Management of diabetic foot ulcer is a multi-disciplinary, time-consuming work. In order to obtain a proper recording, better communication, and fair comparative study, effective method of recording system for diabetic foot ulcer is required. Wagner classification and NPUAP (National Pressure Ulcer Advisory Panel) chronic ulcer staging are widely used but have a drawback that they only consider the depth of the ulcer. Authors devised a recording system for the diabetic foot ulcer and applied it to the patients to examine any problems associated with its use. From September 1999 to January 2001, diabetic foot ulcer recording form was applied to 92 patients with diabetic foot ulcer. The form has 8 fields of recording: date, location, depth, size, status of ulcer, status of margin, interval change, recorder. These fields are for recording itself, treatment plan, or prognostic value. The data were collected and analyzed in detail. Authors proposed criteria for the ideal recording system in the management of diabetic foot ulcer. In conclusion, the diabetic foot ulcer recording system proved to be highly efficient, simple and easy to document the ulcer. In addition, it could help surgeons decide the treatment plan and predict the outcome.
Classification ; Diabetic Foot* ; Humans ; Pressure Ulcer ; Ulcer* ; Wounds and Injuries*

The classification system of diabetic foot not only helps to assess the wound, but it also can be used to predict the outcome of diabetic foot ulcer in the early stage, dynamically monitor the changes in the wound, and rationally direct the therapeutic schedule. At present, there are diverse systems for classifying the diabetic foot, but none has been internationally recognized. The classification systems can be categorized by time sequence, research objective, or structure type. When one of the classification systems is chosen, it is still very important to take the population, facility, and research type into consideration.
Diabetic Foot ; classification ; pathology ; Humans ; Severity of Illness Index ; Wound Healing

Foot complications are a well known factor which contribute to the morbidity of diabetes and increases the chance of amputation. A total of 126 consecutive diabetic patients were evaluated by diabetic foot screening. Forty-one patients showed an impaired protective sense when tested with Semmes-Weinstein monofilament 5.07 (10 g), and 92% of them showed peripheral polyneuropathy in nerve conduction study (NCS). The mean vibration score of the Rydel-Seiffer graduated tuning fork in patients with peripheral polyneuropathy in nerve conduction (NCV) study was 5.38+/-2.0, which was significantly different from that of patients without polyneuropathy in NCS. Among the deformities identified on examination, callus, corn, and hallux valgus were the greatest. While checking the ankle/ brachial index (ABI), we also evaluated the integrity of vasculature in the lower extremities. After extensive evaluation, we classified the patients into eight groups (category 0,1,2,3,4A,4B,5,6). The result of this study suggested that the Semmes-Weinstein monofilament test, Rydel-Seiffer graduated tuning fork test, and checking the ankle/brachial index were simple techniques for evaluating pathologic change in the diabetic foot by office screening, and that this screening based on treatment-oriented classification helps to reduce pedal complications in a diabetic population
Diabetic Angiopathies/diagnosis ; Diabetic Angiopathies/complications ; Diabetic Foot/physiopathology ; Diabetic Foot/diagnosis* ; Diabetic Foot/classification ; Diabetic Neuropathies/diagnosis ; Diabetic Neuropathies/complications ; Female ; Foot/physiopathology ; Human ; Male ; Mass Screening ; Middle Age ; Podiatry/methods ; Sensory Thresholds

It is currently necessary to manage chronic ischemic foot gangrene because the rate of hospitalization and operations is increasing as a result of diet change and the growth of an aging population. Chronic ischemic foot gangrene is caused by Buerger`s disease, atherosclerosis and particularly, diabetes. In this study, we used the Wagner ischemic index with Doppler flowmeter and Wagner classification on 62 patients over 8 years from 1991 to 1998 as an index for treatment and prognosis. We measured the systolic pressure to determine the ischemic index, and according to Wagner the blood flow was inadequate in cases of diabetic foot gangrene and nondiabetic foot gangrene when it was below 0.45 and 0.35, respectively. According to the observation of clinical symptoms, we divided the cases by Wagner classification. Based on the above data, we performed conservative treatment, skin graft, local flap, superficial sural arterial island flap and amputation. We then followed up the patients and observed the treatment results. We concluded that the Wagner ischemic index with Doppler flowmeter and Wagner classification was useful in determining, selecting, and predicting the rate of survival or death as a result of amputation and graft when a surgical operation is performed.
Aging ; Amputation ; Atherosclerosis ; Blood Pressure ; Classification* ; Diabetic Foot ; Diet ; Flowmeters* ; Foot Ulcer* ; Foot* ; Gangrene ; Hospitalization ; Humans ; Prognosis ; Skin ; Transplants

PURPOSE: To evaluate the precipitating factors of amputation as initial treatment in diabetic foot patients. MATERIALS AND METHODS: Between March, 1994 and February 2003, 41 cases (37 patients) diabetic foot patients who had diabetic ulcer, pyogenic inflammation and gangrene and followed up over 1 year were collected. Among them, We evaluate the precipitating factors of amputation for average 39.6months (12-118months). RESULTS: Among many factors, Wagner classification, pulse volume recording of toes, Ankle-Brachial Index and Albumin level are statistically significant in amputation patients. CONCLUSION: In determining the amputation of diabetic foot as initial treatment, the trauma history, circulation of foot and serum albumin level are important precipitating factors. So the education about preventing even minor trauma and maintaining good nutrition state decrease the amputation rate in diabetic foot patients.
Amputation* ; Ankle Brachial Index ; Classification ; Diabetic Foot* ; Education ; Foot ; Gangrene ; Humans ; Inflammation ; Precipitating Factors* ; Serum Albumin ; Toes ; Ulcer

PURPOSE: To evaluate the precipitating factors of amputation as initial treatment in diabetic foot patients. MATERIALS AND METHODS: Between March, 1994 and February 2003, 41 cases (37 patients) diabetic foot patients who had diabetic ulcer, pyogenic inflammation and gangrene and followed up over 1 year were collected. Among them, We evaluate the precipitating factors of amputation for average 39.6months (12-118months). RESULTS: Among many factors, Wagner classification, pulse volume recording of toes, Ankle-Brachial Index and Albumin level are statistically significant in amputation patients. CONCLUSION: In determining the amputation of diabetic foot as initial treatment, the trauma history, circulation of foot and serum albumin level are important precipitating factors. So the education about preventing even minor trauma and maintaining good nutrition state decrease the amputation rate in diabetic foot patients.
Amputation* ; Ankle Brachial Index ; Classification ; Diabetic Foot* ; Education ; Foot ; Gangrene ; Humans ; Inflammation ; Precipitating Factors* ; Serum Albumin ; Toes ; Ulcer

With the advancement of modern medicine, diabatic foot gangrene rather than acute metabolic complications are eneountered as serious problem. The diabetic gangrene, one of the angiopathic and neuropathic complications, is difficult in treatment because of wound infection and delayed healing. The authors reviewed a series of 47 cases in 40 patient of diabetic gangrene that treated in orthopedic department of Eulji General Hospitsl, Seoul, from January 1982 to December 1987. We summarized the obtained results as following. 1. The overall incidence of diabetic gangrene was 0.42%, and 77.5% of patients with gangrene were in over 50 year age group. 2. 72.5% of patients with gangrene were 5–14 years in duration of diabetes. 3. The most common predisposing factor was local pressure(45%), and the most common site of lesions was big toe(34%). 4. Bacterial infections were shown in 90% of cases, and the most common organism wasstaphylococcus(56%).5. Diabetic retinopathy was the most common associated complication and neuropathy, nephropsthy in order. 6. According to the Wagner's classification, grade 4 lesion was most common(47%). 7. There was no correlation between primary healing and the lowest palpable pulse. 8. The overall rate of primary healing was 57%.
Bacterial Infections ; Causality ; Classification ; Clinical Study ; Diabetic Foot ; Diabetic Retinopathy ; Foot ; Gangrene ; History, Modern 1601- ; Humans ; Incidence ; Orthopedics ; Seoul ; Wound Infection

INTRODUCTIONThis is the fi rst prospective study done locally to determine the effectiveness of vacuum-assisted closure (VAC) therapy in the healing of chronic diabetic foot ulcers.

MATERIALS AND METHODSAn electronic vacuum pump was used to apply controlled negative pressure evenly across the wound surface. Changes in wound dimension, presence of wound granulation and infection status of diabetic foot ulcers in 11 consecutive patients with diabetes were followed over the course of VAC therapy.

RESULTSHealing was achieved in all wounds. Nine wounds were closed by split-skin grafting and 2 by secondary closure. The average length of treatment with VAC therapy was 23.3 days. Ten wounds showed reduction in wound size. All wounds were satisfactorily granulated and cleared of bacterial infection at the end of VAC therapy.

CONCLUSIONSVAC therapy was useful in the treatment of diabetic foot infection and ulcers, which after debridement, may present with exposed tendon, fascia and/or bone. These included ray amputation wounds, wounds post-debridement for necrotising fasciitis, wounds post-drainage for abscess, a heel ulcer and a sole ulcer. It was able to prepare ulcers well for closure via split-skin grafting or secondary closure in good time. This reduced cost of VAC therapy, as therapy was not prolonged to attain greater reduction in wound area. VAC therapy also provides a sterile, more controlled resting environment to large, exudating wound surfaces. Large diabetic foot ulcers were thus made more manageable.

Adult ; Debridement ; Diabetic Foot ; classification ; surgery ; therapy ; Female ; Humans ; Male ; Middle Aged ; Negative-Pressure Wound Therapy ; Prospective Studies ; Wound Healing

PURPOSE: Diabetic foot wound (DFW) is known as a major contributor of nontraumatic lower extremity amputation. We aimed to evaluate overall amputation rates and risk factors for amputation in patients with DFW. MATERIALS AND METHODS: From January 2014 to December 2017, 141 patients with DFW were enrolled. We determined rates and risk factors of major amputation in DFW and in DFW with peripheral arterial occlusive disease (PAOD). In addition, we investigated rates and predictors for amputation in diabetic foot ulcer (DFU). RESULTS: The overall rate of major amputation was 26.2% in patients with DFW. Among 141 DFWs, 76 patients (53.9%) had PAOD and 29 patients (38.2%) of 76 DFWs with PAOD underwent major amputation. Wound state according to Wagner classification, congestive heart failure, leukocytosis, dementia, and PAOD were the significant risk factors for major amputation. In DFW with PAOD, Wagner classification grades and leukocytosis were the predictors for major amputation. In addition, amputation was performed for 28 patients (38.4%) while major amputation was performed for 5 patients (6.8%) of 73 DFUs. Only the presence of osteomyelitis (OM) showed significant difference for amputation in DFU. CONCLUSION: This study represented that approximately a quarter of DFWs underwent major amputation. Moreover, over half of DFW patients had PAOD and about 38.2% of them underwent major amputation. Wound state and PAOD was major predictors for major amputation in DFW. Systemic factors, such as CHF, leukocytosis, and dementia were identified as risk factors for major amputation. In terms of DFU, 38.4% underwent amputation and the presence of OM was a determinant for amputation.
Amputation ; Arterial Occlusive Diseases ; Classification ; Dementia ; Diabetic Foot ; Heart Failure ; Humans ; Leukocytosis ; Lower Extremity ; Osteomyelitis ; Risk Factors ; Ulcer ; Wounds and Injuries

PURPOSE: Excessive weight bearing from obesity may induce pains in the lower extremity and resulting functional abnormality. Here we aimed to identify the relationship, it is intended to identity relationship obesity has with diabetic foot ulcer, sensory function, and blood circulation in diabetic patients. MATERIALS AND METHODS: We included patients who hospitalized or visited the department of orthopedic surgery for the treatment of diabetic foot ulcer, between January 2010 and December 2015. Among them, those aged over 30 years, diagnosed with diabetes with a progression of more than one year, and an HbA1c level of less than 7.5% were included for final analysis. For obesity, body mass index (BMI) was used, those with a BMI of over 18.5 kg/m2 were included. Using the Asian cut point of World Health Organization, patients were classified into normal, overweight, or obese. For foot ulcers, patients were classified using the Wagner ulcer classification. For sensory function, it was measured by scoring it with Semmes-Weinstein monofilament of International Working Group on the Diabetic Foot (IWGDF). Moreover for blood circulation, ankle-brachial index (ABI) was measured. RESULTS: For the sensory function, it was found that the overweight group obtained the highest score and the obesity group obtained the lowest score. For ABI, the overweight group scored the highest and the normal group scored the lowest. Moreover diabetic foot ulcer was the highest in the obesity group and the lowest in the normal group. From these results, it was considered that BMI had no relationship with sensory or blood circulation of the feet. However, the relationship between the diabetic foot ulcer and BMI showed statistical significance; according to the result of regression analysis, BMI of diabetic patients had a positive correlation with diabetic foot ulcer. CONCLUSION: This study showed that the sensory function and blood circulation of the feet had no relationship with diabetic foot ulcer; however, BMI appears to have a positive correlation with diabetic foot ulcer. Moreover, it seems to be a good index for determining the risk of diabetic foot ulcer.
Ankle Brachial Index ; Asian Continental Ancestry Group ; Blood Circulation* ; Body Mass Index* ; Classification ; Diabetes Mellitus* ; Diabetic Foot* ; Foot Ulcer ; Foot* ; Humans ; Lower Extremity ; Obesity ; Orthopedics ; Overweight ; Sensation ; Ulcer* ; Weight-Bearing ; World Health Organization