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- Author or Editor: Naohiro Shibuya x
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The relationship between hyperglycemia and adverse outcomes after surgery has been widely documented. Long-term glucose control has been recognized as a risk factor for postoperative complications. In the foot and ankle literature, long-term glycemic control as a potential perioperative risk factor is not well studied. Our goal was to investigate whether hemoglobin A1c (HbA1c) level was independently associated with postoperative complications in a retrospective cohort study.
Three hundred twenty-two patients with a diagnosis of diabetes mellitus were enrolled in the study to assess risk factors associated with postoperative foot and ankle surgery complications.
Bivariate analyses showed that HbA1c level and having at least one comorbidity were associated with postoperative infections. However, after adjusting for other covariates, the only significant factor was HbA1c level, with each increment of 1% increasing the odds of infection by a factor of 1.59 (95% confidence interval [CI], 1.28–1.99). For postoperative wound-healing complications, bivariate analyses showed that body mass index, having at least one comorbidity, and HbA1c level were significant factors. After adjusting for other covariates, the only significant factors for developing postoperative wound complications were having at least one comorbidity (odds ratio, 2.03; 95% CI, 1.22–3.37) and HbA1c level (each 1% increment) (odds ratio, 1.25; 95% CI, 1.02–1.53).
In this retrospective study, HbA1c level had the strongest association with postoperative foot and ankle surgery complications in patients with diabetes.
Background: Sophisticated methods of cryotherapy, such as application of a water-circulating device, have recently been popularized to provide a constant or intermittent therapeutic source in the foot and ankle postoperative setting. In this study, the efficacy and safety of three selected cryotherapy devices (Iceman, EBIce, and Ankle Cryo/Cuff) were investigated.
Methods: Each cryotherapy unit, in the coldest setting, was applied over standard surgical dressings in group I, over one layer of Jones compression bandage in group II, and over two layers of Jones compression bandage in group III on four individuals in excellent overall health. The skin temperature was then recorded every 15 min for 180 min in each trial.
Results: In group I, the Iceman was the only device that required discontinuation in one subject, and the EBIce and Cryo/Cuff were tolerated in all of the subjects. However, the temperatures in all of the devices continued to decrease at the end of the trials. In group II, all of the cryotherapy devices controlled temperatures between 20°C (68°F) and 30°C (86°F). In group III, no device significantly lowered the initial surface skin temperature.
Conclusions: We achieved the safe and effective temperature range when the cryotherapy devices were applied over one layer of Jones compression dressing. The cryotherapy devices resulted in less predicable temperature declination when applied over the thinner surgical dressing. When the devices were applied over two layers of Jones compression dressing, surface skin temperature declination was minimal. (J Am Podiatr Med Assoc 97(6): 439–446, 2007)
Persons with diabetes have a higher incidence of fractures compared with persons without diabetes. However, there is little published information concerning the deleterious effect of late-stage diabetes on fracture healing. There are no studies using animal models that evaluate the effect of advanced diabetes on fracture healing. The purpose of our study was to evaluate cytokine expression, specifically macrophage inflammatory protein 1 (MIP-1) and vascular endothelial growth factor, in fracture healing in a type 2 diabetes rat model.
We evaluated biomarker expression after femur fracture using a rat model. The two groups consisted of 24 Zucker diabetic rats (study group) and 12 Zucker lean rats (control group). An independent reviewer was used to assess delayed union. We evaluated serum samples 2, 4, 7, and 14 days after surgery for MIP-1, vascular endothelial growth factor, leptin, and other cytokine levels.
At 3 weeks, Kaplan-Meier estimates showed that 45.8% of femur fractures in Zucker diabetic rats had healed, whereas 81.8% of those in Zucker lean rats had healed (P = .02). A logistic regression model to predict fast healing that included the three cytokines and diabetes status showed that the only factor achieving significance was MIP-1α. Vascular endothelial growth factor was the only biomarker to show significance compared with delayed healing.
These results confirm significant differences in biomarker expression between diabetic and nondiabetic rats during bone healing. The key factors for bone healing may appear early in the healing process, whereas differences in diabetes versus nondiabetes are seen later in the healing process. Increased levels of MIP-1α were associated with the likelihood of delayed healing.
Lower-extremity pathologic abnormalities have been common in military recruits for many years. Many of these conditions can become chronic and persist even after retiring from military service. We hypothesized that certain foot abnormalities are more prevalent in veterans versus nonveterans. The purpose of this study was to evaluate what foot and ankle disorders are associated with veteran status while controlling for other demographic factors.
The National Health Interview Survey (Podiatry Supplement) from 1990 was used for this secondary data analysis. The data were divided into veterans and nonveterans, and the prevalence of podiatric medical problems, including callus, flatfoot deformity, bunion deformity, hammer toe deformity, arthritis, and sprain, was evaluated for each group.
Flatfoot deformity and arthritis were significantly more prevalent in veterans versus nonveterans in the United States. Bunion deformity was significantly more prevalent in male veterans than in male nonveterans. Male veterans were less likely than male nonveterans to have sprains, and female veterans were more likely than their nonveteran counterparts to have sprains.
These results may help us understand the potential risk factors for podiatric medical problems and may be used for formulating prevention programs. (J Am Podiatr Med Assoc 101(4): 323–330, 2011)