Analysis of 17 years of surgical treatment for chronic limb ischemia in a Chinese National Clinical Center for Geriatric Disorders (2002 to 2018)

Introduction: The journey from single cell to complex being is attributable to stem cells role. Adult stem cells originate during ontogeny & persist in specialized niches within organs. Asymmetric division of each stem cell during differentiation produces : one daughter stem cell & one daughter transit amplifying/intermediate cell having migratory properties. Forced migration of hematopoietic stem/progenitor cells (HSPC) from bone marrow into peripheral blood is called mobilization. Accumulating evidence suggests that attenuation of the chemokine stromal derived factor-1(SDF-1)-CXCR4 axis that plays a pivotal role in retention of HSPC in bone marrow (BM) results in the release of these cells from the BM into peripheral blood. Recently, adult cells have been genetically reprogrammed to an embryonic stem cell like state. Induced pluripotent stem cells (IPSCs) were similar to human embryonic stem cells in morphology, proliferative capacity, expression of cell surface antigens, & gene expression. Treatment of ischemic vascular disease of lower limbs remains a significant challenge. Unfortunately, if medical & surgical salvage procedures fail, amputation is an unavoidable result for those patients. Aim of Work: (Hypothesis) To assess the application of implantation of autologous stem/progenitor cell in the treatment of chronic limb ischemia & to evaluate the safety, efficacy & feasibility of this novel therapeutic approach. Methods: A total of 24 patients with chronic limb ischemia not eligible for arterial reconstruction or endovascular procedures were enrolled & randomized (1:1) to either the implanted group or the control group. Control group: Conventional medical therapy in the form of anti platelet therapy & vasodilators. Implanted group: Subcutaneous injection of 300μ g/day of recombinant human granulocyte colony stimulating factor (G-CSF) for 5 days to mobilize stem/progenitor cells from BM. Total leucocytic count is measured daily to follow up successful mobilization of bone marrow mononuclear cells (BMMNCs). Stem cell Harvesting After 5 days peripheral blood mononuclear cells (PBMNCs) were harvested using a cell separator. Samples from apheresis products are subjected to TLC measurement & immunophenotypic characterization of CD34+ cells by flow cytometry. The collected PBMNCs were implanted by multiple intramuscular injections into ischemic limbs. Results: There was significant increase in pain free walking distance & ankle/brachial index (ABI) & significant decreased rest pain. Effectiveness was documented by : reduced number of amputation, increase ABI & improvement of the quality of life in therapeutic group compared to control group. Conclusion: The novel therapeutic approach of PBMNCs implantation in patients with chronic limb ischemia is safe, feasible & effective in decreasing co-morbidity & rate of amputation. Safety was manifested by absence of complications during G-CSF therapy or during harvesting & injection of the stem cells. Recommendations: 1- Future studies on larger number of patients & longer follow up. 2- Controlled studies using different methods & different cell population (PBMNCs, BMMNCs or MSCs) to compare the outcome of each. 3-Studing the role of endothelial progenitor cell dysfunction in different ischemic diseases to develop successful gene therapy.

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Long-Term Surgical Treatment Results of Critical Lower Limb Ischemia Following Simultaneous Direct and Indirect Revascularization

Novosti Khirurgii ◽

10.18484/2305-0047.2017.2.131 ◽

2017 ◽

Vol 25 (2) ◽

pp. 131-139

Author(s):

V.I. Rusin ◽

◽

V.V. Korsak ◽

P.A. Boldizhar ◽

V.V. Rusin ◽

...

Keyword(s):

Surgical Treatment ◽

Lower Limb ◽

Limb Ischemia ◽

Treatment Results ◽

Lower Limb Ischemia ◽

Indirect Revascularization

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A RCT comparing the outcome of standard wound care and standard wound care combined with longitudinal distractive osteogenesis in chronic non-healing wounds of foot and ankle secondary to chronic limb ischemia

International Journal of Orthopaedics Sciences ◽

10.22271/ortho.2020.v6.i4e.2351 ◽

2020 ◽

Vol 6 (4) ◽

pp. 281-284

Author(s):

Limbu A ◽

Khanal GP ◽

Adhikari SA ◽

Baral B ◽

Shah AB ◽

...

Keyword(s):

Wound Care ◽

Limb Ischemia ◽

Foot And Ankle ◽

Healing Wounds ◽

Chronic Limb Ischemia

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SIMULTANEOUS REVASCULARIZATION OF AORTOFEMORAL AND FEMOROPOPLITEAL ARTERIAL SEGMENTS BY SEMICLOSED LOOP ENDARTERECTOMY

Grekov s Bulletin of Surgery ◽

10.24884/0042-4625-2017-176-2-28-32 ◽

2017 ◽

Vol 176 (2) ◽

pp. 28-32

Author(s):

V. V. Shlomin ◽

A. V. Gusinskiy ◽

M. L. Gordeev ◽

I. V. Mikhailov ◽

D. N. Maistrenko ◽

...

Keyword(s):

Lower Extremity ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Arterial Occlusive Disease ◽

Long Term Results ◽

Single Level ◽

Individual Approach ◽

Chronic Limb Ischemia

OBJECTIVE. The authors would like to consider the possibility and feasibility of simultaneous revascularization of two arterial segments in patients with lower extremity arterial occlusive disease by method of semiclosed loop endarterectomy. MATERIALS AND METHODS. The research included 143 patients. Revascularization of aortofemoral segment was performed on 67 patients. The simultaneous revascularization of aortofemoral and femoropopliteal segments was carried out for 76 patients. The follow-up period was 5 years. RESULTS. There was revealed that the long-term results of multilevel reconstruction were worse that single-level reconstruction. This method requires an individual approach. The best results of simultaneous interventions were obtained in patients aged 60 and older with the III stage of chronic limb ischemia and 2 or 3 working shin arteries. The worst results were observed in patients younger than 50 year old with IV stage of critical limb ischemia and significant lesions of shin arteries.

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Analysis of epidemiological characteristics and surgical treatment of patients with pressure ulcer

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh200319093p ◽

2021 ◽

pp. 93-93

Author(s):

Dragana Petrovic-Popovic ◽

Milan Stojicic ◽

Maja Nikolic-Zivanovic

Keyword(s):

Surgical Treatment ◽

Pressure Ulcer ◽

Traffic Accidents ◽

Pressure Ulcers ◽

Stage Iv ◽

Clinical Center ◽

Bony Prominence ◽

The University ◽

Epidemiological Characteristics ◽

Reconstructive Methods

Introduction/Objective. A pressure ulcer is a localized injury to the skin and/or underlying tissue, usually over a bony prominence. It appears as a result of pressure or combination of pressure and shear. Pressure ulcers can be identified within a wide variety of patient subpopulations and a major role in their treatment plays epidemiological and etiological aspects. Methods. A retrospective study of data analysis included 72 patients with pressure ulcers that were hospitalized and surgically treated during a five-year period at the Clinic for Burns, Plastic and Reconstructive Surgery of the University Clinical Center of Serbia in Belgrade. Main data features used in the analysis were: gender, age, principal diseases, comorbidities and biochemical indicators of malnutrition. The patients' data was obtained from the existing patients? records. Additionally, the study analyzed the method of treating pressure ulcers, types of reconstructive methods in surgical treatment, as well as the incidence rate of partial osteotomy. Results. A total of 72 patients with pressure ulcers were included into this study with 54.7 ? 16.1 mean age. Three times more patients injured in traffic accidents were male (75% vs. 25%), while the most of the patients with multiple sclerosis were female (85.7%). More than 95% of patients who had pressure ulcers of III or IV stage were treated surgically with a reconstructive method of transposition or rotation myocutaneous flap. The patient with pressure ulcer of stage IV was usually treated with partial osteotomy. Conclusion. A surgical reconstructive treatment with fasciocutaneous and myocutanaeous flaps represents a gold standard for treating patients with pressure ulcers. These procedures provide reconstruction with adequate flap coverage and obliteration of dead space with well-vascularized tissue but with necessity of further implementation of antidecubitus measures.

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Personalized reconstructive and plastic approach in the surgical treatment of vulvar cancer

Уральский медицинский журнал ◽

10.52420/2071-5943-2021-20-2-12-16 ◽

2021 ◽

Vol 20 (2) ◽

pp. 12-16

Author(s):

A. A. Mukhin ◽

A. V. Taratonov

Keyword(s):

Surgical Treatment ◽

Squamous Cell ◽

Vulvar Cancer ◽

Locally Advanced ◽

Defect Closure ◽

Anatomical Structures ◽

Clinical Center ◽

Vulvar Reconstruction ◽

Medial Surfaces ◽

Treatment Volume

Introduction. The choice of a rational method of treatment in vulvar cancer is one of the most actual and difficult problems of modern clinical oncology. In the majority of cases vulvar cancer occurs in elderly and senile patients, as well as in some patients with locally advanced form. The aim of the investigation was to assess the possibility of reconstruction after surgical treatment of vulvar cancer.Materials and Methods. A study was conducted involving 151 patients with squamous cell vulvar cancer in whom the gynecological oncology department of Chelyabinsk regional clinical center of oncology and nuclear medicine performed surgical treatment by various methods in the following volume: dilated vulvectomy with the resection of adjacent anatomical structures with reconstructive and plastic component.Results. The original ways of plasty of the postoperative wound after vulvectomy were evaluated, the minimum risk of complications was revealed. The presented technologies permit to use additional variants of the wound defect reconstruction and have a number of advantages in comparison with two dermalfascial flaps from the medial surfaces of the femur used earlier. Discussion. Studies have shown that vulvar reconstruction using skin flaps can avoid complications and improve patients' quality of life. Reconstruction with flaps is not currently an accepted standard of treatment for vulvar cancer. Conclusion. The methods of the wound defect closure are possible after radical vulvectomy in patients with squamous cell vulvar cancer and resection of adjacent anatomical structures without reduction of surgical treatment volume. These methods of wound defect closure contribute to the reduction of postoperative complications and significantly reduce postoperative stay in a medical institution.

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