The Impact of Glycosylated Hemoglobin and Diabetes Mellitus on Wound-Healing Complications and Infection After Foot and Ankle Surgery

2014 ◽  
Vol 104 (4) ◽  
pp. 320-329 ◽  
Author(s):  
Jon M. Humphers ◽  
Naohiro Shibuya ◽  
Benjamin L. Fluhman ◽  
Daniel Jupiter
Keyword(s):  
Diabetes Mellitus ◽  
Wound Healing ◽  
Odds Ratio ◽  
Hba1c Level ◽  
Foot And Ankle ◽  
Surgery Complications ◽  
Postoperative Wound ◽  
Ankle Surgery ◽  
Significant Factors

Background The relationship between hyperglycemia and adverse outcomes after surgery has been widely documented. Long-term glucose control has been recognized as a risk factor for postoperative complications. In the foot and ankle literature, long-term glycemic control as a potential perioperative risk factor is not well studied. Our goal was to investigate whether hemoglobin A1c (HbA1c) level was independently associated with postoperative complications in a retrospective cohort study. Methods Three hundred twenty-two patients with a diagnosis of diabetes mellitus were enrolled in the study to assess risk factors associated with postoperative foot and ankle surgery complications. Results Bivariate analyses showed that HbA1c level and having at least one comorbidity were associated with postoperative infections. However, after adjusting for other covariates, the only significant factor was HbA1c level, with each increment of 1% increasing the odds of infection by a factor of 1.59 (95% confidence interval [CI], 1.28–1.99). For postoperative wound-healing complications, bivariate analyses showed that body mass index, having at least one comorbidity, and HbA1c level were significant factors. After adjusting for other covariates, the only significant factors for developing postoperative wound complications were having at least one comorbidity (odds ratio, 2.03; 95% CI, 1.22–3.37) and HbA1c level (each 1% increment) (odds ratio, 1.25; 95% CI, 1.02–1.53). Conclusions In this retrospective study, HbA1c level had the strongest association with postoperative foot and ankle surgery complications in patients with diabetes.

scholarly journals PROSES PENYEMBUHAN LUKA ULKUS DIABETIKUM DENGAN METODE MODERN DRESSING DIKLINIK MAITIS EFRANS WOUND CARE

2018 ◽  
Vol 10 (2) ◽  
pp. 146-151
Author(s):  
Nadya Putri Nabila
Keyword(s):  
Diabetes Mellitus ◽  
Wound Healing ◽  
Wound Care ◽  
Healing Process ◽  
Case Study Research ◽  
World Population ◽  
Care Clinic ◽  
Diabetic Ulcer ◽  
Patients With Diabetes

Diabetes mellitus (DM) is one of the most common chronic diseases experienced by the world population and ranks fourth cause of death in developing countries. Long-term complications of diabetes mellitus one of them is diabetic ulcer (15%) and is the most cause (85%) of amputation in patients with diabetes mellitus. Currently, more than 5,000 modern types of dressings are reported to be available to treat wounds, especially diabetic ulcers. To know the process of wound healing diabetic ulcer was done with the design of case study research with a sample of 2 people and this study was conducted for 4 weeks. The study was conducted at the Maitis Efrans Wound Care clinic in Bengkulu City. The result was obtained that the assessment of diabetic ulcer wounds before modern wound care on the respondents was a total score of 54 and the respondents two total score of 50 were stated wound regeneration. The healing process of the responder's second ulcers progressed, the total score of one respondent was 30 and the respondent two was 28. Respondents. Progress on the two respondents stated better influenced by wound healing factor that is, age factor.

Predictors of 5-year survival in patients with chronic heart failure and reduced left ventricular ejection fraction depending on the presence of type 2 diabetes mellitus

2021 ◽  
Vol 28 (4) ◽  
pp. 33-39
Author(s):  
L. G. Voronkov ◽  
N. A. Tkach ◽  
O. L. Filatova ◽  
T. I. Gavrilenko
Keyword(s):  
Diabetes Mellitus ◽  
Odds Ratio ◽  
Diabetes Mellitus Type 2 ◽  
Left Ventricular ◽  
Diabetes Mellitus Type ◽  
Term Survival ◽  
Systemic Oxidative Stress ◽  
Vasodilatory Response

The aim – to determine the predictors of 5-year survival of patients with CHF and reduced LV EF depending on the presence of type 2 diabetes mellitus.Materials and methods. 490 case histories of patients in the period from 2011 to 2018 with CHF, 40–80 years of age (median – 64 years), II–IV NYHA functional class, LVEF ≤ 40 % were analyzed. For the analysis of all patients with CHF and reduced LV EF were divided into two groups: Group I included 338 (69 %) patients without diabetes mellitus type 2, group II consisted of 152 (31 %) patients diagnosed with diabetes mellitus type 2. To measure the values ​​of the independent predictors, we calculated the value of the odds ratio (OR) with a 95 % confidence interval. To determine predictors of mortality/survival of the studied patients, was calculated the Хі-square criterion. Additionally, we calculated the estimate of the frequency difference between the groups, the odds ratio, the confidence interval for the odds ratio, the Pearson correlation coefficient r, for all the calculated characteristics we determined the probability of error of the first kind p. As a result, we formed a final table of indicators-predictors of mortality/survival of patients with CHF with reduced LV EF with and without diabetes mellitus type 2 for which there is a statistical relationship between mortality / survival and the studied indicator.Results and discussion. In patients without diabetes, many indicators are associated with the prognosis of long-term survival. These include hemodynamic parameters (heart rate, the left atrium size (LV) and indexed left ventricular (LV) volumes, LV myocardial mass index, right ventricular size (RV) and LV ejection fraction, renal function parameters (microalbuminuria (UIA), glomerular filtration rate (GFR), urea nitrogen), systemic inflammatory marker (C-reactive protein (CRP)), markers of systemic oxidative stress (myeloperoxidase, citrulline, uric acid) and antioxidant defence – SOD, as well as the N-terminal fragment of the precursor of natriuretic peptide (NT-proBNP), flow-dependent vasodilatory response (FDVR), high-density lipoprotein cholesterol (HDL), insulin and the relative content of lymphocytes in the blood. Patients with diabetes had significantly fewer such predictors: in addition to parameters of intracardiac hemodynamics and heart modeling, other significant predictors of 5-year survival were daily UIA level, CRP, SOD, HDL, insulin and the lymphocyte level.Conclusions. Quantitative predictors of poor 5-year survival prognosis among patients with CHF and reduced LV EF with and without concomitant diabetes mellitus type 2 are parameters of heart remodeling, LV systolic function-EF, UIA level, antioxidant stress marker (SOD), HDL level, blood lymphocytes and the level of circulating insulin. Patients without diabetes are characterized by a wider range of poor long-term survival predictors, which include indicators of renal nitrogen function, markers of systemic oxidative stress (myeloperoxidase, citrulline, uric acid), flow-dependent vasodilatory response and circulating NT-proBNP. The determined quantitative predictors can be used in algorithms of individual prediction of the course of CHF and reduced LV EF, which should be created separately for patients with and without concomitant diabetes mellitus type 2

scholarly journals Publications Rates for Podium and Poster Presentations from the American Orthopaedic Foot and Ankle Society

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0004
Author(s):  
Benjamin Williams ◽  
Grace Kunas ◽  
Jonathan Deland ◽  
Scott Ellis
Keyword(s):  
Full Text ◽  
Odds Ratio ◽  
Sports Medicine ◽  
Publication Rate ◽  
Foot And Ankle ◽  
Publication Rates ◽  
Ankle Surgery ◽  
Orthopaedic Society ◽  
American Orthopaedic ◽  
Poster Presentations

Category: Other Introduction/Purpose: National orthopaedic meetings are used to disseminate current research. These abstracts are commonly intended to go on to full-text publication in peer-reviewed journals. Several studies have reviewed the abstract to full-text journal publications for orthopaedic society meetings and reported a 34% to 73% publication rate. This has not been studied for the foot and ankle literature. The purpose of this study is to determine the full-text journal publication rates of podium and poster presentations from the American Orthopaedic Foot and Ankle Society (AOFAS) Annual meetings between 2008 and 2012. Methods: All abstracts submitted to and subsequently accepted for podium and poster presentations from the 2008 to 2012 AOFAS annual meetings were compiled from the AOFAS and the published meeting programs. In May 2016, PubMed searches were performed using individual key words in the abstract title with all authors’ names. The results were reviewed for matches to the meeting abstracts with regards to content similarities. Time to full-text publication was recorded. Full-text publication rates for podium and poster presentations were calculated per year. The top journals of publication for podium and poster abstracts were calculated. Continuous data was summarized using mean ± standard deviation and categorical data was summarized using counts and percents. Difference in publication rates between podium and poster presentations was determined by an odds ratio. Results: From 2008 to 2012, 1262 abstracts were submitted to the annual meeting. The overall abstract publication rate was 62.4%: 73.7% for podium abstracts and 55.8% for poster abstracts. Podium presentations were significantly more likely to be published compared to posters (p< 0.0001; odds ratio 2.17, 95% CI, 1.64-2.86). Mean time to publication was 1.53 and 1.37 years for podium and poster presentations, respectively (p=0.124). The three most common journals for published podium abstracts were Foot and Ankle International (FAI) (50.4%), Journal of Bone and Joint Surgery (JBJS) (13.0%) and The American Journal of Sports Medicine (AJSM) (4.3%). For poster abstracts, the three most common journals were: FAI (36.9%), Journal of Foot and Ankle Surgery (9.4%) and Foot and Ankle Specialist (8.5%). Conclusion: Podium abstracts were over two times more likely to be published compared to poster abstracts. The overall full- text publication rate for the AOFAS was one of the higher reported rates compared to other national orthopaedic society meetings. The significance of the high full-text publication rate is unclear; it may reflect the quality of presented material or commitment to publication by the authors. The top journal for podium and poster abstracts was FAI, indicating the presentations’ specialty-focus.

Effect of Postoperative Oral Antibiotics on Infections and Wound Healing Following Foot and Ankle Surgery

2020 ◽  
Vol 41 (12) ◽  
pp. 1466-1473
Author(s):  
Jacob Carl ◽  
Trevor J. Shelton ◽  
Kevin Nguyen ◽  
Isabella Leon ◽  
Jeannie Park ◽  
...  
Keyword(s):  
Wound Healing ◽  
Retrospective Chart Review ◽  
Final Analysis ◽  
Wound Complications ◽  
Oral Antibiotic ◽  
Foot And Ankle ◽  
Oral Antibiotics ◽  
Infection Rates ◽  
Level Of Evidence ◽  
Ankle Surgery

Background: There is controversy regarding the effectiveness of postoperative antibiotics to prevent wound infection. Some surgeons still use a routine postoperative oral antibiotic regimen. The purpose of this study was to review a series of cases and document statistically any difference in infection rates and whether routine postoperative antibiotics in foot and ankle surgery are justified. Methods: A retrospective chart review of 649 patients was performed who underwent elective foot and ankle surgery. Six hundred thirty-one patient charts were included in the final analysis. Evaluated were patients who did and did not receive postoperative oral antibiotics in order to identify whether a difference in infection rate or wound healing occurred. The study also evaluated risk factors for developing infection following foot and ankle surgery. Results: The number of infections in patients receiving postoperative oral antibiotics was 6 (3%), while the number of infections in those who did not receive postoperative oral antibiotics was 10 (2%) ( P = .597). The difference of deep versus superficial infections and delays in wound healing between the 2 groups was not statistically significant. Patients who developed infections were older and had a higher prevalence of hypertension, a history of neoplasm, and a greater American Society of Anesthesiologists Classification of Physical Health. Conclusion: This study suggests that routine use of postoperative antibiotics in foot and ankle surgery does not affect wound complications or infection rates. Additionally, patients who are older and those with multiple medical problems may be at higher risk for developing postoperative infection following foot and ankle surgeries. Level of Evidence: Level III, retrospective comparative series.

Does Revascularization Prior to Foot and Ankle Surgery Reduce the Incidence of Surgical Site Infection (SSI)?

2019 ◽  
Vol 40 (1_suppl) ◽  
pp. 15S-16S
Author(s):  
Nima Heidari ◽  
Alexander Charalambous ◽  
Iris Kwok ◽  
Alexandros Vris ◽  
Yueyang Li
Keyword(s):  
Wound Healing ◽  
Beneficial Effect ◽  
Surgical Site Infection ◽  
Elective Surgery ◽  
Site Infection ◽  
Foot And Ankle ◽  
Peripheral Vascular ◽  
Level Of Evidence ◽  
Diabetic Foot Infection ◽  
Ankle Surgery

Recommendation: Several studies support the effect of peripheral vascular disease (PVD) on wound healing and surgical site infection (SSI). Despite this, there have been no specific studies proving the beneficial effect of revascularization on SSI prior to operative intervention in the setting of traumatic or elective foot and ankle surgery. The majority of studies on revascularization are in the setting of diabetic foot infection or established ischemia. We recommend that in the presence of an inadequate vascularization in the foot and ankle, vascular optimization should be undertaken prior to elective surgery. Level of Evidence: Limited. Delegate Vote: Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus)

Safety and Efficacy of the Popliteal Fossa Nerve Block When Utilized for Foot and Ankle Surgery

2002 ◽  
Vol 23 (5) ◽  
pp. 394-399 ◽  
Author(s):  
David A. Provenzano ◽  
Eugene R. Viscusi ◽  
Samuel B. Adams ◽  
Michael B. Kerner ◽  
Marc C. Torjman ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Nerve Block ◽  
Popliteal Fossa ◽  
Anesthetic Technique ◽  
Foot And Ankle ◽  
Nerve Stimulator ◽  
Peripheral Nerve Stimulator ◽  
Safety And Efficacy ◽  
Ankle Surgery

The popliteal fossa nerve block (PFNB) offers numerous advantages that make it a suitable anesthetic technique for foot and ankle surgery. In this retrospective study, we investigated the acute and long-term safety and efficacy of this relatively underutilized anesthetic technique for foot and ankle surgery. A review of 834 patients who underwent foot and/or ankle surgery by the coauthor (NAA) was conducted. Four hundred sixty-seven patients received a PFNB with the aid of a peripheral nerve stimulator. Variables assessed included the quality of surgical anesthesia, postoperative analgesia and the acute and long-term incidence of postoperative neuralgia and neuropraxia. The PFNBs were performed by anesthesiologists with various levels of training at a tertiary care hospital and all were supplemented with a saphenous nerve block. The PFNB was successful as the sole anesthetic technique in 79% of the cases; 18% were converted to general anesthesia and 3% required augmentation with local anesthetic. There were no complications associated with the PFNB. There were no incidents of postoperative neuralgia or neuropraxia. Only 12% of patients with a successful block required analgesics in the PACU, while 60% of patients with a failed block required systemic analgesics for surgical site pain (p<0.01). These results suggest that the performance of the PFNB with the guidance of a peripheral nerve stimulator is a safe and effective anesthetic technique for foot and ankle surgery.

Wound closure and special suture techniques

1995 ◽  
Vol 85 (1) ◽  
pp. 2-10 ◽  
Author(s):  
D Gusman
Keyword(s):  
Wound Healing ◽  
Wound Closure ◽  
Suture Techniques ◽  
General Knowledge ◽  
Foot And Ankle ◽  
Tissue Handling ◽  
Ankle Surgery

In this review, the author presents the physiologic events in wound healing. A discussion is provided with emphasis on proper tissue handling and suture techniques. A variety of methods are demonstrated as they are applied to specific clinical situations in foot and ankle surgery. It is the intent of this discussion to add information and techniques that may be used to complement general knowledge in wound and incision repair.

scholarly journals The Combined Lambrinudi and Ankle Arthrodesis with Ring External Fixation in the Long-term Severe Neuromuscular Equinocavovarus Deformity with Ankle and Hindfoot Osteoarthritis: The Cases Presentation and Modified Guideline of Treatment

2019 ◽  
Vol 13 (1) ◽  
pp. 183-188
Author(s):  
Prasit Rajbhandari ◽  
Chayanin Angthong ◽  
Jiancheng Zang ◽  
Sihe Qin ◽  
Andrea Veljkovic
Keyword(s):  
Present Report ◽  
Treatment Algorithm ◽  
Deformity Correction ◽  
Ankle Arthrodesis ◽  
Foot And Ankle ◽  
Improved Outcomes ◽  
Ankle Surgery

Background: Severe equinocavovarus deformity develops from various causes and generally results in major disability that affects patient’s mobility and quality of life. It can be divided into neuromuscular and non-neuromuscular deformities, including two major subtypes: i.e., paralytic and spastic. In addition, ankle osteoarthritis could be caused by prolonged or progressive foot deformity. Objective: The present report proposes a modification of the accepted treatment algorithm and Lambrinudi’s surgical technique with ankle and hindfoot arthrodesis to correct theses challenging deformities with the long-term condition. Results: Two equinocavovarus cases were included, one in a 54-year old male and the second in a 63-year old female with paralaytic and spastic etiologies respectively. Patient’s deformity correction was acceptable. Each patient demonstrated improved outcomes due to a postoperative plantigrade foot and ankle position. No significant complications were encountered during the course of care and last follow-up. The mean follow-up time was 26 months. Conclusion: Severe long term neuromuscular equinocavovarus deformities are a challenging disability in the foot and ankle surgery. The present article proposes a modified guideline of treatment illustrated in two representative case studies of long-term paralytic and spastic equinocavovarus deformities. These conditions can be treated surgically using the stepwise approach as demonstrated in this article with acceptable outcomes.

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