Relationship Between Caregiver Attendance at Wound Clinic Visits and Wound Healing in Patients With Diabetes: A Retrospective Multicenter Evaluation

2021 ◽  
Vol 67 (12) ◽  
pp. 16-24
Author(s):  
Carol Jessee
Keyword(s):  
North Carolina ◽  
Wound Healing ◽  
Standard Deviation ◽  
Lower Extremity ◽  
Lower Limb ◽  
Healing Rate ◽  
Lower Number ◽  
Descriptive Statistics ◽  
Patients With Diabetes ◽  
Clinic Visits

BACKGROUND: Lower extremity wounds in patients with diabetes are significant and burdensome. PURPOSE: To evaluate retrospectively the correlation between lower limb wound outcomes in patients with diabetes and the presence of a caregiver during clinic visits. METHODS: The study was conducted in 3 outpatient wound centers in North Carolina. Patients (N = 85) were categorized into 2 groups: those who were accompanied by a caregiver at 50% or more of their visits to the wound clinic (n = 30) and those accompanied by a caregiver at fewer than 50% of their visits (n = 55). Data were evaluated using descriptive statistics and 2 sample t-tests. RESULTS: Although significant findings between the 2 groups were seen in age, race, Visit Count, Weeks in Service, Accompanied Count, and percentage of visits accompanied, the strongest meaningful correlation was in the Accompanied group between Percent Accompanied and Visit Count. In this group, the number of accompanied visits was 7.47 (range [standard deviation], 1–23 [5.2]) and the percentage was 87% (range [standard deviation], 52–100 [15]). This was stastically significant and with a moderately negative correlation (P = .04; r = -0.38). CONCLUSION: Despite negative predictors of healing, those who were accompanied by a caregiver at 50% or more of their visits demonstrated a higher healing rate and a lower number of total visits than those who were accompanied by a caregiver at fewer than 50% of their visits.

scholarly journals Sarcoma of the Lower Limb: Reconstructive Surgeon's Perspective

2019 ◽  
Vol 52 (01) ◽  
pp. 055-061
Author(s):  
Zhixue Lim ◽  
Sophia A. Strike ◽  
Mark E. Puhaindran
Keyword(s):  
Overall Survival ◽  
Wound Healing ◽  
Lower Extremity ◽  
Functional Outcome ◽  
Lower Limb ◽  
Survival Benefit ◽  
Lower Extremities ◽  
Methodical Approach ◽  
Reconstructive Process

AbstractManagement of sarcomas in the lower extremities have evolved from amputations to limb-preserving surgeries with evidence to support that they have equal overall survival, albeit with better functional outcome. The challenge of reconstruction lies in providing a durable, functional, and aesthetically pleasing limb. However, limb-preserving intention should not delay interventions that provide a survival benefit such as chemotherapy and radiotherapy. The advent of radiotherapy and chemotherapy also has implications on wound healing and should be considered during the reconstructive process. This article reviews the methodical approach, reconstructive strategies, and considerations for the reconstructive surgeon with respect to the lower extremity after sarcoma excision.

scholarly journals Autologous Stem Cell Therapy for Chronic Lower Extremity Wounds: A Meta-Analysis of Randomized Controlled Trials

Cells ◽  
2021 ◽  
Vol 10 (12) ◽  
pp. 3307
Author(s):  
Kuan-Ju Chiang ◽  
Li-Cheng Chiu ◽  
Yi-No Kang ◽  
Chiehfeng Chen
Keyword(s):  
Wound Healing ◽  
Stem Cell ◽  
Cell Therapy ◽  
Lower Extremity ◽  
Randomized Controlled Trials ◽  
Stem Cell Therapy ◽  
Healing Rate ◽  
Complete Healing ◽  
Controlled Trials ◽  
Randomized Controlled

Lower extremity chronic wounds (LECWs) commonly occur in patients with diabetes mellitus (DM) and peripheral arterial disease (PAD). Autologous stem cell therapy (ASCT) has emerged as a promising alternative treatment for those who suffered from LECWs. The purpose of this study was to assess the effects of ASCT on LECWs. Two authors searched three core databases, and independently identified evidence according to predefined criteria. They also individually assessed the quality of the included randomized controlled trials (RCTs), and extracted data on complete healing rate, amputation rate, and outcomes regarding peripheral circulation. The extracted data were pooled using a random-effects model due to clinical heterogeneity among the included RCTs. A subgroup analysis was further performed according to etiology, source of stem cells, follow-up time, and cell markers. A total of 28 RCTs (n = 1096) were eligible for this study. The pooled results showed that patients receiving ASCT had significantly higher complete healing rates (risk ratio (RR) = 1.67, 95% confidence interval (CI) 1.28–2.19) as compared with those without ASCT. In the CD34+ subgroup, ASCT significantly led to a higher complete healing rate (RR = 2.70, 95% CI 1.50–4.86), but there was no significant difference in the CD34− subgroup. ASCT through intramuscular injection can significantly improve wound healing in patients with LECWs caused by either DM or critical limb ischemia. Lastly, CD34+ is an important cell marker for potential wound healing. However, more extensive scale and well-designed studies are necessary to explore the details of ASCT and chronic wound healing.

scholarly journals Predictors for reoperation after lower limb amputation in patients with peripheral arterial disease

VASA ◽  
2019 ◽  
Vol 48 (5) ◽  
pp. 419-424 ◽  
Author(s):  
Martin C. Berli ◽  
Florian Wanivenhaus ◽  
Method Kabelitz ◽  
Tobias Götschi ◽  
Thomas Böni ◽  
...  
Keyword(s):  
Wound Healing ◽  
Peripheral Arterial Disease ◽  
Lower Extremity ◽  
Balloon Angioplasty ◽  
Revision Surgery ◽  
Lower Limb ◽  
Arterial Disease ◽  
Limb Amputation ◽  
Amputation Level ◽  
Peripheral Arterial

Summary. Background: Major amputations in patients with peripheral arterial disease (PAD) carry a high risk for complications, including revision of the amputation, sometimes to a higher level. Determining a safe level for amputation with good wound healing potential depends largely on vascular measurements. This study evaluated potential predictive factors for revision of major lower extremity amputations in patients with PAD. Patients and methods: A retrospective chart review of all major lower extremity amputations at our institution was conducted. Amputations due to trauma or tumor and below-ankle amputations were excluded. Patient demographics, level/type of amputation, level/time of revision, comorbidities and risk factors were extracted. Results: 180 patients with PAD, mean age 66.48 (range: 31–93) years, 125 (69.4%) male were included. Most (154/180, 86.6%) underwent below-knee amputation. 71 (39.4%) patients had coronary arterial disease, 104 (57.8%) had diabetes. More than half of patients, (93/138; 51.7%) had undergone previous balloon angioplasty. 44 (30%) patients required revision surgery: 42/180 (23.3%) were revised at the same level, and in 12/180 (6.7%) a more proximal amputation was necessary. PAD stage was not associated with the level of reamputation (p = 0.4369). Significantly more patients who had previous balloon angioplasty required revision surgery (66.7% versus 45.2%, p = 0.009). 67 (37.2%) patients underwent preoperative TcPO2 measurement: 40/67 (59.7%) had TcPO2 ≥ 40 mmHg; 4/67 (6%) had TcPO2 < 10 mmHG. Three patients with TcPO2 ≥ 40 mmHg, one with 30 mmHg ≤ TcPO2 ≤ 40 mmHg and one with 10 mmHg ≤ TcPO2 ≤ 20 mmHg required re-amputation to a more proximal level. Conclusions: TcPO2 measurements are useful for determining level of lower limb amputation and predicting wound healing problems when an amputation level with TcPO2 < 40 mmHg is chosen. In transtibial amputations, TcPO2 ≥ 40 mmHg does not safely predict wound healing.

Preventive Foot-Care Practices Among Adults with Diabetes in North Carolina, 1997 to 2001

2004 ◽  
Vol 94 (5) ◽  
pp. 483-491 ◽  
Author(s):  
John C. White ◽  
Ronny A. Bell ◽  
Carl D. Langefeld ◽  
Sharon A. Jackson
Keyword(s):  
North Carolina ◽  
Lower Extremity ◽  
Behavioral Risk ◽  
Foot Care ◽  
Factors Associated ◽  
The Past ◽  
Behavioral Risk Factor Surveillance ◽  
Risk Factor Surveillance ◽  
Patients With Diabetes ◽  
Care Practices

Preventive foot-care practices, such as annual foot examinations by a health-care provider, can substantially reduce the risk of lower-extremity amputations. We examined the level of preventive foot-care practices (reported rates of having at least one foot examination by a physician) among patients with diabetes mellitus in North Carolina and determined the factors associated with these practices. Of 1,245 adult respondents to the 1997 to 2001 North Carolina Behavioral Risk Factor Surveillance System, 71.6% reported that they had had their feet examined within the past year, a rate that is much higher than that previously reported by Bell and colleagues in the same population for 1994 to 1995 (61.7%). Foot care was more common among insulin users than nonusers, those having diabetes for 20 years or longer than those having diabetes for less than 10 years, blacks than whites, and those who self-monitored their blood glucose level daily than those who did not. The results of this study indicate that diabetes educational services can be directed at populations at high risk of ignoring the recommended foot-care practices indicated in these analyses, thereby reducing diabetes-related lower-extremity complications. (J Am Podiatr Med Assoc 94(5): 483–491, 2004)

scholarly journals Features Analysis of Lower Extremity Arterial Lesions in 162 Diabetes Patients

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
XiangJiang Guo ◽  
YaXue Shi ◽  
XiaoZhong Huang ◽  
Meng Ye ◽  
GuanHua Xue ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Lower Limb ◽  
Vascular Involvement ◽  
Posterior Tibial ◽  
Tibial Arteries ◽  
Arterial Lesions ◽  
High Prevalence ◽  
Patients With Diabetes ◽  
Crural Arteries ◽  
Angiographic Findings

Objective. This study aimed to investigate the angiographic manifestations of lower extremity atherosclerotic steno-occlusive disease in patients with diabetes.Materials and Methods. A total of 162 patients with diabetes were enrolled in this study. The angiographic findings of lower extremity arterial lesions were evaluated according to location (iliac, femoral, popliteal, and crural artery), type (stenosis or occlusion), and length (<5 cm, 5–10 cm, and >5 cm).Results. A total of 131 of 162 (80.9%) diabetics showed multiple segmental lesions, and 19.1% (31/162) presented single segmental lesions in the lower extremity artery. Crural artery was the mainly involved location (39/162, 85.8%). Among the recorded 660 lesions of 162 cases, 437 (66.2%) were occlusion lesions, while 223 (33.8%) were stenosis lesions. Of 437 occlusion lesions, 308 lesions (70.5%) were in crural artery. More than 10 cm occlusion lesion (242/392, 61.7%) was the main manifestation in crural artery, especially in anterior (92/127, 67.2%) and posterior tibial arteries (91/124, 73.4%), which was higher than that in iliac artery (8/33, 24.2%), popliteal artery (53/157, 33.8%), and femoral artery (11/78, 14.1%).Conclusion. In diabetic subjects with lower limb artery ischemia, the vascular involvement is extremely diffuse and particularly severe in crural arteries, with high prevalence of more than 10 cm occlusion lesions.

The role of angiopoetic factors in wound healing among patients with diabetes treated with negative-pressure wound therapy

Leczenie Ran ◽  
2015 ◽  
Vol 11 (4) ◽  
pp. 171-178
Author(s):  
Beata Mrozikiewicz-Rakowska ◽  
Joanna Kania ◽  
Ewelina Bucior ◽  
Adriana Nowak ◽  
Tomasz Grzela ◽  
...  
Keyword(s):  
Wound Healing ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Wound Therapy ◽  
Patients With Diabetes

Role of topical insulin therapy as an adjunct in the management of pressure ulcer

2020 ◽  
Vol 2 (3) ◽  
pp. 01-03
Author(s):  
Ravi Chittoria
Keyword(s):  
Wound Healing ◽  
Insulin Therapy ◽  
Pressure Ulcer ◽  
Healing Rate ◽  
Pressure Sore ◽  
Pressure Sores ◽  
Established Method ◽  
Wound Bed Preparation ◽  
Wound Healing Rate

Pressure ulcer or pressure sore is one of the complications seen in bedridden patients. Management of these ulcers is often challenging. But there is no well-established method that accelerates the wound healing rate. Various adjunctive methods are used for wound bed preparation before definitive reconstruction plan is made. Here we describe our experience in the role of insulin therapy as an adjunct in the management of pressure sores.

Short Report: The Moisture Balance with Aloe Vera Gel in Diabetic Wound Healing

2018 ◽  
Vol 1 (1) ◽  
pp. 21-23
Author(s):  
Fahrianto Selamet ◽  
Andi Mayasari Usman ◽  
Rian Adi Pamungkas
Keyword(s):  
Diabetes Mellitus ◽  
Wound Healing ◽  
Wound Care ◽  
Aloe Vera ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Short Report ◽  
Bacterial Reduction ◽  
Moisture Balance ◽  
Patients With Diabetes

Diabetic foot ulcer (DF) is a chronic complication of diabetes mellitus (DM), which impact on the morbidity, mortality and quality of patients’ lives.Of those patients with diabetes mellitus, approximately 15% to 25% developed to the foot ulcer. Beside has the infection and debridement of devitalized tissue downloading; the moisture imbalance becomes the factors of recalcitrant to healing. Moist wound healing is often contraindicated to the non-healable wounds. While wound care involves the debridement, bacterial reduction, and moisture balance in order to achieve the good granulation of the tissue development and adequate blood supply.

scholarly journals The Effects of Silver-Releasing Foam Dressings on Diabetic Foot Ulcer Healing

2021 ◽  
Vol 10 (7) ◽  
pp. 1495
Author(s):  
Yu-Chi Wang ◽  
Hsiao-Chen Lee ◽  
Chien-Lin Chen ◽  
Ming-Chun Kuo ◽  
Savitha Ramachandran ◽  
...  
Keyword(s):  
Wound Healing ◽  
Diabetic Foot ◽  
Healing Rate ◽  
Early Period ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Wound Management ◽  
Control Group ◽  
Diabetic Patients ◽  
High Morbidity

Diabetic foot ulcers (DFUs) are a serious complication in diabetic patients and lead to high morbidity and mortality. Numerous dressings have been developed to facilitate wound healing of DFUs. This study investigated the wound healing efficacy of silver-releasing foam dressings versus silver-containing cream in managing outpatients with DFUs. Sixty patients with Wagner Grade 1 to 2 DFUs were recruited. The treatment group received silver-releasing foam dressing (Biatain® Ag Non-Adhesive Foam dressing; Coloplast, Humlebaek, Denmark). The control group received 1% silver sulfadiazine (SSD) cream. The ulcer area in the silver foam group was significantly reduced compared with that in the SSD group after four weeks of treatment (silver foam group: 76.43 ± 7.41%, SSD group: 27.00 ± 4.95%, p < 0.001). The weekly wound healing rate in the silver foam group was superior to the SSD group during the first three weeks of treatment (p < 0.05). The silver-releasing foam dressing is more effective than SSD in promoting wound healing of DFUs. The effect is more pronounced in the initial three weeks of the treatment. Thus, silver-releasing foam could be an effective wound dressing for DFUs, mainly in the early period of wound management.

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