Application and Clinical Effectiveness of Antibiotic-Loaded Bone Cement to Promote Soft Tissue Granulation in the Treatment of Neuropathic Diabetic Foot Ulcers Complicated by Osteomyelitis: A Randomized Controlled Trial.

This study explored the clinical effectiveness of antibiotic-loaded bone cement on primary treatment of diabetic foot infection. This is a randomized controlled study, including thirty-six patients with diabetic foot ulcer complicated by osteomyelitis who had undergone treatment between May 2018 and December 2019. Patients were randomly divided into control group (group A) and study group (group B). Patients in the intervention group received antibiotic-loaded bone cement repair as primary treatment, while patients in the control group received conventional vacuum sealing draining treatment. Clinical endpoints were assessed and compared between the two groups, including wound healing time, wound bacterial conversion, NRS pain score, number of wound dressing changes, and average hospitalization time. All patients were followed up for a period of 12 months after discharge. Results show that compared with the control group, patients in the study group had significant difference in the number of patients for baseline pathogens eradication, short NRS pain score, hospital length of stay and cost, wound surface reduction, healing time, low rate of complications, and infection recurrence. Based on the findings, we conclude that antibiotic-loaded bone cement can be used for treatment of wound in patient with diabetic foot infection. It can help to control wound infections, shorten hospital length of stay, reduce medical cost, and relieve both doctors' and patients' burden. The application of antibiotic-loaded bone cement is suitable for diabetic wound with soft tissue infection or osteomyelitis.

Clinical Effectiveness of Dorsal Branch Skin Flap of Proper Palmar Digital Artery with Distal Pedicle in Repairing of Fingertip Soft Tissue Defect: A 1-Year Prospective Study in a Chinese Tertiary Referral Teaching Hospital.

Background: Digital island flap remains among the most useful types of providing soft-tissues coverage for defect on the fingertip accompanied with underlying structures exposure. Nevertheless, its trends of functional and aesthetic issues such as the limited length of advancement and the limited flap size are the essential disadvantages. The main objective of the study was to assess the clinical effectiveness of dorsal branch skin flap of proper palmar digital artery with distal pedicle in repairing of fingertip soft tissue defect accompanied with underlying structures exposure. Methods: This is a 1-year prospective study, in which 21 patients (24 fingers) with traumatic fingertip skin and soft tissue defects had undergone emergency repair with dorsal skin flap of proper palmar digital artery with distal pedicle. The starting point of the dorsal proper palmar digital artery which is at the connection of distal interphalangeal joint with the digital midline was selected as the rotation point of the surgical skin flap, with an incision area of 1.1 cm × 1.4 cm-2.7 cm × 2.0 cm, the pedicle of 0.8-1.7 cm and disposition of 90°-120° to cover the fingertip. Results: All flaps had completely healed postoperatively. In 2 cases, tension blisters of the flap and partial necrosis were observed, which survived after change in dressing and rational administration vasodilator medication. Patients were followed up to 6 months. Favorable appearance and function were restored, and satisfactory recovery of the sensory functions of the fingers had been achieved. The two-point discrimination of skin flap with anastomosis of nerve could reach 4.5-9.4 mm (mean, 6.80 mm). Conclusions: Repairing the fingertip skin and soft tissue defect of 2nd-5th finger via primary surgical repair with dorsal distal pedicle or proper palmar digital artery skin flap is a good technique. The high survival rate of the flap, the favorable flap's appearance, and the satisfactory recovery of the sensory functions of the fingers are among the advantages of this reconstructive technique.

Effectiveness of a Collaborative Nursing Care Model for the Treatment of Patients with Diabetic Foot Disease by Transverse Tibial Bone Transport Technique: A Pilot Study.

PURPOSE: Medical staff shortages remain a serious challenge, particularly to medical administrators. We aimed to analyze the effectiveness of a collaborative nursing care model in treatment of diabetic foot. DESIGN: A quasi-experimental pilot study. METHODS: Twenty-eight patients with diabetic foot treated by transverse tibial bone transport between January 2017 and March 2018 were randomized. The observational group received collaborative nursing care, while the control group received usual nursing care. Postoperative dorsal foot skin temperature, visual analog scale, self-rating anxiety scale (SAS) score, and other endpoints were assessed. FINDINGS: Postoperative dorsal foot skin temperature was significantly higher in the observation group than in the control group. Visual analog scale and SAS scores were significantly lower in the observational group than in the control group. CONCLUSIONS: The collaborative nursing care model enhanced collaboration between patient and health care providers, shortened hospital stay, and relieved postoperative pain and anxiety.

Comparative effectiveness study between negative pressure wound therapy and conventional wound dressing on perforator flap at the Chinese tertiary referral teaching hospital.

BACKGROUND: Perforator flap techniques with conventional wound dressing have being extensively used in the management of soft-tissue defects. However; the flap's survival rate is not always guaranteed and the wound healing time always long. The aim of this study was to investigate the clinical effectiveness use of a freshly transplanted perforator flap in conjunction with Vacuum-assisted closure (VAC) for better clinical outcomes. METHODS: A prospective, randomized, effectiveness study comparing the clinical outcomes of VAC versus traditional wrap and bandages for the treatment of open wounds that required hospital admission and operative debridement using perforator flaps, was carried out from March 1, 2014 to March 31, 2016 at Wuhan University Zhongnan Hospital. Fifty-one eligible patients were randomized into two groups; study group (perforator flaps covered by VAC) and control group (perforator flaps covered by traditional wrap and bandages). The measured clinical endpoints included the time of the first post-operative dressing change, pain visual analogical scale, perforator flap infection rate, 95% perforator flap healing time and percentage of survived perforator flap. RESULTS: There was no statistically significant difference in the demographic profiles in the two cohorts. There were statistically significant differences in the clinical endpoints in the two groups (p < 0.001; p < 0.05, Table 2). CONCLUSIONS: In summary, VAC combining with perforator flap technique, can diminish accumulated exudation of the transferring flap, protect against postoperative infection, prolong the interval between perforator flap relocation and first postoperative dressing change, decrease pain during removal of dressing, increase perforator flap survival rate, and shorten wound healing time, with a good aesthetic outcome, a good mobility and a satisfactory therapeutic result.