Comparison of Doppler and CT Angiography as a Predictor of Healing Diabetic Foot Ulcers

PURPOSE: Adequate tissue oxygenation is considered as an essential factor for wound healing. In the non- diabetic population, an uncompromised macrocirculation generally leads to adequate tissue oxygenation. On the contrary, the macrocirculation in diabetic patients may not correlate with tissue oxygenation because of structural changes in the capillary basement membrane. Nevertheless, many medical professionals in Korea rely on macrocirculation evaluation when predicting wound healing potential of the diabetic ulcers. The purpose of this study is to compare reliability of two common macrocirculation assessment methods, Doppler probing and CT angiography, on tissue oxygenation in diabetic foot patients. METHODS: Doppler and CT angiography scores were given according to the patency of the anterior and posterior tibial arteries. Tissue oxygenation was measured by transcutaneous partial oxygen tension(TcpO2). Doppler and CT angiography scores were statistically analyzed against TcpO2 values. Sixty-eight diabetic foot ulcer patients were included in this study. RESULTS: The test was carried out on Doppler score and TcpO2 variables displayed a p-value of 0.0202, and concluded that the two variables were statistically dependent. The test used to determine for linear trends between Doppler scores and TcpO2 variables displayed a p-value of 0.0149, displaying statistical linear trend between the two variables. On the contrary, the tests between CT angiography scores and TcpO2 variables showed p-values of 0.1242 and 0.6590, that means no correlation between CT angiography and TcpO2 scores. CONCLUSION: Doppler probing is more reliable than CT angiography in predicting tissue oxygenation of diabetic foot ulcers.

Anatomy of Pitanguy's Dermocartilaginous Ligament

PURPOSE: Pitanguy conducted a series of anatomical studies on "dermocartilaginous ligament" of the nose. However, information on its structure is as yet insufficient, especially in terms of its origin, insertion, and relationships with surrounding tissues. In addition, some of the histologic findings described by Pitanguy are controversial. The present study was undertaken to clarify the anatomy of the "dermocartilaginous ligament". METHODS: Sixteen cadaver noses were examined macroscopically and histologically to determine the presence, origin, insertion, composition, and relationship of the "dermocartilaginous ligament" with surrounding structures. RESULTS: The structure originated from the deep layer of the transverse nasalis muscle and terminated at the caudal edge of the septal cartilage in all 16 cadavers. However, in three cadavers the insertion extended to the orbicularis oris muscle. No direct connection was found between the structure and dermis of dorsal nasal skin. The dermocartilaginous ligaments were mainly composed of a condensation of thin collagen bundles, which were interwoven and without any regular orientation. Elastic fibers were also present in small numbers, and there were few amorphous ground substances. Neither muscle fibers nor chondrocytes was identified within dermocartilaginous ligaments. CONCLUSION: Our macroscopic and histologic findings of the structure do not support the use of the term "dermocartilaginous ligament". According to its origin, insertion, and histologic findings, we recommend that this structure be referred to as the "median musculocartilaginous fascia".