<p>Limb Salvage and Prevention of Ulcer Recurrence in a Chronic Refractory Diabetic Foot Osteomyelitis</p>

Abstract

Biomechanical changes caused by structural foot deformities predispose patients to plantar ulceration. Plantar ulcer recurrence often leads to osteomyelitis, which is more commonly observed in patients with diabetes. Once the infection of diabetic foot ulcer (DFU) spreads and is complicated by osteomyelitis, treatment becomes more complicated and difficult. Osteomyelitis treatment remains challenging because of low drug concentration within the tissue caused by poor circulation and inadequate localized nutrition. Moreover, tissues around plantar ulcers are fewer and are thin, making the formation of granulation tissues difficult due to elevated plantar pressure. Furthermore, the skin around the wound is excessively keratinized, and the epidermis is hard to regenerate. Meanwhile, skin grafting at that site is often not successful due to poor blood circulation. Therefore, it is technically challenging to manage diabetic pressure plantar ulcer with osteomyelitis and prevent its recurrence. Here, we present a case of chronic DFU complicated by osteomyelitis due to foot deformity. The ulcer was successfully healed using advanced wound repair technology comprising of surgical bone resection, vancomycin-loaded bone cement implant, negativepressure wound therapy, and autologous platelet-rich gel. Subsequently, preventive foot care with custom-made offloading footwear was prescribed. The plantar ulcer did not recur and improvement in biomechanical parameters was observed after the intervention. This case represents an effective and comprehensive management strategy for limb salvage and prevention in patients with complicated foot conditions.

The Evaluation of Gait and Balance for Patients with Early Diabetic Peripheral Neuropathy: A Cross-Sectional Study

“… 14 This system is equipped with a triaxial accelerometer and gyroscope that estimates temporal gait, balance, and spatial parameters described in our previous study. 8 It generates digitized signals at a frequency of 100 Hz, which is transmitted in real-time via Bluetooth to a laptop. The participants were assessed on multiple static, dynamic parameters of gait and balance.…”

Comparison and Investigation of Exosomes Derived from Platelet-Rich Plasma Activated by Different Agonists

“…PRP has been widely used in the field of repair and regeneration, including in chronic tendinitis 2 , osteoarthritis 3 , chronic wounds 4 , and plastic surgeries 5 . A series of our previous studies on PRP treatment has revealed positive effects on wound healing in patients with diabetic foot ulcers 6 – 9 . The basic cytokines identified in platelets include transforming growth factor-β (TGF-β), platelet-derived growth factor (PDGF), basic fibroblast growth factor (bFGF), vascular endothelial growth factor (VEGF), and endothelial cell growth factor.…”

Custom-Molded Offloading Footwear Effectively Prevents Recurrence and Amputation, and Lowers Mortality Rates in High-Risk Diabetic Foot Patients: A Multicenter, Prospective Observational Study

“…Results from our previous study, in which we explored use of offloading device in neuropathic diabetic foot, revealed that the device changed plantar biomechanics using wearable sensor technology. 8,25 Notably, this offloading therapy significantly improved clinical outcomes in these patients although one case who underwent IOT presented with recurrence during interruption of the therapy. 8 In the current study, we further explored the effects of interrupting offloading therapy on recurrence and mortality rates in high-risk diabetic foot patients.…”