Toe and flow: Essential components and structure of the amputation prevention team

Rogers, Lee C.; Andros, George; Caporusso, Joseph M.; Harkless, Lawrence B.; Mills, Joseph L.; Armstrong, David G.

doi:10.1016/j.jvs.2010.06.004

Cited by 119 publications

(74 citation statements)

References 20 publications

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“…It is estimated that approximately 70% of such amputations are preventable. 15 These data suggest an important gap in the effective management of DFUs, which could be addressed with better preventative measures.…”

Section: %mentioning

confidence: 98%

Smarter Sole Survival: Will Neuropathic Patients at High Risk for Ulceration Use a Smart Insole-Based Foot Protection System?

Najafi

Ron

Enriquez

et al. 2017

J Diabetes Sci Technol

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Objective: This study examined adherence to alert-based cues for plantar pressure offloading in patients with diabetic foot disease. Method and Design: Participants (n = 17) with in diabetic foot remission (history of neuropathic ulceration) were instructed to wear a smart insole system (the SurroSense Rx, Orpyx Medical Technologies Inc, Calgary, Canada) over a three-month period. This device is designed to cue offloading to manage unprotected sustained plantar pressures in an effort to prevent foot ulceration. A successful response to an alert was defined as pressure offloading, which occurred within 20 minutes of the alert onset. Patient adherence, defined as daily hours of device wear, was determined using sensor data and patient questionnaires. Changes in these parameters were assessed monthly. Results: Patients demonstrating increased adherence over the course of the study received more alerts (0.82 ± 0.31 alerts/hour) than patients whose adherence did not improve (0.36 ± 0.46 alerts/hour, P = .156). By the final stages of the study, participants who had received at least one alert every two hours were more adherent with offloading than participants who received fewer alerts (52.5 ± 4.1% vs 24.7 ± 22.4%, P = .043). Furthermore, duration of time from alert generation to successful offloading was significantly greater in the group receiving fewer alerts. This was measured in the third month with an effect size Cohen’s d = 1.739, P = .043. Conclusion: The results suggest a minimum number of alerts (one every two hours) is required for patients with diabetic neuropathy to optimally respond to offloading cues from a smart insole system.

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Section: %mentioning

confidence: 98%

Smarter Sole Survival: Will Neuropathic Patients at High Risk for Ulceration Use a Smart Insole-Based Foot Protection System?

Najafi

Ron

Enriquez

et al. 2017

J Diabetes Sci Technol

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“…Many of the patients in these specialty centers, just as in cancer treatment centers, are enrolled in some form of clinical trial evaluating new and promising technologies. [26][27][28] Furthermore, the concept of "remission" care, rather than frank "prevention" is a more realistic notion and may assist in communicating the exceptionally high-risk status of these patients and also the commensurate importance for frequent follow-up. 29 …”

Section: The Way Forward: Teams and Technologymentioning

confidence: 99%

Diabetic Foot Ulcers and Vascular Insufficiency: Our Population Has Changed, but Our Methods Have Not

Armstrong

Cohen

Courric

et al. 2011

J Diabetes Sci Technol

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Abbreviations: (CI) confidence interval, (DFU) diabetic foot ulcer, (LEA) lower-extremity amputation, (PAD) peripheral arterial disease AbstractDiabetic foot complications are increasing in prevalence worldwide. Care and attention to these complications have improved greatly. Many advanced therapies are now being investigated or taken through final stages of clinical studies worldwide. However, the data upon which assumptions regarding morbidity, healing, and mortality have been based are grossly outdated. The purpose of this brief article is to report on current data regarding neuropathic and neuroischemic wounds and to propose that the latter category of advanced-stage diabetic foot wound may now be emerging as the most commonly encountered lesion in the developed world. Unfortunately, it is still systematically excluded from most clinical study criteria. Additionally, just as in the care of cancer, we call for therapy of these advanced-stage diabetic foot ulcers to be managed in similarly interdisciplinary centers where patients may have access to potentially beneficial clinical trials.

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“…Rogers et al used the expression "stairway to an amputation" for neuropathy and circulatory disturbances complicated by infection that eventually ends in amputation; they asserted the importance of a team approach between those performing the revascularization and those responsible for wound management. 1 Osteomyelitis is difficult to treat, and resection of infected bone will be needed in most cases. 24 Furthermore, if osteomyelitis is missed, the infection spreads proximally, and if it reaches the heel bone or another ankle-forming bone, major amputation is unavoidable.…”

Section: Infectionmentioning

confidence: 99%

Ulcer Healing After Peripheral Intervention

Azuma

Koya

Uchida

et al. 2014

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp panied by an increase in renal diseases, and the incidence of peripheral arterial disease (PAD) among dialysis patients is also increasing. In Japan, 50% of CLI patients have endstage renal disease (ESRD). 7 Furthermore, populations are aging rapidly in advanced countries; in other words, disease duration is increasing among DM and ESRD patients, in turn, increasing the risk of triggering and advancing arterial diseases. In this patient group, vascular disease is also accompanied by microangiopathy, which causes CLI with tissue loss.Analysis of the factors that impair the ulcer healing process in highly heterogeneous CLI patient groups is complicated. To establish a revascularization strategy after properly determining the healing vs. impairing factors, it is essential to gather ample data on post-revascularization ulcer healing. However, such reports are few, and even the guidelines do not provide revascularization procedural options from the viewpoint of ulcer healing.This review organized the reported factors that impair ulcer healing and identified those that clearly have a major effect on revascularization outcome and limb prognosis. We highlight the factors that are useful in planning revascularization strategies from the viewpoint of ulcer healing. dvancements in endovascular treatment (EVT) for critical limb ischemia (CLI) have enabled vascular surgeons, cardiologists and radiologists to participate in revascularization procedures. However, the number of experts in post-revascularization ulcer management has not caught up with the increasing number of revascularization procedures. Moreover, both education and knowledge regarding ulcer healing are insufficient for physicians performing revascularization. The treatment guideline for diabetic foot ulcers is well-established, 1 but evidence supporting strategies for the complete healing of ischemic ulcers after revascularization remains scant.Among the many studies that have reported limb salvage, complete ulcer healing was reported in only 17 studies (0.9%) according to a literature search from 1985 to 2005. 2 However, ulcer healing after revascularization is a major concern among patients, and the expected healing period is important in terms of health economics and the patient's quality of life (QOL). 3,4 Furthermore, information clarifying stubborn ulcers is meaningful for preventing the onset of ulcers and to educate the medical personnel who may potentially make an early discovery of such ulcers.In particular, there has been a tremendous worldwide increase in the number of patients with diabetes mellitus (DM) and the percentage of CLI patients with DM is increasing markedly, currently accounting for 70%. 5, 6 The increase in DM is accom- Complete ulcer healing is one of the most important goals of treatment for critical limb ischemia; however, it is still difficult to inform patients of the time to ulcer healing before performing revascularization. The tim...

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Toe and flow: Essential components and structure of the amputation prevention team

Cited by 119 publications

References 20 publications

Smarter Sole Survival: Will Neuropathic Patients at High Risk for Ulceration Use a Smart Insole-Based Foot Protection System?

Smarter Sole Survival: Will Neuropathic Patients at High Risk for Ulceration Use a Smart Insole-Based Foot Protection System?

Diabetic Foot Ulcers and Vascular Insufficiency: Our Population Has Changed, but Our Methods Have Not

Ulcer Healing After Peripheral Intervention

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