Objective To evaluate the rates of wound healing and limb preservation following angiosome-targeted infrapopliteal endovascular revascularization in the treatment of diabetic limb ischemia. Methods We performed a retr...Objective To evaluate the rates of wound healing and limb preservation following angiosome-targeted infrapopliteal endovascular revascularization in the treatment of diabetic limb ischemia. Methods We performed a retrospective analysis of data gathered from 102 infrapopliteal angioplasty cases(60 males and 42 females; mean age, 72 ± 11 years) with Fontaine IV ischemia(ankle-brachial index, ABI: 0.16 ± 0.06). Forty-seven angioplasties were performed based on the angiosome concept(direct revascularization, DR), while 55 did not incorporate the angiosome concept(indirect revascularization, IR). The curative effects of angioplasty were assessed by postoperative determinations of ABI performed every 3 months during clinical follow-up visits conducted to assess healing of the ischemic wound. Amputation and death events were recorded throughout the study. Results All 102 patients were successfully revascularized without complications, and during a mean follow-up period of 18 ± 11 months, the mean postoperative ABI improved to 0.84 ± 0.10. The postoperative 6 and 12 month healing rates in the DR group were 85.1% and 93.5%, respectively, while the limb-salvage rates were 100% and 93.5%, respectively. The postoperative 6 and 12 month healing rates in the IR group were 60% and 76.4%, respectively, while the limb-salvage rates were 90.1%, and 85.5%, respectively. Conclusion Angiosome-based Infrapopliteal angioplasty was associated with better wound healing and higher rates of limb salvage in cases of critical diabetic foot ischemia. Revascularization should be provided to patients who have undergone indirect perfusion of the ischemic angiosome, as acceptable rates of limb salvage are obtained.展开更多
Despite a lack of solid evidence in applying the angiosome concept (AC) in current chronic limb threatening ischemia (CLTI) treatment, several encouraging results for improved wound healing and less for limb preservat...Despite a lack of solid evidence in applying the angiosome concept (AC) in current chronic limb threatening ischemia (CLTI) treatment, several encouraging results for improved wound healing and less for limb preservation were reported in various consistency studies. Direct revascularization (DR) following the foot angiosomes distribution (whenever feasible) may afford better clinical results compared to angiosome indifferent, or indirect revascularization (IR), however without clear benefit on survival and for major adverse limb events (MALE). Inside this interrogation,?the notable influence of the remnant collaterals, the foot arches, the wound characteristics, and the type of revascularization (bypass versus endovascular) still remain ardent topics. Current evidence suggests that applying DR in daily vascular practice requires practitioners to be committed to every individual hemodynamic variable in a thorough macro- and micro-vascular evaluation of the ischemic foot. It becomes clearer nowadays that not all CLTI foot ulcers hold same ischemic burden and seemingly need specific DR. In the same setting,?a novel wound targeted revascularization (WTR) design was proposed assembling wider circulatory targets than genuine DR notion, as used by some authors. Beyond specific angiosomal artery reperfusion, WTR associates the available arches, the large- and medium-sized collaterals, and the arterial-arterial communicants, in an intentional “source artery” and “collateral” topographic foot revascularization. However,?up to date, the notion of angiosome wound-guided revascularization (DR and WTR) detains only a reserved level of confirmation. As for DR, the WTR equally needs higher levels of evidence allowed by standardized definition, uniform indications, and pertinent results from multicenter larger prospective analysis, before large application.展开更多
Background:Repair of extensive deep wounds in the forelimb remains challenging for surgeons.The objective of this study was to evaluate the surgical technique and clinical significance of multiple-territory paraumbili...Background:Repair of extensive deep wounds in the forelimb remains challenging for surgeons.The objective of this study was to evaluate the surgical technique and clinical significance of multiple-territory paraumbilical perforator(PUP)flaps in patients with massive soft tissue defects in the upper limbs.Methods:Between January 2017 and September 2021,16 patients(6 women and 10 men)aged 24–54 years(average,41.4 years)who were hospitalized at the First Affiliated Hospital of Soochow University and the North District of the Suzhou Municipal Hospital were investigated.Their injuries included damage to the fingers,dorsal skin of the hands,wrist,or forearm.Their tendons or bones were exposed after debridement.In some patients,multiple-territory PUP flaps that encompassed adjacent angiosomes were transplanted to cover the soft tissue defects.Results:All flaps survived and healed well.After a follow-up of 2–54 months,all patients recovered satisfactorily in terms of characteristic and functional review.Conclusions:The application of PUP flaps,especially those encompassing multiple angiosomes(multiple-territory PUP flaps),can be an optimal reconstruction method for repairing massive soft tissue defects in the forelimb.展开更多
Aim:Crush injuries of the foot are often associated with partial or complete degloving of the heel pad.The purpose of this study is to present an algorithm for the management of various types of heel pad avulsion inju...Aim:Crush injuries of the foot are often associated with partial or complete degloving of the heel pad.The purpose of this study is to present an algorithm for the management of various types of heel pad avulsion injuries,including hyperbaric oxygen(HBO)therapy in the treatment regimen.Methods:We present a prospective study of 27 patients with various types of heel pad avulsion managed in our institution from December 2012 to June 2013.Heel pad avulsion injuries were classified according to the angiosomal pattern.Partial or complete avulsions were classified and treated accordingly.HBO therapy was administered postoperatively.The postoperative period,hospital course,and follow-up were documented in patients with heel pad avulsion injuries.Results:Of 27 patients,20 cases presented with partial avulsion and 7 cases were complete avulsion.Of 20 cases of partial avulsion,one of the flaps was anchored with K-wire.Nineteen cases of partial heel pad avulsion were managed by suturing.Eight patients out of 20 required skin grafting as a secondary procedure at a later date.Out of 7 cases of complete avulsion,one was managed by full-thickness skin grafting,one case by reverse sural artery flap coverage,and four cases were managed by free tissue transfer.No flap revisions were required,and no complications were experienced for the transferred flaps.Conclusion:HBO therapy may be a useful adjunct in the treatment of heel pad avulsion injuries.展开更多
基金supported by Liaoning Provincial Hospital Reform Key Clinical Diagnosis and Treatment Capacity Building Project(Youth Project):Diabetic Foot Multidisciplinary Cooperative Comprehensive Treatment Model Construction Project.(201507-201707)
文摘Objective To evaluate the rates of wound healing and limb preservation following angiosome-targeted infrapopliteal endovascular revascularization in the treatment of diabetic limb ischemia. Methods We performed a retrospective analysis of data gathered from 102 infrapopliteal angioplasty cases(60 males and 42 females; mean age, 72 ± 11 years) with Fontaine IV ischemia(ankle-brachial index, ABI: 0.16 ± 0.06). Forty-seven angioplasties were performed based on the angiosome concept(direct revascularization, DR), while 55 did not incorporate the angiosome concept(indirect revascularization, IR). The curative effects of angioplasty were assessed by postoperative determinations of ABI performed every 3 months during clinical follow-up visits conducted to assess healing of the ischemic wound. Amputation and death events were recorded throughout the study. Results All 102 patients were successfully revascularized without complications, and during a mean follow-up period of 18 ± 11 months, the mean postoperative ABI improved to 0.84 ± 0.10. The postoperative 6 and 12 month healing rates in the DR group were 85.1% and 93.5%, respectively, while the limb-salvage rates were 100% and 93.5%, respectively. The postoperative 6 and 12 month healing rates in the IR group were 60% and 76.4%, respectively, while the limb-salvage rates were 90.1%, and 85.5%, respectively. Conclusion Angiosome-based Infrapopliteal angioplasty was associated with better wound healing and higher rates of limb salvage in cases of critical diabetic foot ischemia. Revascularization should be provided to patients who have undergone indirect perfusion of the ischemic angiosome, as acceptable rates of limb salvage are obtained.
文摘Despite a lack of solid evidence in applying the angiosome concept (AC) in current chronic limb threatening ischemia (CLTI) treatment, several encouraging results for improved wound healing and less for limb preservation were reported in various consistency studies. Direct revascularization (DR) following the foot angiosomes distribution (whenever feasible) may afford better clinical results compared to angiosome indifferent, or indirect revascularization (IR), however without clear benefit on survival and for major adverse limb events (MALE). Inside this interrogation,?the notable influence of the remnant collaterals, the foot arches, the wound characteristics, and the type of revascularization (bypass versus endovascular) still remain ardent topics. Current evidence suggests that applying DR in daily vascular practice requires practitioners to be committed to every individual hemodynamic variable in a thorough macro- and micro-vascular evaluation of the ischemic foot. It becomes clearer nowadays that not all CLTI foot ulcers hold same ischemic burden and seemingly need specific DR. In the same setting,?a novel wound targeted revascularization (WTR) design was proposed assembling wider circulatory targets than genuine DR notion, as used by some authors. Beyond specific angiosomal artery reperfusion, WTR associates the available arches, the large- and medium-sized collaterals, and the arterial-arterial communicants, in an intentional “source artery” and “collateral” topographic foot revascularization. However,?up to date, the notion of angiosome wound-guided revascularization (DR and WTR) detains only a reserved level of confirmation. As for DR, the WTR equally needs higher levels of evidence allowed by standardized definition, uniform indications, and pertinent results from multicenter larger prospective analysis, before large application.
文摘Background:Repair of extensive deep wounds in the forelimb remains challenging for surgeons.The objective of this study was to evaluate the surgical technique and clinical significance of multiple-territory paraumbilical perforator(PUP)flaps in patients with massive soft tissue defects in the upper limbs.Methods:Between January 2017 and September 2021,16 patients(6 women and 10 men)aged 24–54 years(average,41.4 years)who were hospitalized at the First Affiliated Hospital of Soochow University and the North District of the Suzhou Municipal Hospital were investigated.Their injuries included damage to the fingers,dorsal skin of the hands,wrist,or forearm.Their tendons or bones were exposed after debridement.In some patients,multiple-territory PUP flaps that encompassed adjacent angiosomes were transplanted to cover the soft tissue defects.Results:All flaps survived and healed well.After a follow-up of 2–54 months,all patients recovered satisfactorily in terms of characteristic and functional review.Conclusions:The application of PUP flaps,especially those encompassing multiple angiosomes(multiple-territory PUP flaps),can be an optimal reconstruction method for repairing massive soft tissue defects in the forelimb.
文摘Aim:Crush injuries of the foot are often associated with partial or complete degloving of the heel pad.The purpose of this study is to present an algorithm for the management of various types of heel pad avulsion injuries,including hyperbaric oxygen(HBO)therapy in the treatment regimen.Methods:We present a prospective study of 27 patients with various types of heel pad avulsion managed in our institution from December 2012 to June 2013.Heel pad avulsion injuries were classified according to the angiosomal pattern.Partial or complete avulsions were classified and treated accordingly.HBO therapy was administered postoperatively.The postoperative period,hospital course,and follow-up were documented in patients with heel pad avulsion injuries.Results:Of 27 patients,20 cases presented with partial avulsion and 7 cases were complete avulsion.Of 20 cases of partial avulsion,one of the flaps was anchored with K-wire.Nineteen cases of partial heel pad avulsion were managed by suturing.Eight patients out of 20 required skin grafting as a secondary procedure at a later date.Out of 7 cases of complete avulsion,one was managed by full-thickness skin grafting,one case by reverse sural artery flap coverage,and four cases were managed by free tissue transfer.No flap revisions were required,and no complications were experienced for the transferred flaps.Conclusion:HBO therapy may be a useful adjunct in the treatment of heel pad avulsion injuries.
