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Scientifica
Volume 2012 (2012), Article ID 435487, 17 pages
http://dx.doi.org/10.6064/2012/435487
Review Article

Contemporary Evaluation and Management of the Diabetic Foot

Bauer E. Sumpio

Department of Vascular Surgery, Yale University School of Medicine, New Haven, CT 06510, USA

Received 29 July 2012; Accepted 30 September 2012

Academic Editors: M. Morasch and O. C. Velazquez

Copyright © 2012 Bauer E. Sumpio. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Linked References

  1. U.S. Department of Health and Human Services National Diabetes Fact Sheet, 2011.
  2. American Diabetes Association, “Preventive foot care in people with diabetes [position statement],” Diabetes Care, vol. 22, supplement 1, 1999. View at Google Scholar
  3. G. E. Reiber, B. A. Lipsky, Gibbons, and G. W, “The burden of diabetic foot ulcers,” American Journal of Surgery, vol. 176, no. 2, supplement, pp. 5S–10S, 1998. View at Google Scholar
  4. G. E. Reiber, “The epidemiology of diabetic foot problems,” Diabetic Medicine, vol. 13, supplement 1, pp. S6–S11, 1996. View at Google Scholar
  5. R. C. Knox, W. Dutch, P. Blume, and B. E. Sumpio, “Diabetic foot disease,” International Journal of Angiology, vol. 9, no. 1, pp. 1–6, 2000. View at Publisher · View at Google Scholar · View at Scopus
  6. H. J. Murray and A. J. M. Boulton, “The pathophysiology of diabetic foot ulceration,” Clinics in Podiatric Medicine and Surgery, vol. 12, no. 1, pp. 1–17, 1995. View at Google Scholar · View at Scopus
  7. W. Hutton and I. Stokes, “The mechanics of the foot,” in The Foot and Its Disorders, L. Klenerman, Ed., Blackwell Scientific Publications, Oxford, UK, 1991. View at Google Scholar
  8. G. Habershaw and J. Chzran, “Biomechanical considerations of the diabetic foot,” in Management of Diabetic Foot Problems, pp. 53–65, W.B. Saunders, Philadelphia, Pennsylvania, 1995. View at Google Scholar
  9. B. E. Sumpio, “Foot ulcers,” New England Journal of Medicine, vol. 343, no. 11, pp. 787–793, 2000. View at Publisher · View at Google Scholar · View at Scopus
  10. T. J. Phillips, “Chronic cutaneous ulcers: etiology and epidemiology,” Journal of Investigative Dermatology, vol. 102, no. 6, pp. 38S–41S, 1994. View at Google Scholar · View at Scopus
  11. I. A. D. O'Brien, R. J. M. Corrall, and A. S. Krolewski, “Epidemiology of diabetes and its complications,” New England Journal of Medicine, vol. 318, no. 24, pp. 1619–1620, 1988. View at Google Scholar · View at Scopus
  12. P. Laing, “The development and complications of diabetic foot ulcers,” American Journal of Surgery, vol. 176, no. 2, supplement, pp. 11S–19S, 1998. View at Google Scholar
  13. J. S. Weiss and B. E. Sumpio, “Review of prevalence and outcome of vascular disease in patients with diabetes mellitus,” European Journal of Vascular and Endovascular Surgery, vol. 31, no. 2, pp. 143–150, 2006. View at Publisher · View at Google Scholar · View at Scopus
  14. D. E. Bild, J. V. Selby, P. Sinnock, W. S. Browner, P. Braveman, and J. A. Showstack, “Lower-extremity amputation in people with diabetes. Epidemiology and prevention,” Diabetes Care, vol. 12, no. 1, pp. 24–31, 1989. View at Google Scholar · View at Scopus
  15. L. J. Melton 3rd, K. M. Macken, P. J. Palumbo, and L. R. Elveback, “Incidence and prevalence of clinical peripheral vascular disease in a population-based cohort of diabetic patients,” Diabetes Care, vol. 3, no. 6, pp. 650–654, 1980. View at Google Scholar · View at Scopus
  16. K. Kamal, R. J. Powell, and B. E. Sumpio, “The pathobiology of diabetes mellitus: implications for surgeons,” Journal of the American College of Surgeons, vol. 183, no. 3, pp. 271–289, 1996. View at Google Scholar · View at Scopus
  17. M. E. Levin, “Diabetes and peripheral neuropathy,” Diabetes Care, vol. 21, no. 1, p. 1, 1998. View at Google Scholar · View at Scopus
  18. A. J. M. Boulton, C. A. Hardisty, and R. P. Betts, “Dynamic foot pressure and other studies as diagnostic and management aids in diabetic neuropathy,” Diabetes Care, vol. 6, no. 1, pp. 26–33, 1983. View at Google Scholar · View at Scopus
  19. D. J. S. Fernando, E. A. Masson, A. Veves, and A. J. M. Boulton, “Relationship of limited joint mobility to abnormal foot pressures and diabetic foot ulceration,” Diabetes Care, vol. 14, no. 1, pp. 8–11, 1991. View at Google Scholar · View at Scopus
  20. L. Lee, P. A. Blume, and B. Sumpio, “Charcot joint disease in diabetes mellitus,” Annals of Vascular Surgery, vol. 17, no. 5, pp. 571–580, 2003. View at Publisher · View at Google Scholar · View at Scopus
  21. A. Veves, R. A. Malik, R. H. Lye et al., “The relationship between sural nerve morphometric findings and measures of peripheral nerve function in mild diabetic neuropathy,” Diabetic Medicine, vol. 8, no. 10, pp. 917–921, 1991. View at Google Scholar · View at Scopus
  22. A. Veves, D. J. S. Fernando, P. Walewski, and A. J. M. Boulton, “A study of plantar pressures in a diabetic clinic population,” The Foot, vol. 1, no. 2, pp. 89–92, 1991. View at Google Scholar · View at Scopus
  23. E. A. Masson, E. M. Hay, I. Stockley, A. Veves, R. P. Betts, and A. J. M. Boulton, “Abnormal foot pressures alone may not cause ulceration,” Diabetic Medicine, vol. 6, no. 5, pp. 426–428, 1989. View at Google Scholar · View at Scopus
  24. E. Morag, S. Pammer, A. Boulton, M. Young, K. Deffner, and P. Cavanagh, “Structural and functional aspects of the diabetic foot,” Clinical Biomechanics, vol. 12, no. 3, pp. S9–S10, 1997. View at Google Scholar
  25. C. L. Saltzman and W. J. Pedowitz, “Diabetic foot infections,” Instructional Course Lectures, vol. 48, pp. 317–320, 1999. View at Google Scholar · View at Scopus
  26. J. I. Weitz, J. Byrne, G. Patrick Clagett et al., “Diagnosis and treatment of chronic arterial insufficiency of the lower extremities: a critical review,” Circulation, vol. 94, no. 11, pp. 3026–3049, 1996. View at Google Scholar · View at Scopus
  27. B. A. Lipsky, A. R. Berendt, H. G. Deery et al., “Diagnosis and treatment of diabetic foot infections,” Clinical Infectious Diseases, vol. 39, no. 7, pp. 885–910, 2004. View at Publisher · View at Google Scholar · View at Scopus
  28. B. A. Lipsky, D. G. Armstrong, D. M. Citron, A. D. Tice, D. E. Morgenstern, and M. A. Abramson, “Ertapenem versus piperacillin/tazobactam for diabetic foot infections (SIDESTEP): prospective, randomised, controlled, double-blinded, multicentre trial,” Lancet, vol. 366, no. 9498, pp. 1695–1703, 2005. View at Publisher · View at Google Scholar · View at Scopus
  29. B. A. Lipsky, Y. P. Tabak, R. S. Johannes, L. Vo, L. Hyde, and J. A. Weigelt, “Skin and soft tissue infections in hospitalised patients with diabetes: culture isolates and risk factors associated with mortality, length of stay and cost,” Diabetologia, vol. 53, no. 5, pp. 914–923, 2010. View at Publisher · View at Google Scholar · View at Scopus
  30. S. C. Davis, L. Martinez, and R. Kirsner, “The diabetic foot: the importance of biofilms and wound bed preparation,” Current Diabetes Reports, vol. 6, no. 6, pp. 439–445, 2006. View at Publisher · View at Google Scholar · View at Scopus
  31. P. A. Blume, L. K. Paragas, B. E. Sumpio, and C. E. Attinger, “Single-stage surgical treatment of noninfected diabetic foot ulcers,” Plastic and Reconstructive Surgery, vol. 109, no. 2, pp. 601–609, 2002. View at Google Scholar · View at Scopus
  32. D. M. Citron, E. J. C. Goldstein, C. V. Merriam, B. A. Lipsky, and M. A. Abramson, “Bacteriology of moderate-to-severe diabetic foot infections and in vitro activity of antimicrobial agents,” Journal of Clinical Microbiology, vol. 45, no. 9, pp. 2819–2828, 2007. View at Publisher · View at Google Scholar · View at Scopus
  33. E. A. Nelson, S. O'Meara, S. Golder, J. Dalton, D. Craig, and C. Iglesias, “Systematic review of antimicrobial treatments for diabetic foot ulcers,” Diabetic Medicine, vol. 23, no. 4, pp. 348–359, 2006. View at Publisher · View at Google Scholar · View at Scopus
  34. N. Joshi, G. M. Caputo, M. R. Weitekamp, and A. W. Karchmer, “Infections in patients with diabetes mellitus,” New England Journal of Medicine, vol. 341, no. 25, pp. 1906–1912, 1999. View at Publisher · View at Google Scholar · View at Scopus
  35. D. J. Adam, J. Naik, T. Hartshorne, M. Bello, and N. J. M. London, “The diagnosis and management of 689 chronic leg ulcers in a single-visit assessment clinic,” European Journal of Vascular and Endovascular Surgery, vol. 25, no. 5, pp. 462–468, 2003. View at Publisher · View at Google Scholar · View at Scopus
  36. K. A. Collins and B. E. Sumpio, “Vascular assessment,” Clinics in Podiatric Medicine and Surgery, vol. 17, no. 2, pp. 171–191, 2000. View at Google Scholar · View at Scopus
  37. A. J. M. Boulton, D. G. Armstrong, S. F. Albert et al., “Comprehensive fool examination and risk assessment: a report of the task force of the foot care interest group of the American diabetes association, with endorsement by the American association of clinical endocrinologists,” Diabetes Care, vol. 31, no. 8, pp. 1679–1685, 2008. View at Google Scholar
  38. Z. M. Pressley, J. K. Foster, P. Kolm et al., “Digital image analysis: a reliable tool in the quantitative evaluation of cutaneous lesions and beyond,” Archives of Dermatology, vol. 143, no. 10, pp. 1331–1333, 2007. View at Publisher · View at Google Scholar · View at Scopus
  39. M. L. Grayson, G. W. Gibbons, K. Balogh, E. Levin, and A. W. Karchmer, “Probing to bone in infected pedal ulcers: a clinical sign of underlying osteomyelitis in diabetic patients,” Journal of the American Medical Association, vol. 273, no. 9, pp. 721–723, 1995. View at Google Scholar · View at Scopus
  40. R. M. Lozano, M. L. González Fernández, D. M. Hernández, J. V. Beneit Montesinos, S. G. Jiménez, and M. A. Gonzalez Jurado, “Validating the probe-to-bone test and other tests for diagnosing chronic osteomyelitis in the diabetic foot,” Diabetes Care, vol. 33, no. 10, pp. 2140–2145, 2010. View at Publisher · View at Google Scholar · View at Scopus
  41. D. V. Cossman, J. E. Ellison, W. H. Wagner et al., “Comparison of contrast arteriography to arterial mapping with color-flow duplex imaging in the lower extremities,” Journal of Vascular Surgery, vol. 10, no. 5, pp. 522–529, 1989. View at Google Scholar · View at Scopus
  42. B. E. Sumpio, T. Lee, and P. A. Blume, “Vascular evaluation and arterial reconstruction of the diabetic foot,” Clinics in Podiatric Medicine and Surgery, vol. 20, no. 4, pp. 689–708, 2003. View at Publisher · View at Google Scholar · View at Scopus
  43. Y. Feng, F. J. Schlösser, and B. E. Sumpio, “The Semmes Weinstein monofilament examination as a screening tool for diabetic peripheral neuropathy,” Journal of Vascular Surgery, vol. 50, no. 3, pp. 675–682, 2009. View at Publisher · View at Google Scholar · View at Scopus
  44. D. G. Armstrong and L. A. Lavery, “Diabetic foot ulcers: prevention, diagnosis and classification,” American Family Physician, vol. 57, no. 6, pp. 1325–1332, 1998. View at Google Scholar · View at Scopus
  45. J. A. Birke and D. S. Sims, “Plantar sensory threshold in the ulcerative foot,” Leprosy Review, vol. 57, no. 3, pp. 261–267, 1986. View at Google Scholar · View at Scopus
  46. Y. Feng, F. J. Schlösser, and B. E. Sumpio, “The Semmes Weinstein monofilament examination is a significant predictor of the risk of foot ulceration and amputation in patients with diabetes mellitus,” Journal of Vascular Surgery, vol. 53, no. 1, pp. 220–226, 2011. View at Publisher · View at Google Scholar · View at Scopus
  47. M. J. McNeely, E. J. Boyko, J. H. Ahroni et al., “The independent contributions of diabetic neuropathy and vasculopathy in foot ulceration: how great are the risks?” Diabetes Care, vol. 18, no. 2, pp. 216–219, 1995. View at Google Scholar · View at Scopus
  48. B. E. Sumpio, D. G. Armstrong, L. A. Lavery, and G. Andros, “The role of interdisciplinary team approach in the management of the diabetic foot. A Joint Statement from the Society for Vascular Surgery and the American Podiatric Medical Association,” Journal of Vascular Surgery, vol. 51, no. 6, pp. 1504–1506, 2010. View at Publisher · View at Google Scholar · View at Scopus
  49. A. J. M. Boulton, “DCCT: implications for diabetes care in the UK,” Diabetic Medicine, vol. 10, no. 8, p. 687, 1993. View at Google Scholar · View at Scopus
  50. A.D. Association, “Executive summary: standards of medical care in diabetes-2011,” Diabetes Care, vol. 34, supplement 1, pp. S4–S10, 2011. View at Google Scholar
  51. A. Sarage, W. Yui, P. Blume, J. Aruny, and B. Sumpio, “Aggressive revascularization options using cryoplasty in patients with lower extremity vascular disease,” in Re-do Vascular Surgery, G. Geroulakos, Ed., pp. 79–84, Springer, London, UK, 2009. View at Google Scholar
  52. L. Norgren, W. R. Hiatt, J. A. Dormandy, M. R. Nehler, K. A. Harris, and F. G. R. Fowkes, “Inter-society consensus for the management of peripheral arterial disease (TASC II),” Journal of Vascular Surgery, vol. 45, no. 1, pp. S5–S67, 2007. View at Publisher · View at Google Scholar · View at Scopus
  53. P. P. Goodney, A. W. Beck, J. Nagle, H. G. Welch, and R. M. Zwolak, “National trends in lower extremity bypass surgery, endovascular interventions, and major amputations,” Journal of Vascular Surgery, vol. 50, no. 1, pp. 54–60, 2009. View at Publisher · View at Google Scholar · View at Scopus
  54. K. R. Ziegler, A. Muto, S. D. D. Eghbalieh, and A. Dardik, “Basic data related to surgical infrainguinal revascularization procedures: a twenty year update,” Annals of Vascular Surgery, vol. 25, no. 3, pp. 413–422, 2011. View at Publisher · View at Google Scholar · View at Scopus
  55. B. E. Muhs, P. Gagne, and P. Sheehan, “Peripheral arterial disease: clinical assessment and indications for revascularization in the patient with diabetes,” Current Diabetes Reports, vol. 5, no. 1, pp. 24–29, 2005. View at Google Scholar · View at Scopus
  56. D. J. Adam, J. D. Beard, T. Cleveland et al., “Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial,” Lancet, vol. 366, no. 9501, pp. 1925–1934, 2005. View at Publisher · View at Google Scholar · View at Scopus
  57. J. Y. Chun, G. Markose, and A. Bolia, “Developments in subintimal angioplasty in the infrainguinal segment,” Journal of Cardiovascular Surgery, vol. 51, no. 2, pp. 213–221, 2010. View at Google Scholar · View at Scopus
  58. M. J. Bown, A. Bolia, and A. J. Sutton, “Subintimal angioplasty: meta-analytical evidence of clinical utility,” European Journal of Vascular and Endovascular Surgery, vol. 38, no. 3, pp. 323–337, 2009. View at Publisher · View at Google Scholar · View at Scopus
  59. R. Met, K. P. Van Lienden, M. J. W. Koelemay, S. Bipat, D. A. Legemate, and J. A. Reekers, “Subintimal angioplasty for peripheral arterial occlusive disease: a systematic review,” CardioVascular and Interventional Radiology, vol. 31, no. 4, pp. 687–697, 2008. View at Publisher · View at Google Scholar · View at Scopus
  60. J. H. Rogers and J. R. Laird, “Overview of new technologies for lower extremity revascularization,” Circulation, vol. 116, no. 18, pp. 2072–2085, 2007. View at Publisher · View at Google Scholar · View at Scopus
  61. L. A. Garcia and S. P. Lyden, “Atherectomy for infrainguinal peripheral artery disease,” Journal of Endovascular Therapy, vol. 16, no. 2, pp. 105–115, 2009. View at Google Scholar · View at Scopus
  62. G. Al Khoury and R. Chaer, “Evolution of atherectomy devices,” Journal of Cardiovascular Surgery, vol. 52, no. 4, pp. 493–505, 2011. View at Google Scholar
  63. D. L. Steed, D. Donohoe, M. W. Webster, and L. Lindsley, “Effect of extensive debridement and treatment on the healing of diabetic foot ulcers,” Journal of the American College of Surgeons, vol. 183, no. 1, pp. 61–64, 1996. View at Google Scholar · View at Scopus
  64. B. E. Sumpio, D. G. Armstrong, L. A. Lavery, and G. Andros, “The role of interdisciplinary team approach in the management of the diabetic foot a joint statement from the society for vascular surgery and the american podiatric medical association,” Journal of the American Podiatric Medical Association, vol. 100, no. 4, pp. 309–311, 2010. View at Google Scholar · View at Scopus
  65. M. Granick, J. Boykin, R. Gamelli, G. Schultz, and M. Tenenhaus, “Toward a common language: surgical wound bed preparation and debridement,” Wound Repair and Regeneration, vol. 14, no. 1, supplement, pp. S1–S10, 2006. View at Publisher · View at Google Scholar · View at Scopus
  66. M. B. Klein, S. Hunter, D. M. Heimbach et al., “The Versajet water dissector: a new tool for tangential excision,” Journal of Burn Care and Rehabilitation, vol. 26, no. 6, pp. 483–487, 2005. View at Publisher · View at Google Scholar · View at Scopus
  67. B. Bergman-Evans, J. Cuddigan, and N. Bergstrom, “Clinical practice guidelines: prediction and prevention of pressure ulcers,” Journal of Gerontological Nursing, vol. 20, no. 9, pp. 19–26, 1994. View at Google Scholar · View at Scopus
  68. A. J. Singer and R. A. F. Clark, “Cutaneous wound healing,” New England Journal of Medicine, vol. 341, no. 10, pp. 738–746, 1999. View at Publisher · View at Google Scholar · View at Scopus
  69. P. Blume, V. R. Driver, A. J. Tallis et al., “Formulated collagen gel accelerates healing rate immediately after application in patients with diabetic neuropathic foot ulcers,” Wound Repair and Regeneration, vol. 19, no. 3, pp. 302–308, 2011. View at Publisher · View at Google Scholar · View at Scopus
  70. Y. M. Bello and T. J. Phillips, “Recent advances in wound healing,” Journal of the American Medical Association, vol. 283, no. 6, pp. 716–718, 2000. View at Google Scholar · View at Scopus
  71. B. Sumpio, V. R. Driver, and G.W. Gibbons, “A multidisciplinary approach to limb preservation: the role of V.A.C. therapy,” Wounds, supplement, pp. 1–19, 2009. View at Google Scholar
  72. P. Blume, C. Salonga, J. Garbalosa et al., “Predictors for the healing of transmetatarsal amputations: retrospective study of 91 amputations,” Vascular, vol. 15, no. 3, pp. 126–133, 2007. View at Publisher · View at Google Scholar · View at Scopus
  73. S. A. Bus, G. D. Valk, R. W. van Deursen et al., “The effectiveness of footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in diabetes: a systematic review,” Diabetes/Metabolism Research and Reviews, vol. 24, no. 1, pp. S162–S180, 2008. View at Publisher · View at Google Scholar · View at Scopus
  74. S. A. Bus, G. D. Valk, R. W. van Deursen et al., “Specific guidelines on footwear and offloading,” Diabetes/Metabolism Research and Reviews, vol. 24, no. 1, pp. S192–S193, 2008. View at Publisher · View at Google Scholar · View at Scopus
  75. D. G. Armstrong, L. A. Lavery, S. Stern, and L. B. Harkless, “Is prophylactic diabetic foot surgery dangerous?” Journal of Foot and Ankle Surgery, vol. 35, no. 6, pp. 585–589, 1996. View at Google Scholar · View at Scopus
  76. A. R. Catanzariti, E. L. Blitch, and L. G. Karlock, “Elective foot and ankle surgery in the diabetic patient,” Journal of Foot and Ankle Surgery, vol. 34, no. 1, pp. 23–41, 1995. View at Google Scholar · View at Scopus
  77. J. Barrow, J. Hughes, P. Clarke, and L. Klenerman, “A study of the effect of wear on the pressure-relieving properties of foot orthosis,” The Foot, vol. 1, no. 4, pp. 195–199, 1992. View at Google Scholar · View at Scopus
  78. D. A. Nawoczenski, J. A. Birke, and W. C. Coleman, “Effect of rocker sole design on plantar forefoot pressures,” Journal of the American Podiatric Medical Association, vol. 78, no. 9, pp. 455–460, 1988. View at Google Scholar · View at Scopus
  79. P. C. Tang, K. Ravji, J. J. Key, D. B. Mahler, P. A. Blume, and B. Sumpio, “Let them walk! Current prosthesis options for leg and foot amputees,” Journal of the American College of Surgeons, vol. 206, no. 3, pp. 548–560, 2008. View at Google Scholar
  80. D. P. Orgill, E. K. Manders, B. E. Sumpio et al., “The mechanisms of action of vacuum assisted closure: more to learn,” Surgery, vol. 146, no. 1, pp. 40–51, 2009. View at Publisher · View at Google Scholar · View at Scopus
  81. P. A. Blume, J. Walters, W. Payne, J. Ayala, and J. Lantis, “Comparison of negative pressure wound therapy usingVacuum-assisted closure with advanced moist wound therapy in the treatment of diabetic foot ulcers,” Diabetes Care, vol. 31, no. 4, pp. 631–636, 2008. View at Publisher · View at Google Scholar · View at Scopus
  82. S. Vig, C. Dowsett, L. Berg et al., “Evidence-based recommendations for the use of negative pressure wound therapy in chronic wounds: steps towards an international consensus,” Journal of Tissue Viability, vol. 20, supplement, no. 1, pp. S1–S18, 2011. View at Google Scholar
  83. P. A. Blume, J. J. Key, P. Thakor, S. Thakor, and B. Sumpio, “Retrospective evaluation of clinical outcomes in subjects with split-thickness skin graft: comparing V.A.C. therapy and conventional therapy in foot and ankle reconstructive surgeries,” International Wound Journal, vol. 7, no. 6, pp. 480–487, 2010. View at Publisher · View at Google Scholar · View at Scopus
  84. B. Sumpio, P. Thakor, D. Mahler, and P. Blume, “Negative pressure wound therapy as postoperative dressing in below knee amputation stump closure of patients with chronic venous insufficiency,” Wounds, vol. 23, no. 10, pp. 301–308, 2011. View at Google Scholar
  85. P. Sheehan, P. Jones, A. Caselli, J. M. Giurini, and A. Veves, “Percent change in wound area of diabetic foot ulcers over a 4-week period is a robust predictor of complete healing in a 12-week prospective trial,” Diabetes Care, vol. 26, no. 6, pp. 1879–1882, 2003. View at Publisher · View at Google Scholar · View at Scopus
  86. D. J. Margolis, C. Bartus, O. Hoffstad, S. Malay, and J. A. Berlin, “Effectiveness of recombinant human platelet-derived growth factor for the treatment of diabetic neuropathic foot ulcers,” Wound Repair and Regeneration, vol. 13, no. 6, pp. 531–536, 2005. View at Publisher · View at Google Scholar · View at Scopus
  87. D. L. Steed, C. Attinger, T. Colaizzi et al., “Guidelines for the treatment of diabetic ulcers,” Wound Repair and Regeneration, vol. 14, no. 6, pp. 680–692, 2006. View at Publisher · View at Google Scholar · View at Scopus
  88. A. Veves, V. Falanga, D. G. Armstrong, and M. L. Sabolinski, “Graftskin, a human skin equivalent, is effective in the management of noninfected neuropathic diabetic foot ulcers: a prospective randomized multicenter clinical trial,” Diabetes Care, vol. 24, no. 2, pp. 290–295, 2001. View at Google Scholar · View at Scopus
  89. A. J. Boulton, R. S. Kirsner, and L. Vileikyte, “Clinical practice. Neuropathic diabetic foot ulcers,” The New England Journal of Medicine, vol. 351, no. 1, pp. 48–55, 2004. View at Google Scholar · View at Scopus
  90. T. Tan, E. J. Shaw, F. Siddiqui et al., “Inpatient management of diabetic foot problems: summary of NICE guidance,” British Medical Journal, vol. 342, article d1280, 2011. View at Publisher · View at Google Scholar · View at Scopus
  91. S. D. McMurray and K. McDougall, “Improving diabetes foot care in the dialysis facility,” Nephrology News & Issues, vol. 17, no. 10, pp. 57–66, 2003. View at Google Scholar · View at Scopus
  92. A. J. Boulton, “The diabetic foot: a global view,” Diabetes/Metabolism Research and Reviews, vol. 16, supplement 1, pp. S2–S5, 2000. View at Google Scholar
  93. K. Stockl, A. Vanderplas, E. Tafesse, and E. Chang, “Costs of lower-extremity ulcers among patients with diabetes,” Diabetes Care, vol. 27, no. 9, pp. 2129–2134, 2004. View at Publisher · View at Google Scholar · View at Scopus
  94. L. A. Lavery, D. G. Armstrong, R. P. Wunderlich, M. J. Mohler, C. S. Wendel, and B. A. Lipsky, “Risk factors for foot infections in individuals with diabetes,” Diabetes Care, vol. 29, no. 6, pp. 1288–1293, 2006. View at Publisher · View at Google Scholar · View at Scopus
  95. D. A. Ellison, L. Hayes, C. Lane, A. Tracey, and C. N. McCollum, “Evaluating the cost and efficacy of leg ulcer care provided in two large UK health authorities,” Journal of Wound Care, vol. 11, no. 2, pp. 47–51, 2002. View at Google Scholar · View at Scopus
  96. A. Lloyd, W. Sawyer, and P. Hopkinson, “Impact of long-term complications on quality of life in patients with type 2 diabetes not using insulin,” Value in Health, vol. 4, no. 5, pp. 392–400, 2001. View at Publisher · View at Google Scholar · View at Scopus
  97. G. Ragnarson Tennvall and J. Apelqvist, “Health-related quality of life in patients with diabetes mellitus and foot ulcers,” Journal of Diabetes and Its Complications, vol. 14, no. 5, pp. 235–241, 2000. View at Publisher · View at Google Scholar · View at Scopus
  98. D. Goodridge, E. Trepman, and J. M. Embil, “Health-related quality of life in diabetic patients with foot ulcers: literature review,” Journal of Wound, Ostomy, and Continence Nursing, vol. 32, no. 6, pp. 368–377, 2005. View at Google Scholar · View at Scopus
  99. R. Ashford, P. McGee, and K. Kinmond, “Perception of quality of life by patients with diabetic foot ulcers,” Diabetic Foot, vol. 3, pp. 150–155, 2000. View at Google Scholar
  100. N. L. Browse, “The etiology of venous ulceration,” World Journal of Surgery, vol. 10, no. 6, pp. 938–943, 1986. View at Google Scholar · View at Scopus
  101. M. Goldman and A. Fronek, “Consensus paper on venous leg ulcer,” Journal of Dermatologic Surgery & Oncology, vol. 18, pp. 592–602, 1992. View at Google Scholar
  102. T. Phillips, B. Stanton, A. Provan, and R. Lew, “A study of the impact of leg ulcers on quality of life: financial, social, and psychologic implications,” Journal of the American Academy of Dermatology, vol. 31, no. 1, pp. 49–53, 1994. View at Google Scholar · View at Scopus
  103. B. Sumpio, D. Allie, K. Horvath et al., “Role of negative pressure wound therapy in treating peripheral vascular graft infections,” Vascular, vol. 16, no. 4, pp. 194–200, 2008. View at Google Scholar