The Changes of Trends in the Diagnosis and Treatment of Diabetic Foot Ulcer over a 10-Year Period: Single Center Study

BACKGROUND: This study aims to describe the trends in the severity and treatment modality of patients with diabetic foot ulcer (DFU) at a single tertiary referral center in Korea over the last 10 years and compare the outcomes before and after the introduction of a multidisciplinary diabetic foot team. METHODS: In this retrospective observational study, electronic medical records of patients from years 2002 to 2015 at single tertiary referral center were reviewed. Based on the year of first admission, patients were assigned to a group either before or after the year 2012, the year the diabetes team launched. RESULTS: Of the 338 patients with DFU, 229 were first admitted until the year 2011 (group A), while 109 were first admitted since the year 2012 (group B). Mean age was higher in group B, and ulcer size was larger than those of group A. Whereas duration of diabetes was longer in group B, glycemic control was improved (mean glycosylated hemoglobin, 9.48% vs. 8.50%). The proportion of minor lower extremity amputation (LEA) was increased, but length of hospital stay was decreased (73.7±79.6 days vs. 39.8±36.9 days). As critical ischemic limb increased, the proportion of major LEA was not decreased. CONCLUSION: Improved glycemic control, multidisciplinary strategies with prompt surgical treatment resulted in reduced length of hospital stay, but these measures did not reduce major LEAs. The increase in critical ischemic limb may have played a role in the unexpected outcome, and may suggest the need for increased vascular intervention strategies in DFU treatment.

Flush High Ligation and Invaginated Stripping for Patients with Varicose Veins

PURPOSE: Flush high ligation of the saphenofemoral or saphenopopliteal junction combined with invaginated stripping of the greater saphenous vein to just below the knee or perforate invaginate stripping of the proximal lesser saphenous vein appears to be the method of choice for good clinical results and low incidence of damage to the saphenous or sural nerve, and is important in the prevention of recurrence. METHOD: From January 2001 to August 2001, we performed 84 operations for 72 patients with varicose veins. Among them, 77 flush high ligations (62 saphenofemoral and 15 saphenopopliteal) and 64 invaginated strippings (55 greater and 9 lesser saphenous veins) were performed. RESULT: Seventy seven flush high ligations were successfully performed in all patients, but 2 invaginated strippings were failed due to their large branches of greater saphenous veins. All of 9 proximal invaginated strippings for lesser saphenous veins were completely performed without any complications. As early postoperative complications related with invaginated strippings for greater saphenous veins, 24 (43.6%) cases of ecchymosis and 5 (9.1%) cases of paresthesia were occurred at thigh. One case of wound infection at popliteal fossa and 3 cases of wound inflammation at inguinal area were occurred. But those complications were recovered within 10 days. CONCLUSION: The results show that the invaginated stripping is very useful for patients with varicose veins, especially in stripping of lesser saphenous veins and the flush high ligation is safe for the treatment of junctional incompetence.