The spread of infection to soft tissue and bone is a major causal factor for lower-limb amputation. Early diagnosis and appropriate treatment are essential, including treatment which is both local and systemic, and this requires coordination by a multidisciplinary team. Optimal treatment also often involves extensive surgical debridement and management of the wound base, effective antibiotic therapy, consideration for revascularization and correction of metabolic abnormalities such as hyperglycemia. Broad-spectrum empirical therapy is indicated for severe infections, pending culture results and antibiotic susceptibility data. Take into consideration any recent antibiotic therapy and local antibiotic susceptibility data, especially the prevalence of methicillin-resistant S. aureus (MRSA) or other resistant organisms. There is insufficient evidence to recommend use of a specific wound dressing or any type of wound healing agents or products for infected foot wounds. For the duration of antibiotic therapy for osteomyelitis, a longer duration is needed if infected bone remains.

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[in Japanese]

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[in Japanese]

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The diabetic foot clinic of the University of Tokyo Hospital was established as part of the outpatient clinic for the prevention of diabetic foot ulcers in December 2006 and introduced management fee for diabetic complications in April 2008. A total of 1321 diabetic patients had visited the diabetic foot clinic by March 2011. Physicians, a certified diabetic nurse, and researchers in the Department of Wound Care Management of the Graduate School of Medicine have been screening high-risk patients for diabetic foot ulcers, to care for patients with non-ulcerative pathology, arrange consultations with specialists, and educate the patients in the diabetic foot clinic. Although there is still a shortage of the healthcare professionals who provide this intensive approach for diabetic patients, we have done that only 2 of the 1321 diabetic patients who had visited the diabetic foot clinic developed diabetic foot ulcers. Therefore, it is important that patients with neuropathy, angiopathy and/or foot deformity are screened and followed to identify non-ulcerative pathology with inflammation.

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[in Japanese]

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[Purpose] This study aims to clarify the validity of therapeutic angiogenesis using autologous peripheral blood mononuclear cell transplantation (PB-MNC) in patients with critical limb ischemia (CLI). [Subjects and Methods] Eighteen patients who had major amputation despite maximal revascularization therapy and who have been observed more than six months since receiving PB-MNC were enrolled. The collected data included patient characteristic, blood biochemistry, number of CD34 positive cells and platelets, angiographic images, ankle brachial index (ABI), transcutaneous oxygen pressure (tcPO₂), and they were evaluated for correlation between 6 patients with and 12 patients without major amputation. [Results] In patients with major amputation, the levels of C-reactive protein (CRP) continued to be higher, and the levels of ABI and tcPO₂, and the number of transplanted CD34 positive cells and platelets, were lower than those of patients without major amputation. Favorable blood flow of the upperpopliteal arteries, and anterograde flow in two of the infrapopliteal arteries were essential to avoid major amputation. [Conclusions] Therapeutic angiogenesis using PB-MNC was useful for patients with CLI who were managed for infection and who had revascularization of the upperpopliteal arteries and two of the infrapopliteal arteries by endovascular and/or surgical revascularization.

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Though computed tomographic angiography (CTA) has recognized as a useful and low invasive technique for evaluating arterial condition in patients of peripheral arterial diseases (PAD), massive vascular wall calcifications make it difficult to evaluate vascular lumen. We report our clinical experience of computed tomographic digital subtraction angiography (CTDSA) in the diagnosis of PAD. In the aortoiliac region, CPR (curved planer reconstruction) and MIP (maximum intensity projection) reconstruction can visualize arterial lumen better than CTDSA. CTDSA allows selective elimination of the wall calcification which improves the detection and evaluation of PAD even in the CLI patients with severe arterial wall calcification especially in lower leg region.

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