Bone Reconstruction in the Diabetic Foot

Functional Lower Limb Salvage

LEARNING OBJECTIVES

After studying this article, the participant should be able to: 1. Explain the basic concept of functional limb salvage. 2. Understand the complexity of salvaging the limb when consulting the patient, especially regarding how to obtain the best possible functional outcome, whether it be from limb salvage or amputation. 3. Implement orthoplastic thinking to salvage the limb. 4. Understand the latest innovations for limb salvage.

SUMMARY

The goal of limb salvage is to have the patient achieve the best possible function that allows daily activities (eg, walking and running) and the ability to perform tasks that require strength and dexterity. This is a complex process requiring the work of a multidisciplinary team practicing the principles of good wound care, orthoplastic thinking, and strategizing on future function. Understanding the new advances in this field of rapid change and growth will help reconstructive surgeons to make better decisions and incorporate them into daily practice, allowing for the best possible outcome.

The promotion of bone regeneration through CS/GP-CTH/antagomir-133a/b sustained release system

Few studies reported the application of miRNA in bone regeneration. In this study, the expression of miR133a and miR133b in murine BMSCs was inhibited via antagomiR-133a/b and the osteogenic differentiation in murine BMSCs was evaluated. The RT-PCR, flow cytometry, cell counting kit-8, and annexin V-FITC/PI double staining assays were performed. Double knockdown miR133a and miR133b can promote BMSC osteogenic differentiation. At optimum N/P ration (15:1), the loading efficiency can reach over 90%. CTH-antagomiR-133a/b showed no cytotoxicity to BMSCs and diminished miR133a and miR133b expression in BMSCs. Furthermore, chitosan-based sustained delivery system can facilitate continuous dosing of antagomiR-133a/b, which enhanced calcium deposition and osteogenic specific gene expression in vitro. The new bone formation was enhanced after the sustained delivery system containing CTH-antagomiR-133a/b nanoparticles was used in mouse calvarial bone defect model. Our results demonstrate that CTH nanoparticles could facilitate continuous dosing of antagomiR133a/b, which can promote osteogenic differentiation.