Predictive Factors for Limb Salvage and Foot Ulcer Recurrence in Patients with Chronic Limb-Threatening Ischemia After Multidisciplinary Team Treatment: A 6-Year Japanese Single-Center Study

Chronic limb-threatening ischemia (CLTI) is associated with a short-term risk of limb loss. Multidisciplinary teams are often involved in CLTI treatment; however, in Asian countries, multidisciplinary teams that include podiatrists specializing in foot wounds and vascular surgeons who can perform distal bypass surgery are lacking. We investigated predictive factors for limb salvage and foot ulcer recurrence in patients with CLTI treated by a Japanese single-center intensive multidisciplinary team over 6 years. We retrospectively investigated 84 patients with CLTI and foot ulcers who had undergone revascularization and wound treatment between October 2013 and December 2019. Following postrevascularization treatment, including undertaking minor amputations, the healing rate was 77.8%, and the average wound healing time was 75 ± 68 days. To achieve adequate blood supply, 17.7% of patients were treated using a combination of endovascular revascularization and bypass surgeries. Thirty-three (44%) patients had wound recurrence and there was wound recurrence within 6 months in 58.9% of these patients. Multivariate logistic regression analysis showed that postrevascularization skin perfusion pressure was significantly associated with wound healing (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.033-1.243, P = .0078). Diabetes mellitus (OR 9.72, 95% CI 1.855-50.937, P = .0071), and heart disease (OR 3.51, 95% CI 1.052-11.693, P = .0411) were significantly associated with wound recurrence ( P < .05). Treatment within a single-center intensive multidisciplinary team resulted in good patient outcomes. Our study indicates that the revascularization endpoint of CLTI treatment should be marked by attainment of adequate blood supply and wound healing. The timing of revascularization and debridement is of utmost importance for the successful treatment of CLTI wounds.

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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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Short Report: The Moisture Balance with Aloe Vera Gel in Diabetic Wound Healing

International Journal of Nursing and Health Services (IJNHS) ◽

10.35654/ijnhs.v1i1.9 ◽

2018 ◽

Vol 1 (1) ◽

pp. 21-23

Author(s):

Fahrianto Selamet ◽

Andi Mayasari Usman ◽

Rian Adi Pamungkas

Keyword(s):

Diabetes Mellitus ◽

Wound Healing ◽

Wound Care ◽

Aloe Vera ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Short Report ◽

Bacterial Reduction ◽

Moisture Balance ◽

Patients With Diabetes

Diabetic foot ulcer (DF) is a chronic complication of diabetes mellitus (DM), which impact on the morbidity, mortality and quality of patients’ lives.Of those patients with diabetes mellitus, approximately 15% to 25% developed to the foot ulcer. Beside has the infection and debridement of devitalized tissue downloading; the moisture imbalance becomes the factors of recalcitrant to healing. Moist wound healing is often contraindicated to the non-healable wounds. While wound care involves the debridement, bacterial reduction, and moisture balance in order to achieve the good granulation of the tissue development and adequate blood supply.

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The Effects of Silver-Releasing Foam Dressings on Diabetic Foot Ulcer Healing

Journal of Clinical Medicine ◽

10.3390/jcm10071495 ◽

2021 ◽

Vol 10 (7) ◽

pp. 1495

Author(s):

Yu-Chi Wang ◽

Hsiao-Chen Lee ◽

Chien-Lin Chen ◽

Ming-Chun Kuo ◽

Savitha Ramachandran ◽

...

Keyword(s):

Wound Healing ◽

Diabetic Foot ◽

Healing Rate ◽

Early Period ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Wound Management ◽

Control Group ◽

Diabetic Patients ◽

High Morbidity

Diabetic foot ulcers (DFUs) are a serious complication in diabetic patients and lead to high morbidity and mortality. Numerous dressings have been developed to facilitate wound healing of DFUs. This study investigated the wound healing efficacy of silver-releasing foam dressings versus silver-containing cream in managing outpatients with DFUs. Sixty patients with Wagner Grade 1 to 2 DFUs were recruited. The treatment group received silver-releasing foam dressing (Biatain® Ag Non-Adhesive Foam dressing; Coloplast, Humlebaek, Denmark). The control group received 1% silver sulfadiazine (SSD) cream. The ulcer area in the silver foam group was significantly reduced compared with that in the SSD group after four weeks of treatment (silver foam group: 76.43 ± 7.41%, SSD group: 27.00 ± 4.95%, p < 0.001). The weekly wound healing rate in the silver foam group was superior to the SSD group during the first three weeks of treatment (p < 0.05). The silver-releasing foam dressing is more effective than SSD in promoting wound healing of DFUs. The effect is more pronounced in the initial three weeks of the treatment. Thus, silver-releasing foam could be an effective wound dressing for DFUs, mainly in the early period of wound management.

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#69: Improving Communication About the Care and Prevention of Infections in a Pediatric Oncology Unit by Using Patient Daily Goals in Multidisciplinary Rounds

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piaa170.069 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

pp. S22-S22

Author(s):

Escobedo-Melendez Griselda ◽

Martinez-Albarran Manuel ◽

Magaña-Saldivar Isadora ◽

Jimenez Norma ◽

Gomez-Huerta Elizabeth ◽

...

Keyword(s):

Length Of Stay ◽

Pediatric Oncology ◽

Multidisciplinary Team ◽

Statistical Significance ◽

Healthcare Providers ◽

Multidisciplinary Teams ◽

Use Of Resources ◽

Multidisciplinary Rounds ◽

Prevention Of Infections ◽

Oncology Unit

Abstract Background In children with cancer infections are the most frequent complication, with fatal outcomes if not addressed promptly. Therefore, care and prevention of infections in these patients require multidisciplinary interventions, with effective communication among healthcare providers to reduce the morbidity, length of stay, and the inappropriate use of resources. We used the Institute of Healthcare Improvement (IHI) model for improving the communication among healthcare providers by using patient daily goals after the oncology pediatric unit multidisciplinary rounds. Methods A multidisciplinary team was identified in the pediatric oncology unit. The team received weekly coaching on the IHI methodology. The methodology used included the creation of a block diagram to understand the baseline processes and a key driver diagram. Then, after a literature review, a data collection plan and measures were identified. The team identified different ideas for changes and prioritized them using an impact-effort matrix. Finally, several rounds of Plan-Do-Study-Act (PDSA) cycles reached the desired changes that organized the patient daily goals for sharing in the form of a worksheet. This worksheet was shared with nurses and pharmacist staff, a chat group was created, and the routine use of the daily goals for patient management was taught and incorporated into the rest of the care team staff. The percentage of excellent communication among all multidisciplinary teams and outcomes (length of stay, intensive care unit admission, and mortality) were recorded at baseline and endline. We determined the statistical significance of the baseline vs. endline difference by using χ 2 and t-tests. Results A total of 105 patients with suspected infections were included over a 6-month period (June through November 2019). We found a significant increase per month in the percent of agreement in excellent communication in the patient daily goals between infectious diseases specialist faculty and fellows, nurses, pharmacist, and pediatric oncology faculty and fellows (33.3% vs. 91.3%) (P = 0.004). Length of stay decreased monthly after our interventions (baseline: mean 14.7 days [SD 12.4] vs. after intervention: mean 6.7 days [SD 2.7]) (P = 0.014). There were only one ICU admission and no deaths during the implementation period. Conclusions Our approach using patient daily goals improved communication among a multidisciplinary team, leading to decreased length of stay and supporting adequate outcomes.

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Omniflow II biosynthetic grafts versus expanded polytetrafluoroethylene grafts for infrainguinal bypass surgery. A single-center retrospective analysis

Vascular ◽

10.1177/17085381211029815 ◽

2021 ◽

pp. 170853812110298

Author(s):

Bart CT van de Laar ◽

Hugo C van Heusden ◽

Pieternel CM Pasker-de Jong ◽

Vincent van Weel

Keyword(s):

Limb Salvage ◽

Infection Rate ◽

Bypass Surgery ◽

Primary Patency ◽

Knee Surgery ◽

Secondary Patency ◽

Single Center ◽

Expanded Polytetrafluoroethylene ◽

Infrainguinal Bypass ◽

Omniflow Ii

Introduction: The aim of this study is to evaluate the outcome of Omniflow II biosynthetic vascular grafts as compared to synthetic expanded polytetrafluoroethylene (ePTFE) grafts in infrainguinal bypass surgery. Methods: A single-center, retrospective, observational study was performed reviewing patients with critical limb ischemia who underwent infrainguinal bypass surgery between 2014 and 2018. Patients characteristics, graft characteristics, and treatment outcomes were collected. Patency rates were compared using Kaplan–Meier estimates. Results: Sixty bypasses were performed in 57 patients. For above-knee surgery, six were Omniflow and 13 were synthetic. For below-knee surgery, 19 were Omniflow and 22 were synthetic. Patient characteristics between groups were similar. However, American Society of Anesthesiologists (ASA) classification scores were higher in the Omniflow group as compared to ePTFE (88% was ASA 3 or higher versus 60%; p = 0.018). Furthermore, wound, ischemia, and foot infection (WIfI) composite scores were higher in the Omniflow group ( p = 0.0001). There was a trend toward more active infection at time of surgery in the Omniflow group (40 vs 22.9%, p = 0.15). At 1 year, primary patency rates were 60.0% versus 46.9% for above-knee Omniflow versus ePTFE grafts, respectively ( p = 0.72). Secondary patency rates were 80.0% versus 82.5% ( p = 0.89), and limb salvage rates were 83.3% versus 100% ( p = 0.14). For below-knee surgery, 1- and 2-year primary patency rates in Omniflow versus ePTFE grafts were 36.0% versus 41.8% ( p = 0.60) and 36.0% versus 31.1% ( p = 0.87). Secondary patency rates were 66.8% versus 75.2% at 1 year ( p = 0.53) and 58.8% versus 48.3% ( p = 0.77) at 2 years. Below-knee limb salvage rates for Omniflow versus ePTFE after 2 years were 88.0% versus 68.3% ( p = 0.28), respectively. Aneurysmal degeneration occurred in 2/25 (8%) in the Omniflow group and 0/35 (0%) in the ePTFE group. Bypass infections occurred in 2/25 (8%) in the Omniflow group and 0/35 (0%) in the ePTFE group ( p = 0.09). Conclusion: Omniflow bypasses were more commonly implanted in patients with higher limb infection rate as confirmed with a higher adapted WIfI score. A trend toward a higher infection rate of Omniflow grafts was observed but not statistically significant. Graft infection rates were relatively low and treatable with antibiotics. No significant difference in graft performance was observed. The choice between the two studied grafts remains based on surgeon’s preference.

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Surgical Treatment of Diabetic Foot Ulcers Complicated by Osteomyelitis with Gentamicin-Loaded Calcium Sulphate-Hydroxyapatite Biocomposite

Journal of Clinical Medicine ◽

10.3390/jcm10020371 ◽

2021 ◽

Vol 10 (2) ◽

pp. 371

Author(s):

Kor H. Hutting ◽

Wouter B. aan de Stegge ◽

Jaap J. van Netten ◽

Wouter A. ten Cate ◽

Luuk Smeets ◽

...

Keyword(s):

Wound Healing ◽

Surgical Treatment ◽

Treatment Regimen ◽

Diabetic Foot ◽

Prospective Trial ◽

Calcium Sulphate ◽

Foot Ulcers ◽

Ulcer Recurrence ◽

Diabetic Foot Ulcers ◽

Cox Regression Analysis

Diabetic foot ulcers, complicated by osteomyelitis, can be treated by surgical resection, dead space filling with gentamicin-loaded calcium sulphate-hydroxyapatite (CaS-HA) biocomposite, and closure of soft tissues and skin. To assess the feasibility of this treatment regimen, we conducted a multicenter retrospective cohort study of patients after failed conventional treatments. From 13 hospitals we included 64 patients with forefoot (n = 41 (64%)), midfoot (n = 14 (22%)), or hindfoot (n = 9 (14%)) ulcers complicated by osteomyelitis. Median follow-up was 43 (interquartile range, 20–61) weeks. We observed wound healing in 54 patients (84%) and treatment success (wound healing without ulcer recurrence) in 42 patients (66%). Treatment failures (no wound healing or ulcer recurrence) led to minor amputations in four patients (6%) and major amputations in seven patients (11%). Factors associated with treatment failures in univariable Cox regression analysis were gentamicin-resistant osteomyelitis (hazard ratio (HR), 3.847; 95%-confidence interval (CI), 1.065–13.899), hindfoot ulcers (HR, 3.624; 95%-CI, 1.187–11.060) and surgical procedures with gentamicin-loaded CaS-HA biocomposite that involved minor amputations (HR, 3.965; 95%-CI, 1.608–9.777). In this study of patients with diabetic foot ulcers, complicated by osteomyelitis, surgical treatment with gentamicin-loaded CaS-HA biocomposite was feasible and successful in 66% of patients. A prospective trial of this treatment regimen, based on a uniform treatment protocol, is required.

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Predictive Factors of Poor Prognosis After Surgical Management of Traumatic Acute Subdural Hematomas: A Single-Center Series

World Neurosurgery ◽

10.1016/j.wneu.2019.02.194 ◽

2019 ◽

Vol 126 ◽

pp. e944-e952 ◽

Cited By ~ 3

Author(s):

Guillaume Baucher ◽

Lucas Troude ◽

Vanessa Pauly ◽

Florian Bernard ◽

Laurent Zieleskiewicz ◽

...

Keyword(s):

Surgical Management ◽

Predictive Factors ◽

Poor Prognosis ◽

Single Center ◽

Subdural Hematomas

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An in vivo Investigation on the Wound-Healing Effect of Two Medicinal Herbs Using an Animal Model with Foot Ulcer

European Surgical Research ◽

10.1159/000122834 ◽

2008 ◽

Vol 41 (1) ◽

pp. 15-23 ◽

Cited By ~ 45

Author(s):

T.W. Lau ◽

D.S. Sahota ◽

C.H. Lau ◽

C.M. Chan ◽

F.C. Lam ◽

...

Keyword(s):

Wound Healing ◽

Animal Model ◽

Foot Ulcer ◽

Medicinal Herbs ◽

Healing Effect ◽

Wound Healing Effect

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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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