The International Journal of Lower Extremity Wounds

Publisher: SAGE Publications

Description

The International Journal of Lower Extremity Wounds concentrates on in-depth multidisciplinary reviews of evidence-based diagnostic techniques and methods, disease and patient management, and surgical and medical therapeutics for lower extremity wounds such as burns, stomas, ulcers, fistulas, and traumatic wounds. The journal emphasizes the science and practice of lower extremity wound care from major theoretical advances to tested clinical practice. Such care includes soft tissue reconstruction, musculoskeletal surgery, neurologic depreciation, prosthetics, and the legal and economic implications of wound management. The journal also offers evaluations of assessment and monitoring tools, dressings, gels, cleansers, pressure management, footwear/orthotics, casting, and bioengineered skin. The International Journal of Lower Extremity Wounds presents focused original articles, literature reviews, case reports, and commentaries about specialized topics by leading wound physicians, vascular and orthopedic surgeons, diabetologists, podiatrists, nurses, and other health-care specialists, such as: Preventing and healing wounds; Early signs of tissue breakdown; Infection control; Debridement of wounds; Objective assessment; Significance of the size, color, and depth of wounds; Skin care management; Difficult-to-heal wounds due to a number of conditions which compromise circulation; Revascularization; Alternative and complementary care integrated with conventional care; Advanced wound care technologies such as hyperbaric oxygen therapy and wound vacs.

  • Impact factor
    1.25
  • 5-year impact
    0.00
  • Cited half-life
    5.90
  • Immediacy index
    0.13
  • Eigenfactor
    0.00
  • Article influence
    0.00
  • Website
    The International Journal of Lower Extremity Wounds website
  • Other titles
    International journal of lower extremity wounds (Online), The international journal of lower extremity wounds
  • ISSN
    1534-7346
  • OCLC
    50544496
  • Material type
    Document, Periodical, Internet resource
  • Document type
    Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details

SAGE Publications

  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author cannot archive a post-print version
  • Restrictions
    • 12 months embargo
  • Conditions
    • On author website, repository and PubMed Central
    • On author's personal web site
    • Publisher copyright and source must be acknowledged
    • Publisher's version/PDF cannot be used
    • Post-print version with changes from referees comments can be used
    • "as published" final version with layout and copy-editing changes cannot be archived but can be used on secure institutional intranet
    • If funding agency rules apply, authors may use SAGE open to comply
  • Classification
    ​ yellow

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Foot infections occurring in patients with severe peripheral arterial disease (PAD) who are not considered candidates for revascularization and limb salvage efforts are generally treated with major amputations. Herein we describe our early experiences in managing foot infections with minor amputations and palliative wound care as a strategy to avoid the functional disability often associated with major amputations. Patients with severe PAD that underwent minor amputations and subsequent palliative wound care for moderate/severe infections were paired with age-matched controls with PAD that underwent primary major amputations for foot infections. Eleven patients who underwent minor amputations and palliative wound care of 13 limbs were compared to an age-matched cohort of 12 patients undergoing 13 major amputations.The median age was 80 years in both groups. Survival at 1 and 2 years did not differ significantly between groups. All patients who were ambulatory and/or independently living remained so following palliative management; in contrast, major amputation changed ambulatory status in 75% of patients and independent living status in 50%. Palliative management did not result in ascending/systemic sepsis or progressive necrosis. The need for reoperations was uncommon in both groups. In summary, minor amputations and operative drainage with subsequent palliative wound care appears to be a safe management option in patients with severe PAD and moderate or severe foot infections that are not candidates for revascularization. Palliative management may result in less functional impairment than major amputation.
    The International Journal of Lower Extremity Wounds 07/2014;
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    ABSTRACT: The course of mycosis fungoides (MF) is indolent except when transformation to a large T-cell lymphoma occurs. The diagnosis of transformed MF relies on the presence of more than 25% of large cells on biopsy of an MF lesion. Treatment of transformed MF is a major challenge as these patients have poor outcome. Here, we report a 61-year-old man presenting with tumoral ulcer on the plantar area of the foot who was diagnosed cutaneous CD30(-) large cell transformed MF and treated with systemic methotraxate and bexarotene therapy.
    The International Journal of Lower Extremity Wounds 05/2014;
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    ABSTRACT: Skin maceration is a clinical manifestation in venous leg ulcers that leads to severe consequences for patients' quality of life and wound management. The aim of this study was to explore the use of transepidermal water loss (TEWL) measurement technique to quantify different level of surrounding skin maceration in patients with venous leg ulcers. A total of 50 patients were recruited and TEWL measurements were taken with a portable device on different locations surrounding the leg ulcer and on control skin. A clinical score for maceration was used and correlated to the involvement of surrounding skin. Statistically significant differences of TEWL values were noted between affected skin and control site (P < .001). Statistics showed an increase in TEWL values as the maceration clinical score increased (r = 0.954). Objective monitoring of skin maceration in venous leg ulcer with TEWL measurement represents an useful tool to analyze morphologic changes at different time points during treatment.
    The International Journal of Lower Extremity Wounds 05/2014;
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    ABSTRACT: Coordinated extracellular matrix deposition is a prerequisite for proper wound healing which is mainly orchestrated by matrix metalloproteinases (MMPs). Diabetic wounds generally show compromised wound healing cascade and abnormal MMP9 concentration is one of the cause. Our group have recently shown that the polymorphism -1562 C>T in the promoter region of MMP9 gene is associated with pathogenesis of wound healing impairment in T2DM patients. In present study we have done expression profiling of MMP9 gene in the wound biopsy of DFU cases. Expression level of MMP9 mRNA was then compared with susceptible -1562 C>T genotypes (TT and CT) as well as with different grades of wounds. We also screened the promoter region of MMP9 gene to see the methylation state of CpGs present there. Our study suggests that levels of MMP9 mRNA increase significantly with the wound grades. Moreover, the MMP9 levels in diabetic wounds were also dependent on -1562 C>T polymorphism in the promoter region of MMP9. Diabetic wounds also showed a significant unmethylated status of MMP9 promoter compared to control wounds. In conclusion, The risk genotypes of -1562 C>T polymorphism along with lack of methylation of CpG sites in MMP9 gene promoter may result in altered expression of MMP9 in wounds of T2DM cases resulting into nonhealing chronic ulcers in them.
    The International Journal of Lower Extremity Wounds 05/2014;
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    ABSTRACT: Elephantiasis nostras verrucosa (ENV) is a rare dermatologic condition caused by chronic nonfilarial lymphedema. The treatment for ENV is challenging and based solely on case reports. We report novel therapy for ENV with maggot debridement therapy (MDT), an effective wound therapy that has gained popularity with the rise of antimicrobial resistance. MDT, in combination with tangential surgical debridement, was effective in the treatment of ENV. In nature, sheep infested with more than 16 000 blow fly larvae exhibit ammonia toxicity. Although hyperammonemia as a side effect of maggot therapy has been theorized, its existence has not been described in human studies until this case. This patient exhibited hyperammonemia during maggot therapy; with alterations in serum ammonia reflecting changes in larval population. Maggot therapy should be considered for the treatment of ENV. Hyperammonemia with maggot therapy exists, and clinicians who employ this treatment should be aware of this potential adverse effect.
    The International Journal of Lower Extremity Wounds 05/2014;
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    ABSTRACT: Impaired wound-healing activity in diabetes could result from several factors, including severely damaged angiogenic responses, which can affect wound healing process to cause delayed wound repair. Mesenchymal stem cells (MSCs) have been shown to enhance wound healing via multiple effects, including promoting angiogenesis both in vitro and in vivo; however, the mechanisms involved in enhancing diabetic wound healing are barely understood. This article reviews the recent literatures on MSCs treatment for promoting angiogenesis or vascularization in diabetic wounds and the potential mechanisms involved, with an emphasis on the role of paracrine soluble factors. Meanwhile, the potential benefits and related risks associated with the therapeutic use of MSCs have been presented and may lead to better understanding of the influence of MSCs without increasing potential risks. Further investigation will be required to determine the molecular basis of paracrine mechanisms and regulated angiogenesis of MSCs for its rational manipulation for impaired angiogenesis repair and diabetic wound healing.
    The International Journal of Lower Extremity Wounds 05/2014;
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    ABSTRACT: Sir, The Toll-like receptor 4 (TLR4) plays an important role in immunity, tissue repair, and regeneration.1 TLR4 is also an important regulator of wound inflammation and plays an important role in restoring damaged tissue integrity during normal wound healing.2 Any imbalance in TLR4 mediated signaling may abrogate the proper wound healing cascade. Type 2 diabetes mellitus (T2DM) wounds are hard to heal and altered TLR4-mediated signaling may be contributing for the same.3 Genetic alterations in TLR4 signaling are generally manifested by 2 ways: Either there is inadequate TLR4 expression on cell surface or the receptor itself is not able to bind properly with its ligands.4,5 This altered binding of TLR4 with its ligands may be due to the single nucleotide polymorphisms (SNPs) in the extracellular domain of TLR4. http://ijl.sagepub.com/content/early/2014/02/12/1534734614529654.full
    The International Journal of Lower Extremity Wounds 04/2014;
  • The International Journal of Lower Extremity Wounds 01/2012;
  • The International Journal of Lower Extremity Wounds 10/2009; 8(3):133.
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    ABSTRACT: Vasculitic ulcers are related to numerous underlying etiologies including autoimmune disease, rheumatoid arthritis and other inflammatory conditions.The resulting ulcerations are associated with high levels of pain, inflammation and tissue necrosis. Current therapies, including surgical intervention, are limited by the underlying inflammatory process and complications secondary to the wound etiology. conservative care has been relatively unsuccessful in promoting wound closure.This case presentations reviews the successful results of using a xenograft in the treatment of an inflammatory ulcer associated with cryoglobulinemia and vasculitis. Product integrity was maintained postoperatively, compared to an allograft, thereby allowing the wound treatment site to progress to closure.The type of cross linkage of acellular grafts may have a direct effect on product stability and treatment outcomes.
    The International Journal of Lower Extremity Wounds 10/2009; 8(3):157-61.
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    ABSTRACT: The consensus is that a multidisciplinary approach for patients with diabetic foot ulcer is effective in reducing the number of leg amputations. Concern remains, however, about cost and health-related quality of life issues. From August 2005 to March 2007, a multidisciplinary diabetic foot protocol (DFP) was used at the authors' teaching hospital.There were devices to reduce pressure on the foot.After healing, there were custom-fabricated orthoses and footwear, and monitoring of progress in ambulation. All subjects were educated about diabetic foot disease and its complications and prevention.They were also instructed to call and visit the hospital if there were any signs of new lesions.This study compared responses to the short form 36 questionnaires (SF-36) about health-related quality of life and the cost of medical care for patients receiving DFP care from August 2005 to March 2007 and those who had standard care from August 2003 to July 2005.There were 56 and 40 diabetic foot ulcer patients on DFP and standard care packages, respectively. Their gender distribution and mean age were similar. The average total cost of DFP patients was significantly lower than that for standard care patients ($1127.02 and $1824.58, respectively, P = .02). DFP patients had significantly higher scores on the SF-36 for both the physical and mental health dimensions than standard care patients. It was concluded that DFP was less expensive and gave patients a better quality of life, compared to standard care. On the basis of this finding, DFP should be used by every hospital to improve outcomes for patients with diabetic foot ulcer.
    The International Journal of Lower Extremity Wounds 10/2009; 8(3):153-6.
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    ABSTRACT: Patients with squamous cell carcinoma of the lower limb may exhibit locally advanced or metastatic disease. Surgical resection to control the primary tumor is often extensive.The case of a 51-year-old man with squamous cell carcinoma on Marjolin's ulcer affected, rapidly growing, and involving soft and bone tissues is described. Treatment required performing a hemipelvectomy. Immediate reconstruction was chosen as surgical procedure planning the harvest of 4 superficial muscles and 1 deep muscle of the abdomen to protect the pelvic content and to eliminate the dead spaces.The chosen technique minimized postoperative complications, and at 7 years follow-up, the patient is disease free.
    The International Journal of Lower Extremity Wounds 10/2009; 8(3):162-4.
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    ABSTRACT: The authors present a rare case of panniculitis ossificans (PO) in a 30-year-old woman. Differential diagnoses and treatment are discussed. PO is an important differential diagnosis to sarcomas.
    The International Journal of Lower Extremity Wounds 10/2009; 8(3):165-8.
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    ABSTRACT: A magnetic resonance imaging (MRI) protocol was performed in leprosy patients with a neuropathic foot and superficial ulcers and/or localized cellulitis but no clinical suspicion of osteomyelitis. The aim of the study was to determine if unsuspected osteomyelitis was present in this defined group of leprosy patients. A total of 15 neuropathic feet from 9 patients were included. Clinically and on MRI, the forefoot was predominantly affected. MRI findings of osteomyelitis were found in 4 feet. In feet with osteomyelitis, 3 had a superficial ulcer and 3 had clinical signs of localized cellulitis. A clinical diagnosis of cellulitis was confirmed on MRI in 2 feet.A striking discrepancy between clinical and MRI findings was found.This study shows that, compared with clinical evaluation, MRI is a sensitive method for the detection of unsuspected osteomyelitis in neuropathic feet with superficial ulcers and/or cellulitis. MRI findings in this group of patients may influence clinical decision making and may prevent further complications, because osteomyelitis requires more aggressive medical treatment. This preliminary communication should pave the wave for designed controlled studies so that patients with Hansen's neuropathy may get the best medical care.
    The International Journal of Lower Extremity Wounds 10/2009; 8(3):169-73.
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    ABSTRACT: Neuropathic leg ulcers (NLUs) affect more than 10% of diabetic patients with peripheral neuropathy and represent the most common cause of ulceration of the leg in these patients. Though their pathogenesis is well known, related to the chronic neuropathic edema, the management of NLUs, mainly based on elastocompression, is still controversial, with lower healing rates than nondiabetic venous leg ulcers. The authors tested if a novel gel formulation, containing amino acids and hyaluronic acid (Vulnamin)gel; Errekappa, Milan, Italy), will improve the outcomes of NLUs when used together with elastocompression. Thirty patients affected by NLU were randomized into 2 groups, both treated with 4-layer elastocompressive bandaging: patients in group A were topically treated with the application of Vulnamin) gel, whereas patients in group B received only the inert gel vehicle. The healing rate at 3 months was evaluated as the primary endpoint, whereas the secondary endpoints were healing time, reduction in ulcer area and ulceration score in 4 weeks, number of infective complications, and overall satisfaction of patients. Healing rate was significantly (P < .05) higher in patients in group A when compared with those in group B; healing time, patients' satisfaction, and reduction in ulcer area and ulceration score in 4 weeks were also higher in patients in group A. However, no significant differences were found in the prevalence of infections and other adverse events. The use of Vulnamin) gel with elastocompression is safe and effective in the management of NLUs of diabetic patients.
    The International Journal of Lower Extremity Wounds 09/2009; 8(3):134-40.
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    ABSTRACT: The aim of this study was to analyze the outcomes of treatment of necrotizing soft-tissue infections (NSTIs) in the feet of diabetic patients and to determine factors associated with limb salvage and mortality. A retrospective study of a consecutive series of 145 diabetic patients suffering from NSTIs treated in the Diabetic Foot Unit, La Paloma Hospital was done. NSTIs were classified as necrotizing cellulitis if it involved the subcutaneous tissue and the skin, as necrotizing fasciitis if it involved the deep fascia, and as myonecrosis in those cases where muscular necrosis was present. In the necrotizing cellulitis group (n = 109), 8 (7.3%) major amputations were performed. In the necrotizing fasciitis group (n = 25), 13 (52%) major amputations were undertaken. In the myonecrosis group (n = 11), 6 (54.5%) major amputations were performed. Predictive variables related to limb loss were fasciitis (OR = 20, 95% CI = 3.2-122.1) and myonecrosis (OR = 53.2, 95% CI = 5.1-552.4). Predictive variables of mortality were age >75 years (OR = 10.3, 95% CI = 1.9-53.6) and creatinine values >132.6 micromol/L (OR = 5.8, 95% CI = 1.1-30.2). NSTIs of the foot are an important cause of morbidity and mortality in diabetic patients.When fascia and/or muscle are involved, there are significant risks of major amputation.
    The International Journal of Lower Extremity Wounds 09/2009; 8(3):141-6.
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    ABSTRACT: Topical oxygen therapy provides another tool in the armamentarium of clinicians treating refractory lower extremity wounds. Devices suitable for providing topical oxygen therapy in a clinical setting have recently become available. This article reviews the evidence to justify the use of this treatment modality, including in vitro, preclinical data, and clinical data. It also provides a protocol for how to administer topical oxygen therapy as well as guidance on patient selection and management to optimize outcomes. Randomized controlled trials are not yet reported and clearly necessary. The current body of evidence suggests that topical oxygen therapy may be considered as a second line of therapy for refractory wounds.
    The International Journal of Lower Extremity Wounds 07/2009; 8(2):105-11.
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    ABSTRACT: This study aimed to examine the rates and risk factors for ipsilateral re-amputation in 121 patients with diabetic foot and prior amputation. Twenty-six (21.5%) patients required re-amputation during a mean follow-up of 18 months. Most re-amputations were performed within the first 6 months of the initial amputation. Re-amputation was more common among patients in whom the initial amputation had only affected one or two toes. Age (hazard ratio: 1.06) and heel lesions (hazard ratio: 2.69) were significantly associated with re-amputation. There is a high risk of re-amputation in the diabetic foot, especially within the first 6 months of the initial amputation, mainly due to poor selection of the original amputation level in an effort to save a greater part of the lower extremity. Patients 70 years and those with heel lesions are at greatest risk of re-amputation.
    The International Journal of Lower Extremity Wounds 07/2009; 8(2):69-74.
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    ABSTRACT: Necrotizing fasciitis of the lower limb is not uncommon, with poor outcome. This study reviewed 118 cases (78 males and 40 females) with mean age of 45 + 16.5 years (range 12-95 years) of lower limb necrotizing fasciitis admitted to the Department of Surgery, BHU in India between 1995 and 2007. Most patients (n = 97) presented with fever. Other presenting symptoms included painful swelling, bullae, erythema, ulcer, and necrosis. Comorbid conditions such as diabetes, tuberculosis, malignancy, and immunosuppressive therapy were associated in 72 (61%) cases. Amputations were done in 24 patients. Thirty one patients developed septic shock. Renal dialysis was done in 16 patients and ventilatory support was needed in 12 patients. The most common organism identified was beta-hemolytic streptococci (n = 42). Eighteen patients died, a mortality of 15%. The authors consider early diagnosis and aggressive surgical intervention to be crucial for the successful treatment of disease.
    The International Journal of Lower Extremity Wounds 07/2009; 8(2):112-6.

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