On diabetic foot, wound healing, amputation prevention, and the merger of consumer tech with medical devices
An email from Ben Lipsky brings new biomarker data — IL-17, IL-12p70, HMGB1, IL-8, CRP — that may be the strongest case yet for splitting "moderate" and "severe" diabetic foot infections in the IDSA and WIfI classification.
A new single-center study from the Netherlands quantifies the devastating outcomes of the diabetic foot attack: only 48.5% wound closure, 46% major amputation by 12 months, 26% one-year mortality, and 12-month amputation-free survival of just 39.7%. Time is tissue.
Screenshot Screenshot Screenshot Microsurgical limb salvage is one of the most complex, high-stakes interventions in modern reconstructive surgery. For patients with peripheral artery disease (PAD), the decision to proceed with free tissue transfer (FTT) is fraught with uncertainty—especially when calcified, fragile vessels may compromise flap viability from the outset. A new study by Felder and colleagues,... Continue Reading →
Miyake K, Kikuchi S, Uchida D, Doita T, Miyagawa S, Azuma N Understanding Pedal Circulation’s Role in CLTI Wound Healing In chronic limb-threatening ischemia (CLTI), achieving complete wound healing is critical for reducing morbidity and improving patient outcomes. Although the Global Limb Anatomic Staging System (GLASS) provides a robust framework for assessing CLTI severity, its... Continue Reading →
The Wound, Ischemia, and foot Infection (WIfI) classification system is a pivotal tool in assessing the severity of limb-threatening conditions, particularly in patients with peripheral artery disease (PAD) and diabetes. A recent study underscores the importance of restaging WIfI after initial vascular and podiatric interventions to effectively monitor patient progress and guide subsequent treatment strategies.... Continue Reading →
From JAMA Armstrong, Tan, Boulton, and Bus, JAMA. 2023;330(1):62-75. doi:10.1001/jama.2023.10578 In diabetic foot disease, tissue loss,ischemia, and infection frequentlyoverlap. However, one is frequentlymore dominant than the other atdifferent times in the life cycle of anacute-on-chronic event. Here, theamount of tissue loss, ischemia, andfoot infection can be ordinally gradedto help predict outcome and assist incommunicating a plan... Continue Reading →
This from our UK toe and flowmigos. It tends to add up WIfI, which is not entirely the way it was intended to work, but the simplicity and completeness of this form is pretty great. Enjoy.
Accuracy of the pedal acceleration time to diagnose limb ischemia in patients with and without diabetes using the WIfI classification Excellent work from Castro-Santos and coworkers. Accuracy of the pedal acceleration time to diagnose limb ischemia in patients with and without diabetes using the WIfI classification Introduction: Evaluation of limb hemodynamics using the ankle–brachial index... Continue Reading →
Presenting limb severity is associated with long-term outcomes after infrainguinal revascularization for chronic limb-threatening ischemia This from our toe and flowmigos at UCSF. Type of Research: Single-center retrospective cohort study Key Findings: Among 413 patients undergoing infrainguinal revascularization for CLTI, long-term risk of major amputation was associated with presenting WIfI stage (p<0.001). Autogenous vein bypass provided... Continue Reading →
Profs. DG Armstrong (USC) Noboyushi Azuma (Asahikawa University), Sanjay Misra (Mayo) and Elina Quiroga (University of Washington) joined chairs Profs. Michael Conte (UCSF), John White (Advocate) and Joseph Mills (Baylor College of Medicine) to review implementation of Global Vascular Guidelines in limb preservation. David G. Armstrong, Professor of Surgery and Director of the Southwestern Academic... Continue Reading →
