Pathology of Skin, Nerve and Vasculature in the Amputated Limb of Diabetes

Study Overview
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Brief Summary
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To explore the pathology of nerve, vascular, and skin in the amputated leg To diagnose small-fiber sensory neuropathy of the contralateral leg by investigating the skin intervention To search for (1) mechanisms of amputation and (2) prevention measures for further amputation in the currently healthy-looking limb

Detailed Description
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Diabetic foot occurs in 15% of diabetic population (3) and 15% of the diabetic foot patients end up with lower limb amputation. Peripheral neuropathy (sensory, motor and autonomic), peripheral vascular disease, trauma, infection and poor wound healing all contribute to diabetic foot problem. Peripheral neuropathy could be evaluated in a variety of ways, including vibratory thresholds, thermal thresholds, pressure perception thresholds, muscle strength. All these predict foot ulceration to some degree(1). Motor nerve conduction velocity is an independent predictor for the development of new foot ulcer in diabetic population. For more detailed structural study of neuropathy in diabetic patient, we could use skin biopsy method. Skin biopsy with PGP9.5 immunohistochemistry has been demonstrated by ultrastructural studies to label the terminal portions of both small myelinated and unmyelinated nerve in the epidermis . Intra-epidermal nerve fiber (IENF) density is reduced in patient with impaired glucose tolerance and clinically overt diabetes . Previous IENF density study was performed in diabetic patients with sensory symptom but no foot ulcer. Now we tried to evaluate IENF density in severe diabetic foot patient who received below knee amputation. Skin biopsy willl be performed at amputated leg. The skin biopsy area will be located at lateral side of distal leg, 10 cm above the lateral malleolus as previous protocol of our group . Underlying sural nerve and posterior tibial nerve will be also harvested for further ultra-structural study. The result will be compared to the control group which were recruited from a previously described cohort matched by gender and age.

Official Title
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Pathology of Skin, Nerve and Vasculature in the Amputated Limb of Diabetes

Conditions
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Wound, Diabetes, Amputation

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diabetic foot wound patient who underwent below-knee amputation Exclusion Criteria: Diabetic foot wound patient who couldn't receive below-knee amputation due to severe heart disease, high anesthetic risk.

Ages Eligible for Study
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Minimum Age: 10 Years
Maximum Age: 90 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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small-fiber sensory neuropathy, nerve pathology, vasculature pathology, amputation, diabetic foot wound, sensory neuropathy, below knee amputation