The "1-4-4-2" Model for the Diabetic Foot Team.

The cause of diabetic foot complications is often multifactorial; therefore, expertise from multiple surgical and medical specialties is warranted for improved clinical outcomes. Teamwork should be carefully coordinated with strategic planning and treatment should be adaptable to the given clinical scenario. This article describes the formation and interplay of an effective multidisciplinary team for the treatment of the diabetic foot analogous to that seen in elite team sports.

Soft Tissue and Osseous Substitutes for the Diabetic Foot.

Several soft tissue and osseous substitutes have become widely available for consideration in diabetic foot and ankle reconstruction. Although autogenous skin and bone grafts remain the gold standard, the diabetic foot often presents with challenging clinical scenarios in which these options are limited or contraindicated. Selection of the appropriate substitute depends on the patient's medical status, type and extent of soft tissue and bone loss, and expected function of the given site. This article reviews several of the specific advanced orthobiologics and their clinical indications.

Relationship between alkaline phosphatase and all-cause mortality in peritoneal dialysis patients.

Elevated levels of serum alkaline phosphatase (AlkPhos) have been reported to be associated with increased mortality risk in hemodialysis (HD) patients. We examined the association of serum AlkPhos with all-cause mortality in our PD patients. The study enrolled 90 PD patients beginning in 1995. On enrollment, demographics and clinical and biochemical data were recorded. Patients were followed to September 2011. Mean age of the enrollees was 52 years, with 61% being women, and most (81%) being of African descent. Mean and median AlkPhos were 135 U/L and 113 U/L respectively. Mean and maximum follow-up were 2.61 and 16 years respectively. As expected, AlkPhos correlated directly with serum intact parathyroid hormone (r = 0.36, p = 0.003). In a Cox multivariate regression analysis with adjustment for confounding variables, AlkPhos as a continuous (relative risk: 1.016; p = 0.004) anda categorical variable [> 120 U/L and < or = 120 U/L (relative risk: 6.0; p = 0.03)] remained a significant independent predictor of mortality. For each unit increase in enrollment AlkPhos, there was a 1.6% increase in the relative risk of death. Elevated serum AlkPhos is significantly and independently associated with increased mortality risk in our PD patients followed for up to 16 years. AlkPhos should be evaluated prospectively as a potential therapeutic target in clinical practice.