Promoting Limb Salvage through Multi-Disciplinary Care of the Diabetic Patient

Salvo, Nichol L.; Walsh, Mark D.; Brewster, Luke P.

doi:10.1007/s11936-017-0547-1

Cited by 7 publications

(6 citation statements)

References 66 publications

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“…Combining techniques like angioplasty or bypass surgery with microsurgical free flap reconstruction can reduce amputation rates and is being routinely performed on patients with impaired peripheral perfusion caused by plaques accumulating in the arteries. 9,[16][17][18][19][20] Publications regarding the choice of anastomotic technique for free flap transfer in patients suffering from PAD are scarce. We show no significant changes in flap outcome when comparing ETE versus ETS anastomoses in patients with PAD.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Outcomes of End-to-End versus End-to-Side Anastomoses in Lower Extremity Free Flap Reconstructions

Broer

Moellhoff

Mayer

et al. 2020

J Reconstr Microsurg

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Background Whether to perform an end-to-end (ETE) versus end-to-side (ETS) arterial anastomosis is an integral part of preoperative planning and intraoperative decision making in free flap-based reconstructions. This study evaluated the impact of microsurgical anastomotic technique on outcomes of lower extremity reconstructions, with a focus on patients with peripheral arterial disease (PAD). Methods Over a 6-year period, 425 patients underwent 437 microvascular lower extremity free flap reconstructions with fasciocutaneous anterolateral thigh- or gracilis muscle flaps at a single surgical center. The cases were divided into an ETE (n = 297 patients) versus ETS (n = 128 patients) group according to the anastomotic technique. A retrospective analysis of patients' demographics, perioperative details, surgical complications, free flap types, recipient sites, flap survival, and the potential impact of PAD on outcomes was performed. Patient groups were comparable regarding comorbidities, American Society of Anesthesiologists scores, types of performed free flaps and recipient sites. Results We found no significant differences between the ETE versus ETS groups regarding the rate of major or minor complications (p > 0.05). Specifically, in patients suffering from PAD (n = 64) the type of arterial anastomosis had no effect on the outcome. Conclusion Overall, no significant differences in outcomes were observed when comparing the types of performed arterial anastomosis. This observation also held true for the subgroup of patients with PAD. Given that an ETS anastomosis did not increase the risk to encounter complications while preserving distal perfusion, we believe that this technique is the method of choice, especially in patients with impaired vascular status.

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Section: Discussionmentioning

confidence: 99%

Comparison of Outcomes of End-to-End versus End-to-Side Anastomoses in Lower Extremity Free Flap Reconstructions

Broer

Moellhoff

Mayer

et al. 2020

J Reconstr Microsurg

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“…When we manage difficult wounds, the blood supply to the wound must first be confirmed. 26 The other challenges are controlling the infection, offloading the wound, and improving nutrition. Although novel or advanced dressings for wounds have been developed, the saline wet-to-dry technique is often used at our hospital due to the high cost of newer techniques, for which our government health insurance does not pay.…”

Section: Discussionmentioning

confidence: 99%

Bidirectional Irrigation System to Treat a Difficult Wound: A Case Series

Chen

Hou

Peng

2020

The International Journal of Lower Extremity Wounds

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Aims To date, there is no distinct principle determining whether to use irrigation under negative-pressure wound therapy (NPWT). We developed a new economical device to manage difficult wounds, employing 1 of 2 techniques depending on the wound condition. Methods This case series study was conducted in 12 patients with difficult wound, from 2017 to 2018. Four patients were treated with Type A bidirectional irrigation system (wound irrigation), while 8 patients were treated with Type B bidirectional irrigation system (wound irrigation combined with NPWT). Results In the Type A device group, inflammatory profiles in case I, case IV, and case VIII were not monitored due to the stability of their wound. The mean recovery period was 3.75 weeks (2-8 weeks), with decreases in 100% healing rate. In the Type B device group, we noted an average of 71% reduction in inflammatory profiles. All patients’ infections were resolved or were healing, and 7 patients recovered satisfactorily. The recovery period ranged from 4 to 17 weeks, with a median value of 7 weeks. Conclusion Bidirectional irrigation system decreases secondary infections and complications, and increases the healing rate in patients with difficult wound.

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“…The importance of foot care and the limitations experienced by patients with CLI are well known. 28) The aim of foot care for patients with CLI is cure and prevention of wound progression before revascularization. To evaluate ulcers and gangrene for continuous treatment, the Wound, Ischemia, and foot Infection (WIfI) classification has been used recently as a comprehensive evaluation system for wounds.…”

Section: Discussionmentioning

confidence: 99%

Outcomes in Patients with Critical Limb Ischemia due to Arteriosclerosis Obliterans Who Did Not Undergo Arterial Reconstruction

et al. 2018

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The prevalence of arteriosclerosis obliterans (ASO) and critical limb ischemia (CLI) is currently increasing, and arterial reconstruction is often attempted to salvage the limb. Some patients cannot undergo attempted revascularization because of contraindications, and they only receive conservative treatment. In this study, we investigate the comorbidities and survival rates of patients with CLI who receive conservative treatment. Thirty-five patients with CLI due to ASO, who had not undergone revascularization surgery (C group), were enrolled. As controls, 136 patients with CLI due to ASO who did undergo revascularization (R group), mainly via bypass surgery, were enrolled. Coronary artery disease, heart failure, and respiratory dysfunction were factors indicating conservative treatment. Limb salvage rates and survival rates were not significantly different between the two groups. Patients who had survived for less than two years after surgery had a higher prevalence of chronic heart failure, cardiovascular disease, and end-stage renal disease compared to patients who had survived for more than two years. The use of statins, dual antiplatelets, aspirin, or warfarin did not influence whether a patient survived for longer than two years. 77% of patients survived for more than two years after receiving only conservative therapies. Surgical revascularization did not improve the prognosis of patients with CLI as compared with the conservative therapy. Clinicians might start with conservative treatment while considering other treatment options for patients with CLI.

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Promoting Limb Salvage through Multi-Disciplinary Care of the Diabetic Patient

Cited by 7 publications

References 66 publications

Comparison of Outcomes of End-to-End versus End-to-Side Anastomoses in Lower Extremity Free Flap Reconstructions

Comparison of Outcomes of End-to-End versus End-to-Side Anastomoses in Lower Extremity Free Flap Reconstructions

Bidirectional Irrigation System to Treat a Difficult Wound: A Case Series

Outcomes in Patients with Critical Limb Ischemia due to Arteriosclerosis Obliterans Who Did Not Undergo Arterial Reconstruction

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