Wound Management and the Utility of Adjunctive Technologies in Diabetic Limb Salvage

2018 ◽  
Author(s):  
Tammer Elmarsafi ◽  
John S Steinberg
Keyword(s):  
Lower Extremity ◽  
Limb Salvage ◽  
Negative Pressure Wound Therapy ◽  
Arterial Disease ◽  
Wound Management ◽  
Skin Substitutes ◽  
Management Options ◽  
Wound Therapy ◽  
Peripheral Arterial ◽  
Extremity Salvage

As the projected prevalence of diabetes worldwide advances, the need for comprehensive treatments becomes paramount. Diabetes is estimated to afflict over 430 million people by the year 2030. It is without question that complications associated with poorly managed diabetes become a threat to the limbs and lives of this cohort. A targeted, specific, and comprehensive algorithm toward the management of lower extremity pathology related to diabetes is an essential public health endeavor. This review is aimed at addressing three key areas: surgical and adjunctive management options for diabetic lower extremity ulcerations, the challenges of lower extremity salvage, and to provide an introduction to the utility of advanced wound management technologies. An emphasis directed at understanding risks and benefits of each modality is discussed. An analysis of available biologic allografts and skin substitutes will be provided in the context of our working knowledge in regenerative medicine and wound treatments.   This review has 5 figures and 45 references Key Words: amputation, biologics, debridement, diabetes, infection, , limb salvage, negative pressure wound therapy, peripheral arterial disease, , ulcer

scholarly journals Negative Pressure Wound Therapy (NPWT) in open wound management: A study of 16 Cases in Orthopaedic Department of Faridpur Medical College Hospital

2013 ◽  
Vol 7 (2) ◽  
pp. 63-66
Author(s):  
Nusrat Shaheed ◽  
A S M Jahangir Chowdhury ◽  
Anadi Ranjan Mondal ◽  
Amal Chandra Paul ◽  
Md Shahin Akhter ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Granulation Tissue ◽  
Negative Pressure ◽  
Open Fracture ◽  
Negative Pressure Wound Therapy ◽  
Soft Tissue Defect ◽  
Healing Time ◽  
Wound Management ◽  
Wound Therapy ◽  
College Hospital

Wound management is a major concern in open fracture cases. Negative Pressure Wound Therapy (NPWT) is an  advanced method for managing open wounds. It is a topical treatment using sub-atmospheric pressure to increase  blood flow, remove bacteria and increase growth of granulation tissue in the wound. The study was performed to  evaluate the results of NPWT in patients with open fracture in lower extremity. Using Aquarium pump as an NPWT  device, 16 patients were prospectly treated for open fractures in their inferior extremity. Mean patients' age range was  21 to 60 yrs. The patients under study either had suffered from trauma, fall or had post operative wound infection.  Many of them had wounds with underlying tendon or bone exposure. Necrotic tissues were debrided before applying  NPWT. Dressings were changed every 3rd or 4th day and treatments were continued for 07 to 28 days. Exposed  tendons and bones were successfully covered with healthy granulation tissue in all cases, depth of the wounds  reduced as well as surface areas. In 12 cases coverage of granulation tissue were achieved and further managed by  skin grafting, 4 cases with wound infections were closed with secondary suture. No significant complications were  noted regarding the treatment. NPWT was found to facilitate the rapid formation of healthy granulation tissue on  open wounds in lower extremity and thus to shorten healing time and minimize secondary soft tissue defect coverage  procedures. DOI: http://dx.doi.org/10.3329/fmcj.v7i2.13500 Faridpur Med. Coll. J. 2012;7(2):63-66

Treatment of Arterial Ulcers

2018 ◽  
Author(s):  
Vahram Ornekian ◽  
David E Janhofer ◽  
Cameron Akbari ◽  
Karen K Evans
Keyword(s):  
Lower Extremity ◽  
Limb Salvage ◽  
Systematic Approach ◽  
Diagnostic Testing ◽  
Treatment Strategies ◽  
Arterial Disease ◽  
Management Guidelines ◽  
Ischemic Limb ◽  
Life Threatening ◽  
Peripheral Arterial

Ischemic ulceration of the lower extremity is a challenging problem that requires a careful, systematic approach to achieve healing and favourable outcomes. Ulceration may become limb and life threatening, and limb salvage requires a concerted, multispecialty approach that includes vascular surgeons, plastic surgeons, and podiatrists among others. In this chapter, we propose an algorithm for the evaluation and treatment of ischemic ulceration of the lower extremity. We provide a review of management guidelines, including a discussion of important considerations for appropriate history taking, physical examination evaluation, diagnostic testing modalities, and medical and surgical treatment strategies, taking into account patient functional and ambulatory goals of care. This review contains 8 figures, 4 tables and 73 references Key Words: amputation, diabetes, ischemic, limb salvage, lower extremity, peripheral arterial disease, reconstruction, revascularization, ulcer, wound

The Efficacy of Negative Pressure Wound Therapy and Antibiotic Beads in Lower Extremity Salvage

2020 ◽  
Vol 247 ◽  
pp. 499-507
Author(s):  
Karen E. Burtt ◽  
Ido Badash ◽  
Hyuma A. Leland ◽  
Daniel J. Gould ◽  
Alexis D. Rounds ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Wound Therapy ◽  
Extremity Salvage

Surgical and endovascular hybrid approach in peripheral arterial disease of the lower limbs

VASA ◽  
2016 ◽  
Vol 45 (5) ◽  
pp. 417-422 ◽  
Author(s):  
Anouk Grandjean ◽  
Katia Iglesias ◽  
Céline Dubuis ◽  
Sébastien Déglise ◽  
Jean-Marc Corpataux ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Peripheral Arterial Disease ◽  
Limb Salvage ◽  
Hybrid Approach ◽  
Arterial Disease ◽  
Early Mortality ◽  
Secondary Patency ◽  
Limb Salvage Rate ◽  
Peripheral Arterial ◽  
Salvage Rate

Abstract. Background: Multilevel peripheral arterial disease is frequently observed in patients with intermittent claudication or critical limb ischemia. This report evaluates the efficacy of one-stage hybrid revascularization in patients with multilevel arterial peripheral disease. Patients and methods: A retrospective analysis of a prospective database included all consecutive patients treated by a hybrid approach for a multilevel arterial peripheral disease. The primary outcome was the patency rate at 6 months and 1 year. Secondary outcomes were early and midterm complication rate, limb salvage and mortality rate. Statistical analysis, including a Kaplan-Meier estimate and univariate and multivariate Cox regression analyses were carried out with the primary, primary assisted and secondary patency, comparing the impact of various risk factors in pre- and post-operative treatments. Results: 64 patients were included in the study, with a mean follow-up time of 428 days (range: 4 − 1140). The technical success rate was 100 %. The primary, primary assisted and secondary patency rates at 1 year were 39 %, 66 % and 81 %, respectively. The limb-salvage rate was 94 %. The early mortality rate was 3.1 %. Early and midterm complication rates were 15.4 % and 6.4 %, respectively. The early mortality rate was 3.1 %. Conclusions: The hybrid approach is a major alternative in the treatment of peripheral arterial disease in multilevel disease and comorbid patients, with low complication and mortality rates and a high limb-salvage rate.

Outcomes after Emergency Admission with a Diabetic Foot Attack Indicate a High Rate of Healing and Limb Salvage But Increased Mortality: 18-Month Follow-up Study

2020 ◽  
Author(s):  
Erika Vainieri ◽  
Raju Ahluwalia ◽  
Hani Slim ◽  
Daina Walton ◽  
Chris Manu ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Diabetic Foot ◽  
Emergency Admission ◽  
Arterial Disease ◽  
Major Amputation ◽  
Outcome Data ◽  
High Rate ◽  
Free Survival ◽  
Peripheral Arterial

Abstract Aim The diabetic foot attack (DFA) is perhaps the most devastating form of diabetic foot infection, presenting with rapidly progressive skin and tissue necrosis, threatening both limb and life. However, clinical outcome data in this specific group of patients are not available. Methods Analysis of 106 consecutive patients who underwent emergency hospitalisation for DFA (TEXAS Grade 3B or 3D and Infectious Diseases Society of America (IDSA) Class 4 criteria). Outcomes evaluated were: 1) Healing 2) major amputation 3) death 4) not healed. The first outcome reached in one of these four categories over the follow-up period (18.4±3.6 months) was considered. We also estimated amputation free survival. Results Overall, 57.5% (n=61) healed, 5.6% (n=6) underwent major amputation, 23.5% (n=25) died without healing and 13.2% (n=14) were alive without healing. Predictive factors associated with outcomes were: Healing (age<60, p=0.0017; no Peripheral arterial disease (PAD) p= 0.002; not on dialysis p=0.006); major amputation (CRP>100 mg/L, p=0.001; gram+ve organisms, p=0.0013; dialysis, p= 0.001), and for death (age>60, p= 0.0001; gram+ve organisms p=0.004; presence of PAD, p=0.0032; CRP, p=0.034). The major amputation free survival was 71% during the first 12 months from admission, however it had reduced to 55.4% by the end of the follow-up period. Conclusions In a unique population of hospitalised individuals with DFA, we report excellent healing and limb salvage rates using a dedicated protocol in a multidisciplinary setting. An additional novel finding was the concerning observation that such an admission was associated with high 18-month mortality, almost all of which was after discharge from hospital.

scholarly journals Full circumference lower extremity degloving injury treated with hydrosurgical debridement and negative-pressure wound therapy with gauze wound filler for fixation of avulsed flap skin grafts

2020 ◽  
Vol 2020 (12) ◽  
Author(s):  
Tae Nagama ◽  
Natsuko Kakudo ◽  
Atsuyuki Kuro ◽  
Yujiro Ozaki ◽  
Yasuko Shirasawa ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Traumatic Injury ◽  
Skin Grafts ◽  
Wound Therapy ◽  
Left Lower Extremity ◽  
Degloving Injury ◽  
Severe Traumatic Injury ◽  
Degloving Injuries

Abstract Degloving, a skin and subcutis avulsion, is a severe traumatic injury sometimes caused by rolling wheels or machines. Although avulsed flaps are often readapted to its original site, most of these tissues become necrotic. Due to the extensive skin and soft tissue deficiency caused by necrosis, treatment becomes difficult. Skin grafts harvested from avulsed flaps may be used to treat degloving injuries, while negative pressure wound therapy (NPWT) is used to secure the grafts. Commonly used porous polyurethane foam wound fillers are difficult to set in circumferential extremity degloving injuries; gauze-based wound fillers are easier to use and cause less pain during dressing changes. We present a case of an extensive, full-circumference left lower-extremity degloving injury, treated using NPWT with gauze-based wound fillers for fixation of skin grafts harvested from avulsed flaps after hydrosurgical debridement. For complex wound geometries, gauze-based wound fillers can be easily applied for skin graft immobilization.

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