{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T11:14:24Z","timestamp":1783509264813,"version":"3.55.0"},"reference-count":22,"publisher":"MDPI AG","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:sec id=\"st1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Diabetic foot ulcers combined with ischemia and infection can be difficult to treat. Few studies have quantified the level of blood supply and infection control required to treat such complex diabetic foot ulcers. We aimed to propose an index for ischemia and infection control in diabetic chronic limb-threatening ischemia (CLTI) with forefoot osteomyelitis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st2\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively evaluated 30 patients with diabetic CLTI combined with forefoot osteomyelitis who were treated surgically from January 2009 to December 2016. After 44 surgeries, we compared patient background (age, sex, hemodialysis), infection status (preoperative and 1- and 2-week postoperative C-reactive protein [CRP] levels), surgical bone margin (with or without osteomyelitis), vascular supply (skin perfusion pressure), ulcer size (wound grade 0\u20133 using the Society for Vascular Surgery Wound, Ischemia, and foot Infection classification), and time to wound healing between patients with healing ulcers and those with nonhealing ulcers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st3\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Preoperative CRP levels and the ratio of ulcers classified as wound grade 3 were significantly lower and skin perfusion pressure was significantly higher in the healing group than in the nonhealing group (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .05). No other significant differences were found between groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st4\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study demonstrates that debridement should be performed first to control infection if the preoperative CRP level is greater than 40 mg\/L. Skin perfusion pressure of 55 mm Hg is strongly associated with successful treatment. We believe that this research could improve the likelihood of salvaging limbs in patients with diabetes with CLTI.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.7547\/18-185","type":"journal-article","created":{"date-parts":[[2021,4,20]],"date-time":"2021-04-20T01:48:25Z","timestamp":1618883305000},"source":"Crossref","is-referenced-by-count":8,"title":["The Degree of Blood Supply and Infection Control Needed to Treat Diabetic Chronic Limb-Threatening Ischemia with Forefoot Osteomyelitis"],"prefix":"10.3390","volume":"111","author":[{"given":"Miki","family":"Fujii","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroto","family":"Terashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koichi","family":"Yokono","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David G.","family":"Armstrong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","reference":[{"key":"i8750-7315-111-2-Article_4-b01","series-title":"Diabetologia","doi-asserted-by":"publisher","first-page":"747","DOI":"10.1007\/s00125-008-0940-0","article-title":"Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease: the EURODIALE Study","volume":"51","author":"Prompers","year":"2008","unstructured":"Prompers\n              L\n            \n            \n              Schaper\n              N\n            \n            \n              Apelqvist\n              J\n            \n            :\n          \n          Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease: the EURODIALE Study.\n\t\t\t\t\tDiabetologia51: 747,\n\t\t\t\t\t2008.\n\t\t\t\thttp:\/\/gateway.webofknowledge.com\/gateway\/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000254750400007&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.1007\/s00125-008-0940-018297261"},{"key":"i8750-7315-111-2-Article_4-b02","series-title":"Wound Repair Regen","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1111\/wrr.12418","article-title":"Surgical treatment strategy for diabetic forefoot osteomyelitis","volume":"24","author":"Fujii","year":"2016","unstructured":"Fujii\n              M\n            \n            \n              Terashi\n              H\n            \n            \n              Yokono\n              K:\n            \n          \n          Surgical treatment strategy for diabetic forefoot osteomyelitis.\n\t\t\t\t\tWound Repair Regen24: 447,\n\t\t\t\t\t2016.\n\t\t\t\t10.1111\/wrr.1241826844669"},{"key":"i8750-7315-111-2-Article_4-b03","series-title":"J Foot Ankle Surg","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1053\/j.jfas.2013.07.009","article-title":"Efficacy of magnetic resonance imaging in diagnosing diabetic foot osteomyelitis in the presence of ischemia","volume":"52","author":"Fujii","year":"2013","unstructured":"Fujii\n              M\n            \n            \n              Armstrong\n              DG\n            \n            \n              Terashi\n              H:\n            \n          \n          Efficacy of magnetic resonance imaging in diagnosing diabetic foot osteomyelitis in the presence of ischemia.\n\t\t\t\t\tJ Foot Ankle Surg52: 717,\n\t\t\t\t\t2013.\n\t\t\t\t10.1053\/j.jfas.2013.07.009http:\/\/gateway.webofknowledge.com\/gateway\/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000326908700006&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f324160720"},{"key":"i8750-7315-111-2-Article_4-b04","series-title":"JAPMA","first-page":"24","article-title":"Efficacy of magnetic resonance imaging in diagnosing osteomyelitis in diabetic foot ulcers","volume":"104","author":"Fujii","year":"2014","unstructured":"Fujii\n              M\n            \n            \n              Terashi\n              H\n            \n            \n              Tahara\n              S:\n            \n          \n          Efficacy of magnetic resonance imaging in diagnosing osteomyelitis in diabetic foot ulcers.\n\t\t\t\t\tJAPMA104: 24,\n\t\t\t\t\t2014."},{"key":"i8750-7315-111-2-Article_4-b05","series-title":"J Diabetes Investig","first-page":"212","article-title":"Report of the committee on the classification and diagnostic criteria of diabetes mellitus","volume":"19","author":"Seino","year":"2010","unstructured":"Committee of the Japan Diabetes Society on the Diagnostic Criteria of Diabetes Mellitus;\n          \n            \n              Seino\n              Y\n            \n            \n              Nanjo\n              K\n            \n            \n              Tajima\n              N\n            \n            :\n          \n          Report of the committee on the classification and diagnostic criteria of diabetes mellitus.\n\t\t\t\t\tJ Diabetes Investig19: 212,\n\t\t\t\t\t2010.\n\t\t\t\thttp:\/\/gateway.webofknowledge.com\/gateway\/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000289907000010&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3"},{"key":"i8750-7315-111-2-Article_4-b06","series-title":"J Vasc 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629,\n\t\t\t\t\t1997.\n\t\t\t\t10.1016\/S0741-5214(97)70062-4"},{"key":"i8750-7315-111-2-Article_4-b08","series-title":"Int Wound J","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1111\/j.1742-481X.2006.00236.x","article-title":"Validation of a diabetic foot surgery classification","volume":"3","author":"Armstrong","year":"2006","unstructured":"Armstrong\n              DG\n            \n            \n              Lavery\n              LA\n            \n            \n              Frykberg\n              RG\n            \n            :\n          \n          Validation of a diabetic foot surgery classification.\n\t\t\t\t\tInt Wound J3: 240,\n\t\t\t\t\t2006.\n\t\t\t\t10.1111\/j.1742-481X.2006.00236.x16984580"},{"key":"i8750-7315-111-2-Article_4-b09","series-title":"J Foot Ankle Surg","doi-asserted-by":"publisher","first-page":"441","DOI":"10.1053\/j.jfas.2011.03.018","article-title":"A modified transmetatarsal 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for treating diabetic foot osteomyelitis: a randomized comparative trial.\n\t\t\t\t\tDiabetes Care37: 789,\n\t\t\t\t\t2014.\n\t\t\t\t10.2337\/dc13-152624130347http:\/\/gateway.webofknowledge.com\/gateway\/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000331708600036&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3"},{"key":"i8750-7315-111-2-Article_4-b13","series-title":"Diabet Med","doi-asserted-by":"publisher","first-page":"813","DOI":"10.1111\/j.1464-5491.2011.03528.x","article-title":"Does osteomyelitis in the feet of patients with diabetes really recur after surgical treatment? natural history of a surgical series","volume":"29","author":"Arag\u00f3n-S\u00e1nchez","year":"2012","unstructured":"Arag\u00f3n-S\u00e1nchez\n              J\n            \n            \n              L\u00e1zaro-Mart\u00ednez\n              JL\n            \n            \n              Hern\u00e1ndez-Herrero\n              C\n            \n    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