COMPARISON OF WOUND HEALING RATE AND TIME TO COMPLETE WOUND HEALING ACCORDING TO WOUND LOCATION IN CRITICAL LIMB ISCHEMIA

Abstract Background Critical limb ischemia (CLI) is the most progressed manifestation of peripheral artery disease. Although patients with CLI commonly complicate with severely calcified lesions in infrapopliteal lesions, the prognostic impact of infrapopliteal arterial calcification on wound healing in patients with CLI has not been systematically studied. Purpose The aim of current study was to elucidate the prognostic impact of infrapopliteal arterial calcification on wound healing in CLI undergoing endovascular therapy (EVT). Methods This study enrolled 639 CLI patients with tissue loss (age 74±10 years, male 62%, diabetes 69%, hemodialysis 57%, Rutherford class 5 77%, class 6 23%) primarily treated with EVT for the infrapopliteal lesions between April 2010 and December 2015. Arterial calcification was assessed by high intensity fluoroscopy and classified into 3 groups as follows; 1) none, 2) unilateral and 3) bilateral calcification. The primary outcome measure was complete wound healing. The predictors of the outcome were evaluated by Cox proportional hazards regression analysis. Results During a mean follow-up period of 22±19 months, 1-year wound healing rate were 59.0%. In Kaplan-Meier analysis, 1-year wound healing rate was worse in patients with bilateral calcification than in those with unilateral or none calcification (Figure, 46.2% versus 55.1% versus 67.8%, P<0.001). After multivariate analysis, the predictors of wound healing were non-ambulatory status (hazard ratio (HR) 0.67 [95% confidential interval (CI) 0.53–0.85], P=0.001) and bilateral calcification (HR 0.75 [95% CI 0.47–0.98], versus none or unilateral calcification, P=0.036). Figure 1 Conclusion Infrapopliteal Arterial calcification as well as non-ambulatory status was associated with wound healing in patients with CLI.

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Wound healing of critical limb ischemia with tissue loss in patients on hemodialysis

Vascular ◽

10.1177/1708538116673015 ◽

2016 ◽

Vol 25 (3) ◽

pp. 272-282 ◽

Cited By ~ 4

Author(s):

Yohsuke Honda ◽

Keisuke Hirano ◽

Masahiro Yamawaki ◽

Shinsuke Mori ◽

Shigemitsu Shirai ◽

...

Keyword(s):

Wound Healing ◽

Limb Salvage ◽

Critical Limb Ischemia ◽

Healing Rate ◽

Young Patients ◽

Limb Ischemia ◽

Tissue Loss ◽

Wound Recurrence ◽

Healing Wound ◽

Wound Healing Rate

We assessed wound healing in patients on hemodialysis (HD) with critical limb ischemia (CLI). This study enrolled 267 patients (including 120 patients on HD and 147 patients not on HD) who underwent endovascular therapy (EVT) for CLI. The primary endpoint was wound-healing rate at two years. Secondary endpoints were time to wound healing, wound recurrence rate, and limb salvage at two years. The percentage of male and young patients was higher in the HD patients ( p < 0.01). A lower patency of the pedal arch after EVT was observed frequently in HD patients ( p < 0.01). The wound-healing rate was significantly lower in HD patients (79.5% vs. 92.4%, p < 0.001). Time to wound healing was significantly longer in HD patients (median 132 days vs. 82 days, p = 0.005). Wound recurrence was observed more frequently in HD patients (25.0% vs. 10.2%, p = 0.007). Limb salvage (72.8% vs. 86.4%, p = 0.002) was significantly lower in HD patients. In a cox proportional hazard model, HD was an independent predictor of wound healing (risk ratio (RR), 0.46; 95% confidence interval (CI), 0.33–0.62; p < 0.001) and wound recurrence (RR, 1.58; 95% CI, 1.11–2.22; p = 0.01). HD was independently associated with lower and delayed wound healing, and wound recurrence.

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Endovascular revascularization of multilevel arterial disease in patients with critical limb ischemia

International Surgery Journal ◽

10.18203/2349-2902.isj20182025 ◽

2018 ◽

Vol 5 (6) ◽

pp. 2039

Author(s):

Asser Abd El Hamid Goda

Keyword(s):

Wound Healing ◽

Limb Salvage ◽

Critical Limb Ischemia ◽

Healing Rate ◽

Limb Ischemia ◽

Arterial Disease ◽

Endovascular Revascularization ◽

The Mean ◽

Revascularization Procedures ◽

Salvage Rate

Background: Critical limb ischemia (CLI) occurs due to progressive obstructive nature of atherosclerosis disease. Nowadays, there is widespread use of endovascular revascularization procedures for restoration of blood flow in CLI. The aim this study is evaluation of the efficacy of endovascular intervention for multilevel arterial disease in patients with critical limb ischemia.Methods: This prospective study was included CLI patients due to multilevel arterial disease who underwent endovascular revascularization between January 2016 and January 2017 in our institution. Study end points were limb salvage and wound healing. Results: The mean age of patients was (61.7±7.47) years, with 13 (61.9%) men. Eight limbs were identified as Rutherford category 4 (38.1%), ten limbs as Rutherford category 5 (47.6%), and three limbs as Rutherford category 6 (14.3%). Limb salvage rate was (90.5%) at 1 year. Wound healing rate was 80.9%.Conclusions: This study proved that endovascular revascularization of multilevel arterial disease for patients with critical limb ischemia is effective.

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Prognosis of critical limb ischemia patients with tissue loss after achievement of complete wound healing by endovascular therapy

Journal of Vascular Surgery ◽

10.1016/j.jvs.2014.11.065 ◽

2015 ◽

Vol 61 (4) ◽

pp. 951-959 ◽

Cited By ~ 15

Author(s):

Norihiro Kobayashi ◽

Keisuke Hirano ◽

Masatsugu Nakano ◽

Yoshiaki Ito ◽

Hiroshi Ishimori ◽

...

Keyword(s):

Wound Healing ◽

Endovascular Therapy ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Tissue Loss ◽

Complete Wound Healing

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Wound healing after revascularization for critical limb ischemia

International Angiology ◽

10.23736/s0392-9590.19.04096-3 ◽

2019 ◽

Vol 38 (3) ◽

Author(s):

Masaya Sano ◽

Kota Yamamoto ◽

Akihiko Seo ◽

Atsushi Akai ◽

Daisuke Akagi ◽

...

Keyword(s):

Wound Healing ◽

Critical Limb Ischemia ◽

Limb Ischemia

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Role of topical insulin therapy as an adjunct in the management of pressure ulcer

Clinical Research and Clinical Trials ◽

10.31579/2578-8868/15 ◽

2020 ◽

Vol 2 (3) ◽

pp. 01-03

Author(s):

Ravi Chittoria

Keyword(s):

Wound Healing ◽

Insulin Therapy ◽

Pressure Ulcer ◽

Healing Rate ◽

Pressure Sore ◽

Pressure Sores ◽

Established Method ◽

Wound Bed Preparation ◽

Wound Healing Rate

Pressure ulcer or pressure sore is one of the complications seen in bedridden patients. Management of these ulcers is often challenging. But there is no well-established method that accelerates the wound healing rate. Various adjunctive methods are used for wound bed preparation before definitive reconstruction plan is made. Here we describe our experience in the role of insulin therapy as an adjunct in the management of pressure sores.

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Evaluation of Tissue Perfusion by Wound Blush and 2D Color-Coded Digital Subtraction Angiography During Endovascular Intervention and Its Impact on Limb Salvage in Critical Limb Ischemia

Journal of Endovascular Therapy ◽

10.1177/15266028211065957 ◽

2021 ◽

pp. 152660282110659

Author(s):

Hassan Lotfy ◽

Ahmed Abou El-Nadar ◽

Wael Shaalan ◽

Ali El Emam ◽

Akram Ibrahim ◽

...

Keyword(s):

Wound Healing ◽

Digital Subtraction Angiography ◽

Limb Salvage ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Tissue Perfusion ◽

Technical Failure ◽

Digital Subtraction ◽

Reliable Technique ◽

Significant Difference

Purpose: Critical limb ischemia (CLI) is an entity with high mortality if not properly treated. The primary aim of CLI revascularization is to enhance wound healing, which greatly depends on microvascular circulation. The available tools for assessment of revascularization success are deficient in the evaluation of local microvascular tissue perfusion, that wound blush (WB) reflects. A reliable technique that assesses capillary flow to foot lesions is needed. This study aims to assess WB angiographically at sites of interest in the foot after revascularization and its impact on limb salvage in CLI. Materials and Methods: 198 CLI patients (Rutherford category 5/6) with infrainguinal atherosclerotic lesions amenable for endovascular revascularization (EVR) were included. Limbs were directly or indirectly revascularized by EVR. Direct revascularization meant that successful revascularization of the area of interest according to the angiosome concept was achieved. A completion angiographic run was taken to assess WB. Patients were divided into 2 groups; positive and negative WB groups. In the event of a disagreement between the observational investigators, the digital subtraction angiography (DSA) series was analyzed for hemodynamic changes with a computerized 2D color-coded DSA (Syngo iFlow). Results: 176 limbs had successful revascularization in 157 patients. The successful revascularization rate was 88.9% (176/198), with technical failure encountered in 22 limbs. 121 patients had positive WB and 55 patients had negative WB. Direct revascularization of target areas was obtained in 98 limbs (55.7%). There was a significant difference in the rate of achieving direct flow to the lesion between the positive WB and negative WB groups (36.4% vs 19.3%, p≤0.001). We noticed a nonsignificant difference between patients who had direct revascularization of the foot lesion(s) and those who had indirect revascularization as regards limb salvage. Patients were followed up for 25.2 ± 12.7 months. By the end of the first year, limb salvage rate was significantly higher in patients who had positive WB (98% vs 63%, p<0.001, after 2 years (97% vs 58%, p<0.001) and after 3 years (94% vs 51.5%, p<0.001). Conclusions: WB is an important predictor and a prognostic factor for wound healing in CLI patients with soft tissue lesions.

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Treatment of Cutaneous Ulcers with Multilayered Mixed Sheets of Autologous Fibroblasts and Peripheral Blood Mononuclear Cells

Cellular Physiology and Biochemistry ◽

10.1159/000489767 ◽

2018 ◽

Vol 47 (1) ◽

pp. 201-211 ◽

Cited By ~ 5

Author(s):

Takahiro Mizoguchi ◽

Koji Ueno ◽

Yuriko Takeuchi ◽

Makoto Samura ◽

Ryo Suzuki ◽

...

Keyword(s):

Wound Healing ◽

Growth Factor ◽

Healing Rate ◽

Mononuclear Cells ◽

Mixed Cell ◽

Peripheral Blood Mononuclear ◽

Fibroblast Migration ◽

Autologous Fibroblasts ◽

Blood Mononuclear Cells ◽

Wound Healing Rate

Background/Aims: We have developed a mixed-cell sheet consisting of autologous fibroblasts and peripheral blood mononuclear cells with a high potency for angiogenesis and wound healing against refractory cutaneous ulcers in mouse and rabbit models. To increase the effectiveness of the mixed sheet, we developed a multilayered mixed sheet. Methods: We assessed the therapeutic effects of multilayered sheets on cutaneous ulcers in mice. Growth factors and chemokines were assessed by enzyme-linked immunosorbent assay. Angiogenesis and fibroblast migration were measured by using tube formation and migration assays. Wound healing rate of cutaneous ulcers was evaluated in mice with diabetes mellitus. Results: The concentration of secreted vascular endothelial growth factor, hepatocyte growth factor, transforming growth factor, C-X-C motif chemokine ligand (CXCL)-1, and CXCL-2 in multilayered sheets was much higher than that in single-layered mixed-cell sheets (single-layered sheets) and multilayered sheets of fibroblasts alone (fibroblast sheets). The supernatant in multilayered sheets enhanced angiogenic potency and fibroblast migration compared with single-layered and fibroblast sheets in an in vitro experiment. The wound healing rate in the multilayered sheet-treated group was higher compared with the no-treatment group (control) at the early stage of healing. Moreover, both vessel lumen area and microvessel density in tissues treated with multilayered sheets were significantly increased compared with tissues in the control group. Conclusion: Multilayered sheets promoted wound healing and microvascular angiogenesis in the skin by supplying growth factors and cytokines. Accordingly, our data suggest that multilayered sheets may be a promising therapeutic material for refractory cutaneous ulcers.

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Abstract 14293: Time to Wound Healing and Major Adverse Limb Events in Patients With Critical Limb Ischemia Treated With Endovascular Therapy

Circulation ◽

10.1161/circ.132.suppl_3.14293 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Grant W Reed ◽

Negar Salehi ◽

Pejman Raeisi-Giglou ◽

Umair Malik ◽

Rami Kafa ◽

...

Keyword(s):

Wound Healing ◽

Endovascular Therapy ◽

Critical Limb Ischemia ◽

Proportional Hazards ◽

Limb Ischemia ◽

Major Amputation ◽

Cox Proportional Hazards ◽

Time Dependent ◽

Kaplan Meier

Introduction: There have been few studies evaluating the influence of time to wound healing on outcomes in patients with critical limb ischemia (CLI) after endovascular therapy. Methods: In this prospective study, patients with CLI treated with endovascular therapy were assessed for comorbidities, presence of wounds, wound healing, and major adverse limb events (MALE; major amputation, surgical endartectomy, or bypass) over time. The incidence of MALE was compared across patient and wound characteristics by Kaplan-Meier analysis. Associations between these variables and MALE were determined by Cox proportional hazards analysis. Results: A total of 252 consecutive patients with CLI were treated between November 1, 2011 and April 1, 2015; 179 (71%) had wounds, of which 97 (54%) healed. During median follow-up of 12.7 months (interquartile range 3.9 - 23.9 months), 46 (18%) had MALE. Wounds were associated with a greater risk of MALE (Hazard Ratio [HR] 3.5; 95% Confidence Interval [CI] 1.4-8.9; p=0.008). As a time-dependent covariate, wound healing was associated with less MALE (HR 0.23; 95% CI 0.10-0.53; p<0.001), and MALE was more frequent in patients with unhealed wounds (23% vs 11%; p<0.0001) (Figure - A). There was significantly less MALE in patients whose wounds healed within 4 months (24% vs 10%; p=0.032) (Figure - B), and less major amputation in those with healed wounds within 3 months (16% vs 5%; p=0.033). After multivariate adjustment for age, presence of diabetes, renal function, wound size, and procedural failure, independent predictors of MALE were wound healing as a time-dependent covariate (HR 0.18; 95% CI 0.08 - 0.40; p<0.0001), and creatinine ≥ 2 (HR 2.3; 95% CI 1.3-4.2; p=0.005). Conclusions: A shorter time to wound healing is associated with less MALE in patients with CLI after endovascular therapy. Efforts should be made to achieve wound healing as quickly as possible in this population, especially in those with renal dysfunction.

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Clinical Application of Platelet-Rich Plasma Gel (PRP) in Trauma Wounds of Extremities

Stem Cells and Regenerative Medicine - Biomedical and Health Research ◽

10.3233/bhr210033 ◽

2021 ◽

Author(s):

Jie Zhang ◽

Xiaolin Feng ◽

Yuxia Wang ◽

Dakang Chen ◽

Bo Zhang

Keyword(s):

Wound Healing ◽

Healing Rate ◽

Platelet Rich Plasma ◽

Healing Time ◽

Second Stage ◽

Autologous Platelet Rich Plasma ◽

Wound Healing Time ◽

Autologous Platelet ◽

Tissue Defects ◽

Wound Healing Rate

Research purposes: Autologous platelet-rich plasma gel (Platelet-Rich Plasma, PRP) was prepared and used for transplantation for the treatment of traumatic trauma wounds of extremities. Explore platelet-rich plasma gel (PRP) to promote the healing of exposed bone and tendon wounds. Methods: Fifteen patients with extremity bone and tendon exposed wounds were treated with autologous platelet-rich plasma gel (PRP) transplantation to observe the wound healing rate and wound healing time. Results: Among the 15 patients, 8 cases healed directly, 7 cases had active granulation growth, and second-stage skin graft wound healing; the wound healing rate was 100%, and the average wound healing time was 36 days. Conclusion: Autologous platelet-rich plasma gel (PRP) transplantation for the treatment of traumatic trauma hard wounds of the extremities, can inhibit the bacterial growth of the wounds, effectively promote the repair of soft tissue defects and accelerate the healing of bone and tendon wounds of the extremities.

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