 10.1016/j.jrras.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Kantilaras A, Widyatmoko A. Role of Doppler Ultrasound and Percutaneous Transluminal Angioplasty in Early Diagnosis and Management of Peripheral Artery Disease. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2021.7855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Peripheral arterial disease (PAD) denotes vascular disorder which peripheral artery’s obstruction or constriction is found. PAD with diabetic history is more susceptible to ischemic ulcer than PAD with no diabetic. The presence of Diabetes mellitus (DM) in PAD can speed up 4 times greater risk of developing Critical Limb Ischemia. In our hospital, difficulty performing extremity perfusion assessment is often found because those examinations are not available, so possibility of PAD can be missed. Therefore, optimalization use of Doppler Ultrasound (DUS) is important in our case.
AIM: The purpose of our case writing is to give information about substantial parameter of DUS in determine presence of PAD and define the role of percutaneous transluminal angioplasty (PTA) in PAD. The earlier PAD discovered, faster further treatment conducted, especially PTA.
CASE REPORT: A 65-year-old female patient with intermittent left calf pain for 7 months who went to internal medicine outpatient has reported. She has history of type 2 DM and significant hyperlipidemia. On physical examination, vital signs revealed normal value. Body mass index was 28 kg/m2. Resting ankle-brachial index (ABI) measurement was 1.14 and 1.12 at the right and left dorsalis pedis, respectively. DUS showed spectral narrow, reversal flow and no clear spectral window in superficial femoral artery. There are clear spectral window, spectral narrow, and reversal flow in poplitea artery. No clear spectral window, no spectral narrow, and no reversal flow in anterior tibia artery. Clear spectral window, reversal flow, and no spectral narrow are appear in posterior tibia artery. Arteriogram of left inferior extremity showed middle part partial stenosis of anterior tibia artery. Dilatation with standard balloon for 1 min was done. After that, no stenosis in same location and she wasn’t feel calf pain again.
CONCLUSION: Compared with two other parameters, reversal flow in DUS is most important parameter to establish presence of stenosis. PTA is adequate to give revascularization stenosis in PAD.
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Papanas N, Mani R, Rerkasem K. Ultrasound: The Magic Wand for Wound Healers. INT J LOW EXTR WOUND 2020; 19:291-292. [DOI: 10.1177/1534734620977227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Nikolaos Papanas
- Diabetes Centre-Diabetic Foot Clinic, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Raj Mani
- Founding Editor, International Journal of Lower Extremity Wounds
| | - Kittipan Rerkasem
- NCD Centre of Excellence, Research Institute of Health Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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