BACKGROUND:Minor amputations, defined as resection of bone below the ankle, are important procedures for managing diabetes-related foot infections (DFI). The optimal method to determine the presence of residual bone infection is unclear and unplanned reoperation rates are common. Although international guidelines endorse the use of histopathology, this approach has not been universally adopted. PURPOSE:We evaluated the utility of histopathological analysis from samples collected from 'proximal' or 'marginal' bone during minor amputations. STUDY DESIGN:A retrospective, single-center study was conducted at Sir Charles Gairdner Hospital, in Perth, Western Australia. METHODS:The primary outcome of interest was treatment success at six months, defined as being alive and no unplanned reoperation at the original operation site. RESULTS:Of 67 cases, 22 (33 %) had positive histopathology. Patients with positive margins were less likely to have treatment success compared to those with negative margins (50 % versus 82 %; P = 0.006). Antibiotic duration was significantly shorter in patients with negative histopathological margins compared to patients with positive histopathological margins (median 14 vs 42 days; P = 0.0003). The concordance between histopathology and microbiology was 51 %. CONCLUSION:Positive histopathology was associated with lower rates of treatment success, despite receiving longer antibiotic durations. Positive culture from the same samples were not predictive of outcome. Larger, prospective studies are needed to define optimal sampling methods and antibiotic therapy following minor amputation.

Diabetes-related foot disease (DFD) is a common, costly, and severe complication of diabetes mellitus. DFD is associated with high rates of morbidity and mortality and poses a significant burden on patients, healthcare systems and society. While the detrimental impact of DFD is widely recognised, the precise financial implications of its management in Australia remain unclear due to inconsistent and inconclusive contemporary data. Therefore, the aim of this review was to identify, summarise and synthesise existing evidence to estimate the costs associated with DFD management in Australia. Searches were conducted in MEDLINE, Embase, AMED, CINAHL, Joanna Briggs Institute EBP, and the Cochrane Library from November 2011 to July 2023. Australian studies investigating costs associated with DFD management were eligible for inclusion. Two independent reviewers performed the study selection, data extraction and quality assessment steps. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS 2022) checklist was used to assess study quality. A descriptive analysis was performed due to limited existing evidence and large heterogeneity between study populations to conduct meta-analyses. Three economic evaluations were included in the review. One study was rated as ‘poor’, one as ‘very good’ and one as ‘excellent’ when assessed against the CHEERS checklist. The estimated cost of DFD management varied between studies and comparisons were not possible due to the different methodological approaches and data sources. The studies were unable to provide an overall cost of DFD with respect to all aspects of care as they did not capture the multi-faceted level of care throughout the entire patient journey between sectors and over time. There is limited contemporary evidence for the costs associated with DFD management within Australia, particularly related to direct costs and resource utilisation. Further research into the economic impact of DFD management is needed to inform optimisation of national service delivery and improve health outcomes for individuals with DFD in Australia. Integrating real-world data on impact of clinical interventions with parallel economic evaluation could be a valuable approach for future research, which would offer a more comprehensive understanding of the clinical and economic outcomes beyond solely model-based evaluations. PROSPERO Registration No. CRD42022290910.

Diabetes-related foot disease (DFD) is a common, costly, and severe complication of diabetes mellitus. DFD is associated with high rates of morbidity and mortality and poses a significant burden on patients, healthcare systems and society. While the detrimental impact of DFD is widely recognised, the precise financial implications of its management in Australia remain unclear due to inconsistent and inconclusive contemporary data. Therefore, the aim of this review was to identify, summarise and synthesise existing evidence to estimate the costs associated with DFD management in Australia. Searches were conducted in MEDLINE, Embase, AMED, CINAHL, Joanna Briggs Institute EBP, and the Cochrane Library from November 2011 to July 2023. Australian studies investigating costs associated with DFD management were eligible for inclusion. Two independent reviewers performed the study selection, data extraction and quality assessment steps. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS 2022) checklist was used to assess study quality. A descriptive analysis was performed due to limited existing evidence and large heterogeneity between study populations to conduct meta-analyses. Three economic evaluations were included in the review. One study was rated as ‘poor’, one as ‘very good’ and one as ‘excellent’ when assessed against the CHEERS checklist. The estimated cost of DFD management varied between studies and comparisons were not possible due to the different methodological approaches and data sources. The studies were unable to provide an overall cost of DFD with respect to all aspects of care as they did not capture the multi-faceted level of care throughout the entire patient journey between sectors and over time. There is limited contemporary evidence for the costs associated with DFD management within Australia, particularly related to direct costs and resource utilisation. Further research into the economic impact of DFD management is needed to inform optimisation of national service delivery and improve health outcomes for individuals with DFD in Australia. Integrating real-world data on impact of clinical interventions with parallel economic evaluation could be a valuable approach for future research, which would offer a more comprehensive understanding of the clinical and economic outcomes beyond solely model-based evaluations. PROSPERO Registration No. CRD42022290910.

Methods A qualitative study was conducted with the aim of exploring levels and determinants of adherence to wearing knee-high RCW offloading devices. Semi-structured interviews of ten participants, who had active DFUs and had their wounds offloaded by RCWs, were commenced at two diabetic foot clinics in Jordan. Adherence levels was explored through participants’ self-estimation of time and activities (steps) of wearing the prescribed offloading device, then the determinants of this behavior were investigated including facilitators and barriers. Arabic was the original language of the interviews which was translated to English by backtranslation. Data were analysed through thematic content analysis which led to develop themes, categories, and sub-categories.

ObjectivesTo explore adherence to wearing removable cast walkers (RCWs) among patients with diabetic foot ulcers (DFUs).Methods A qualitative study was conducted with the aim of exploring levels and determinants of adherence to wearing knee-high RCW offloading devices.Semi-structured interviews of ten participants, who had active DFUs and had their wounds offloaded by RCWs, were commenced at two diabetic foot clinics in Jordan.Adherence levels was explored through participants' self-estimation of time and activities (steps) of wearing the prescribed offloading device, then the determinants of this behavior were investigated including facilitators and barriers.Arabic was the original language of the interviews which was translated to English by backtranslation.Data were analysed through thematic content analysis which led to develop themes, categories, and sub-categories. ResultsTwo main key themes present the findings including: 1) The levels of adherence to wearing RCWs were varied, which were represented by three main categories: i) times and durations for which RCWs were worn; ii) specific activities for which RCWs were not worn; and iii) specific steps for which RCWs were not worn.2) Adherence to wearing RCWs was affected by multiple factors; which was represented by four main categories: i) factors related to personal knowledge or beliefs; ii) factors related to the severity of diabetic foot disease; iii) factors related to the social environment; iv) factors related to the usability of the RCWs. ConclusionsLevel of adherence to wearing RCWs is varied and can be affected by many psychosocial and physiological factors.Food first strategies incorporating a commercial wound supplement to support intake and overcome taste fatigue

Background: Deep-space surgical site infections carry significant morbidity and mortality. The evidence for gentamicin-containing collagen implants at reducing surgical site infections in open infrainguinal arterial surgery is limited. This study examined whether gentamicin-containing collagen implants reduces 30-day surgical site infections and their severity following open infrainguinal arterial surgery. Methods: A retrospective observational cohort study that included all patients undergoing infrainguinal arterial bypass or endarterectomy between November 2015 and March 2019 at a single tertiary vascular unit. Patients with contaminated/infected surgical fields, surgical wounds treated with negative pressure therapy, or the usage of antimicrobial implants and dressings other than Collatamp G (R) (Aralez Pharmaceuticals, Canada) were excluded. Patients with gentamicin-containing collagen implants placed abutting vasculature were compared against patients without gentamicin-containing collagen implants. Outcomes included the rate of surgical site infections and their severity within 30 days after the operation. Results: In 159 procedures (mean age 67.7 years, 74.8% male, 33.3% diabetic, 16.4% chronic renal failure, 25.2% anticoagulated postoperatively, 32.7% with prosthetic implants), 55 (34.6%) procedures received gentamicin-containing collagen implants. There were significantly more males (85.5% vs. 69.2%; P = 0.025), higher rates of obesity (41.8% vs. 26.0%; P = 0.041), and hyperlipidemia (65.5% vs. 49.0%; P = 0.048) in the gentamicin-containing collagen implant group. In total, 6 (3.8%) procedures developed deep-space surgical site infections (1 with gentamicin-containing collagen implant, 5 without) and 13 (8.2%) had severe surgical site infections thatrequired re-intervention (1 with gentamicin-containing collagen implant, 12 without). On logistic regression analysis, the absence of gentamicin-containing collagen implants statistically significantly increased the odds of overall surgical site infections (OR = 2.50; 95% CI 1.01 - 6.19; P = 0.047). There was no statistically significant difference in the odds of deep-space surgical site infections or the severity and need for reintervention of surgical site infections. Conclusions: This is the first study that examined the effect of gentamicin-containing collagen implants on the severity of surgical site infections in vascular surgery. Gentamicin-containing collagen implants may reduce the odds of overall surgical site infections. It did not reduce the odds of deep-space surgical site infections or the severity and reintervention rate of surgical site infections following infrainguinal arterial revascularization. Larger studies are required to achieve adequate power to assess for these outcomes.

Background: Chronic wounds affect at least 1.9% of the population, significantly impairing quality of life for sufferers and placing a large financial burden on the health system. Adequate nutrition is required for wound healing and many patients with chronic wounds are significantly malnourished. Methods: A systematic search of the literature was conducted utilising the Medline, PubMed, Cochrane Library and CINAHL Plus databases. The terms malnutrition and nutrition in alternate searches were used in various combinations with the Boolean phrase 'AND' to find applicable articles: chronic wound, wound healing, ulcer, diabetic, venous, arterial and foot. A total of 20 articles fit the criteria to review. Results: This review has established that it is likely that malnutrition contributes to wound severity and limb loss; however, this is only level 3 evidence. This review has identified a paucity of consistent evidence of the influence of nutrition on wound healing. Conclusions: There are limited good-quality, randomised controlled trials (RCTs) to assess the impact of nutrition or malnutrition on wound healing in patients with vascular wounds. More research is required to evaluate the impact of education and/or supplementation on rates of healing in the different wound types.

Background: Chronic wounds affect at least 1.9% of the population, significantly impairing quality of life for sufferers and placing a large financial burden on the health system(1,2). Adequate nutrition is required for wound healing and many patients with chronic wounds are significantly malnourished. Methods: A systematic search of the literature was conducted utilising the Medline, PubMed, Cochrane Library and CINAHL Plus databases. The terms malnutrition and nutrition in alternate searches were used in various combinations with the Boolean phrase 'AND' to find applicable articles: chronic wound, wound healing, ulcer, diabetic, venous, arterial and foot. A total of 20 articles fit the criteria to review. Results: This review has established that it is likely that malnutrition contributes to wound severity and limb loss; however, this is only level 3 evidence(2-4). This review has identified a paucity of consistent evidence of the influence of nutrition on wound healing. Conclusions: There are limited good-quality, randomised controlled trials (RCTs) to assess the impact of nutrition or malnutrition on wound healing in patients with vascular wounds. More research is required to evaluate the impact of education and/or supplementation on rates of healing in the different wound types.