{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T03:54:49Z","timestamp":1790913289974,"version":"4.1.0"},"reference-count":52,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["International Wound Journal"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Haemodialysis patients face a markedly elevated risk of foot lesions because of coexisting diabetes mellitus (DM), peripheral arterial disease (PAD) and uremia\u2010related impairment of wound healing. Structured outpatient strategies and the optimal place of basic fibroblast growth factor (bFGF) within a stepwise algorithm remain poorly defined. To report complete healing and its durability in haemodialysis patients treated with bFGF for foot lesions, and to propose a stepwise limb\u2010salvage algorithm with prespecified escalation criteria in which bFGF precedes dehydrated human amnion\/chorion membrane (dHACM) or surgery. Retrospective observational case series of 20 haemodialysis patients receiving bFGF (trafermin; Fiblast Spray) for foot lesions across three outpatient wound\u2010care programmes. Wound status was documented by area, depth, tissue exposure and WIfI classification; perfusion was assessed in every patient by toe\u2010brachial and ankle\u2010brachial indices, duplex ultrasonography and angiography, independently of any pre\u2010existing recorded diagnosis. Complete healing was defined a priori as 100% re\u2010epithelialization confirmed on two consecutive visits at least 2\u2009weeks apart. Tier entry criteria and escalation triggers were prespecified, using a wound\u2010area reduction below 50% at 4\u2009weeks as the principal threshold. The broader haemodialysis population (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009212) served as contextual comparator. Mean age was 75.0\u2009\u00b1\u20097.3\u2009years (range, 59\u201392); there were six men and 14 women. DM was present in 15 patients (75.0%) and registry\u2010recorded PAD in 8 (40.0%), against 56.6% and 17.9% in the broader population; objective testing identified hemodynamically significant PAD in 12 patients (60.0%), all of whom were revascularized. Mean baseline wound area was 5.5\u2009\u00b1\u20093.4\u2009cm (2), and WIfI stages 1\u20134 comprised 5, 8, 6 and 1 patients. Twelve patients (60.0%) were managed with bFGF alone, five (25.0%) required dHACM and three (15.0%) required surgery. Complete healing was achieved in 18 of 20 patients (90.0%) at a mean of 8.9\u2009\u00b1\u20094.4\u2009weeks, with no amputation of any level. Over a median follow\u2010up of 13.0\u2009months (range, 6\u201328), recurrence at the same site occurred in two patients (10.0%); amputation\u2010free survival at 12\u2009months was 100% and overall survival 95%. The bFGF\u2010treated cohort carried a disproportionate burden of DM and PAD, supporting targeted early biologic intervention in this highest\u2010risk subgroup. Within a stepwise algorithm combining objective perfusion assessment with prespecified escalation criteria, 90% of wounds healed completely without amputation, providing a practical limb\u2010salvage framework for this vulnerable population.\n                  <\/jats:p>","DOI":"10.1111\/iwj.71059","type":"journal-article","created":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T03:18:06Z","timestamp":1790911086000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Early Outpatient\n                    <scp>bFGF<\/scp>\n                    \u2010Based Wound Care for Foot Lesions in Haemodialysis Patients: A Real\u2010World Stepwise Limb\u2010Salvage Strategy From Japan"],"prefix":"10.1111","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8225-9363","authenticated-orcid":false,"given":"Sadanori","family":"Akita","sequence":"first","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Tamaki Aozora Hospital Group  Tokushima Japan"},{"name":"Department of Bioregulation and Pharmacological Medicine Fukushima Medical University  Fukushima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Motoyuki","family":"Tamaki","sequence":"additional","affiliation":[{"name":"Department of Diabetes, Metabolism, and Endocrinology Tamaki Aozora Hospital Group  Tokushima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Hayashi","sequence":"additional","affiliation":[{"name":"Department of Clinical Engineering Tamaki Aozora Hospital Group  Tokushima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0488-0098","authenticated-orcid":false,"given":"Masanori","family":"Tamaki","sequence":"additional","affiliation":[{"name":"Department of Nephrology Tamaki Aozora Hospital Group  Tokushima Japan"},{"name":"Department of Nephrology Tokushima University Graduate School of Biomedical Sciences  Tokushima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaharu","family":"Tamaki","sequence":"additional","affiliation":[{"name":"Department of Nephrology Tamaki Aozora Hospital Group  Tokushima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11892-010-0128-0"},{"issue":"10","key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"1747","DOI":"10.1093\/ndt\/gfv114","article-title":"Risk Factors for Foot Ulceration and Lower Extremity Amputation in Adults on Dialysis: A Systematic Review and Meta\u2010Analysis","volume":"30","author":"Kaminski M. R.","year":"2015","journal-title":"Nephrology, Dialysis, Transplantation"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)67698-2"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1615439"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2013.08.003"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2006.12.037"},{"issue":"2","key":"e_1_2_11_8_1","first-page":"S37","article-title":"Characteristics of Dialysis\u2010Related Amputation Patients","volume":"12","author":"Otsubo S.","year":"2008","journal-title":"Hemodialysis International. International Symposium on Home Hemodialysis"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfl241"},{"issue":"7","key":"e_1_2_11_10_1","doi-asserted-by":"crossref","first-page":"1460","DOI":"10.2337\/dc10-0310","article-title":"Diabetic Foot Prevention: A Neglected Opportunity in High\u2010Risk Patients","volume":"33","author":"Lavery L. A.","year":"2010","journal-title":"Diabetes Care"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)67700-8"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1172\/JCI32169"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/0022034509359125"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc06-1600"},{"issue":"3","key":"e_1_2_11_15_1","first-page":"473","article-title":"The Deterioration of WIfI Risk Stratification During the Natural History of a Chronic Diabetic Foot Wound","volume":"23","author":"Lew E. 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J.","year":"2015","journal-title":"Cochrane Database of Systematic Reviews"},{"issue":"2","key":"e_1_2_11_51_1","first-page":"860","article-title":"Effects of Basic Fibroblast Growth Factor on Corneal Wound Healing in a Diabetic Mouse Model","volume":"233","author":"Mantelli F.","year":"2018","journal-title":"Journal of Cellular Physiology"},{"key":"e_1_2_11_52_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1524-475X.11.s2.1.x"},{"key":"e_1_2_11_53_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524-475X.2007.00283.x"}],"container-title":["International Wound Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/iwj.71059","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/iwj.71059","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/iwj.71059","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T03:18:11Z","timestamp":1790911091000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/iwj.71059"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":52,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1111\/iwj.71059"],"URL":"https:\/\/doi.org\/10.1111\/iwj.71059","archive":["Portico"],"relation":{},"ISSN":["1742-4801","1742-481X"],"issn-type":[{"value":"1742-4801","type":"print"},{"value":"1742-481X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"2026-05-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-23","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-01","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e71059"}}