Aggressive Wound Care by a Multidisciplinary Team Improves Wound Healing after Infrainguinal Bypass in Patients with Critical Limb Ischemia
| Autor: | Hiroshi Ishimura, Atsushi Guntani, Eisuke Kawakubo, Ryoichi Kyuragi, Shinsuke Mii, Kiyoshi Tanaka, Shinsuke Yasukawa |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Male
Time Factors medicine.medical_treatment Kaplan-Meier Estimate 030204 cardiovascular system & hematology Wound care 0302 clinical medicine Ischemia Risk Factors 030212 general & internal medicine Aged 80 and over integumentary system Leg Ulcer Nerve Block Skin Transplantation General Medicine Limb Salvage Combined Modality Therapy Treatment Outcome Lower Extremity Skin grafting Female medicine.symptom Cardiology and Cardiovascular Medicine Vascular Surgical Procedures medicine.medical_specialty Critical Illness Revascularization Amputation Surgical Disease-Free Survival 03 medical and health sciences Negative-pressure wound therapy medicine Humans Therapeutic Irrigation Aged Proportional Hazards Models Retrospective Studies Patient Care Team Wound Healing Debridement business.industry Critical limb ischemia Surgery Disinfection Amputation Multivariate Analysis business Wound healing |
| Zdroj: | Annals of Vascular Surgery. 41:196-204 |
| ISSN: | 0890-5096 |
| DOI: | 10.1016/j.avsg.2016.09.024 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|