Diabetic foot ulcers are one of the main complications of diabetes and frequently lead to amputation of the lower extremities. All patients with diabetes should be screened annually to establish their risk of foot ulceration. While foot ulcers affect almost 5% of the patients with diabetes, the cumulative lifetime incidence may be as high as 15%. The development of a foot ulcer usually result from a combination of neuropathy and tissue ischemia caused by peripheral artery disease. Other factors have been identified such as repetitive pressure loading on insensitive feet, previous foot ulcer or amputation of the other leg and poor glycemic control. An understanding of the risk factors for diabetic foot ulcer permits identification of individuals at high risk and prompt management is essential to prevent the development of a foot ulcer. Further studies are needed to establish the independent risk factors associated with diabetic foot ulceration.
Amputation ; Diabetic Foot ; Foot ; Foot Ulcer ; Humans ; Incidence ; Ischemia ; Leg ; Lower Extremity ; Peripheral Arterial Disease ; Risk Factors ; Ulcer

BACKGROUND: Some diabetic feet heal without complication, but others undergo amputation due to progressive wounds. This study investigates the risk factors for amputation of diabetic feet. METHODS: A total of 55 patients who visited our institution from 2008 to 2012 were included in the study. The patients with abnormal fasting blood sugar levels, lower leg vascularity, and poor nutrition were excluded from the study group, and the wound states were unified. The patients were categorized into a treatment success group (n=47) and a treatment failure group (n=8), and their hemoglobin A1C (HgA1C), C-reactive protein (CRP), white blood cell count (WBC), and serum creatinine levels were analyzed. RESULTS: The initial CRP, WBC, and serum creatinine levels in the treatment failure group were significantly higher than that of the treatment success group, and the initial HgA1C level was significantly higher in the treatment success group. The CRP and WBC levels of both groups changed significantly as time passed, but their serum creatinine levels did not. CONCLUSIONS: The initial CRP, WBC, and serum creatinine levels were considered to be risk factors for amputation. Among them, the serum creatinine level was found to be the most important predictive risk factor. Because serum creatinine represents the renal function, thorough care is needed for the feet of diabetic patients with renal impairment.
Amputation ; Blood Glucose ; C-Reactive Protein ; Creatinine ; Diabetes Complications ; Diabetic Foot ; Fasting ; Foot ; Foot Ulcer ; Hemoglobins ; Humans ; Leg ; Leukocyte Count ; Risk Factors ; Treatment Failure ; Ulcer

Background: Pyoderma gangrenosum is a rare ulcerative skin disease that can present as an ulcerative skin disease with the prominence of pain. The pathogenesis may be related to disruptions in the immune pathways. Targeted therapy is lacking and current treatment is largely empirical and consists of corticosteroids and cyclosporine first line. Early recognition can improve clinical outcomes. Case: This case is a 67-year-old male diabetic who was admitted for a progressive ulcerative lesion on the right leg. Arterial Doppler studies and CT angiogram of the right lower extremity were normal. Blood and deep wound cultures of the lesion showed Klebsiella pneumoniae and Pseudomonas aeruginosa. Multiple antibiotic regimens were given with no improvement of the ulcerating lesions of the leg. Pain on the lesion remained persistent. The tissue biopsy of the lesion taken during debridement revealed that it was a pyoderma gangrenosum with dystrophic sclerosis. Oral prednisone at 1 mg/kg was added to the regimen which improved pain but the lesion did not improve. The persistence of the pain and progression to sepsis during the hospital course prompted the decision to do an above-knee amputation of the right leg. He was discharged improved. Conclusion Pyoderma gangrenosum is a rare non-infectious cause of an ulcerative lesion in the lower extremity. Diabetes is a strong risk factor for this disease. The course is prolonged with the possibility of secondary infections. Upon histopathologic confirmation, an anti-inflammatory regimen could help improve outcomes.
Pyoderma Gangrenosum ; Diabetic Foot ; Leg Ulcer ; Inflammation ; Anti-Bacterial Agents ; Amputation, Surgical

PURPOSE: A reverse sural artery flap is a useful method for the soft tissue coverage of the lower leg, around the foot and ankle. We present our experience with the reverse sural artery flap for the coverage of a soft tissue defect due to ulceration, necrosis, and trauma in diabetic patients. MATERIALS AND METHODS: We treated 5 diabetic patients who showed soft tissue defects around their lower leg, foot and ankle. The causes of the soft tissue defect were an ulcer and infection in 4 cases, and trauma in 1 case. The sites of the soft tissue defect were around the ankle in 2 cases. In the other cases, the defect site were the lower third of the leg, the hind foot, the foot dorsum. The mean follow up period was 12.4 months. The size of the soft tissue defect ranged from 4 x 3 cm to 15 x 10 cm. RESULTS: All the flaps survived. The donor site was covered with a split thickness skin graft. There was no recurrence of the soft tissue defect during the follow-up period. Conclusion: The reverse sural artery flap is a valuable method for covering certain types soft tissue defect of foot and ankle in diabetic patients.
Ankle* ; Arteries* ; Diabetic Foot ; Follow-Up Studies ; Foot* ; Humans ; Leg ; Necrosis ; Recurrence ; Skin ; Tissue Donors ; Transplants ; Ulcer

We report a patient who presented with three months of foot pain, lytic navicular bone lesions in the foot, and a painless ipsilateral leg skin ulcer. Bone and skin biopsies revealed organisms compatible with Blastomyces. Systemic blastomycosis is very rare, especially with bone involvement in the foot.
Biopsy ; Blastomyces ; Blastomycosis* ; Foot* ; Humans ; Leg ; Skin ; Skin Ulcer

PURPOSE: To validate the Cardiff Wound Impact Schedule (CWIS) to assess the health-related quality of life (HRQoL) of Sri Lankan patients with diabetic leg and foot ulcers. METHODS: English version of CWIS was examined for cultural compatibility, translated into Sinhala and pretested. The Sinhala versionwas administered in parallel with the validated Sinhala version of SF-36 by an interviewer to all patients (n = 140) at baseline to determine the construct validity. Reliability of CWIS was measured by internal consistency and test-retest stability. The instrument was readministered in 2 weeks on 33 patients with nonhealing ulcers to determine the test-retest stability and in 3 months on 50 patients with healed ulcers to determine the ability of CWIS to discriminate HRQoL between patients with healed versus nonhealed ulcers. Acceptability of CWIS was assessed by the response rate, completion rate and the average time taken to complete a single interview. RESULTS: The construct validity demonstrated moderately significant correlations between related subscales of CWIS and SF-36 (Spearman's r = .32–.51, p = .021 to p < .001) for the whole study sample. Internal consistencies (Cronbach α = .68–.86) and test-retest stability (.56–.70) were acceptable. The tool was sensitive in discriminating the impact of the wound on HRQoL in healed versus nonhealed status (p ≤ .001). The tool showed good acceptability. CONCLUSIONS: The Sinhala version of CWIS is valid, reliable and acceptable for assessing the impact of wound on HRQoL. This instrument is sensitive in detecting the differences of the impact of healed and nonhealed ulcers on QoL in patients with diabetic leg and foot ulcer.
Adult ; Aged ; Cross-Cultural Comparison ; Cross-Sectional Studies ; Diabetic Angiopathies/*diagnosis/ethnology ; Diabetic Foot/diagnosis/ethnology ; Female ; Humans ; Leg Ulcer/*diagnosis/ethnology ; Male ; Middle Aged ; Quality of Life ; Reproducibility of Results ; Severity of Illness Index ; Sri Lanka/ethnology ; Surveys and Questionnaires

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

OBJECTIVETo investigate the optimal operation method for the management of various chronic wounds in legs and feet.

METHODSFifty-one chronic wounds were evaluated according to infection, inflammatory response, and distribution in different areas of the leg and foot. Preoperative treatment was given accordingly, then transposition of skin flap, skin grafting, or amputation was performed. The healing rate after single session operation and average hospitalization were statistically analyzed.

RESULTSThe wound healing rate after single session operation was 86. 3% , the average hospital stay was (17. 8 +/- 2. 1) days, and the appearance and function of the leg and foot after operation was satisfactory.

CONCLUSIONThe appropriate preoperative treatment and operation method conforming to the wound location and evaluation are of vital importance in the management of chronic wounds in the leg and foot. Operation is one of the most effective ways to repair chronic wounds in the leg and foot, and it can shorten the wound healing process and restore the function.

Adult ; Chronic Disease ; Foot Ulcer ; pathology ; surgery ; Humans ; Leg Ulcer ; pathology ; surgery ; Longevity ; Male ; Surgical Flaps ; Wound Healing

A 47-year-old male patient presented us with erythematous, telangiectatic, purpuric or hyperpigmented patqhes, recurrent painful ulceration and ivory white atrophic scars on the lower portions of his legs, ankles and dorsal surfaces of both feet exacerbating on every summer for 5 years. The histopathalogical findings of an atrophic patch showed endothelial proliforetiion, partial occlusion of the dermal capillaries and fibrinoid material) on the superficial blood vessels, This patient was treated with aspirin and dipyriclamole for 4 months, and the skin lesions were improved significantly.
Ankle ; Aspirin ; Blood Vessels ; Capillaries ; Cicatrix ; Foot ; Humans ; Leg ; Male ; Middle Aged ; Skin ; Ulcer ; Vasculitis*

Livedo reticularis with summer ulceration was first reported by Feldaker et al in 1955, that is characterized by livedo reticularis and ulcerations of the legs or feet beginning primarily the summer or warmer months of the year, and healing the winter months. A 32-year old rnan has suffered from periodic painful ulcerations, which were occurred during the summer, on the both ankles and brown to bluish colored reticulated discoloration on the lower legs for about 10 years. Histopathological findings showed endothelial proliferation and partial occlusion of the dermal capillaries, fibrinoid material on the superficial blood vessels, and partial epidermal necrolysis. This patient. was treated with antiplatelet aggregating medications and antihypertensive drug.
Adult ; Ankle ; Blood Vessels ; Capillaries ; Foot ; Humans ; Leg ; Livedo Reticularis* ; Ulcer*