Medicine and Health Sciences Commons^™

Diabetic Foot Wound Care, Richard Q. Vuong

Family Medicine Clerkship Student Projects

Diabetic foot wound care educational pamphlet developed during the family medicine rotation for 3rd-year medical students. This project was developed in Brookfield, CT.

Retrospective Cohort Evaluating The Comparative Effectiveness Of Ceftaroline And Daptomycin As First-Line Therapies For Inpatient Treatment Of Diabetic Foot Infection In The United States Veterans Health Care System, Alyssa C. Eaves, Chengwen Teng Pharm.D., Ph.D., Kirk E. Evoy, Christopher R. Frei

Faculty Publications

Background Both ceftaroline and daptomycin are possible therapeutic options for diabetic foot infection (DFI) and both are active against methicillin-resistant Staphylococcus aureus (MRSA) infection; however, no previous studies have evaluated their efectiveness head-to-head.

Objective This study compared hospital readmission and mortality proportions among patients receiving ceftaroline fosamil or daptomycin for DFI.

Patients and Methods This was a retrospective cohort, comparative efectiveness study of adults (aged ≥ 18 years) admitted to United States Veterans Health Care System hospitals with a diagnosis code for DFI between 1 October 2010 and 30 September 2014 with an electronic order for ceftaroline or daptomycin as …

Deteriorated Regional Calf Microcirculation Measured By Contrast-Free Mri In Patients With Diabetes Mellitus And Relation With Physical Activity, Jie Zheng, Christopher Sorensen, Ran Li, Hongyu An, Charles F Hildebolt, Mohamed A Zayed, Michael J Mueller, Mary K Hastings

2020-Current year OA Pubs

OBJECTIVE: To evaluate regional calf muscle microcirculation in people with diabetes mellitus (DM) with and without foot ulcers, compared to healthy control people without DM, using contrast-free magnetic resonance imaging methods.

METHODS: Three groups of subjects were recruited: non-DM controls, DM, and DM with foot ulcers (DM + ulcer), all with ankle brachial index (ABI) > 0.9. Skeletal muscle blood flow (SMBF) and oxygen extraction fraction (SMOEF) in calf muscle were measured at rest and during a 5-min isometric ankle plantarflexion exercise. Subjects completed the Yale physical activity survey.

RESULTS: The exercise SMBF (ml/min/100 g) of the medial gastrocnemius muscle were …

Should Weight-Bearing Activity Be Reduced During Healing Of Plantar Diabetic Foot Ulcers, Even When Using Appropriate Offloading Devices?, Gustav Jarl, Jaap J Van Netten, Peter A Lazzarini, Ryan T Crews, Bijan Najafi, Michael J Mueller

2020-Current year OA Pubs

Physical activity is an essential part of general health and diabetes management. However, recommending weight-bearing physical activity for people with plantar diabetic foot ulcers is controversial, even when gold standard offloading devices are used, as it is commonly thought to delay healing. We aimed to narratively review relevant studies investigating the relationship between plantar diabetic foot ulcer healing and weight-bearing activity, plantar pressure and device adherence. We defined relevant studies as those from two systematic reviews, along with those identified since using a similar updated Pubmed search strategy. We identified six studies. One study found that more daily steps were …

Implementation Of An Electronic Alert For Improving Adherence To Diabetic Foot Exam Screenings In Type 2 Diabetic Patients In Primary Care Clinics, Ruby Denson

Student Scholarly Projects

Practice Problem: Patients with type 2 diabetes mellitus (T2DM) are at an increased risk of complications including foot ulcerations (Harris-Hayes et al., 2020). Preventive care is essential for the early detection of foot ulcers but despite the advantages of preventive screening, a limited number of primary care providers perform annual foot exams (Williams et al., 2018).

PICOT: The clinical question that guided this project was, “In adult patients with T2DM receiving care in a primary care setting, will the implementation of an electronic clinical reminder alert (ECR) increase provider adherence to performing an annual diabetic foot exam and risk …

Surgical Management Of Diabetic Foot And Ankle Infections., Claire M Capobianco, John Stapleton, Thomas Zgonis

John J Stapleton DPM, FACFAS

Delayed treatment of any diabetic foot infection can lead to a limb- or life-threatening scenario. Urgent and/or emergent surgery may be necessary in the early diagnosis of a severe diabetic foot infection that is followed by staged reconstructive procedures. This article provides the reader with a thorough understanding of the surgical management of severe diabetic foot infections and describes and guides treatment based on a rational schematic approach that identifies the anatomic location of the diabetic foot infection.

Split-Thickness Skin Grafts For Closure Of Diabetic Foot And Ankle Wounds: A Retrospective Review Of 83 Patients., Crystal L Ramanujam, John Stapleton, Krista L Kilpadi, Roberto H Rodriguez, Luke C Jeffries, Thomas Zgonis

John J Stapleton DPM, FACFAS

The aim of this study was to determine if split-thickness skin grafts could be successfully used for closure of foot and ankle wounds in diabetic patients. The authors retrospectively reviewed the charts of 100 consecutive patients who underwent a soft tissue surgical reconstruction with split-thickness skin grafts to their foot and/or ankle in our institution from 2005 to 2008. After application of inclusion criteria, 83 eligible charts remained. Of the 83 patients, 54 (65%) healed uneventfully, 23 (28%) required regrafting, and 6 (7%) had a complication resolved with conservative management. All patients had a successful surgical outcome, defined as having …

Soft Tissue Reconstruction Pyramid In The Diabetic Foot., Claire M Capobianco, John Stapleton, Thomas Zgonis

John J Stapleton DPM, FACFAS

Foot complications and ulceration are well-known sequelae to uncontrolled diabetes. Patients with chronic foot ulcers or wounds resulting from surgical debridement of deep-space infections are at continued risk for development of osteomyelitis and potential amputation. Moreover, these wounds often necessitate multiple outpatient clinic visits, daily dressing care, and prolonged periods of non-weight bearing, all of which have been shown to adversely affect the patient's quality of life. After a prudent period of wound-healing response, the authors believe that early and aggressive soft tissue reconstruction is in the patient's best interest and is crucial for resolution of the chronic nonhealing wound. …

Advanced Plastic Surgery Techniques For Soft Tissue Coverage Of The Diabetic Foot., Thomas Zgonis, John Stapleton, Thomas S Roukis

John J Stapleton DPM, FACFAS

Obtaining stable, durable, and functional wound closure of a diabetic foot wound or open pedal amputation through plastic surgical techniques is essential to limit the potential for repeated ulceration, infection, and "supra-pedal" amputation. Myriad conservative and surgical techniques can be used to obtain wound closure. The authors discuss their approach and present operative pearls for their most commonly employed plastic surgical techniques to provide adequate soft tissue coverage of diabetic foot wounds. Emphasis is placed on the techniques necessary to perform these procedures and the surgical thought process involved in closing diabetic foot wounds.

Plastic Surgery Reconstruction Of The Diabetic Foot., Thomas Zgonis, John Stapleton, Roberto H Rodriguez, Valerie A Girard-Powell, Douglas T Cromack

John J Stapleton DPM, FACFAS

Soft tissue reconstruction of the diabetic foot is a challenge for the perioperative team. Primary closure may not be an option and secondary healing may not be reliable. Therefore, surgery is vital and should be coordinated among a well-functioning multidisciplinary team that specializes in caring for patients with diabetes mellitus. Team members must have expertise in reconstructive surgery to ensure adequate wound healing. This article emphasizes the appropriate timing and staging of surgery, discusses the most common plastic surgery techniques, and underscores the importance of a team approach in the management of diabetic foot wounds.

Surgical Treatment Of Charcot Neuropathy., Thomas Zgonis, John Stapleton, Luke C Jeffries, Valerie A Girard-Powell, Lynanne J Foster

John J Stapleton DPM, FACFAS

Charcot neuroarthropathy, a chronic progressive destruction of joint integrity, is believed to result from a disturbance in pain and proprioceptive sensation. It is most commonly treated in patients with uncontrolled diabetes mellitus and dense peripheral neuropathy. Prevention, early diagnosis, and early treatment are key to a patient's successful outcome. Educating the patient is paramount to avoid further complications and subsequent amputations. This article describes the pathophysiology, staging, surgical treatment, and natural course of Charcot neuroarthropathy.

Diabetic Lisfranc Fracture-Dislocations And Charcot Neuroarthropathy., Bradley A Levitt, John Stapleton, Thomas Zgonis

John J Stapleton DPM, FACFAS

The goal with Lisfranc fracture-dislocations is to regain joint congruity and reestablish midfoot stability to avoid debilitating posttraumatic arthrosis and chronic pain in the sensate patient. In the diabetic population, dense peripheral neuropathy and/or vascular disease are equally important and may alter the surgical approach to traumatic tarsometatarsal injuries. The initial diagnosis in the diabetic population may be delayed due to subtle radiographic findings and/or patient unawareness of trauma in the insensate foot. Failure to initiate treatment in the early stages of acute diabetic neuropathic Lisfranc injuries can predispose the patient to midfoot instability, potential ulceration, infection, and Charcot neuroarthropathy.

Combined Lateral Column Arthrodesis, Medial Plantar Arteryflap, And Circular External Fixation For Charcot Midfoot Collapse With Chronic Plantar Ulceration., Thomas Zgonis, Thomas S Roukis, John Stapleton, Douglas T Cromack

John J Stapleton DPM, FACFAS

No abstract provided.

Surgically Induced Charcot Neuroarthropathy Following Partial Forefoot Amputation In Diabetes., T Zgonis, John Stapleton, N Shibuya, T S Roukis

John J Stapleton DPM, FACFAS

No abstract provided.

A Stepwise Approach To The Surgical Management Of Severe Diabetic Foot Infections., Thomas Zgonis, John Stapleton, Thomas S Roukis

John J Stapleton DPM, FACFAS

Foot infections are common among diabetic patients with ulceration and are a major cause of hospitalization and lower extremity amputation. Aggressive and emergent surgical intervention is essential in the face of life- or limb-threatening infection to achieve limb salvage and survival. Critical limb ischemia, neuropathy, and an impaired host complicate the treatment of a severe diabetic foot infection. A severe diabetic foot infection carries a 25% risk of major amputation. For this reason, surgery should be coordinated with a well-functioning multidisciplinary team that specializes in diabetic limb preservation. Timing of surgery and strategies employed should be understood and agreed on …

Surgical Management Of Diabetic Foot Infections And Amputations., Thomas Zgonis, John Stapleton, Valerie A Girard-Powell, Ryan T Hagino

John J Stapleton DPM, FACFAS

The incidence of diabetes with severe foot infections (eg, necrotizing fasciitis, gas gangrene, ascending cellulitis, infection with systemic toxicity or metabolic instability) has risen significantly during the past decade. Foot infections are a major cause of hospitalization and subsequent lower extremity amputation among patients with diabetes mellitus who have a history of a preexisting ulceration. Surgical management often is required to address severe diabetic foot infections because they can be limb- or life-threatening. Critical limb ischemia, neuropathy, and an immunocompromised host, which often are associated with diabetic foot infections, complicate treatment and are associated with a poorer prognosis.

A Case Report Of A Double Advancement Flap Closure Combined With An Ilizarov Technique For The Chronic Plantar Forefoot Ulceration., Ronald Belczyk, John Stapleton, Thomas Zgonis

John J Stapleton DPM, FACFAS

Soft tissue closure of defects on the plantar surface of the foot continues to be a challenge for the reconstructive surgeon secondarily to the limited number of surgical options and often difficulty of replacing durable and similar soft tissue coverage. Primary closure and skin grafting may not be suitable for the weight-bearing surfaces of the plantar forefoot area, and closure may then be obtained by other means of plastic surgery techniques.

Surgical Reconstruction Of The Diabetic Charcot Foot: Internal, External Or Combined Fixation?, John Stapleton, Thomas Zgonis

John J Stapleton DPM, FACFAS

Charcot neuroarthropathy of the foot and ankle is a devastating neuropathic complication that can eventually lead to a lower extremity amputation in the presence of an ulceration or infection. Current surgical approaches for the management of the diabetic Charcot foot and ankle deformities are largely based on expert opinions in various fixation methods attempting to avoid major postoperative complications. The goal of this article is to discuss the advantages and disadvantages of various internal, external, or combined fixation methods as they relate to the inherent challenges in the management of the diabetic Charcot foot.

Plantar Foot Donor Site As A Harvest Of A Split-Thickness Skin Graft., Ronald Belczyk, John Stapleton, Peter A Blume, Thomas Zgonis

John J Stapleton DPM, FACFAS

The authors present a minimally invasive procedure for harvesting a split thickness skin graft (STSG) from the plantar surface of the foot. This is another option to consider for soft tissue reconstruction of diabetic foot wounds to help restore form and function and to prevent amputation. The authors do not recommend this technique for all soft tissue wounds of the toes and plantar aspect of the foot but believe it is a viable option for selected small diabetic foot wounds that may benefit from a STSG.

Advanced Foot And Ankle Fixation Techniques In Patients With Diabetes., Nicholas J Bevilacqua, John Stapleton

John J Stapleton DPM, FACFAS

This article presents advanced techniques and current fixation constructs that are advantageous for the management of diabetic foot and ankle trauma and Charcot neuroarthropathy. Both these pathologies are often intimately related, and the fixation constructs that are required often require sound biomechanical concepts coupled with innovative approaches to achieve bone healing and limb salvage.

Addressing Psychosocial Aspects Of Care For Patients With Diabetes Undergoing Limb Salvage Surgery., Thomas S Roukis, John Stapleton, Thomas Zgonis

John J Stapleton DPM, FACFAS

Surgeons provide a key role in improving the life of patients with diabetes-related foot complications who undergo limb salvage surgery as an alternative to amputation. An integrated multidisciplinary approach is essential to improve the emotional well-being of these patients to avoid potential complications that may prolong their convalescence and further degrade their psychosocial welfare. The authors attempt to increase awareness of critical preoperative risk factors that should be obtained by a thorough comprehensive psychosocial evaluation. In addition, this article discusses how to interact with the patient and his or her family throughout the perioperative period, assisting the patient in managing …