SUMMARY Introduction: Patients suffering from diabetes mellitus (DM) frequently present with infected diabetic foot ulcers (DFU). This study was done to record the anatomical site and the grade of ulcers according to Wagner’s classification and to culture the microorganisms from the ulcers and determine their antibiotic sensitivity. Materials and methods: Prospective study was conducted on 77 diabetic patients who were admitted with DFU from June until December 2011. Patients with end stage renal failure, those who had previous vascular surgery on the involved limb, or hyperbaric oxygen or maggot therapy for the ulcers, or had unrelated skin diseases around the involved foot were excluded from the study. Specimens for culture were obtained by a sterile swab stick or tissue sample was taken from the wound with sterile surgical instruments. Results: Wagner’s grade III and IV ulcers were most common. Majority of the ulcers involved toes (48%). Gram negative microorganisms were predominantly isolated (71.1%). Gram positive microorganisms were less frequently cultured (27.7%). Fungus was cultured from one sample (1.2%). Gram negative microorganisms were sensitive to aminoglycosides, cephalosporins or β-lactamase inhibitors. More than 40% were resistant to ampicillin. Gram positive microorganisms were sensitive to cloxacillin. MRSA were sensitive to vancomycin. Conclusion: Empirical use of antibiotics should be curtailed to prevent development of drug resistant strains of microorganisms and MRSA. We suggest use of antiseptic solutions to clean the ulcers until antibiotic sensitivity report is available. Results of our altered treatment regimen we plan to publish in a later study.
Diabetic Foot ; Foot Ulcer

Amputation of diabetic foot ulcer and infection is a critical modality for saving a patient's life from life threatening infections or ischemic limbs. However, it can cause serious handicaps or complications, such as lifetime shortening and re-amputation of the other limb. The minimal amputation is the main goal of amputation in diabetic patients. However, insufficient amputation can have a harmful effect on patients. The decision of amputation is very difficult and should be made using multidisciplinary approaches. All aspects of the patient's situation, including vascular status, degree of infection, and medical conditions should be considered. The foot surgeon should keep in mind the notion that proper amputation can lead to a new life for diabetic foot patients.
Amputation* ; Diabetic Foot* ; Extremities ; Foot ; Humans ; Ulcer*

PURPOSE: The treatment of diabetic foot ulcers with total contact cast has been reported to be associated with numerous undesirable complications. This study shows that our technique of total contact casting that incorporates high concentration silver coated foam dressing. MATERIALS AND METHODS: Forty-four diabetic foot ulcers were treated with total contact cast along with high concentration silver coated foam dressing. Complication and healing rates were evaluated. RESULTS: Eighty five percent of the ulcers healed within 6 weeks with an overall complication rate of 7%. There were only two cases (5%) of infection and no recurrent ulceration and no another site new pressure ulcer in our study. CONCLUSION: Total contact casting incorporates high concentration silver coated foam dressing resulted in fewer complications rate and healing rate that is comparable to other studies.
Bandages* ; Diabetic Foot* ; Pressure Ulcer ; Silver* ; Ulcer*

PURPOSE: This study was performed to evaluate the effectiveness of self-home dressing with nanocrystalline silver dressing method on the treatment of chronic ulcer wounds of the foot. MATERIAL AND METHODS: One hundred-nine patients with chronic foot ulcer due to various causes were treated with nanocrystalline silver dressing material. Dressing was done by themselves in their home. Dressing changes were performed every 2 to 3 days until complete reepithelization. RESULTS: One hundred two cases of all cases had a complete reepithelization. It took 49 days to have a complete reepithelization on average. Seven cases failed to complete reepithelization because of infection. There was no silver intoxication in any cases. CONCLUSION: Using nanocrystalline silver is a useful dressing method for various superficial chronic ulcer and it can be done by themselves at their home. Thus it is considered to be more comfortable to both patients and doctors.
Bandages ; Diabetic Foot ; Foot Ulcer ; Foot* ; Humans ; Methods ; Silver* ; Ulcer* ; Wounds and Injuries

PURPOSE: Microcirculation of diabetic patients is commonly comporomised, regardless of the condition of the macrocirculation. Therefore, direct tissue oxygenation measurement is recommended in determining tissue viability and predicting wound healing potential. This study was designed to determine cut-off value of the tissue oxygenation in predicting wound healing in diabetic foot patients. METHODS: This study included 41 feet of 41 diabetic foot patients who were treated in the Diabetic Wound Center of author's institution between January and June, 2009. Main inclusion criteria were type 1 or 2 diabetes and a foot ulcer (duration > 3 weeks) and ulcer area(from 1cm2 to 4cm2). Measurements of the area of diabetic foot ulcer were carried out before treatment. Transcutaneous oxygen pressure(TcpO2) was measured at adjacent site of ulcer. The healing wound was defined as complete wound closure within 12 weeks. RESULTS: Average diabetic foot ulcer areas with healing and nonhealing wounds were 2.67+/-0.76 and 2.59+/-0.75 cm2, respectively. There was no significant difference in the wound area between the groups. Average foot TcpO2 in healing and nonhealing wounds were 68.56+/-23.07 and 30.98+/-16.66mmHg, respectively(p<0.01). The rate of healing wound increased as TcpO2 increased. In particular, TcpO2 lower than 40mmHg and higher than 40mmHg showed the most significant difference(wound healing rates of 25% and 71%, respectively). CONCLUSION: Based on the results of the study, the minimal TcpO2 value thought to be required for adequate wound healing in diabetic wounds(cut-off value) is 40 mmHg.
Diabetic Foot ; Foot ; Foot Ulcer ; Humans ; Microcirculation ; Oxygen ; Tissue Survival ; Ulcer ; Wound Healing

PURPOSE: This study examined the results of a single or double V-Y advancement flap, which was found to be technically simple for the management of chronic plantar ulcer in patients with neuropathic diabetic foot. MATERIALS AND METHODS: From January 2004 to December 2005, 29 patients who were hospitalized for the management of a neuropathic diabetic foot plantar ulcer were examined. All patients underwent single- or double-V-Y advancement flap for the management of the ulceration. Hematological, hemodynamic, diabetic, bacteriologic, and radiological tests wereperformed prior to surgery. The condition of the wound was checked during surgery, and the healing rate, healing time and recurrence during the follow-up examinations were evaluated after surgery. RESULTS: The mean age of the patients was 53.4 years (36-69). The plantar ulcers were the most commonly found in the forefoot area (12 cases). Nine cases showed ulcers in the hindfoot area, 6 cases were found are in the lateral foot area, and 2 cases were identified in the medial foot area. The area covered with the V-Y advancement flap averaged 2.05 cm(2) (0.8-3.9). The mean healing time of the wound was 4.7 weeks (3-8). One day after surgery, there were 7 cases of partial circulation disturbance that were managed with a partial stitch out and secondary intension wound healing. There were 5 cases of recurrence of the wound. CONCLUSION: A V-Y advancement flap to manage chronic diabetic plantar ulcers can produce excellent or good results. However, a high incidence of delay in healing of the surgical wound can be expected, and a longer period is needed to protect the wound comparing with normal patients.
Diabetic Foot ; Follow-Up Studies ; Foot ; Foot Ulcer ; Hemodynamics ; Humans ; Incidence ; Recurrence ; Ulcer ; Wound Healing

Human ; Male ; Middle Aged ; Diabetic Foot ; Foot Ulcer ; Tretinoin

PURPOSE: Diabetic foot ulcer with osteomyelitis is notorious with its complexity and healing difficulties. Bone biopsy is considered to be the gold standard method of guidance for antibiotic therapy. However, it is often replaced by cultures of ulcer swabs or by superficial samples because of the technical difficulties and possible adverse events. In this study, we compared microbiologic results of bone biopsy with those of superficial tissue biopsy or swab culture to investigate concordance and diagnostic value in bone involved diabetic foot ulcers. METHODS: This study involved 106 patients with diabetic foot ulcers who showed positive results in bone probing test. Tissue samples for microbiologic tests were collected from all the patients by using superficial cotton swab, superficial tissue biopsy, and bone biopsy. The microbiologic results of bone biopsy were compared with swab culture and superficial tissue biopsy statistically. RESULTS: The positive predictive value of bone probing test for underlying osteomyelitis was 82.1%. Microbiology of the bone biopsy showed same results with those of the swab culture and superficial tissue in 64% and 63%, respectively. Statistical analysis demonstrated that the microbiology of the swab culture or superficial tissue did not coincide with that of the bone biopsy. CONCLUSION: These results suggest that the microbiologic results of superficial tissue or swab culture do not coincide with those of bony tissue. To select appropriate antibiotic regimen for diabetic ulcer with bone involvement, the specimen for the microbiologic test should be obtained from involved bone.
Biopsy ; Diabetic Foot ; Humans ; Osteomyelitis ; Ulcer

PURPOSE: The most common cause of plantar ulceration is an excessive plantar pressure in patients with peripheral neuropathy. Foot orthosis and therapeutic footwear have been used to decrease the plantar pressure and prevent the plantar ulceration in in diabetes patients. We investigated whether protective sock with functional insoles reduce plantar pressure while walking in 17 diabetes patients. METHODS: An in-shoe measurement device was used to measure the peak plantar pressure while walking. Peak plantar pressure data were collected while walking under two conditions: 1) wearing diabetic sock and 2) wearing the protective sock with functional insoles. Each subject walked 3 times in 10-m corridor under three conditions, and data were collected in 3 steps in the middle of corridor with in right and left feet, respectively. Pared t-test was used to compare the peak plantar pressures in three plantar areas under these two conditions. RESULTS: The protective sock with functional insoles significantly reduced the peak plantar pressure on the lateral rearfoot, but significantly increased the peak plantar pressure on the middle forefoot, and medial midfoot (p < 0.05). However, there were not significant in medial and lateral forefoot, lateral midfoot, and medial rearfoot between diabetic sock and the protective sock conditions (p>0.05). CONCLUSION: The protective sock with functional insoles reduced plantar pressures in the rearfoot and supported the medial longitudinal arch. However, it is necessary to change the position of metatarsal pad in the insole design of forefoot area to prevent diabetic foot ulceration.
Diabetes Mellitus ; Diabetic Foot ; Foot Orthoses ; Foot Ulcer ; Foot* ; Humans ; Metatarsal Bones ; Peripheral Nervous System Diseases ; Ulcer ; Walking

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*