Ilizarov technology in China: a historic review of thirty-one years

Purpose To summarize the evolution of Ilizarov technology in China, highlight important milestones, introduce the atmosphere of the era concerning the first uses and development of this technology, and share Chinese modification and experience in this field. Method A thorough interview with senior ASAMI members of China and literature search and physical books in libraries was undertaken to summarize the history of Ilizarov technology in China. Results The formal development of Ilizarov technology began when professor Ilizarov himself came to Beijing (1991) and gave a speech. In the following 31 years, his technology was rapidly developed through China, with many symposiums held and associations established including ASAMI China (2003) and ILLRS China (2015). Today, Ilizarov technology has become the main treatment of complex fractures, defects, nonunion, infections, deformities, and chronic ischemic ulcers of the limbs. In those years, Chinese scholars also developed some special treatment methods and made many modifications to Ilizarov external fixators. Conclusion Ilizarov technology has developed in China for 31 years. It revolutionized the treatment of complex limb traumas, deformities, and diseases. In the treatment of millions of patients, Chinese scholars had many unique experiences and made modifications to this technology which is worthy to share with the world.

Effect of Topical Oxygen Therapy on Chronic Wounds

Over the past three decades, there has been a growing interest in the use of oxygen therapy to promote wound healing. Although the most commonly recognized oxygen therapy for the treatment of chronic wounds is hyperbaric oxygen therapy, topical oxygen therapy has a greater level of evidence supporting its use in chronic wound care. Still, it is imperative that these two treatment modalities be recognized not merely as competitors, but as distinct therapeutic entities. Through personal experience and a thorough literature review, we investigated the use of topical oxygen therapy in the management of chronic wounds. The benefits of using topical oxygen therapy have been demonstrated in patients with diabetic foot ulcers, ischemic ulcers, post-revascularization ulcers, and pressure ulcers. There are several topical oxygen devices currently on the market that are versatile, relatively low-risk, and generally well-tolerated by patients. While these devices have been used in the treatment of chronic wounds at different locations and of different etiologies, other uses of these devices are still being investigated. Topical oxygen therapy is yet another tool in our arsenal to be used in treating difficult to heal chronic wounds and could potentially be used more readily.

Evaluation Of The Radiofrequency Ablation Of Lumbar Sympathetic Ganglia In Lower Limb Ischemic Ulcers In Indian Population

Antecedentes: la simpatectomía lumbar mediante radioablación es un tratamiento útil de la isquemia periférica. Sin embargo, la eficacia clínica con respecto a las úlceras de las extremidades inferiores no está suficientemente establecida en la población india. El estudio se realizó para evaluar el papel de la ablación por radiofrecuencia (ARF) de los ganglios simpáticos lumbares en la cicatrización de las úlceras isquémicas del miembro inferior. Método: El estudio prospectivo con 63 pacientes registrados en el servicio de Cirugía General con úlceras isquémicas de miembros inferiores entre diciembre de 2017 y julio de 2019 fueron tratados con ARF. Se excluyó del estudio a los pacientes con enfermedad cardiopulmonar, embarazadas, malformaciones congénitas o infección cutánea en el lugar de la intervención, o que padecían trastornos hemorrágicos. Se realizó una investigación clínica de la herida y se recopilaron datos demográficos. La reducción comparativa en el tamaño de la herida se evaluó mediante el ANOVA de Friedman (P <0,001). La diferencia en la puntuación del dolor, la estancia hospitalaria y la distancia recorrida se evaluaron mediante la prueba de pares emparejados de Wilcoxon (P <0,001), la prueba t para datos no emparejados y la prueba t para datos emparejados (P <0,05). Resultado: la mayoría de los pacientes eran hombres (n = 40) con una edad media de 60,93 DE14,34 años. Se observó una reducción significativa en el tamaño de la herida, las puntuaciones de dolor y la estancia hospitalaria después del procedimiento (P <0,001). El número de sesiones de RFA se asoció significativamente con el tamaño de la úlcera y la clasificación de Fontaine 2 y 3 (P <0,0001). Conclusión: La ARF de los ganglios simpáticos lumbares es una posible modalidad de tratamiento para las úlceras isquémicas de las extremidades inferiores.

Outcome after Hybrid Outflow Interventions for Chronic Limb-threatening Ischemia

Background and Aims: Because chronic limb-threatening ischemia (CLTI) is often associated with multilevel arterial disease, it usually requires revascularization at different sites of the limb vasculature. We aim to assess the outcome of the hybrid interventions including open surgical revascularization together with outflow segment percutaneous transluminal angioplasty (PTA) in patients with chronic limb-threatening ischemia. Material and Methods: This study included all hybrid outflow-PTA interventions (n = 80) on patients suffering from CLTI performed in Helsinki University Hospital between 2003 and 2015. Follow-up ended on 31 December 2019. Patient data were prospectively collected into our vascular registry and scrutinized retrospectively. Thirty-one patients (39%) suffered from rest pain (Rutherford category IV) and 49 patients (61%) had ischemic ulcers (Rutherford category V–VI). The most common open surgical procedure was femoral endarterectomy (n = 63, 79%) and the most common endovascular procedure was superficial femoral artery percutaneous transluminal angioplasty (n = 65, 81%). Mean follow-up time was 56 months (range: 4 days–183 months). Results: Limb salvage was at 30 days—92%, at 1 year—91%, and at 5 and 10 years—86%. Survival and amputation-free survival were at 30 days—93% and 86%, at 1 year—80% and 76%, at 5 years—51% and 48%, and at 10 years—21% and 21%. Wound healing at 3, 6, and 12 months was 48%, 71%, and 87%. Freedom from target lesion revascularization was at 30 days—97%, at 1 year—88%, at 5 years—72%, and at 10 years—66%. Conclusion: Hybrid outflow revascularization is an important tool in the vascular surgeon’s armamentarium for treatment of patients with multilevel arterial disease causing chronic limb-threatening ischemia.

Wskaźnik terapeutyczny miejscowego zakażenia rany (TILI) jako przydatne narzędzie w efektywnej pielęgnacji ran niegojących się dla lekarzy i pielęgniarek podstawowej opieki zdrowotnej, lekarzy rodzinnych i personelu zakładów opiekuńczo-leczniczych

The problem of hard-to-heal wounds is associated with an increase in the incidence of civilization diseases. Venous leg ulcers, ischemic ulcers and wounds in diabetic foot syndrome are a particular problem, and the early detection of local wound infections is a serious interdisciplinary challenge in everyday practice. Local wound infections are often undetected or detected too late. They can impair physiological wound healing as well as lead to systemic infection and even sepsis. According to the statements that: “The fate of the wounded rests with the one who applies the first dressing” (Col. Nicholas Senna, 1897), and “The responsibility for the patient rests with the doctor who comes to the patient first” (John Murphy, Medical Society, Chicago, 1889) the success of the treatment of infected wounds depends to a particular extent on the prompt and proper response of those who come in contact with the patient first. The purpose of this document is to briefly present issues related to the problem of hard-to-heal wounds, indicate the direction of therapeutic management and diagnostic support for the staff (doctors and nurses) of primary healthcare units, care and treatment institutions and social welfare centers, general physicians and medical careers of patients suffering from hard-to-heal wounds. The developed TILI score is to facilitate the decision whether or not to use antiseptics and/or antimicrobial dressings in the effective therapy of a hard-to-heal wound.

A prospective study to determine the application of site, ischemia, neuropathy, bacterial infection and depth scoring in the outcome and management of diabetic foot ulcers

Background: The objective of the study was to classify diabetic ulcers based on the recently described SINBAD classification system and to determine the management based on SINBAD score.Methods: Prospective study, conducted in Victoria Hospital from November 2017 to May 2019. 120 patients with diabetic ulcers were classified according to the SINBAD classification system, wherein a score of one is given for site beyond forefoot, presence of ischemia, presence of neuropathy, bacterial infection, area >1 cm2 and depth beyond subcutaneous tissue. The wounds are scored at presentation and the outcome are evaluated according to respective score.Results: In this study 120 patients with mean age of 50.12 years were included. Lower socio-economic groups correlated with higher incidence of diabetic foot. According to SINBAD classification 42.5% had forefoot, 57.5% had hind foot wounds, 56.3% were purely ischemic ulcers, 19.2% were neuropathic ulcers, 40.0% were neuro-ischemic ulcers 68.3% had bacterial infection, 70.8% had ulcer, size >1 cm2, 55% had ulcer deeper than skin & sub cutaneous tissues. Healing probability in score 1 was 100%, score 2 was 87.5%, Score 3 was 70%, score 4 was 58.6% healing, score 5 was 7.1% and score 6 was 1.1% healing (p=0.004). Ischemia, neuropathy, bacterial infection, area >1 cm2 and depth beyond subcutaneous tissue had significant effect on healing.Conclusions: SINBAD classification system includes 6 parameters, describing the pathological evolution of diabetic ulcers. Treatment protocols can be determined based on the score. The system is easy to score and apply in routine practise.

Hyperbaric oxygen therapy in patients suffering from wounds in calciphylaxis: a narrative review

Background: Calcific uremic arteriolopathy (calciphylaxis) is a rare and highly lethal vascular disease. Vascular calcification with calcium depositions lead to ischemic ulcers associated with gangrene, severe pain and poor healing. Although hyperbaric oxygen (HBO2) therapy has been used in the treatment of calciphylaxis, evidence of its effectiveness is limited. Objective: To determine whether HBO2 therapy has a beneficial effect in the healing of calciphylaxis ulcers. Methods: A search was made in PubMed using a comprehensive strategy to identify the effect of HBO2 on calciphylaxis wounds. Included in the analysis were studies published up to October 2018 involving a minimum of four patients receiving HBO2 therapy. Results: Ten retrospective (case) series were included. This review included a total of 131 patients with calciphylaxis who were treated with HBO2 therapy; of these, 58 patients (45%) had full response on HBO2 with complete wound closure. Regarding partial response, 17 of the patients (13%) experienced substantial wound improvement on different wound scale scores. Conclusion: Patients with calcific uremic arteriolopathy can benefit from HBO2. More research is needed using standardized wound scores. Outcomes related to quality of life and pain relief should also be assessed.