The International Journal of Lower Extremity Wounds

Publisher: SAGE Publications

Journal 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.

Current impact factor: 0.93

Impact Factor Rankings

2016 Impact Factor Available summer 2017
2014 / 2015 Impact Factor 0.928
2013 Impact Factor 1.194
2012 Impact Factor 1.25
2011 Impact Factor 1.2

Impact factor over time

Impact factor

Additional details

5-year impact 1.10
Cited half-life 6.40
Immediacy index 0.18
Eigenfactor 0.00
Article influence 0.30
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 can archive a post-print version
  • Conditions
    • Authors retain copyright
    • Pre-print on any website
    • Author's post-print on author's personal website, departmental website, institutional website or institutional repository
    • On other repositories including PubMed Central after 12 months embargo
    • 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
    • Must link to publisher version with DOI
    • Publisher last reviewed on 29/07/2015
  • Classification

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Leg ulceration is a chronic health condition that constitutes a significant disease burden. In this cross-sectional descriptive study, a sample of wound care clinicians were asked to respond to a web-based survey. Based on a review of literature and recommended best practices in the management of mixed arteriovenous (AV) ulcers, a questionnaire was developed to examine the knowledge, attitude, and practice pattern in the management of AV ulcers. A total of 436 clinicians participated in the survey. A number of assessment techniques were perceived to be relevant for the assessment of AV ulcers; medical history and the appearance of ulcers were the most commonly used methods in clinical practice. While over 80% of the participants conceded that compression should be used to promote wound healing, half of them would consider using compression for AV ulcers if ankle brachial index was less than 0.8. Half of the participants considered an ankle brachial index of 0.8 or higher as the optimal cutoff value for safe compression. The majority of respondents disagreed with the perception that caring for people with AV ulcers was unrewarding. However, challenges to promote treatment adherence, address psychosocial concerns, and optimize symptom management are common.
    No preview · Article · Jan 2016 · The International Journal of Lower Extremity Wounds
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    ABSTRACT: The aims of this study were to evaluate factors influencing the distribution of ciprofloxacin in tissue of patients suffering from varying degrees of peripheral arterial disease (PAD). Blood and tissue samples were collected from patients undergoing debridement or amputation procedures and the amount of ciprofloxacin in them was determined using high-performance liquid chromatography. All patients were administered a 200-mg dose of intravenous ciprofloxacin prior to the debridement or amputation procedure. Data, including patient gender, age, type of diabetes, presence of neuropathy, medications taken, and severity of PAD were collected. These data were then analyzed to determine factors influencing the concentrations of ciprofloxacin in tissue of the lower limbs. The Kruskal-Wallis test, Spearman correlation, and chi-square test were used to relate covariates and fixed factors with the concentration of ciprofloxacin in tissue. Following bivariate analysis, a 3-predictor regression model was fitted to predict tissue concentrations of ciprofloxacin given information about these predictors. Blood and tissue samples were collected from 50 patients having an average age of 68 years. Thirty-three patients were males and 35 patients suffered from type 2 diabetes. The average number of medications that these patients were taking was 10. The majority of patients (n = 35) were suffering from severe PAD. Tissue concentrations of ciprofloxacin were mainly related to plasma concentrations of ciprofloxacin, number of medications that the patients were taking and severity of PAD.
    No preview · Article · Dec 2015 · The International Journal of Lower Extremity Wounds
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    ABSTRACT: Pyoderma gangrenosum (PG) is a rare, relapsing cutaneous disease with 4 distinctive clinical manifestations: ulcerative, bullous, pustular, and vegetative lesions. It mainly occurs in adults and is frequently associated with systemic diseases, most commonly inflammatory bowel disease, rheumatologic disease, or hematological dyscrasias. However, there have been no previous reports of PG in a patient with hereditary spherocytosis, a common inherited hemolytic anemia. We report here a unique case of PG in a 15-year-old boy with underlying hereditary spherocytosis.
    No preview · Article · Dec 2015 · The International Journal of Lower Extremity Wounds
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    ABSTRACT: Vasculitic ulcers are an emerging problem in wound care that needs to be well defined and adequately approached by caregivers. Cutaneous vasculitis includes several inflammatory disorders that compromise microvessels and specifically the cutaneous vascular system: arterioles, capillaries, postcapillary venules. The pathogenetic role of circulating immunocomplexes and autoantibodies (antineutrophil antibodies) in these diseases has been widely demonstrated in animal models and in humans. Vasculitis can be limited to the skin or represent the cutaneous signs in case of systemic vasculitis with visceral involvement. The injury of cutaneous microvessels may result in impairment of blood flow and consequent focal ischemia and formation of skin ulcers. The ulcers are often multiple and localized on the lower leg and foot where the microcirculatory anatomy and rheologic dynamics are predisposing factors. Approximately 3% to 5% of skin ulcers may be caused by a vasculitic disorder.
    No preview · Article · Dec 2015 · The International Journal of Lower Extremity Wounds
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    ABSTRACT: Prolidase deficiency is an autosomal recessive disorder, which is associated with chronic skin ulcers, a characteristic facial appearance, mental retardation, and recurrent infections. This study describes 4 patients with recurrent leg ulcerations and abnormal facies who were first clinically suspected of prolidase deficiency and then biochemically confirmed. Two siblings and 2 other patients were admitted to our clinic at different times, and they had some common features such as chronic leg and foot ulcers recalcitrant to treatment, consanguineous parents, facial dysmorphism, mental retardation, and widespread telangiectasias. Physical examination and detection of low prolidase level in blood finally led us to the diagnose of ulcers secondary to prolidase deficiency. Prolidase deficiency is a rare genodermatosis and must be considered in the differential diagnosis of recurrent leg and foot ulcers that develop at an early age.
    No preview · Article · Dec 2015 · The International Journal of Lower Extremity Wounds
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    ABSTRACT: Sweat glands exhibit a documented role in epidermal reepithelialization after wounding. However, the regenerative potential of sweat glands has remained underappreciated due to the absence of useful markers for the analysis of determination and differentiation processes in the developing eccrine sweat gland from epithelium. Although the current knowledge of keratin expression in most of the different origins has been described, it remains widely shared and not unified in eccrine sweat glands of C57BL/6J mice that are commonly used as animal models for sweat gland and wound healing studies, both at the molecular and cellular levels. Aiming to answer this question, we have investigated the changes in cytokeratin expression patterns during the embryonic, neonatal, juvenile, and young adult stages (E12.5, E17.5, P0.5, P5, and P28). In this article, we demonstrate that the morphology of murine sweat gland progenitor cells are similar to epidermal stem cells before birth (E12.5 and E17.5); at postnatal stages, the duct formed gradually and curled to glob. K8 and K19 were expressed in the eccrine sweat gland cells at all times and highly expressed after birth at both gene and protein levels. Also, histological results revealed K8 and K19 positive cells localized in the secretary portion of glands. Meanwhile, K14 strongly expressed both in vivo and in vitro at E12.5, while it weakly expressed at other stages. Moreover, K10 was rarely detected before birth, but it expressed positively in vivo and in vitro only at the protein level after birth. These data indicate the pattern of main cytokeratin expression at different stages during murine sweat gland development and might provide an efficient tool for sweat gland research and exciting potential for developing targeted therapies for wound healing.
    No preview · Article · Dec 2015 · The International Journal of Lower Extremity Wounds
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    Preview · Article · Dec 2015 · The International Journal of Lower Extremity Wounds
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    ABSTRACT: In this article, we describe emergency and elective pathways within our orthopedic multidisciplinary inpatient care of patients with diabetic foot problems. We performed a retrospective cohort review of 19 complex patients requiring orthopedic surgical treatment of infected ulceration or Charcot feet or deformity at our institution. A total of 30 admissions (19 emergency, 11 elective) were included. The pathways were coordinated by a multidisciplinary team and comprised initial assessment and investigation and a series of key events, which consisted of emergency and elective surgery together with the introduction, and change of intravenous antibiotics when indicated. Patients had rigorous microbiological assessment, in the form of deep ulcer swabs, operative tissue specimens, joint aspirates, and blood cultures according to their clinical presentation as well as close clinical and biochemical surveillance, which expedited the prompt institution of key events. Outcomes were assessed using amputation rates and patient satisfaction. In the emergency group, there were 5.6 ± 3.0 (mean ± SD) key events per admission, including 4.2 ± 2.1 antibiotic changes. In the elective group, there were 4.8 ± 1.4 key events per inpatient episode, with 3.7 ± 1.3 antibiotic changes. Overall, there were 3 minor amputations, and no major amputations. The podiatric and surgical tissue specimens showed a wide array of Gram-positive, Gram-negative, aerobic and anaerobic isolates and 15% of blood cultures showed bacteremia. When 9 podiatric specimens were compared with 9 contemporaneous surgical samples, there was concordance in 2 out of 9 pairs. We have described the successful modern care of the orthopedic diabetic foot patient, which involves close clinical, microbiological, and biochemical surveillance by the multidisciplinary team directing patients through emergency and elective pathways. This has enabled successful surgical intervention involving debridement, pressure relief, and stabilization, with low rates of amputation.
    No preview · Article · Dec 2015 · The International Journal of Lower Extremity Wounds
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    ABSTRACT: Necrotizing fasciitis (NF) is a severe and rapidly progressive infectious disease that attacks superficial an as well as deep fascia, subcutaneous fat tissue, and muscle. Although the incidence is of relatively low frequency, the median mortality is high. NF is a great burden to patients and hospitals. The most common cause of NF is trauma injuries, followed by other conditions with comorbidity. A classification for NF was presented concerning microbial cause, depth of infection, and anatomy. But the value of classification is not convincing. Early diagnosis of NF is essential and still to be realized by far. Information from clinic or laboratory might contribute to the purpose. Surgery is used in exploration debridement and tissue reconstruction as the main method with NF. Negative pressure wound therapy has proved to be useful in improving wound bed preparation and healing.
    No preview · Article · Nov 2015 · The International Journal of Lower Extremity Wounds
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    ABSTRACT: Infections in lower extremities are sometimes concerned with systemic immunological disorders such as idiopathic thrombocytopenic purpura and systemic lupus erythematosus, which are treated with systemic steroids. Steroid therapy impairs the epithelial wound healing and with systemic condition, especially with systemic lupus erythematosus, the wound is susceptible for infection. Even a pyoderma gangrenosum sometimes occurs in a patient with idiopathic thrombocytopenic purpura with an incisional wound of hernia. The severe signs and symptoms are the deep skin and soft tissue infections, mainly caused by group A streptococcus, composed of necrotizing fasciitis and muscle necrosis. Medically suspected necrotizing fasciitis patients should be empirically and immediately administered with broad-spectrum antibiotics, which may cover the common suspected pathogens. In type I (polymicrobial) infection, the selection of antimicrobial should be based on medical history and Gram staining and culture. The coverage against anaerobes is important in type I infection. Metronidazole, clindamycin, or beta-lactams with beta-lactamase inhibitor or carbapenems are the treatment of choice against anaerobes, while early surgical debridement-wide enough and deep enough-is the core treatment of necrotizing fasciitis and results in significantly better mortality compared with those who underwent surgery after a few hours of delay. When necrotizing fasciitis is considered and the patient is brought to the operation room, aggressive and extensive surgical debridement is explored. Tissue involved should be completely removed until no further evidence of infection is seen. When further debridement is required, the patient must return to the operating room immediately. In this context, the temporal coverage using the artificial dermis after debridement is useful because there is no loss of the patient's own tissue and yet it is easier for "second-look" surgery or secondary reconstruction, and extensive enough debridement is always the mainstay of the therapy.
    No preview · Article · Sep 2015 · The International Journal of Lower Extremity Wounds

  • No preview · Article · Sep 2015 · The International Journal of Lower Extremity Wounds
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    Preview · Article · Sep 2015 · The International Journal of Lower Extremity Wounds
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    ABSTRACT: Soft tissue defects of the pretibial area and the foot are among the most common complications in patients with lower extremity injuries and remain a challenge for surgeons. This study examined the clinical effects of repairing pretibial and foot soft tissue defects with a medial crural fasciocutaneous flap. Twenty-three injury cases with soft tissue defects in the middle/lower parts of the tibia and ankle/heel were treated. Of these, 8 injuries were in the lower pretibial region, 11 injuries were in the heel, and 4 injuries were in the dorsalis pedis. The dimensions of the soft tissue defects ranged from 7 cm × 5 cm to 18 cm × 10 cm. The crural fasciocutaneous flap was used for wound repair in all cases. The skin harvest dimensions ranged from 12 cm × 6 cm to 23 cm × 12 cm, and the width of the reverse flap pedicle was greater than 4 cm. The patients were followed up for 6 to 27 months postsurgery. All flaps survived and appeared healthy, and leg function was satisfactorily recovered. Five patients suffered from distal flap necrosis and 2 patients suffered from effusion. The area of the crural fasciocutaneous flap harvest appeared to have a good blood supply, and the procedure was easy to perform without injuries to the main vasculature. In conclusion, the medial crural fasciocutaneous flap is a safe and effective clinical intervention for the reconstruction of soft tissue defects of the pretibial area and foot.
    No preview · Article · Aug 2015 · The International Journal of Lower Extremity Wounds
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    ABSTRACT: Chronic wounds develop when the sequence of healing events are disrupted, usually in patients with underlying diseases such as diabetes mellitus, venous insufficiency, peripheral artery disease, and neuropathies and they affect most often the lower extremities. We present a 68-year-old woman with plantar ulceration, lasting for approximately 18 months, resistant to healing with conventional therapy and various modalities we used. The patient had a long history of seronegative enteropathic arthritis, Crohn’s disease, secondary fibrillar amyloidosis, multiplex neuropathy, and small vessel vasculitis, the latter being the trigger event for the ulceration of her right foot. Before the decision for a final surgical intervention, we implemented a mechanical periodic stimulus using a soft toothbrush, which resulted in the gradual and complete healing of the ulcer within a period of 6 weeks. Patient’s history and previous treatments are presented along with the procedures that led to the healing of the chronic wound. This report supports the idea that periodic mechanical stimulus is of great importance for the healing process and this could be the mechanism of action of some other methods that have been described in the medical literature.
    No preview · Article · Apr 2015 · The International Journal of Lower Extremity Wounds

  • No preview · Article · Mar 2015 · The International Journal of Lower Extremity Wounds
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    ABSTRACT: The 9th Wound Healing and Tissue Repair and Regeneration Annual Meeting of Chinese Tissue Repair Society was hold in Wuhan, China. This meeting was focused on the innovation, translation application, and cooperation in wound care both in China and other countries. More than 400 delegates took part in this meeting and communicated successfully. © The Author(s) 2014.
    No preview · Article · Dec 2014 · The International Journal of Lower Extremity Wounds