Shinsuke Mii1, Kiyoshi Tanaka2, Ryoichi Kyuragi3, Hiroshi Ishimura4, Shinsuke Yasukawa5, Atsushi Guntani6, Eisuke Kawakubo6. 1. Department of Vascular Surgery, Saiseikai Yahata General Hospital, Kitakyushu-City, Japan; Vascular Center, Steel Memorial Yawata Hospital, Kitakyushu-City, Japan. Electronic address: mii@yahata.saiseikai.or.jp. 2. Vascular Center, Steel Memorial Yawata Hospital, Kitakyushu-City, Japan; Department of Vascular Surgery, Kokura Memorial Hospital, Kitakyushu-City, Japan. 3. Vascular Center, Steel Memorial Yawata Hospital, Kitakyushu-City, Japan; Department of Vascular Surgery, Kyushu Medical Center, Fukuoka, Japan. 4. Vascular Center, Steel Memorial Yawata Hospital, Kitakyushu-City, Japan; Sakai Orthopedic Clinic, Fukuoka, Japan. 5. Vascular Center, Steel Memorial Yawata Hospital, Kitakyushu-City, Japan; Yasukawa Dermatology Clinic, Fukuoka, Japan. 6. Department of Vascular Surgery, Saiseikai Yahata General Hospital, Kitakyushu-City, Japan.
Abstract
BACKGROUND: A long period is generally required for ischemic ulcer to heal after revascularization. The strategy of postoperative wound care can affect wound healing. This study was conducted to investigate the degree to which aggressive wound care (AWC) by a team of multidisciplinary specialists actually shortens the time to wound healing and increases the rate of wound healing in limbs undergoing surgical bypass for ischemic tissue loss in a real clinical setting. METHODS: A total of consecutive 126 patients undergoing infrainguinal bypass for tissue loss from April 2011 to March 2015 were reviewed. Prior to March 2013, standard wound care (SWC) including typical daily dressing change with disinfection and irrigation, occasional surgical debridement, and negative pressure wound therapy (when necessary) was performed by vascular surgeons. Thereafter, in addition to SWC, AWC including intense daily bedside surgical debridement under a sciatic nerve block by an anesthesiologist and active skin grafting by a dermatologist, if necessary, was performed. Wound healing and major amputation were defined as the end points. The 1-year outcomes of the 2 groups were calculated using the Kaplan-Meier method and compared, and the significant predictors of each outcome were determined by a Cox proportional hazards analysis. RESULTS: The wound healing of the AWC group was superior to that of the SWC group (AWC versus SWC, 1-year wound healing rate: 92% vs. 80%; mean wound healing time: 48 days vs. 82 days; P = 0.011), and no significant difference between the 2 regimens in the freedom from major amputation was observed. AWC, Rutherford 5, no wound infection, normal serum albumin, direct angiosome, and cilostazol use were significant predictors of wound healing, and female gender and no cilostazol use were significant predictors of major amputation by a multivariate analysis. CONCLUSIONS: Aggressive wound care by the team consisting of multidisciplinary specialists remarkably shortened the time to wound healing and increased the rate of wound healing within 1 year.
BACKGROUND: A long period is generally required for ischemiculcer to heal after revascularization. The strategy of postoperative wound care can affect wound healing. This study was conducted to investigate the degree to which aggressive wound care (AWC) by a team of multidisciplinary specialists actually shortens the time to wound healing and increases the rate of wound healing in limbs undergoing surgical bypass for ischemic tissue loss in a real clinical setting. METHODS: A total of consecutive 126 patients undergoing infrainguinal bypass for tissue loss from April 2011 to March 2015 were reviewed. Prior to March 2013, standard wound care (SWC) including typical daily dressing change with disinfection and irrigation, occasional surgical debridement, and negative pressure wound therapy (when necessary) was performed by vascular surgeons. Thereafter, in addition to SWC, AWC including intense daily bedside surgical debridement under a sciatic nerve block by an anesthesiologist and active skin grafting by a dermatologist, if necessary, was performed. Wound healing and major amputation were defined as the end points. The 1-year outcomes of the 2 groups were calculated using the Kaplan-Meier method and compared, and the significant predictors of each outcome were determined by a Cox proportional hazards analysis. RESULTS: The wound healing of the AWC group was superior to that of the SWC group (AWC versus SWC, 1-year wound healing rate: 92% vs. 80%; mean wound healing time: 48 days vs. 82 days; P = 0.011), and no significant difference between the 2 regimens in the freedom from major amputation was observed. AWC, Rutherford 5, no wound infection, normal serum albumin, direct angiosome, and cilostazol use were significant predictors of wound healing, and female gender and no cilostazol use were significant predictors of major amputation by a multivariate analysis. CONCLUSIONS: Aggressive wound care by the team consisting of multidisciplinary specialists remarkably shortened the time to wound healing and increased the rate of wound healing within 1 year.
Authors: Maria Teresa B Abola; Jonathan Golledge; Tetsuro Miyata; Seung-Woon Rha; Bryan P Yan; Timothy C Dy; Marie Simonette V Ganzon; Pankaj Kumar Handa; Salim Harris; Jiang Zhisheng; Ramakrishna Pinjala; Peter Ashley Robless; Hiroyoshi Yokoi; Elaine B Alajar; April Ann Bermudez-Delos Santos; Elmer Jasper B Llanes; Gay Marjorie Obrado-Nabablit; Noemi S Pestaño; Felix Eduardo Punzalan; Bernadette Tumanan-Mendoza Journal: J Atheroscler Thromb Date: 2020-07-04 Impact factor: 4.928
Authors: Raffaele Grande; Gioia Brachini; Antonio V Sterpetti; Valeria Borrelli; Raffaele Serra; Francesco Pugliese; Giuseppe D'Ermo; Elvira Tartaglia; Paolo Rubino; Andrea Mingoli; Paolo Sapienza Journal: Int Wound J Date: 2019-10-27 Impact factor: 3.315