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  • 1
    Online Resource
    Online Resource
    Necrotizing Soft-Tissue Infections in the Feet of Patients With Diabetes: Outcome of Surgical Treatment and Factors Associated With Limb Loss and Mortality
    SAGE Publications ; 2009
    In:  The International Journal of Lower Extremity Wounds Vol. 8, No. 3 ( 2009-09), p. 141-146
    Details
    In: The International Journal of Lower Extremity Wounds, SAGE Publications, Vol. 8, No. 3 ( 2009-09), p. 141-146
    Abstract: The aim of this study was to analyze the outcomes of treatment of necrotizing soft-tissue infections (NSTIs) in the feet of diabetic patients and to determine factors associated with limb salvage and mortality. A retrospective study of a consecutive series of 145 diabetic patients suffering from NSTIs treated in the Diabetic Foot Unit, La Paloma Hospital was done. NSTIs were classified as necrotizing cellulitis if it involved the subcutaneous tissue and the skin, as necrotizing fasciitis if it involved the deep fascia, and as myonecrosis in those cases where muscular necrosis was present. In the necrotizing cellulitis group (n = 109), 8 (7.3%) major amputations were performed. In the necrotizing fasciitis group (n = 25), 13 (52%) major amputations were undertaken. In the myonecrosis group (n = 11), 6 (54.5%) major amputations were performed. Predictive variables related to limb loss were fasciitis (OR = 20, 95% CI = 3.2-122.1) and myonecrosis (OR = 53.2, 95% CI = 5.1-552.4). Predictive variables of mortality were age 〉 75 years (OR = 10.3, 95% CI = 1.9-53.6) and creatinine values 〉 132.6 µmol/L (OR = 5.8, 95% CI = 1.1-30.2). NSTIs of the foot are an important cause of morbidity and mortality in diabetic patients.When fascia and/or muscle are involved, there are significant risks of major amputation.
    Type of Medium: Online Resource
    ISSN: 1534-7346 , 1552-6941
    URL: Article
    DOI: 10.1177/1534734609344106
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2009
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  • 2
    Online Resource
    Online Resource
    In-Hospital Complications and Mortality Following Major Lower Extremity Amputations in a Series of Predominantly Diabetic Patients
    SAGE Publications ; 2010
    In:  The International Journal of Lower Extremity Wounds Vol. 9, No. 1 ( 2010-03), p. 16-23
    Details
    In: The International Journal of Lower Extremity Wounds, SAGE Publications, Vol. 9, No. 1 ( 2010-03), p. 16-23
    Abstract: The purpose of this study was to analyze the outcomes of major lower extremity amputations (MLEAs) in a series, including diabetic patients, with the aim to study whether diabetes mellitus is a risk factor of in-hospital mortality and perioperative complications. A retrospective analysis of 283 MLEAs (221 of these patients were diabetic and 62 were nondiabetic) performed between January 1, 1998, and December 31, 2008, at the General Surgery Department and Diabetic Foot Unit of La Paloma Hospital in Las Palmas de Gran Canaria (Canary Islands) was done. The significant risk factors of mortality were 〉 " xbd="324" xhg="301" ybd="1481" yhg="1446"/ 〉 75 years of age (odds ratio [OR] = 4.1, 95% confidence interval [CI] = 1.4-11.7), postoperative cardiac complications (OR = 12.3, 95% CI = 3.7-40.2) and postoperative respiratory complications (OR = 3.8, 95% CI = 1.0-13.3). No statistically significant risk factors were found related to the presence of systemic and wound-related complications. In diabetic patients, the significant risk factors of mortality were postoperative cardiological complications (OR = 13.6, 95% CI = 3.1-59.6), postoperative respiratory complications (OR = 5.9, 95% CI = 1.0-35.5), and first episode of amputation (OR = 5.9, 95% CI = 1.4-24.3). There were no statistically significant differences in the outcome of major amputations between diabetic and nondiabetic patients. Hospital stay was significantly longer in diabetic patients ( P 〈 .01) though when the patients with diabetic foot infections were excluded, this difference was not found.
    Type of Medium: Online Resource
    ISSN: 1534-7346 , 1552-6941
    URL: Article
    DOI: 10.1177/1534734610361946
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2010
    detail.hit.zdb_id: 2135166-1
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  • 3
    Online Resource
    Online Resource
    Super-Oxidized Solution (Dermacyn Wound Care) as Adjuvant Treatment in the Postoperative Management of Complicated Diabetic Foot Osteomyelitis : Preliminary Experience in a Specialized Department
    SAGE Publications ; 2013
    In:  The International Journal of Lower Extremity Wounds Vol. 12, No. 2 ( 2013-06), p. 130-137
    Details
    In: The International Journal of Lower Extremity Wounds, SAGE Publications, Vol. 12, No. 2 ( 2013-06), p. 130-137
    Abstract: Surgery is usually used to treat diabetic foot osteomyelitis (DFO), whether primarily or in cases in which antibiotics are not able to control infection. In many cases, the bone is only partially removed, which means that residual infection remains in the bone margins, and the wound is left open to heal by secondary intent. The use of culture-guided postoperative antibiotic treatment and adequate management of the wound must be addressed. No trials exist dealing with local treatment in the postoperative management of these cases of complicated DFO. We decided to test a super-oxidized solution, Dermacyn Wound Care (DWC; Oculus Innovative Sciences Netherlands BV, Sittard, Netherlands) to obtain preliminary experience in patients in whom infected bone remained in the surgical wounds. Our hypothesis was that DWC could be useful to control infection in the residual infected bone and surrounding soft tissues and would thus facilitate healing. Fourteen consecutive patients who underwent conservative surgery for DFO, in whom clean bone margins could not be assured, were treated in the postoperative period with DWC. Eleven cases were located in the forefoot, 6 on the first ray and the rest in lesser toes, 1 in the Lisfranc joint, and 2 on the calcaneus. No side effects appeared during treatment. Neither allergies nor skin dermatitis were found. Limb salvage was successfully achieved in 100% of the cases. Healing was achieved in a median period of 6.8 weeks.
    Type of Medium: Online Resource
    ISSN: 1534-7346 , 1552-6941
    URL: Article
    DOI: 10.1177/1534734613476710
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2013
    detail.hit.zdb_id: 2135166-1
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