Clinical comprehensive treatment protocol for managing diabetic foot ulcers: A retrospective cohort study.

BACKGROUND: Diabetic foot ulcers (DFUs) are a common complication of diabetes, often leading to severe infections, amputations, and reduced quality of life. The current standard treatment protocols for DFUs have limitations in promoting efficient wound healing and preventing complications. A comprehensive treatment approach targeting multiple aspects of wound care may offer improved outcomes for patients with DFUs. The hypothesis of this study is that a comprehensive treatment protocol for DFUs will result in faster wound healing, reduced amputation rates, and improved overall patient outcomes compared to standard treatment protocols. AIM: To compare the efficacy and safety of a comprehensive treatment protocol for DFUs with those of the standard treatment protocol. METHODS: This retrospective study included 62 patients with DFUs, enrolled between January 2022 and January 2024, randomly assigned to the experimental (n = 32) or control (n = 30) group. The experimental group received a comprehensive treatment comprising blood circulation improvement, debridement, vacuum sealing drainage, recombinant human epidermal growth factor and anti-inflammatory dressing, and skin grafting. The control group received standard treatment, which included wound cleaning and dressing, antibiotics administration, and surgical debridement or amputation, if necessary. Time taken to reduce the white blood cell count, number of dressing changes, wound healing rate and time, and amputation rate were assessed. RESULTS: The experimental group exhibited significantly better outcomes than those of the control group in terms of the wound healing rate, wound healing time, and amputation rate. Additionally, the comprehensive treatment protocol was safe and well tolerated by the patients. CONCLUSION: Comprehensive treatment for DFUs is more effective than standard treatment, promoting granulation tissue growth, shortening hospitalization time, reducing pain and amputation rate, improving wound healing, and enhancing quality of life.

The efficacy and safety of non-surgical treatment of diabetic foot wound infections and ulcers: A systemic review and meta-analysis.

This meta-analysis evaluates the efficacy and safety of non-surgical treatments for diabetic foot ulcers and infections. After a rigorous literature review, seven studies were selected for detailed analysis. The findings demonstrate that non-surgical treatments significantly reduce wound infection rates (standardized mean difference [SMD] = -15.15, 95% confidence interval [CI]: [-19.05, -11.25], p < 0.01) compared to surgical methods. Ulcer healing rates were found to be comparable between non-surgical and surgical approaches (SMD = 0.07, 95% CI: [-0.38, 0.51], p = 0.15). Importantly, the rate of amputations within 6 months post-treatment was significantly lower in the non-surgical group (risk ratio [RR] = 0.19, 95% CI: [0.09, 0.41], p < 0.01). Additionally, a lower mortality rate was observed in patients treated non-surgically (RR = 0.28, 95% CI: [0.13, 0.59], p < 0.01). These results affirm the effectiveness and safety of non-surgical interventions in managing diabetic foot ulcers, suggesting that they should be considered a viable option in diabetic foot care.

Sodium-Glucose Cotransporter 2 Inhibitors Reduce the Risk of Hospitalization for Heart Failure and Amputation Rate Compared With Incretin-Based Therapy in Patients With Diabetic Foot Disease: A Nationwide Population-Based Study.

OBJECTIVE: Major adverse cardiovascular event (MACE) outcomes associated with sodium-glucose cotransporter 2 inhibitor (SGLT2i) and glucagon-like peptide-1 receptor agonist (GLP-1 RA) therapies remain unclear in patients with type 2 diabetes and newly diagnosed diabetic foot complications (DFCs). This study examined the impact of SGLT2i and GLP-1 RA use on the rates of MACEs and amputations in patients with type 2 diabetes and without cardiovascular disease. METHODS: Data from the Taiwan National Health Insurance Research Database (2004-2017) were analyzed, focusing on patients with type 2 diabetes without previous MACE and newly diagnosed DFCs. The primary outcome was the first MACE occurrence, and the secondary outcomes included MACE components, all-cause mortality, and lower extremity amputation (LEA) rates. RESULTS: SGLT2i users showed a significant decrease in the MACE (hazard ratio [HR], 0.64; 95% confidence interval [CI], 0.46-0.88) and hospitalization for heart failure (HR, 0.54; 95% CI, 0.35-0.83) rates compared with dipeptidyl peptidase-4 inhibitor users. The amputation rates were also lower in SGLT2i users without LEA at the first DFC diagnosis (HR, 0.28; 95% CI, 0.10-0.75) and did not increase in those with a history of peripheral artery disease or LEA. No significant differences were observed between dipeptidyl peptidase-4 inhibitor and GLP-1 RA users in terms of the primary or secondary outcomes. CONCLUSION: In patients with type 2 diabetes initially diagnosed with DFC, SGLT2i are effective in significantly reducing the hospitalization for heart failure and MACE rates. SGLT2i lower the amputation rates, especially in patients who have not previously had a LEA, than the dipeptidyl peptidase-4 inhibitor therapy.

[Topicality of the fundamental and determining importance of chronic critical ischemia of the extremities and its restorative treatment using crural/pedal bypasses in Germany and in Saxony-Anhalt]. / Aktualität der grundlegenden und determinierenden Bedeutung der chronisch-kritischen Extremitätenischämie sowie ihrer sich reetablierenden Behandlung mittels kruraler/pedaler Bypässe in Deutschland und in Sachsen-Anhalt.

INTRODUCTION: Currently, there is an increase in severe stages of peripheral arterial occlusive disease (PAOD) with critical ischemia. This seems to correspond to the general demographic change as well as a consequence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic of the last 3 years. The now established and accepted interventional/endovascular approach for severe lower leg PAOD in experienced hands is still considered the first-line treatment but from the authors' perspective crural/pedal venous bypass is experiencing a renaissance. MATERIAL AND METHODS: Compact narrative review of the current state of crural/pedal bypass surgery in Germany and Saxony-Anhalt (SA) combined with selective references from the current scientific medical literature and own clinical experiences. RESULTS: The current statistics of case-related diagnosis-related groups (DRG) data show that, especially with the occurrence of the corona pandemic, a decrease in inpatient case numbers of patients with PAOD stage IIB can be observed nationwide and also in SA. The severe PAOD stages have remained approximately the same in case numbers but increased in SA. The risk stratification based on the wound, ischemia and foot infection (WIFI) classification offers the possibility to be able to make statements about the risk of amputation, benefits and type of revascularization measures. The length of the occlusion, occlusion site of the affected vessels and degree of calcification are taken into account in the global limb anatomic staging system (GLASS) to assess the prognosis. The evaluation of the case-based hospital statistics from 2015 to 2020 showed a constant use of femorocrural/femoropedal bypass surgery in Germany as well as a slight increase in reconstruction using femorocrural bypasses in SA, which seems to correlate with the tendency for an increase in the number of cases of severe PAOD. Parameter-based objectification of the severity of critical limb ischemia should be included in the indications for placement of a crural/pedal bypass. The WIFI classification and GLASS are suitable for this purpose as a relative prognosis of success is also possible. The treatment of critical limb ischemia by crural/pedal bypass surgery continues to find a constant application in Germany and SA.

Study Protocol of a Prospective Multicenter Observational Study Evaluating Acute Lower Limb Ischemia.

INTRODUCTION: Acute lower limb ischemia (ALI) is a limb- and potentially life-threatening condition which requires urgent evaluation and treatment. Contemporary data on optimal therapy and prognosis of ALI are lacking, while surgical, hybrid, and foremost endovascular techniques have rapidly evolved over the past decades. Available clinical guidelines are not based on high-level evidence and do not fully reflect day-do-day practice. Contemporary data on etiology, procedural strategies as well as patient outcomes in ALI are urgently needed to improve care and prevent limb loss. The current study was initiated by the European Vascular Research Collaborative (EVRC), established by young European vascular specialists, and aims to provide insight into contemporary treatment strategies in ALI and its clinical results within Europe. In this manuscript we report the rationale and a detailed study protocol. MATERIAL AND METHODS: The proposed study is a prospective, international, multicenter, observational study on ALI (PROMOTE-ALI) (ClinicalTrials.gov - NCT05138679). Patients with ALI (Rutherford classification grade I -III) of one or both lower extremities will be included in the study. The primary endpoint of the study is amputation-free survival (AFS) at 30 d. Secondary endpoints are freedom from target limb reintervention, freedom from complications, clinical outcome of the index leg, and limb salvage and survival at 30 and 90 d after diagnosis of ALI. CONCLUSIONS: ALI remains a challenging condition and due to the heterogeneous etiology, clinical presentation and treatment strategies, a large multicenter study on this topic is needed to gain contemporary data on clinical outcomes and prognosis, especially for modern endovascular techniques. PROMOTE-ALI is expected to provide these data and set a benchmark for future randomized controlled trials (RCTs).

Amputation rate of diabetic foot ulcer and associated factors in diabetes mellitus patients admitted to Nekemte referral hospital, western Ethiopia: prospective observational study.

BACKGROUND: Diabetes foot ulcer is a devastating and much-feared complication of diabetes. Diabetes foot ulcerations which developed gangrene can take weeks or months to heal and can sometimes not heal at all so that amputation for non-traumatic causes is a frequent outcome in the diabetic foot. Despite this, there is no finding on predictors of the amputation rate of diabetes foot ulcers in Ethiopia. Hence this study was aimed to identify factors associated with the amputation rate of diabetes foot ulcer patients in Nekemte referral hospital. PATIENTS AND METHODS: A prospective observational study was conducted among adult diabetes foot ulcer patients admitted to Nekemte referral hospital from March 15 to June 15, 2018. A pus swab was obtained from the ulcers before any ulcer cleaning to conduct gram staining. The primary outcome was the amputation rate. Cox regression analysis was used to estimate the hazard ratios and time from study entry to healing was evaluated as censored event times by Kaplan-Meier curves. RESULT: Over the study period, 115 diabetes foot ulcer patients were admitted to the NRH; of these patients, 64(55.65%) were males while the mean age of participants was 44.4 ± 14.7. A total of 34(29.57%) of the diabetes foot ulcer were overweight and 16(13.91%) were obese while the mean ± standard deviation of body mass index (BMI) was 24.94 ± 3.69 kg/m2 and a total of 56(48.69%) diabetic foot ulcer had a diabetic complication. Of patients with diabetic foot ulcer, 35(30.43%) were undergone lower extremity amputations (LEA). Patients who were prescribed with inappropriate antibiotics were unlikely to heal. A total of 18(46.15%) of the patients who were taken inappropriate antibiotics were healed whereas 21(53.85%) were not healed (P = 0.017). Besides, the higher the Wagner grade, the worse the outcome of healing. A total of 19(21.84%) and 16(57.14%) of patients with grade < 4 and grade ≥ 4, respectively, did not heal (P = 0.005). CONCLUSION: The amputation rate of diabetes foot ulcers was rapid for patients prescribed inappropriate antibiotics and higher grades of the foot ulcer. Therefore, the presence of clinical pharmacists plays a pivotal role to promote the appropriate use of antibiotics and besides the daily care, special attention should be given for patients having an advanced grade of diabetes foot ulcer.

Transcutaneous oxygen pressure (TcPO2) and ulcer outcome in diabetic patients: Is there any correlation?

BACKGROUND: Due to poor blood circulation, the prevalence of foot ulcer is extensively reported among diabetic patients. Diabetic neuropathy is the critical factor of diabetes that can affect the nerves. OBJECTIVE: To examine the outcomes and correlation between TcPO2 and ulcer outcomes among diabetic patients. MATERIAL AND METHODS: A prospective cohort design has been employed to compare and correlate TcPO2 group with ulcer outcomes. A total of 192 patients were enrolled, who underwent diagnosis for ulcer outcome. Descriptive analysis and Pearson Correlation were used for data analysis via SPSS version 20. RESULTS: The prevalence of minor amputation among diabetic patients in 25-40 mmHg 75 (85.22%) and >40 mmhG 73 (84.88%) group is reported for ulcer outcome. Mostly diabetic patients were healed with intact skin (male = 36, female = 73), and improved ulcer healing (male = 23, female = 43). Correlation between ulcer size (p = .016), ABI (p = .044), TBI (p = .000), Adiponectin (p = .009), HbA1c (p = .033), and S. creatinine (p = .025) was significant with TcpO2 group. CONCLUSIONS: The study concluded that there is a positive and significant correlation between TcPO2 group and ulcer outcome. There is a positive association between TcPO2 baseline and degree of ulcer healing with intact skin.

Impact of multidisciplinary foot care team on outcome of diabetic foot ulcer in term of lower extremity amputation at a tertiary care unit in Karachi, Pakistan.

To compare the outcomes of diabetic foot ulcers (DFU) in terms of healing and lower extremity amputation (LEA) rate before and after training of multidisciplinary foot care team (MDFCT). Subjects were categorised into two groups; Group-A cases seen between 1997 and 2006 (before upgrading of training and services of MDFCT) and Group-B cases seen between 2007 and 2016 (after upgrading of training and services of MDFCT). Baseline demographic characteristics, biochemical results, and outcomes of DFU in terms of healing or amputation were analysed by using statistical package social science (SPSS) version 20. Total 7994 DFU cases seen, 888 in group A and 7106 in group B. Mean age of patients was 53.80 ± 10.40 years and mean haemoglobin (HbA1c) was 10.12 ± 2.44. Overall, decreasing trends of amputations were observed from baseline 27.5% to 3.92% during the period of 20 years. In group A, 479 (78.8%) subjects healed completely compared with 3806 (89.1%) in group B. Significant reduction in toe amputations ([13.81%] vs [8.11%]) and below knee amputations [(5.26%) vs (1.82%)] were seen. Similarly, rates of above knee amputation ([1.80%] vs [0.35%] P-value 0.008) in two groups was also significant. Significant improvement was observed in outcomes of DFU in terms of amputation through multidisciplinary team approach.

Decreasing rates of major lower-extremity amputation in people with diabetes but not in those without: a nationwide study in Belgium.

AIMS/HYPOTHESIS: The reduction of major lower-extremity amputations (LEAs) is one of the main goals in diabetes care. Our aim was to estimate annual LEA rates in individuals with and without diabetes in Belgium, and corresponding time trends. METHODS: Data for 2009-2013 were provided by the Belgian national health insurance funds, covering more than 99% of the Belgian population (about 11 million people). We estimated the age-sex standardised annual amputation rate (first per year) in the populations with and without diabetes for major and minor LEAs, and the corresponding relative risks. To test for time trends, Poisson regression models were fitted. RESULTS: A total of 5438 individuals (52.1% with diabetes) underwent a major LEA, 2884 people with above- and 3070 with below-the-knee major amputations. A significant decline in the major amputation rate was observed in people with diabetes (2009: 42.3; 2013: 29.9 per 100,000 person-years, 8% annual reduction, p < 0.001), which was particularly evident for major amputations above the knee. The annual major amputation rate remained stable in individuals without diabetes (2009: 6.1 per 100,000 person-years; 2013: 6.0 per 100,000 person-years, p = 0.324) and thus the relative risk reduced from 6.9 to 5.0 (p < 0.001). A significant but weaker decrease was observed for minor amputation in individuals with and without diabetes (5% and 3% annual reduction, respectively, p < 0.001). CONCLUSIONS/INTERPRETATION: In this nationwide study, the risk of undergoing a major LEA in Belgium gradually declined for individuals with diabetes between 2009 and 2013. However, continued efforts should be made to further reduce the number of unnecessary amputations.

Lower-extremity amputations in people with and without diabetes in Germany, 2008-2012 - an analysis of more than 30 million inhabitants.

BACKGROUND AND PURPOSE: Lower-extremity amputations (LEAs) in people with diabetes are associated with reduced quality of life and increased health care costs. Detailed knowledge on amputation rates (ARs) is of utmost importance for future health care and economics strategies. We conducted the present cohort study in order to estimate the incidences of LEA as well as relative and attributable risk due to diabetes and to investigate time trends for the period 2008-2012. METHODS: On the basis of the administrative data from three large branches of German statutory health insurers, covering ~34 million insured people nationwide (about 40% of the German population), we estimated age-sex-standardized AR (first amputation per year) in the populations with and without diabetes for any, major, and minor LEAs. Time trends were analyzed using Poisson regression. RESULTS: A total of 108,208 individuals (diabetes: 67.3%; mean age 72.6 years) had at least one amputation. Among people with diabetes, we observed a significant reduction in major and minor ARs during 2008-2012 from 81.2 (95% CI 77.5-84.9) to 58.4 (55.0-61.7), and from 206.1 (197.3-214.8) to 177.0 (169.7-184.4) per 100,000 person-years, respectively. Among people without diabetes, the major AR decreased significantly from 14.3 (13.9-14.8) to 11.6 ([11.2-12.0], 12.0), whereas the minor AR increased from 15.8 (15.3-16.3) to 17.0 (16.5-17.5) per 100,000 person-years. The relative risk (RR) comparing the diabetic with the nondiabetic populations decreased significantly for both major and minor LEAs (4% and 5% annual reduction, respectively). CONCLUSION: In this large nationwide population, we still found higher major and minor ARs among people with diabetes compared with those without diabetes. However, AR and RR of major and minor LEAs in the diabetic compared with the nondiabetic population decreased significantly during the study period, confirming a positive trend that has been observed in smaller and regional studies in recent years.

[Operative treatment of diabetics with vascular complications : Secondary data analysis of diagnosis-related groups statistics from 2005 to 2014 in Germany]. / Operative Versorgung von Diabetikern mit vaskulären Komplikationen : Sekundärdatenanalyse der DRG-Statistik von 2005 bis 2014 in Deutschland.

BACKGROUND: In Germany approximately 40,000 amputations per year are performed on patients with diabetes mellitus, often with accompanying vascular complications. OBJECTIVE: The aim of this study was to present the various degrees of severity of the vascular complications and the temporal changes of the treatment options in diabetics with vascular complications in Germany. MATERIAL AND METHODS: The microdata of the diagnosis-related groups (DRG) statistics of the Federal Statistical Office were analyzed over the period from 2005 to 2014. All cases were included in which the main or secondary diagnosis of diabetes mellitus with concurrent vascular complications (diabetic angiopathy and peripheral arterial disease) was encrypted. RESULTS: The median age of the 1,811,422 cases was 73 years and 62% were male. While the total number of amputations remained stable over time, there was a 41% reduction in knee-preserving and a 31% reduction in non-knee preserving major amputations with an 18% increase in minor amputations. Revascularization increased by 33% from 36 procedures in 2005 to 48 procedures per 100,000 inhabitants. The increase in revascularization was evident in the area of endovascular therapy alone where there was an increase of 78%. CONCLUSION: Due to the significant increase in endovascular revascularization measures, there was a significant increase in the proportion of diabetes patients with vascular pathologies in whom revascularization was carried out. As a result, improved limb preservation was achieved despite equally high amputation rates due to increasing minor amputation rates.

Effectiveness of Platelet-Rich Plasma to Enhance Healing of Diabetic Foot Ulcers in Patients With Concomitant Peripheral Arterial Disease and Critical Limb Ischemia.

We sought to investigate the effect of autologous platelet-rich plasma (PRP) on the healing rate of diabetic foot ulcers in patients with diabetes and concomitant peripheral arterial disease (PAD). Diabetic patients with foot ulceration presenting with PAD who were treated with local growth factors in a single center, during a 24-month period from May 2009 to April 2011, were retrospectively reviewed. Based on the severity of PAD, subjects were divided into groups A (Fontaine classification stages I, IIa, and IIb) and B (Fontaine classification stages III and IV), with those included in the latter being considered to suffer from critical limb ischemia (CLI). End points of the analysis were clinical improvement, limb salvage, and amputation rate. Outcome was compared between groups A and B. Overall, 72 patients were evaluated, 30 with CLI. Ulcer area reduction >50% was observed in 58/72 patients while reduction >90% was achieved in 52/72 patients. There were 14 (19%) major and minor amputations, whereas the limb salvage rate was 89%. This variable was significantly different between groups A and B (100% vs. 73%, P < .001), as is rate of reduction in ulcer area >90% (83% vs. 56%, P = .02). Reduction of ulcer area >50% was observed in the majority of patients in both groups (group A 86% vs. group B 73%, P = .23). In conclusion, PRP could serve as a useful adjunct during management of diabetic foot ulcers even in diabetic patients with unreconstructable arterial disease.

The Amputation Rate and Associated Risk Factors within 1 Year after the Diagnosis of Diabetic Foot Ulcer / 대한족부족관절학회지

PURPOSE: This study investigates the amputation rate within 1 year after the diagnosis of diabetic foot ulcer and its associated risk factors. MATERIALS AND METHODS: This study enrolled 60 patients with diabetic foot ulcer. The mean and standard deviation age was 64.4±12.8 years (range, 32~89 years); the mean and standard deviation prevalence period for diabetes mellitus was 21.0±7.5 years (range, 0.5~36 years). The amputation rate was evaluated by dividing the subjects into two groups—the major and minor amputation groups—within 1 year following the initial diagnosis of diabetic foot ulcer. Multivariate Cox proportional hazards regression analysis was used to identify the risk factors for amputation. RESULTS: The total amputation rate of 38.3% (n=23) was comprised of the amputation rate for the major amputation group (10.0%) and rate for the minor amputation group (23.8%). There was a high correlation between peripheral artery disease (toe brachial pressure index <0.7) and amputation (hazard ratio [HR] 5.81, confidence interval [CI] 2.09~16.1, p<0.01). Nephropathy was significantly correlated with the amputation rate (HR 3.53, CI 1.29~9.64, p=0.01). CONCLUSION: Clinicians who treat patients with diabetic foot complications must understand the fact that the amputation rate within 1 year is significant, and that the amputation rate of patients with peripheral artery disease or nephropathy is especially high.

Organization of wound healing services: The impact on lowering the diabetes foot amputation rate in a ten-year review and the importance of early debridement.

Diabetes foot ulceration (DFU) has a negative impact on the quality of life and leads to disabling morbidity, such as lower extremity amputation (LEA). This study aimed to evaluate the LEA trend before and after the establishment of the diabetes foot team, an on-time debridement, on-site screening, and multidisciplinary integration with standardizing care, in Chang Gung Memorial Hospital, Chia Yi, Taiwan, starting in 2010. The study retrospectively investigated the non-traumatic LEA rate in diabetes foot (identified by using ICD-9-Clinical Modification (CM) codes, 250.70-250.83) and whole patients with diabetes (ICD-9 250.XX) yearly from 2004 to 2013. Patients were enrolled from hospitalization, emergency room (ER), or outpatient departments, respectively. Despite the overall incidence of diabetes foot in patients with diabetes remaining constant, from 3.47% in 2004 to 3.58% in 2013, the incidence of hospitalized diabetes foot from diabetes reduced, from 2.83% in 2004 to 1.51% in 2013. Introduction of integrated wound care also led to a reduction of the average LEA rate in hospitalized patients, from 15.27% (2004-2009) to 6.08% (2010-2013) (P<0.001). A similar decline of the LEA rate was observed for patients from hospitalization, ER and outpatient departments together with an average LEA rate from 7.99% (2004-2009) down to 3.02% (2010-2013) (P<0.001). In trend analysis, the curve estimation revealed a quadratic trend in the relationship between LEA rate and time (R-square=0.869, P=0.001) for hospitalized patients as well as a linear (R-square=0.819, P<0.001) and quadratic (R-square=0.845, P=0.001) trend in the relationship between LEA rate and time for hospitalization, ER, and outpatient departments together. The LEA rate for DM patients declined from 372.72/100,000 in 2004 to 61.74/100,000 in 2013. With establishment of an organizing, standardized wound care protocol and integrated multidisciplinary team, we demonstrated a significant decline in the LEA rate both in diabetes foot patients and all patients with diabetes. These improvements can be attributed to introducing an efficient pathway with on-time debridement and early intervention of diabetes foot ulcers.

The delayed management of main arterial injuries in extremity trauma: Surgical challenges and outcomes.

OBJECTIVE: To analyse the early outcome of main arterial injuries with delayed treatment in extremity trauma and help vascular surgeons in determining proper treatment strategy for such injuries. METHODOLOGY: Forty-three patients with delayed treatment of main arterial injuries during May 2003 and January 2008 were reviewed retrospectively. RESULTS: In 43 patients, injuries were caused by blunt trauma in 26 cases and penetrating trauma in 17 cases. The maximum ischaemia time was 38 hours and the minimum was 13 hours. Eight patients underwent primary amputations and four patients underwent secondary amputation. There was no perioperative mortality, while wound infection occurred in five patients, followed by graft occlusion in four patients, arteriovenous fistulae in two patients and pseudoaneurysm in one patient. CONCLUSION: The delayed intervention in main arterial injuries is associated with higher risk of amputation, while the suitable surgical techniques may decrease the risk of limb loss. Viable limbs should be revascularized in otherwise stable patients even with long periods of ischaemia.

The Role of PCR Waveform by Plethysmography in Electric Burns

PURPOSE: A vast array of injuries result from high voltage electrical damage. The compartment syndrome of forearm prone to have high risk of major amputations, especially in arc burn. Early decompressing fasciotomy has been recommended for the prevention of limb amputations. There are controversies about the effect of fasciotomy. We tried to Pressure Cuff Recording (PCR) wave forms of Plethysmography for the monitoring early signs of vascular compromises in decision of early selective fasciotomy. We investigated the role of PCR wave forms to reduce major amputation rate. METHODS: We reviewed 875 burned limb of 520 electric current damage victims (fasciotomy or amputation were performed, PCR wave forms evaluated) during the last 14 years (from Jan. 1, 1996 to Jun. 30, 2009). We analysed the differences of amputation rates by the currency, input/output, burn types, effects of PGE1 adminstration, fasciotomy time, converting of PCR wave forms. RESULTS: There was no major amputations among low tension victims (minor amputation rate; 0.3%). The minor and major amputation rate were 19.5% and 27.0 in high tension injury. The flash burns rarely made the amputations, but arc burns had 12.1% of minor and 41.2% of major amputations. The direct contact burns had 24.7% of minor and 21.3% of major amputations. Most of the victims had their hand as input and foot as output. The minor and major amputation rate were 26.2% and 10.9% in none-fasciotomy, 8.8% and 48.0% in within 8 hours, 10.0% and 52.9% in 8-24 hours, 9.3% and 63.0% in over 24 hours fasciotomy group. Final normal type (N type) of PCR result had only 3.1% of minor amputations and 3.1% of major amputations. Final obstructive type (O type) had 37.6% of minor amputations, 60.8% of major amputations. Initial stenotic type (S type) of converted to N type had 6.6% amputation, but to O type had 98.7% amputation. CONCLUSION: The early selective fasciotomy are essential to reduce major amputations in high tension injuries, especially in arc burns. The PCR wave form converting to obstructive type could be helpful to predict the possible amputation. The PCR wave form is a good tool to monitor early signs of vascular compromise around fasciotomy. It plays as the index of immediate fasciotomy decision.

Clinical study on Tangshukang liquid on diabetic foot amputation rate / 国际中医中药杂志

Objective To investigate the effects of Tangshukang liquid on the rate of diabetic foot amputation.Methods 80 patients with diabetic foot were divided into two groups (40 ones in each group) by single-blind method. On the basis of conventional treatment of controlling blood glucose, preventing infection, improving microcirculation and carrying out partial debridement for both groups, the treatment group was applied Tangshukang liquid (homemade) externally, and the control group was applied gauze of mixture liquid (gentamiycin+654-2+insulin) externally. Both groups were treated with 4 therapeutic courses (30 days equal one therapeutic course). Therapeutic effects were observed after the treatment. Results Amputation rate of diabetic foot was significantly reduced in the treatment group, especially the patients with wet gangrene.Conclusion Tangshukang Liquid can significantly reduce the amputation rate of diabetic foot and has good effect on diabetic foot with wet gangrene.

Analysis of epidemiology and clinical characteristics of 208 diabetic foot patients / 中国糖尿病杂志

Corresponding author:PAN Cong-qing,E-mail:cq.pan@163.com Objective The prevalence of diabetic foot was 2.3% for out-patients and 8.6% (208/2428) for in-patients with amputation rate of 17.3% in our hospital from May 1997 to Dec 2000, more often seen on right than left extremity and in patients over 50 years old than in the younger.