Does the advantage of transcutaneous oximetry measurements in diabetic foot ulcer apply equally to free flap reconstruction?

BACKGROUND Transcutaneous oxygen pressure(TcpO2)is a precise method for determining oxygen perfusion in wounded tissues.The device uses either electrochemical or optical sensors.AIM To evaluate the usefulness of TcpO2 measurements on free flaps(FFs)in diabetic foot ulcers(DFUs).METHODS TcpO2 was measured in 17 patients with DFUs who underwent anterolateral thigh(ALT)-FF surgery and compared with 30 patients with DFU without FF surgery.RESULTS Significant differences were observed in the ankle-brachial index;duration of diabetes;and haemoglobin,creatinine,and C-reactive protein levels between the two groups.TcpO2 values were similar between two groups except on postoperative days 30 and 60 when the values in the ALT-FF group remained<30 mmHg and did not increase>50 mmHg.CONCLUSION Even if the flap is clinically stable,sympathectomy due to adventitia stripping during anastomosis and arteriovenous shunt progression due to diabetic polyneuropathy could lead to low TcpO2 values in the ALT-FF owing to its thick fat tissues,which is supported by the slow recovery of the sympathetic tone following FF.Therefore,TcpO2 measurements in patients with DFU who underwent FF reconstruction may be less accurate than in those who did not.

Surgical treatment of 82 patients with diabetic lower limb ischemia by distal arterial bypass

Background Diabetic lower limb ischemia is a serious complication of diabetes mellitus. This study was conducted to investigate the effectiveness of distal arterial bypass treatment in diabetic patients with lower limb ischemia. Methods From July 2000 to July 2004, 96 lower limbs of 82 diabetic patients （type 2） with severe lower limb ischemia were treated in Xuan Wu Hospital. Arterial bypass with femoro-popliteal polytetrafluoroethylene （PTFE） and graft-tibial autologous grafts was performed on 31 limbs （32.3%）. Popliteal-tibial artery bypass alone was performed on 22 limbs （22.9%）. Combined lilac artery stenting, femoro-popliteal artery PTFE graft bypass, and graft-tibial artery autologous graft bypass was performed on 12 limbs （12.5%）, and femoro-tibial artery graft bypass was performed on 10 limbs （10.4%）. Popliteal-tibial-pedal artery graft bypass was performed on 7 limbs （7.3%）. Results Arterial grafts in 92 limbs of 79 patients were patent on discharge. Three patients with 4 ischemic limbs （3.7%） died of respiratory failure 12 hours, 3 days and 7 days after operation respectively. Early operation success rate was 96.3% （79/82）. Graft patency rate of patients on discharge was 95.8% （92/96）. The short-term total effectiveness rate was 83.3% （80/96）. Foot ulcer healing rate was 35.7% （10/28）. 97.4% （75/77） patients were followed up for a mean of 13.5 months. The long-term total effective rate was 80.7% （71/88）. The total amputation rate was 4.5% （4/88）. Mortality was 4.5%. The total graft patency rate was 90.9% （80/88）.Conclusion In the treatment of diabetic foot, distal lower limb arterial bypass can help to avoid amputation or lower the amputation level, and may promote foot ulcer healing and improve patient＇s quality of life.

Decreased expression of complement regulatory proteins, CD55 and CD59, on peripheral blood leucocytes in patients with type 2 diabetes and macrovascular diseases

Background Macro- and microvascular diseases are the leading cause of morbidity and mortality in diabetic patients, but their mechanisms remain unclear. Recent reports provide evidence that the levels of CD55 and CD59 are decreased in diabetic microvascular diseases. However, very little is known about the levels of CD55 and CD59, the relationship between them and carotid artery intima-media thickness, and the effects of statins on CD55 and CD59 in diabetic macrovascular diseases. Methods The mean fluorescence intensity （MFI） of CD55 and CD59 expression on peripheral blood leucocyte subsets （lymphocytes, monocytes and neutrophils） was studied using flow cytometry, and carotid artery intima-media thickness was measured using B-mode ultrasonography in 23 healthy subjects （controls）, 19 patients with type 2 diabetes （T2DM）, and 43 patients with type 2 diabetes and macrovascular diseases （T2DM-M）. The patients with T2DM-M were assigned to two subgroups based on whether statins were used： group with statins （n=-23） and group without statins （n=20）. Results Compared with the controls and T2DM, the MFI of CD55 positive neutrophils was significantly lower in T2DM-M （P=0.049 vs controls and P=0.033 vs T2DM）; similarly, the MFI of CD59 positive monocytes was also lower in T2DM-M （P=0.038 vs controls and P=0.043 vs T2DM）. The MFI of CD59 positive neutrophils in T2DM-M was lower than in T2DM （P=0.032）. The levels of CD55 and CD59 were negatively associated with age and blood pressure （r=-0.245- -0.352, P=0.041-0.003）, but not acute-phase reactants and carotid artery intima-media thickness. The levels of CD55 and CD59 increased after treatment with statins, but the results were not significantly different （P 〉0.05 ）. Conclusions CD55 and CD59 expressions on peripheral blood leucocytes are decreased in T2DM patients with macrovascular diseases. The results suggest that the decreased levels of complement regulatory proteins might play an important role in diabetic macrovascular diseases.