Angiosome‐targeted revascularisation in diabetic foot ulcers

Abstract

Peripheral vascular disease is a common complication of type 2 diabetes and is often more severe and diffuse than in non-diabetic individuals with a higher risk of major amputations in the lower limbs. Diabetic foot revascularisation using both traditional bypass surgery and endovascular therapy are often burdened by the failure and the inevitable subsequent massive amputation. In this study, we examined the clinical response of diabetic patients with critical limb ischaemia and extended ischaemic wounds, treated with a new angiosome-based revascularisation technique. In a 3-year period, nine diabetic patients with imminent amputation threatening and foot ulcers with no feasible arterial revascularisation options were treated by the angiosome-based surgical technique by means of deep vein arterialisation. The postoperative tcPO2 evaluation showed a mean increase in the cutaneous oxygen tension in all patients treated. The overall survival rates were 88·88%, 88·88% and 77·77% at 12, 24 and 36 months, respectively. Limb salvage was 100% at 1 year and steady at 88·88% thereafter. Surgical deep venous arterialisation might be considered as an extreme alternative to attempt tissue preservation in limbs unfit for conventional arterial revascularisations. This technique would give advantages to the patients in terms of better compliance to the minor amputations and thus avoiding major limb amputations.

Spinal cord stimulation to achieve wound healing in a primary lower limb critical ischaemia referral centre

“…Critical lower limb ischaemia (CLI) is a common disease that usually results from progressive narrowing of the arteries caused by atherosclerosis . Severe ischaemic pain, claudication, tissue loss and finally limb amputation are common complications of peripheral arterial disease (PAD), especially among patients affected by diabetes mellitus and end‐stage renal disease and on haemodialysis . The common treatment of PAD includes correction of risk factors, medical therapy and revascularisation through endovascular treatment or distal bypass, in order to restore a pulsatile flow as distal as possible .…”

Bacterial distribution, changes of drug susceptibility and clinical characteristics in patients with diabetic foot infection

“…When bacteria invade into host cells, antibacterial drugs cannot effectively enter the cells. The compromised anti-infection effects result in delayed wound healing and cause great suffering in patients (18). The results of this study showed that the susceptibility of pathogens to conventional antibacterial drugs have declined year by year from 2013 to 2016, which was closely related to the unreasonable use of antibacterial drugs.…”

Matrix metalloproteinases and risk stratification in patients undergoing surgical revascularisation for critical limb ischaemia

“…With such aims, predictive indices and risk‐stratification of patients with CLI can guide the physician in choosing and tailoring the treatment of PAD. This is even more valiant when newer and ancillary approaches to PAD such as angiosome‐targeted revascularisation , extreme distal bypass , gene therapy , vacuum‐assisted closure (VAC) therapy , spinal cord stimulation and prostaglandin E1 infusions are considered.…”