ArticleFrontiers in surgery2025
A three-stage sequential surgical approach to a more efficient management of clinical stage 4 diabetic foot ulcers.
Article in Frontiers in surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
- [Expert consensus on the application of bone cement in the treatment of diabetic wounds (2026 edition)].Zhonghua shao shang yu chuang mian xiu fu za zhi · 2026Article
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Authors and funding
12 authors.
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Abstract
Background: It has been a great challenge to treat clinical stage 4 Diabetic foot ulcers (DFUs) due to high rates of major amputations and prolonged healing time. This study aimed to assess the effectiveness of a three-stage sequential surgical approach, which based on the Integrated Surgery Wound Treatment (ISWT) mode, to manage clinical stage 4 DFUs and compare the benefit of incorporating tibial cortex transverse transport (TTT) surgery at stage 3 treatment. Methods: Twenty-three patients with clinical stage 4 DFUs aged 45-75 years treated between January 2022 and February 2023 were retrospectively analyzed. Eleven patients (Group A) received wound debridement, antibiotic-loaded bone cement (ALBC) at stage 1 treatment, percutaneous transluminal angioplasty (PTA), wound debridement, and ALBC at stage 2 treatment, and skin grafting with TTT at stage 3 treatment, while twelve patients (Group B) received the same treatment without TTT. Assessed clinical outcomes included length of hospital stay, ulcer healing duration, ulcer recurrence rate, reintervention (re)-PTA rate, amputation rate, mortality rate, visual analog scale (VAS) scores, ankle-brachial index (ABI), and two-point discrimination (2-PD) ability. The computed tomographic angiography (CTA) was used to evaluate vascular hyperplasia. Results: Group A showed no occurrences of re-PTA ( Conclusion: The sequential three-stage approach based on the ISWT mode effectively manages clinical stage 4 DFUs. Incorporating TTT surgery at stage 3 extends the benefits of PTA surgery.
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