The purpose of this study was to investigate the clinical efficacy of antibiotic-loaded bone cement (ALBC) combined with Negative pressure wound therapy (NPWT) aspiration technique in the treatment of multidrug-resistant diabetic foot ulcers (MDRO-DFUs).

A retrospective analysis of the clinical data of 80 patients with MDROs-DFU who were used Vacuum sealing drainage (VSD) as NPWT excipient and met the inclusion criteria from January 2019 to January 2024 at our hospital. Patients were divided into an experimental group and a control group, with 40 cases in each. The control group received conventional treatment, routine debridement, and NPWT treatment, while the experimental group received ALBC treatment in addition to the treatment plan of the control group. Measurements of blood inflammatory indicators, foot hemodynamic indicators, wound bacterial clearance time, wound healing time, and hospital stay were taken before and after treatment for both groups.

Inflammatory indexes, Vascular endothelial growth factor(VEGF), and internal diameter of dorsalis pedis arteriosus of both groups after treatment were significantly better than those before treatment, and the improvement of the experimental group was more obvious than that of the control group; the experimental group had a significantly shorter time of trauma bacterial turnover, healing time of trauma, and hospitalization time compared with that of the control group (P<0.05).

Diabetic foot ulcer (DFU) is a common and complex complication in patients with diabetes mellitus. The study of antibiotic-loaded bone cement for the treatment of infected diabetic foot is limited. We aimed to assess the efficacy of antibiotic-loaded bone cement for the treatment of infected diabetic foot.

The MEDLINE, Embase, BIOSIS, the Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Knowledge databases were systematically searched up to May 2023 with no language restrictions. We assessed eligible studies for the efficacy of antibiotic-loaded bone cement for the treatment of infected diabetic foot. The standard mean differences (SMDs) or the risk ratios (RRs) were calculated for continuous or dichotomous data, respectively. Data were analysed using the Cochrane Collaboration's RevMan 5.0 software.

Nine articles with 565 patients were analysed in our meta-analysis. The wound healing time in ABC group was significantly shorter than that in the control group (SMD = -1.64, 95% CI -2.27 to -1.02 p < 0.00001, I2 = 88%). The ABC group had a significantly decreased number of debridements (SMD = -2.47, 95% CI -4.24 to -0.70, p < 0.00001, I2 = 95%). The pooled data showed no significant difference (RR = 0.41, 95% CI 0.12 to 1.39, p = 0.84, I2 = 0%).

This is the first meta-analysis comparing the efficacy of antibiotic-loaded bone cement for the treatment of infected diabetic foot. Antibiotic-loaded bone cement treatment significantly shortened the wound healing time and reduced the number of debridements without increasing the incidence of complications.

PROSPERO CRD42023406017.

To investigate the effectiveness of antibiotic bone cement combined with the vacuum sealing drainage (VSD) technique for repairing sacrococcygeal pressure ulcer wounds.

A retrospective analysis was conducted on data from 136 patients treated at Yantai Affiliated Hospital of Binzhou Medical College between May 2020 and June 2022. The cases were devided into a control group and a study group according to their treatment regimen. Indicators of postoperative recovery including blood routine recovery time, hospital stay, antibiotic application time, and healing time were compared between the two groups. Before the procedure and 6, 12, 24, and 48 hours following the operation, the pain levels of patients in both groups were examined using a visual analogue scale (VAS). On the 3rd, 7th, 14th, 21st, and 28th days of treatment, the pressure ulcer scale for healing (PUSH) was used to measure the pressure ulcer area between the two groups. On the 7th, 14th, 21st, and 28th days following treatment, the capillary density values were compared between the two groups, along with the levels of interleukin-1β (IL-1β), interleukin-12 (IL-12), and c-reactive protein (CRP). The proportions of immunoglobulin M (IgM) and immunoglobulin G (IgG) levels, CD3+, CD4+, and CD8+ T cell subsets, as well as CD4+/CD8+ ratio, were compared between the two groups.

The blood routine recovery time, hospital stays, antibiotic usage duration, and healing time were all significantly shorter in the study group compared to those in the control group (all P<0.05). At 6 h, 12 h, 24 h, and 48 h following surgery, the VAS score in study group was significantly lower than that of the control group (P<0.05). The study group also showed a greater reduction in pressure ulcer area, with lower PUSH scores observed on days 14, 21, and 28 (P<0.05). Post-treatment levels of IL-1β, IL-12, and CRP decreased in both groups, with significantly lower levels in the study group (P<0.05). Following therapy, both groups demonstrated significantly increased levels of CD3+, CD4+, CD4+/CD8+, IgM and IgG and reduced level of CD8+. These improvements were more pronounced in the study group (all P<0.05).

The combination of antibiotic bone cement and VSD is effective in enhancing recovery, reducing pain and inflammation, and improving immune response in the treatment of sacrococcygeal pressure ulcers.

In this editorial, we comment on an article by Liao et al published in the current issue of the World Journal of Diabetes. We focus on the clinical significance of tibial transverse transport (TTT) as an effective treatment for patients with diabetic foot ulcers (DFU). TTT has been associated with tissue regeneration, improved blood circulation, reduced amputation rates, and increased expression of early angiogenic factors. Mechanistically, TTT can influence macrophage polarization and growth factor upregulation. Despite this potential, the limitations and conflicting results of existing studies justify the need for further research into its optimal application and development. These clinical implications highlight the efficacy of TTT in recalcitrant DFU and provide lasting stimuli for tissue re-generation, and blood vessel and bone marrow improvement. Immunomodulation via systemic responses contributes to its therapeutic potential. Future studies should investigate the underlying molecular mechanisms to enhance our understanding and the efficacy of TTT. This manuscript emphasizes the potential of TTT in limb preservation and diabetic wound healing and suggests avenues for preventive measures against limb amputation in diabetes and peripheral artery disease. Here, we highlight the clinical significance of the TTT and its importance in healing DFU to promote the use of this technique in tissue regeneration.

Hyperbaric oxygen therapy (HBOT) has been used in patients with diabetic foot ulcers (DFU) for many years, but its clinical efficacy is still controversial. Therefore, this study explored the efficacy of HBOT applied to DFU by means of meta-analysis. PubMed, Cochrane Library, Embase, CNKI and Wanfang databases were searched, from database inception to October 2023, and published randomised controlled trials (RCTs) of HBOT in DFU were collected. Two investigators independently screened the collected literature, extracted relevant data and assessed the quality of the literature. Review Manager 5.4 software was applied for data analysis. Twenty-nine RCTs with 1764 patients were included. According to the combined results, when compared with conventional treatment, HBOT significantly increased the complete healing rate of DFUs (46.76% vs. 24.46%, odds ratio [OR]: 2.83, 95% CI: 2.29-3.51, p < 0.00001) and decreased the amputation rate (26.03% vs. 45.00%, OR: 0.41, 95% CI: 0.18-0.95, p = 0.04), but the incidence of adverse events was significantly higher in patients (17.37% vs. 8.27%, OR: 2.49, 95% CI: 1.35-4.57, p = 0.003), whereas there was no significant difference in the mortality (6.96% vs. 12.71%, OR: 0.52, 95% CI: 0.21-1.28, p = 0.16). Our results suggest that HBOT is effective in increasing the complete healing rate and decreasing the amputation rate in patients with DFUs, but increases the incidence of adverse events, while it has no significant effect on mortality.

A meta-analysis research was implemented to appraise the effect of antibiotic bone cement (ABC) in treating infected diabetic foot wounds (IDFWs). Inclusive literature research till April 2023 was done and 1237 interconnected researches were revised. The 15 selected researches enclosed 895 IDFWs persons were in the utilized researchers' starting point, 449 of them were utilizing ABC, and 446 were in the control group. Odds ratio and 95% confidence intervals were utilized to appraise the consequence of ABC in treating IDFWs by the contentious approach and a fixed or random model. ABC had significantly lower wound healing time (MD, -9.83; 95% CI, -12.45--7.20, p < 0.001), and time to bacterial conversion of the wound (MD, -7.30; 95% CI, -10.38--4.32, p < 0.001) compared to control in IDFWs persons. However, caution needs to be taken when interacting with its values since there was a low sample size of most of the chosen research found for the comparisons in the meta-analysis.

Chinese physicians developed the Tibial Transverse Transport (TTT) technique to treat diabetic foot ulcers with more than 90% effective rate. But this method still could not avoid the in-hospital death of patients. This study adopted a case-control study to explore the risk factors of in-hospital death in elderly patients with chronic ischemic diabetic foot after receiving TTT treatment.

A total of 54 patients were included in the study from January 1, 2017 to April 30, 2021, by being paired with the cases in case group with their demographic data and results of blood routine, liver and kidney function. There were nine patients in case group with six male and three male. Forty-five patients were selected in control group according to gender and diabetes type with 30 male and 15 female. Single factor logics regression analysis was used to explore the risk factors and odd ratios (OR) of in-hospital death in patients. The nomogram and decision curve analysis (DCA) had been done by R Studio software.

The study found that age, course of diabetic foot, small dense low-density Lipoprotein (smLDL), homocysteine (Hcy), superoxide dismutase (SOD), and prealbumin (PA) were risk factors for in-hospital death of patients. The smLDL had the highest risk. The nomogram showed that PA accounted for the largest proportion in the death risk factors. The results of DCA proved that above six risk factors were the risk factors for patients with TEXAS Stage 3 and 4 diabetic foot ulcers.

In the future diagnosis and TTT treatment for diabetic foot ulcers, doctors need to pay close attention to age, course of diabetic foot, smLDL, Hcy, SOD, and PA.

Diabetic foot ulcerations (DFUs) are a common but highly morbid complication of long-standing diabetes, carrying high rates of associated major amputation and mortality. Transverse tibial bone transport (TTT) has recently been applied for treatment of DFUs with the aim of accelerating wound healing. This study was performed to evaluate the effectiveness and safety of TTT in patients with DFUs.

Two authors independently retrieved the platforms of PubMed, Embase and CENTRAL, to identify studies associated with treatment of DFUs with TTT. Quantitative meta-analyses were performed to pool all available outcomes about the effectiveness and complications of TTT operation, with fixed- (I2<50%) or random-effect (I2>50%) model according to I2.

A total of 7 studies, involving 818 participants, were included, with 661 participants treated with TTT operation. The pooled healing rate and limb salvage rate were 0.96 (95%CI: 0.93~0.98) and 0.98 (95%CI: 0.95~1.00) respectively after treatment with TTT. The pooled mean healing time was 15.03 (95%CI: 9.05~21.00) months. When compared with the pre-operative baseline values, the ankle-brachial index (ABI, MD: 0.23; 95%CI: 0.03~0.44; p<0.001), skin temperature (MD: 1.56; 95%CI: 0.30~2.81; p<0.001), and visual analogue scale (VAS, MD: 3.70; 95%CI: 1.97~5.44; p<0.001) were significantly improved at the final follow-up. When compared with non-TTT group, the TTT group was associated with higher healing rate (OR: 10.43; 95%CI: 3.96~27.43; p<0.001) and limb salvage rate (OR: 9.65; 95%CI: 3.30~28.20; p<0.001). Concerning the complications of the TTT process, the pooled risks of fracture at transportation site and pin-site infection were 0.02 (95%CI: 0.00~0.04) and 0.08 (95%CI: 0.00~0.22), respectively; and the DFU recurrence rate in TTT group was significantly lowered comparing to that of the non-TTT group (RR: 0.18; 95%CI: 0.06~0.49; p=0.001).

TTT operation was associated with high healing rate and limb salvage rate, and could significantly improve the ABI, skin temperature, and VAS after operation. When compared with the control group, TTT group provided significantly higher healing rate and limb salvage rate. However, TTT operation should be conducted with caution concerning the incidences of fracture at tibia, infection at pin channels and necrosis of skin overlying the anterior tibia.