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Armstrong D.G.,University of Arizona | Andros G.,Amputation Prevention Center
International Wound Journal | Year: 2012

Because of changes in demography, non-communicable diseases cause more deaths worldwide than infectious disease for the first time in history. One of the most prevalent of these maladies is diabetes mellitus, which resulted in 4·6 million deaths in 2011. There will be approximately 552 million people with diabetes worldwide by 2030. For these patients, one of the most common severe complications will be a foot wound. Patients with diabetes have at least a 25% lifetime risk of developing a foot ulcer. Many of these infections go on to amputation. Those patients have a 50% mortality rate in the 5 years following the initial amputation. Indeed, these problems are costly as well. In 2010, spending on diabetes was estimated to account for 11·6% of the total health care expenditure in the world. This review merges scientific evidence with expert experience to show the role of negative pressure wound therapy using reticulated open cell foam (V.A.C.® Therapy, KCI USA, Inc., San Antonio, TX) in limb preservation. © 2012 The Authors. International Wound Journal © 2012 Blackwell Publishing Ltd and Medicalhelplines.com Inc. Source


Schaper N.C.,CAPHRI Institute | Andros G.,Amputation Prevention Center | Apelqvist J.,Skane University Hospital | Bakker K.,IWDGF | And 7 more authors.
Diabetes/Metabolism Research and Reviews | Year: 2012

The International Working Group on the Diabetic Foot (IWDGF) has produced in 2011 a guideline on the diagnosis and treatment of peripheral arterial disease in patients with diabetes and a foot ulcer. This document, together with a systematic review that provided the background information on management, was produced by a multidisciplinary working group of experts in the field and was endorsed by the IWDGF. This progress report is based on these two documents and earlier consensus texts of the IWDGF on the diagnosis and management of diabetic foot ulcers. Its aim is to give the clinician clear guidance on when and how to diagnose peripheral arterial disease in patients with diabetes and a foot ulcer and when and which treatment modalities should be considered, taking both risks and benefits into account. © 2012 John Wiley & Sons, Ltd. Source


Najafi B.,Rosalind Franklin University of Medicine and Science | Crews R.T.,Rosalind Franklin University of Medicine and Science | Armstrong D.G.,University of Arizona | Rogers L.C.,Amputation Prevention Center | And 2 more authors.
Gait and Posture | Year: 2010

The joint deformity that arises as a result of Charcot neuroarthropathy, leads to gait modification. Ulceration risk associated with the deformity is generally assessed by measuring plantar pressure magnitude (PPM). However, as PPM is partially dependent on gait speed and treatment interventions may impact speed, the use of PPM to validate treatment is not ideal. This study suggests a novel assessment protocol, which is speed independent and can objectively (1) characterize abnormality in dynamic plantar loading in patients with foot Charcot neuroarthropathy and (2) screen improvement in dynamic plantar loading after foot reconstruction surgery. To examine whether the plantar pressure distribution (PPD) measured using EMED platform, was normal, a customized normal distribution curve was created for each trial. Then the original PPD was fitted to the customized normal distribution curve. This technique yields a regression factor (RF), which represents the similarity of the actual pressure distribution with a normal distribution. RF values may range from negative 1 to positive 1 and as the value increases positively so does the similarity between the actual and normalized pressure distributions. We tested this novel score on the plantar pressure pattern of healthy subjects (N = 15), Charcot patients pre-operation (N = 4) and a Charcot patient post-foot reconstruction (N = 1). In healthy subjects, the RF was 0.46 ± 0.1. When subjects increased their gait speed by 29%, PPM was increased by 8% (p < 10-5), while RF was not changed (p = 0.55), suggesting that RF value is independent of gait speed. In preoperative Charcot patients, the RF < 0, however, RF increased post-surgery (RF = 0.42), indicating a transition to normal plantar distribution after Charcot reconstruction. © 2009 Elsevier B.V. All rights reserved. Source


Rogers L.C.,Amputation Prevention Center | Rogers L.C.,Western University of Health Sciences | Frykberg R.G.,Podiatry Section
Medical Clinics of North America | Year: 2013

The Charcot foot or Charcot neuroarthropathy (CN) is a rare, but complex and often misdiagnosed complication of diseases causing peripheral neuropathy, like diabetes. Early recognition and treatment can prevent complications like ulcers and amputations. This article provides a review of the current evidence base and offers a pathway for treatment. © 2013 Elsevier Inc. Source


Mills Sr. J.L.,University of Arizona | Conte M.S.,University of California at San Francisco | Armstrong D.G.,University of Arizona | Pomposelli F.B.,St Elizabeths Medical Center | And 3 more authors.
Journal of Vascular Surgery | Year: 2014

Critical limb ischemia, first defined in 1982, was intended to delineate a subgroup of patients with a threatened lower extremity primarily because of chronic ischemia. It was the intent of the original authors that patients with diabetes be excluded or analyzed separately. The Fontaine and Rutherford Systems have been used to classify risk of amputation and likelihood of benefit from revascularization by subcategorizing patients into two groups: ischemic rest pain and tissue loss. Due to demographic shifts over the last 40 years, especially a dramatic rise in the incidence of diabetes mellitus and rapidly expanding techniques of revascularization, it has become increasingly difficult to perform meaningful outcomes analysis for patients with threatened limbs using these existing classification systems. Particularly in patients with diabetes, limb threat is part of a broad disease spectrum. Perfusion is only one determinant of outcome; wound extent and the presence and severity of infection also greatly impact the threat to a limb. Therefore, the Society for Vascular Surgery Lower Extremity Guidelines Committee undertook the task of creating a new classification of the threatened lower extremity that reflects these important considerations. We term this new framework, the Society for Vascular Surgery Lower Extremity Threatened Limb Classification System. Risk stratification is based on three major factors that impact amputation risk and clinical management: Wound, Ischemia, and foot Infection (WIfI). The implementation of this classification system is intended to permit more meaningful analysis of outcomes for various forms of therapy in this challenging, but heterogeneous population. © 2014 by the Society for Vascular Surgery. Source

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