case_images: PMC9732241_01
case_images: Imaging diagnosis of diabetic lower extremity ulcers before treatment for case 1 (A-C) and case 2 (D-F). (A) Picture showed an ulcerated surface on the inner skin of the right calf, about 3.0x2.0 cm in size and 6 mm in depth; (B) MRI showed a local subcutaneous soft tissue defect at the medial margin of the right calf, with swelling in the margin and adjacent soft tissue space; (C) Gray-scale sonography showed a heterogeneous low echo area in the subcutaneous soft tissue of the medial side of the right calf; (D) Picture showed an ulcerated surface in the skin of the right heel, about 7.5 x 4.6 cm in size and 4 mm in depth, with necrosis and exudation; (E) MRI showed extensive swelling of the soft tissue and fascia in the lower part of the right calf with unclear and disordered layers; (F) CDFI showed local skin defects and discontinuity in the skin of the right heel. The blood flow signal in the low echo surface was not obvious, and a little blood flow signal could be seen in the periphery. The red arrows indicate the ulcer defects.
case_images: fendo-13-1046896-g001.jpg
case_images: PMC9732241_02_fendo-13-1046896-g001.jpg
case_images: f1
case_images: Physical examination revealed a skin defect about 7.5 x 4.6 cm in size and 4 mm in depth, with black crusts and yellowish exudate, surrounding skin redness and swelling, and pain when walking and pressing the wound ( Figure 1D ). MRI examination showed that the ulcer did not involve bone tissue ( Figure 1E ). CDFI showed mild atherosclerosis of lower extremity arteries ( Figure 1F ).
case_images: Showing of skin wounds and CDFI or PDI ((Power Doppler Imaging)) ultrasound imaging for progress in the treatment of diabetic lower extremity ulcers in two cases. Wound conditions at the (A) 1th, (B) 7th, (C) 14th, (D) 21th, (E) 35th, and (F) 60th day of post therapy showed the gradual healing of ulceration for case 1; Wound conditions at the (G) 1th, (H) 7th, (I) 14th, (J) 30th, (K) 40th, and (L) 150th day of post therapy showed the gradual healing of ulceration for case 2. PDI showed that the blood flow of the soft tissue around the ulcer gradually increased, and the blood flow was very abundant before healing.
case_images: fendo-13-1046896-g002.jpg
case_images: PMC9732241_02_fendo-13-1046896-g002.jpg
case_images: f2
case_images: Heel ulcer debridement was performed on the patient first ( Figure 2G ). Achilles tendon was partially necrotic and pale color with partial yellowness. After 7 consecutive days of ultrasound combined with microbubble therapy, the ulcer area did not change significantly ( Figure 2H ). On the 7th day, the granulation tissue grew obviously, and the tendon tissue grew slightly ( Figure 2H ). On the 14th day, the wound contracted slightly and granulation tissue grew with bright red color ( Figure 2I ). On the 30th day, the granulation tissue tended to fill the wound, and a little epidermal tissue grew around it ( Figure 2J ). On the 40th day, the wound contracted and became slightly smaller, granulation tissue protruded from the skin surface, and the tendon tissue was completely repaired with normal color ( Figure 2K ). With no other treatment, after 150 days, the wound was covered with epidermis and the ulcer was basically healed ( Figure 2L ).
case_images: The timeline of the treatment process of case 1 from the day of injury to the day of healing.
case_images: fendo-13-1046896-g003.jpg
case_images: PMC9732241_01_fendo-13-1046896-g003.jpg
case_images: f3
case_images: To be clear, the timeline of entire treatment process of this case was presented in  Figure 3 .
case_images: PMC9732241_02
case_images: Imaging diagnosis of diabetic lower extremity ulcers before treatment for case 1 (A-C) and case 2 (D-F). (A) Picture showed an ulcerated surface on the inner skin of the right calf, about 3.0x2.0 cm in size and 6 mm in depth; (B) MRI showed a local subcutaneous soft tissue defect at the medial margin of the right calf, with swelling in the margin and adjacent soft tissue space; (C) Gray-scale sonography showed a heterogeneous low echo area in the subcutaneous soft tissue of the medial side of the right calf; (D) Picture showed an ulcerated surface in the skin of the right heel, about 7.5 x 4.6 cm in size and 4 mm in depth, with necrosis and exudation; (E) MRI showed extensive swelling of the soft tissue and fascia in the lower part of the right calf with unclear and disordered layers; (F) CDFI showed local skin defects and discontinuity in the skin of the right heel. The blood flow signal in the low echo surface was not obvious, and a little blood flow signal could be seen in the periphery. The red arrows indicate the ulcer defects.
case_images: fendo-13-1046896-g001.jpg
case_images: PMC9732241_02_fendo-13-1046896-g001.jpg
case_images: f1
case_images: Physical examination revealed a skin defect about 7.5 x 4.6 cm in size and 4 mm in depth, with black crusts and yellowish exudate, surrounding skin redness and swelling, and pain when walking and pressing the wound ( Figure 1D ). MRI examination showed that the ulcer did not involve bone tissue ( Figure 1E ). CDFI showed mild atherosclerosis of lower extremity arteries ( Figure 1F ).
case_images: Showing of skin wounds and CDFI or PDI ((Power Doppler Imaging)) ultrasound imaging for progress in the treatment of diabetic lower extremity ulcers in two cases. Wound conditions at the (A) 1th, (B) 7th, (C) 14th, (D) 21th, (E) 35th, and (F) 60th day of post therapy showed the gradual healing of ulceration for case 1; Wound conditions at the (G) 1th, (H) 7th, (I) 14th, (J) 30th, (K) 40th, and (L) 150th day of post therapy showed the gradual healing of ulceration for case 2. PDI showed that the blood flow of the soft tissue around the ulcer gradually increased, and the blood flow was very abundant before healing.
case_images: fendo-13-1046896-g002.jpg
case_images: PMC9732241_02_fendo-13-1046896-g002.jpg
case_images: f2
case_images: Heel ulcer debridement was performed on the patient first ( Figure 2G ). Achilles tendon was partially necrotic and pale color with partial yellowness. After 7 consecutive days of ultrasound combined with microbubble therapy, the ulcer area did not change significantly ( Figure 2H ). On the 7th day, the granulation tissue grew obviously, and the tendon tissue grew slightly ( Figure 2H ). On the 14th day, the wound contracted slightly and granulation tissue grew with bright red color ( Figure 2I ). On the 30th day, the granulation tissue tended to fill the wound, and a little epidermal tissue grew around it ( Figure 2J ). On the 40th day, the wound contracted and became slightly smaller, granulation tissue protruded from the skin surface, and the tendon tissue was completely repaired with normal color ( Figure 2K ). With no other treatment, after 150 days, the wound was covered with epidermis and the ulcer was basically healed ( Figure 2L ).