당뇨병성 족부궤양의 임상적 관찰

구본정,최대은,정진옥,나소영,이효진,홍우정,김군순,조영석,김도희,송민호,노흥규,김영건 대한당뇨병학회 2002 임상당뇨병 Vol.3 No.3

연구배경: 당뇨병의 유병률이 증가함에 따라 당뇨병의 만성합병증 또한 증가하고 있다. 당뇨병성 족부궤양은 하지절단의 원인이 되는 무서운 만성 합병증이다. 이러한 당뇨병성 족부궤양의 관리에는 예방 및 즉각적인 치료가 필수이다. 저자들은 당뇨병성 족부병변이 발생한 환자들의 임상적 특성을 알아보고, 예방과 적절한 치료지침을 세우는데 도움이 되고자 본 연구를 수행하였다. 방법: 2001년 1월부터 12월까지 충남대학교병원 내분비병동에 당뇨병성 족부궤양으로 입원한 총 73명의 환자들 대상으로 후향적으로 의무기록을 검토하였다. 결과 : 1. 당뇨병성 족부궤양으로 입원한 환자는 60대(38.4%)가 가장 많았으며, 남자(79.5%)에서 보다 많았다. 2. 당뇨병성 족부궤양으로 입원한 환자의 평균 당뇨병 유병기간은 14.6년이었다. 3. 족부궤양의 발생원인은 잘 모르는 경우(72.6%)가 대부분이었다. 4. 균배양검사에서는 Staphylococcus가 가장 많이 동정되었다. 5. Wagner법에 의한 족부궤양의 중등도 분류에서는 3등급(41.4%)이 가장 많았다. 6. 총 73명의 환자 중 63명(86.3%)은 내과적으로 성공적으로 치료하였으며, 9명의 환자는 하지 절단술을 시행받았다. 내과적으로 치료한 환자의 재원기간(약 25.1일)이 외과적인 경우(약 80.4일)보다 짧았다. 7. 혈관조형술은 20명(27.4%)의 환자에서 시행했으며, 16명(80%)에서 양성이었다. 8. 골주사검사는 62명(84.9%)의 환자에서 시행되었고, 양성인 경우는 35명(56.5%)이었다. 9. 족부절단의 위험인자 분석에서는 궤양의 정도와 관련이 있었으며(p=0.014), 당뇨병의 유병기간이나, 혈관조형술의 결과, 골주사 검사 결과 등과는 관련이 없었다. 결론 : 당뇨병성 족부궤양은 일단 한 번 발병하면 입원기간도 길고 치료가 어려운 질환이다. 발 관리에 대한 조기교육과 엄격한 혈당조절을 통한 예방만이 가장 최선의 방법이라 하겠다. Background : The diabetes mellitus is increasing now. So chronic complication of diabetes is being a big problem in the world. The Diabetic foot ulcer is one of the serious chronic complication because they can cause lower limb amputation. Prevention and prompt treatment is important in management of diabetic foot ulcer. We plan to study to evaluate clinical characteristics and to help the making a prevention policy and treatment plan in diabetic patients with foot ulcer. Methods : We reviewed medical record and checked the results of bacteriologic culture, angiography, and bone scan in diabetic patient with foot ulcer admitted to CNUH during last one year. Results : 1. Diabetic foot ulcers were occurred most frequently in 7th decades of age (38.4%) and more prevalently in man (79.5%). 2. The mean disease duration of diabetes who had a foot ulcer was about 14.6 years. 3. The most common causative event of diabetic foot ulcer was unknown (72.6%). 4. Wound culture was done in 53 (72.6%) diabetic patients with foot ulcer and the most common organism was Staphylococcus. 5. We graded diabetic foot ulcer by Wagner grading system and most common ulcer was grade 3(41.4%). 6. We was treated medically in 63(86.3%) patients and surgically in 9 patients. The duration of hospital stay was longer in surgically(80.4 days) treated patients than in medically(25.1 days). 7. Angiography was done in 20(27.4%) patients and positive result was 80%. 8. 3-phase bone scan was done in 62(84.9%) patients and positive results was 56.5% 9. Risk factors for amputation was ulcer grade and not related to duration of diabetes, angiographic findings and bone scan results. Conclusion : Diabetic foot ulcer is serious disease. Education for foot care and strict glycemic control should be necessary to prevent diabetic foot ulcer.

당뇨병 환자의 족부 진균 질환 유병률과 당뇨병성 족부 질환과의 상관성 조사

이광훈 ( Kwang Hoon Lee ),이주희 ( Ju Hee Lee ),이정덕 ( Jeong Deuk Lee ),조백기 ( Baik Kee Cho ),김형옥 ( Hyung Ok Kim ),김계정 ( Kea Jeung Kim ),김낙인 ( Nack In Kim ),송해준 ( Hae Jun Song ),손숙자 ( Sook Ja Son ),김상원 ( Sang 대한피부과학회 2003 대한피부과학회지 Vol.41 No.7

Object : The purpose of this study was to determine the prevalence of fungal infection and ulcer on the feet of diabetic patients and the existence of correlation between ulcer and fungal infection. Methods : A total 21,693 outpatients diagnosed as diabetes mellitus at the department of endocrinology of 32 hospitals were examined. The diabetic patients with foot problems were consulted to the department of dermatology. Physical examination and KOH preparation were performed. Results : 13,271 patients had certain kinds of foot problem, accounting for 61.2% of 21,693 diabetics examined. Of these, fungal foot disease were found in 10,403 that constituted 78.4% (48.0% of the entire diabetic population). Tinea pedis was the diagnosis in 6,496 (29.9%), onychomycosis in 7,783 (35.9%), and coexistence was in 3,883 (17.9%). Foot deformity was in 1,346 (6.2% of diabetics; 10.1% of foot disease), non-palpable pulse in 1,051 (4.8% ; 7.9%), and foot ulcer was in 425 (2.0% ; 3.2%), following in a descending order of frequency. Odds ratios for diabetic foot ulcer were 2.5 in patients with the foot deformity, 1.6 with fungal foot disease and 2.2 with non-palpable pulse. Conversely, Odds ratios for fungal foot disease were 2.5 with foot deformity, and 1.6 with foot ulcer. A total of 5,486 patients paid a visit to the department of dermatology. Of these, 4,519 patients were diagnosed with fungal infection through physical examination and KOH smear by dermatologists. The population comprised of 2,272 males and 2,247 females, showing similar prevalence between sexes. However, age did have positive correlation regarding prevalence of fungal foot disease. The number of diabetic patients with toenail problems was 3,847 patients (70%) and onychomycosis was proven mycologically in 3,276. Onychomycosis of distal subungal type was the most common clinical finding, most frequently involving the great toenails. Abnormal skin findings of the foot were seen in 3,885(70.8%) and tinea pedis was found in 3,209 (58.5%), most commonly involving the soles. Conclusion : This study showed that fungal infection might be regarded as a risk factor of foot ulcer. Treatment of fungal infection in diabetic patients might prevent diabetic foot disease such as ulcer and reduce the disability, morbidity and mortality in diabetic patients. (Korean J Dermatol 2003;41(7) : 908~915)

감염성 당뇨 족부 궤양 치료에서 Texas 기준 체계에 따른 음압치료 적용

장영재,임성안,최용수,백성년,배안나 대한족부족관절학회 2022 대한족부족관절학회지 Vol.26 No.2

Purpose: A group of patients who were hospitalized for diabetic foot ulcers was classified according to the University of Texas Staging System for Diabetic Foot Ulcers, and we attempted to evaluate whether this staging system could be a criterion for treatment success using vacuum-assisted closure (VAC) technique. Materials and Methods: A total of 32 patients were diagnosed with diabetic foot ulcers according to the University of Texas Staging System for Diabetic Foot Ulcers. Of these, 24 patients who were evaluated as stage B according to the staging system were classified as Group 1, and 8 patients in stage D were classified as Group 2. After applying VAC, the treatment success rate was compared by evaluating the size and severity of ulcers between the two groups. Results: The grade of granulation after VAC was on average 3.75±0.53 in Group 1 and 2.25±0.71 in Group 2. There was better granulation after VAC application in Group 1 (p<0.01). The success rate of the treatment was 22 cases (91.67%) in Group 1 and one case (12.5%) in Group 2. Thus there were statistically significant differences in the success rate of treatment between groups 1 and 2 (Pearson’s chisquare test, p=0.01; odd ratio 77.00, 95% confidence interval [CI] 1.26~14.66; relative risk 4.30, 95% CI 1.26~14.66). Conclusion: These results suggest that there was a higher success rate of treatment with VAC in stage B patients. The University of Texas Staging System for Diabetic Foot Ulcers can thus be an index for applying VAC to patients with infective diabetic foot ulcers.

적외선 체열 촬영을 이용한 당뇨병성 족부질환의 예측

김종문,이정모,김종훈,김석주,유두식,이수영 대한체열학회 2003 대한체열진단학회지 Vol.3 No.1

당뇨발을 위한 생체역학적 치료방법들에 관한 고찰

고은경,정도영,Koh, Eun-Kyung,Jung, Do-Young 대한물리치료학회 2007 대한물리치료학회지 Vol.19 No.5

Diabetic foot ulcers result from abnormal mechanical loading of the foot, such as repetitive pressure applied to the plantar aspect of the foot while walking. Diabetic peripheral neuropathy causes changes in foot structure, affecting foot function and subsequently leading to increased plantar foot pressure, which is a predictive risk factor for the development of diabetic foot ulceration. To early identify the insensitive foot makes it possible to prevent diabetic foot ulceration and to protect the foot at risk from abnormal biomechanical loading. Abnormal foot pressures can be reduced using several different approaches, including callus debridement, prescription of special footwear, foot orthosis. injection of liquid silicone, Achilles tendon lengthening, and so forth. Off-loading of the diabetic wound is a key factor to successful wound healing as it is associated with reduced inflammatory and accelerated repair processes. Pressure relief can be achieved using various off-loading modalities including accommodative dressing, walking splints, ankle-foot orthosis, total contact cast, and removable and irremovable cast walkers.

피부과와 내과의 협진에 의한 당뇨병성 족부궤양의 치료 경험

이석종 ( Seok Jong Lee ),차영창 ( Young Chang Cha ),이원채 ( Won Chae Lee ),나건연 ( Gun Yoen Na ),김도원 ( Do Won Kim ),하승우 ( Sung Woo Ha ),김보완 ( Bo Wan Kim ) 대한피부과학회 2002 대한피부과학회지 Vol.40 No.11

N/A Background : Recently, the prevalence of diabetes mellitus and its complications have been increased in Korea and they cause many socioeconomic losses in both patients and their families. But, there are neither sufficient medical assistance including concern of medical personnel nor social assistance in Korea nowadays. Objectives : In this study, we tried to reduce the risk of amputation and preserve the function of the foot by an early evaluation, proper treatment and consultation by dermatologists. Methods : We randomly chose 18 cases of diabetic foot ulcer and took care of them with proper and earlier debridement, dressing, antibiotics and cooporation with departments of internal medicine, especially endocrinology, nephrology and division of infectious disease. After healing of the ulcer, we recommended specially designed shoes and foot care products to prevent the recurrence of the foot problems. Results : The average duration of diabetes was 18 years and preexisting complications were neuropathy, nephropathy, vasculopathy and/or foot deformities. The precipitating factors of foot ulcer were burn, callus, fungal infection, bony deformity or trauma. Three cases underwent toe amputation and one case with severe vasculopathy was transferred to the vascular surgery. Average healing time was 14 weeks. Conclusion : Proper evaluation and management of diabetic foot ulcer patients with multidisciplinary approach should achieve good wound healing. Consequently, it can reduce the risk of amputation and improve the quality of life in the patient with diabetic foot ulcer. Among them, dermatologists who has a point of view of both a medical and surgical doctor may play a pivotal role in the management of diabetic foot ulcer.

유리 조직 이식술을 이용한 당뇨병성 족부 궤양의 치료

송준영,김기수,김희동,박인석,Song, June-Young,Kim, Ki-Soo,Kim, Hee-Dong,Park, In-Suk 대한미세수술학회 2001 Archives of reconstructive microsurgery Vol.10 No.2

Diabetic foot ulcer is a serious complication which result from long-standing diabetes. Especially, severe infected diabetic foot ulcer results in unwanted lower extremity amputation. The diabetic patient is considered the relative contraindication for microsurgery because of the severe peripheral vascular disease. Recently, microvascular free tissue transfer technique applied to diabetic foot ulcer. It is well known that free tissue transfer provides immediate soft tissue coverage and control of infection. So it is possible that preservation of the lower extremity through free tissue transfer. A retrospective study of diabetic patients who had infected foot ulcer from 1999 to 2000 with foot defects reconstructed with free tissue transfer were reviewed. Thirteen patients were studied with mean follow-up of 12.7 months. There were two deaths during follow-up period. There were two failures after free flap surgery. All eleven survived patients were ambulatory. There was no recurrence of ulcer. No patient need amputation above the ankle joint. We have found that free tissue transfer for infected diabetic foot ulcer is very effective surgical technique. Careful patient selection and regular follow-up is important.

Monitoring System for Diabetic Foot Ulceration Patients Using Robotic Palpation

Woonjae Choi,Bummo Ahn 제어·로봇·시스템학회 2020 International Journal of Control, Automation, and Vol.18 No.1

Foot ulceration in diabetic patients is commonly occurred and leads to amputation of the leg. Furthermore, pathogenesis of the foot ulceration is not only clinical presentation variable and complicated, but alsorequired medical management at early stage. However, patients, initially, have been neglected the condition oftheir feet because the initial ulcer does not have a major effect on the patient’s life. Therefore, the foot ulcerationbecomes serious, and then the patients come to treat in the hospital. Therefore, early diagnosis is important for thetreatment of the foot ulceration in diabetic patients. Recently, the changes in mechanical properties (Elastic moduli)of the plantar tissue were found to be important factors in the diagnosis of diabetic foot ulceration. In this paper,we, therefore, developed a monitoring system that can measure the elastic moduli of the plantar tissue of patients,which can be used to check the condition of patients’ feet with monitoring the elastic moduli change of plantartissue. The system was designed to be portable and easy to use, and is consists of probe, force sensor, linear actuator, micro control unit, display module, battery, and housing. To validate the system performance, we carried outpalpation experiments with applying 3mm and 5mm palpation depths to tissue phantom. In addition, we measuredthe reaction forces according to the applied palpations and estimated the elastic moduli of the tissue phantom. Wealso performed the experiments on the plantar tissue of human at the same experimental condition and estimated theelastic moduli of the plantar tissue. From the results, the estimated elastic moduli on tissue phantom show similarvalue even if the palpation depths are different. The results were similar when the plantar tissues were tested, whichmeans that the system can be used to monitor the foot ulceration in diabetic patients.

난치성 당뇨 족부 궤양에 대한 임상적 고찰: 치료에 영향을 미치는 인자 분석

박세진,이승희,박헌용,김장환,신헌규,김유진,최재열,Park, Se-Jin,Lee, Seung-Hee,Park, Hun-Yong,Kim, Jang-Hwan,Shin, Hun-Kyu,Kim, Eu-Gene,Choi, Jae-Yeol 대한족부족관절학회 2011 대한족부족관절학회지 Vol.15 No.4

Purpose: Diabetic foot ulcer is one of the most important diabetic complications because it increases the risk of amputations. Moreover, it lowers the quality of patients' life and increases the social medical expenses. Authors analyzed risk factors of intractable diabetic foot ulcer using retrospective study. Materials and Methods: From January 2007 to December 2010, 40 patients who could not achieve complete healing despite more than 12 weeks of proper management among who had been diagnosed and treated as diabetic foot ulcer at our hospital were included and evaluated retrospectively. We compared the risk factors between two groups who were finally treated by amputation and non-amputation. Results: The sample was composed of 31 male patients (77.5%) and 9 female patients (22.5%). Comorbidity including hypertension and hyperlipidemia were 77.5% and 80% each. By Wagner classification, 30 patients (80%) had ulcerative lesion over the grade 3. From bacteriology results, 29 patients (72.5%) had polybacteria infection. 35 patients (87.5%) had neuropathy and 26 patients (65%) had vascular stenosis at least one level. The mean initial ankle-brachial index and toe-brachial index were 0.982 and 0.439. In comparison between amputation group and non-amputation group, ulcer severity, number of stenotic vessel and initial ankle-brachial index/toe-brachial index had statistical significance. Conclusion: The most commonly risk factor of intractable diabetic foot ulcer was peripheral neuropathy reaching 87.5% of cases. In comparison with non-amputation group, ulcer severity according to Wagner classification, number of stenotic vessel and initial ankle-brachial index/toe-brachial index were demonstrated as a risk factor of amputation in intractable diabetic foot ulcer.

적외선 체열촬영을 이용한 당뇨병성 족부궤양의 평가

이수영,유두식,정순열,정진상 건국대학교 의과학연구소 1998 건국의과학학술지 Vol.8 No.-

To assess whether the development of plantar foot ulceration could be predicted from the mean plantar foot temperature(MFT), as assessed by digital infrared thermographic imaging(DITI), in patients with or without diabetic polyneuropathy or foot ulceration, 46 feet with no diabetic polyneuropathy(group Ⅰ), 40 feet with diabetic polyneuropathy(group Ⅱ), and 17 feet with diabetic foot ulcer(group Ⅲ) were assessed by DITI in six standard plantar sites and were correlated with laboratory findings (blood sugar, hemoglobin Alc, C-peptide). Total MFT was significantly higher in group Ⅲ(33.18±1.86℃) than group Ⅰ(29.13±1.63℃) or group Ⅱ(30.89±1.51℃). There were increasing tendency of focal MFT in the third metatarsal head and greater toe where revealed higher incidence of foot ulceration. There was a trend toward elevation of glycosylated hemoglobin(HbAlc) in groupⅢ. In conclusion, DITI is a simple, noninvasive method of idenfifying the neuropathic foot at increased risk of ulceration. Patients with high plantar foot temperature are at increased risk of neuropathic foot ulceration.