[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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　Background: Foot ulcer healing is influenced by various factors. As poor nutritional status may cause poor wound healing, we investigated the relationship between controlling nutritional status（CONUT）score and foot ulcer healing.
 Method: This retrospective single-center study was conducted using data taken between April 2010 and April 2021. A total of 186 limbs of 136 patients with chronic foot ulcers who underwent minor amputation were included. The CONUT score was determined using the preoperative blood test values. The study population was divided into an ulcer healing group and a non-healing group.
 Results: The healing group included 146 limbs, and the non-healing group included 40 limbs. The mean CONUT scores were 4.50±2.63 in the healing group and 5.78±2.47 in the non-healing group（p= 0.008）. ROC curve indicated that the most appropriate CONUT score cutoff was 5. In multivariate analysis, dialysis（p= 0.026）and high CONUT score（≥5）（p= 0.038）were predictive of incomplete ulcer healing.　
 Conclusion: Poor nutritional status, especially CONUT score（≥5）, decreases the healing rate of foot ulcers. CONUT score may be helpful in predicting the prognosis of foot ulcers.

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　We investigated the usefulness of a specific stacked AN69 membrane dialyzer for peripheral artery disease（PAD）of the lower extremities in hemodialysis patients. Hollow fiber polysulfone（PS）dialyzers were used in 11 patients and 13 limbs with skin perfusion pressure（SPP）values of 40 mmHg or less at the first toe. The peripheral hemodynamics of the lower extremities during dialysis were compared using SPP and infrared thermography when each dialysis membrane was used. Dialysis was judged to be effective when:（1）the SPP value at 240 minutes after the start of dialysis was maintained or increased compared to the value before dialysis, and（2）thermographic images showed improvement in blood flow on the skin surface. The PS membrane did not improve peripheral blood flow in all limbs; however, when the AN69 membrane was used, it improved in 8 of 13 limbs. The AN69 membrane was effective in improving peripheral blood flow in the lower extremities during hemodialysis for PAD.

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　Foot problems due to the difficulties of foot care, including using nail clippers, for community-dwelling older are a challenge. However, research about the issue is lacking. Physical changes as the patient ages lead to them being negligent about foot care activities, such as clipping nails, leading to worsening condition of the feet and an increase in pain. Furthermore, foot skin fungal infections may be transmitted to the nail. We report a case report of urgent foot care treatment for two older people who live on welfare. They were not able to cut their nails by themselves and had foot pain. This care report provides insight into hidden issues concerning foot problems of older people in Japan.

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　Acute lower extremity arterial occlusion is a rare and serious complication of total knee arthroplasty（TKA）. If diagnosed too late, it can lead to necrosis or amputation of the lower extremity. In this study, a patient’s leg was amputated due to occlusion of the superficial femoral artery after TKA. Subsequently, wound dehiscence occurred at the same site and the wound was dissected. Evaluation of blood flow and infection of the wound indicated femoral amputation; however, the patient was cured with conservative treatment. Herein, we report a course of treatment that involved observing changes in the wound, evaluating blow flow, and treatment with appropriate wound management techniques.

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　We report a patient with chronic limb-threatening ischemia based on diabetes mellitus who was able to acquire prosthesis walking using a saddle-type body weight-supported walker（SBWSW）following left below-knee amputation. The aim of this case report was to verify the utility of the SBWSW. The patient was a 67-year-old female. Dry gangrene extended from all left toes to the rearfoot, which necessitated left lower leg below-knee amputation. The level of activities of daily living（ADL）at admission indicated that moderate to maximum caregiving were necessary（Barthel index: 30）. From preoperation until the provisional prosthesis was completed, she practiced standing and walking using the SBWSW. In addition, she actively practiced walking with a crutch, and training for ADL. At the time of discharge, the patient was able to wear a prosthesis and walk independently with a cane（0.76 m/s）for up to 600 m. The SBWSW assists in strengthening the muscles of the lower limb on the unaffected side and allows patients with disuse syndrome and difficulty walking before surgery to increase their walking endurance with a low load and high frequency. Our findings suggest that the SBWSW is useful in gait training.

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