{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T08:59:39Z","timestamp":1777712379201,"version":"3.51.4"},"reference-count":48,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2023,7,11]],"date-time":"2023-07-11T00:00:00Z","timestamp":1689033600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The International Journal of Lower Extremity Wounds"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:p>\n                    After surgical treatment of Charcot neuro-osteoarthropathy (CNO) complicated by plantar ulcer and midtarsal osteomyelitis, offloading is mandatory to protect the surgical site. Total contact casting is, to date, the standard-of-care to offload the foot during the postoperative period. We have compared the application of external circular fixator, to the standard of care, with regard to surgical wound healing and time to healing. During the time period from January 2020 to December 2021, 71 consecutive patients admitted to our unit with diabetes and CNO complicated by plantar ulceration and midtarsal osteomyelitis were enrolled in our study. All patients were classified as stage 2, according to the Frykberg &amp; Sanders classification. Wifi wound stage was W2 I0 FI2 in 43 of 71 patients (60.6%) and W2 I2 FI2 in 28 of 71 patients (39.4%). In cases where critical limb ischemia occurred, we performed an endovascular procedure to obtain patency in at least one of the tibial arteries. Localization of osteomyelitis was carried out with magnetic resonance imaging studies, and the degree of deformity was assessed using plain X-ray or computed tomography. A localized ostectomy through the ulceration was carried out with a fasciocutaneous flap to cover the surgical site. In 36 patients, an external circular fixator was applied intraoperatively (exfix+ group); the remaining 35 patients received fiberglass cast in the postoperative period (exfix\u2212 group). Complete healing of the surgical site was achieved in 36 of 36 patients in the exfix+ arm and in 22 of 35 in the exfix\u2212 arm (\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u2009&lt;\u2009.02). Time to healing was 68\u2009\u00b1\u200928 days in exfix+ and 102\u2009\u00b1\u200988 days in exfix\u2212 (\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u2009=\u2009.05). Circular external frames should be considered as an effective offloading device that enhances the healing rate and reduces time to healing after surgical treatment of midfoot osteomyelitis in subjects affected by CNO.\n                  <\/jats:p>","DOI":"10.1177\/15347346231185403","type":"journal-article","created":{"date-parts":[[2023,7,12]],"date-time":"2023-07-12T02:08:49Z","timestamp":1689127729000},"page":"170-176","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Circular External Fixation as a New Offloading Standard of Treatment in Charcot Neuro-Osteoarthropathy Complicated by Midfoot Osteomyelitis: A Pilot, Prospective Case\u2013Control Study"],"prefix":"10.1177","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9659-0276","authenticated-orcid":false,"given":"L","family":"Dalla Paola","sequence":"first","affiliation":[{"name":"Diabetic Foot Department, Maria Cecilia Hospital GVM Care &amp; Research, Ravenna, Italy"},{"name":"Vascular Surgery Institute, Ferrara University School of Medicine, Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G","family":"Baldazzi","sequence":"additional","affiliation":[{"name":"Diabetic Foot Department, Maria Cecilia Hospital GVM Care &amp; Research, Ravenna, Italy"},{"name":"Vascular Surgery Institute, Ferrara University School of Medicine, Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T","family":"Gabellini","sequence":"additional","affiliation":[{"name":"Diabetic Foot Department, Maria Cecilia Hospital GVM Care &amp; Research, Ravenna, Italy"},{"name":"Vascular Surgery Institute, Ferrara University School of Medicine, Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A M","family":"Cosacco","sequence":"additional","affiliation":[{"name":"Diabetic Foot Department, Maria Cecilia Hospital GVM Care &amp; Research, Ravenna, Italy"},{"name":"Vascular Surgery Institute, Ferrara University School of Medicine, Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"I","family":"Massi","sequence":"additional","affiliation":[{"name":"Diabetic Foot Department, Maria Cecilia Hospital GVM Care &amp; Research, Ravenna, Italy"},{"name":"Vascular Surgery Institute, Ferrara University School of Medicine, Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A","family":"Carone","sequence":"additional","affiliation":[{"name":"Diabetic Foot Department, Maria Cecilia Hospital GVM Care &amp; Research, Ravenna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4545-2804","authenticated-orcid":false,"given":"A","family":"Brocchi","sequence":"additional","affiliation":[{"name":"Diabetic Foot Department, Maria Cecilia Hospital GVM Care &amp; Research, Ravenna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2741-9499","authenticated-orcid":false,"given":"M","family":"Mucignat","sequence":"additional","affiliation":[{"name":"Diabetic Foot Department, Maria Cecilia Hospital GVM Care &amp; Research, Ravenna, Italy"},{"name":"Vascular Surgery Institute, Ferrara University School of Medicine, Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A","family":"Alnaser","sequence":"additional","affiliation":[{"name":"Diabetic Foot Department, Maria Cecilia Hospital GVM Care &amp; Research, Ravenna, Italy"},{"name":"Vascular Surgery Institute, Ferrara University School of Medicine, Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2023,7,11]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.2174\/1573399810602040431"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2015.09.023"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1080\/14656566.2017.1316375"},{"issue":"2","key":"e_1_3_2_5_2","first-page":"29","article-title":"Updating the diabetic foot treatment algorithm: recommendations on treatment using advanced medicine and therapies","volume":"30","author":"Blume P","year":"2018","unstructured":"Blume P, Wu S. 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