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Massara M, Pucci G, Stilo G, Alberti A, Surace R, Foti G, Volpe P. The role of the cord blood platelet gel in the management of a diabetic foot with tendon exposure. Regen Med 2021; 16:1051-1056. [PMID: 34558982 DOI: 10.2217/rme-2021-0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Diabetic foot infection is frequent in diabetic patients and is due to neuropathy, trauma or peripheral arterial disease. The presence of an abscess requires urgent drainage and specific antibiotic therapy. Patients with critical limb ischemia need revascularization and, subsequently the intervention of a plastic surgeon is often required in cases of exposure of tendons and ligaments. During the COVID-19 pandemic, a patient was refered to our department with an abscess on the dorsum of the left foot. After urgent drainage with tendon exposure, he started specific antibiotic therapy and underwent tibial vessels angioplasty. After infection healing cord blood platelet gel was applied, accelerating the healing process, with injection of its liquid part into the exposed tendons, thus retaining the vital functions of the tendons.
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Affiliation(s)
- Mafalda Massara
- Unit of Vascular & Endovascular Surgery, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, 89124, Italy
| | - Giulia Pucci
- Calabria Cord Blood Bank, Service of Immunohaematology & Transfusion Medicine, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, 89214, Italy
| | - Giuseppe Stilo
- Unit of Vascular & Endovascular Surgery, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, 89124, Italy
| | - Antonino Alberti
- Unit of Vascular & Endovascular Surgery, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, 89124, Italy
| | - Rosangela Surace
- Calabria Cord Blood Bank, Service of Immunohaematology & Transfusion Medicine, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, 89214, Italy
| | - Giovanni Foti
- Calabria Cord Blood Bank, Service of Immunohaematology & Transfusion Medicine, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, 89214, Italy
| | - Pietro Volpe
- Unit of Vascular & Endovascular Surgery, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, 89124, Italy
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Gulaĭ IS, Snegirev AI, Denisova NP, Dmitriev AB. [Chronic spinal stimulation in treatment of lower limb critical ischaemia syndrome]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2021; 27:128-135. [PMID: 33825739 DOI: 10.33529/angio2020413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Obliterating peripheral artery disease is a commonly occurring pathological condition, most often resulting from an atherosclerotic lesion of vessels with progressive narrowing of their lumens. The consequences of decompensation of chronic arterial insufficiency such as ischaemic pain, claudication, and trophic impairments are in some instances difficult to treat, despite using multicomponent medicamentous therapy and/or performing revascularizing interventions. This article describes a clinical case report regarding the use of spinal stimulation in a patient presenting with stage IV chronic lower limb ischaemia according to the Fontaine classification. This is accompanied and followed by depicting the dynamics of the laboratory, instrumental, and clinical parameters over a two-year follow-up period. In order to explain the choice of the intervention and the causes of the described picture, discussed are the existing theories of the mechanisms of action of spinal stimulation. To this is added a literature review of using this method in treatment of lower limb critical ischaemia when performing reconstructive angiosurgical treatment is unavailable. Mention is also made of the incidence and types of probable complications, as well as possibilities and limitations of the method.
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Affiliation(s)
- Iu S Gulaĭ
- Division of Functional Neurosurgery, Federal Centre of Neurosurgery of the RF Ministry of Public Health, Novosibirsk, Russia
| | | | - N P Denisova
- Division of Functional Neurosurgery, Federal Centre of Neurosurgery of the RF Ministry of Public Health, Novosibirsk, Russia
| | - A B Dmitriev
- Division of Functional Neurosurgery, Federal Centre of Neurosurgery of the RF Ministry of Public Health, Novosibirsk, Russia
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Volpe P, Pucci G, Stilo G, Alberti A, Foti G, Surace R, Massara M. Use of cord blood platelet gel to enhance healing of deep surgical site dehiscences after peripheral bypass. Regen Med 2020; 15:1951-1956. [PMID: 33118483 DOI: 10.2217/rme-2020-0034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Surgical site dehiscence after lower limb revascularization through bypass represents a serious postoperative complication, especially in diabetic and obese patients, with subsequent risk of early graft failure, infection, sepsis, hemorrhage, major amputation and sometimes death. To prevent bypass exposure and subsequent complications, physicians recur to reoperation, antibiotic therapy, advanced dressing and vacuum-assisted closure therapy. To improve the process of wound healing, cord blood platelet gel can be used to fill deep and large wounds. Growth factors released from platelets in the cord blood platelet gel stimulate the process of healing and allow patients to be followed up in Outpatient Surgery, thus reducing hospital stay and costs, while providing excellent results.
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Affiliation(s)
- Pietro Volpe
- Unit of Vascular & Endovascular Surgery, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", 89124 Reggio Calabria, Italy
| | - Giulia Pucci
- Calabria Cord Blood Bank, Service of Immunohaematology & Transfusion Medicine, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", 89124 Reggio Calabria, Italy
| | - Giuseppe Stilo
- Unit of Vascular & Endovascular Surgery, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", 89124 Reggio Calabria, Italy
| | - Antonino Alberti
- Unit of Vascular & Endovascular Surgery, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", 89124 Reggio Calabria, Italy
| | - Giovanni Foti
- Calabria Cord Blood Bank, Service of Immunohaematology & Transfusion Medicine, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", 89124 Reggio Calabria, Italy
| | - Rosangela Surace
- Calabria Cord Blood Bank, Service of Immunohaematology & Transfusion Medicine, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", 89124 Reggio Calabria, Italy
| | - Mafalda Massara
- Unit of Vascular & Endovascular Surgery, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", 89124 Reggio Calabria, Italy
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Grande R, Brachini G, Sterpetti AV, Borrelli V, Serra R, Pugliese F, D'Ermo G, Tartaglia E, Rubino P, Mingoli A, Sapienza P. Local release of metalloproteinases and their inhibitors after a successful revascularisation procedure. Int Wound J 2019; 17:149-157. [PMID: 31657109 DOI: 10.1111/iwj.13249] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 09/20/2019] [Accepted: 09/22/2019] [Indexed: 12/19/2022] Open
Abstract
An altered balance between metalloproteinases (MMPs) and their inhibitor tissue inhibitor of metalloproteinases (TIMPs) may influence the healing process of a minor amputation following a successful vein graft. To speed up this process, negative pressure wound therapy (NPWT) and advanced moist wound dressing have been proposed. We determined the systemic and local release of MMP-1, -2, -3, -9, TIMP-1, and TIMP-2 by enzyme linked immunosorbent assay (ELISA) technique and their influences in the healing process in 26 patients who underwent minor amputation after a successful revascularisation procedure. Twelve patients (group 1) were medicated with NPWT and 14 (group 2) with advanced moist wound dressing. Plasma samples were collected on the morning of surgery and thereafter at 1, 3, and 5 months; exudates were collected 3 days after surgery when amputation was performed and thereafter at 1, 3, and 5 months. Fifteen age-matched healthy male volunteers served as controls. All wounds healed in 5 ± 0.5 months. Follow-up plasma and local release of MMP-1, -2, -3, and -9 were overall significantly lower when compared with the preoperative levels, while those of TIMP-1 and -2 were significantly higher with no differences among the groups. Despite no differences in the healing process being observed among the two types of medications, at 1 month the local release of MMP-2 and -9 was significantly lower (P = .013 and .047, respectively) and that of TIMP-1 was significantly higher (P = .042) in group 1 as compared to group 2. A correct and aggressive local approach to the wound is able to promote the healing of the lesion stimulating the extracellular matrix turnover with local MMP/TIMP adequate balance and favouring the creation of granulation tissue. However, a successful restoration of an adequate blood flow remains the key point of a durable and rapid wound healing.
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Affiliation(s)
- Raffaele Grande
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Gioia Brachini
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Antonio V Sterpetti
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Valeria Borrelli
- Department of Diagnostic Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Raffaele Serra
- Department of Medical and Surgical Sciences, University "Magna Graecia", Catanzaro, Italy
| | | | - Giuseppe D'Ermo
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Elvira Tartaglia
- Department of General and Vascular Surgery, Centre Hospitalier Sud Francilienne, Paris, France
| | - Paolo Rubino
- Department of Vascular Surgery, Civil Hospital, Catanzaro, Italy
| | - Andrea Mingoli
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Paolo Sapienza
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
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Klinkova AS, Kamenskaya OV, Ashurkov AV, Murtazin VI, Lomivorotov VV, Karaskov AM. [Factors of adverse prediction of application of spinal cord stimulation with chronic pain syndrome in patients with critical lower limb ischemia]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:23-30. [PMID: 31626215 DOI: 10.17116/jnevro201911909123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To study the clinical dynamics in the long-term period after spinal cord stimulation (SCS) in patients with chronic pain syndrome and critical lower limb ischemia (CLLI) and to identify factors affecting the prognosis of SCS. MATERIAL AND METHODS The clinical dynamics was analyzed in 48 patients with pain syndrome and CLLI 1 year after SCS. Microcirculatory blood flow (MBF) was studied in the affected foot by laser-doppler flowmetry (LDF) (Perfusion Units (PU)) and transcutaneous oximetry (TcpO2, mmHg.) using an occlusive test before and after SCS. The factors associated with negative clinical dynamics 1 year after SCS were determined. RESULTS In 74% of cases, SCS contributes to the improvement of clinical status (reduction of pain syndrome, increase in motor activity, healing of ulcers). After SCS, according to LDF and TcpO2, the authors observed an increase in MBF and tissue metabolism - from 1.3 (0.7-2.8) to 6.2 (3.8-8.7) PU and from 14.5 (7.5-22.1) to 41.1 (26.4-57.6) mmHg, respectively with normalization of the MBF reserve during the occlusion test. Negative clinical dynamics after SCS is associated with high comorbidity, TcO2 <10 mmHg and the duration of pain. CONCLUSION SCS contributes to the improvement of the clinical status of patients with chronic pain syndrome and CLLI. The negative dynamics is associated with high comorbidity, TcrO2 <10 mmHg and the duration of pain.
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Affiliation(s)
- A S Klinkova
- Meshalkin National medical research center of the Ministry of Health of the Russian Federation
| | - O V Kamenskaya
- Meshalkin National medical research center of the Ministry of Health of the Russian Federation
| | - A V Ashurkov
- Meshalkin National medical research center of the Ministry of Health of the Russian Federation
| | - V I Murtazin
- Meshalkin National medical research center of the Ministry of Health of the Russian Federation
| | - V V Lomivorotov
- Meshalkin National medical research center of the Ministry of Health of the Russian Federation
| | - A M Karaskov
- Meshalkin National medical research center of the Ministry of Health of the Russian Federation
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Abstract
Spinal cord stimulation (SCS) has been well established as a safe and effective treatment of pain derived from a wide variety of etiologies. Careful patient selection including a rigorous trial period and psychological evaluation are essential. When patients proceed to permanent implantation, various considerations should be made, such as the type of lead, type of anesthesia, and waveform patterns for SCS. This article discusses the common indications for SCS, patient selection criteria, and pertinent outcomes from randomized clinical trials related to common indications treated with SCS. Technical considerations, such as type of implant, anesthesia, and programming, are also discussed.
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Affiliation(s)
- Andrew K Rock
- Department of Neurosurgery, Albany Medical College, 43 New Scotland Avenue, Albany, NY 12208, USA
| | - Huy Truong
- Department of Neurosurgery, Albany Medical College, 43 New Scotland Avenue, Albany, NY 12208, USA
| | - Yunseo Linda Park
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 43 New Scotland Avenue, Albany, NY 12208, USA
| | - Julie G Pilitsis
- Department of Neurosurgery, Albany Medical College, 43 New Scotland Avenue, Albany, NY 12208, USA; Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 43 New Scotland Avenue, Albany, NY 12208, USA.
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Lawson McLean A, Kalff R, Reichart R. Spinal Cord Stimulation for Acute Pain Following Surgery for Cervical Myelopathy: A Novel Treatment Strategy. Pain Pract 2018; 19:310-315. [PMID: 30369016 DOI: 10.1111/papr.12742] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/28/2018] [Accepted: 10/19/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Chronic pain syndromes caused by degenerative and postinfectious changes in the cervical spine continue to pose significant management challenges to neurosurgeons and pain practitioners. The identification of an individualized treatment plan, astute surgical technique, comprehensive and multimodal analgesia, and adequate rehabilitation processes do not necessarily result in diminished pain. CASE SUMMARY We present the case of a patient with chronic pain treated surgically for degenerative cervical myelopathy secondary to cervical spinal stenosis. Following this surgery, the patient experienced an intractable postoperative pain syndrome that had anatomical borders, and an intensity and character that were different from the background chronic pain from which he suffered. We successfully implanted a cervical spinal cord stimulation (SCS) lead in the period following his stenosis surgery, which had good therapeutic effect on the postoperative-onset pain. To the best of our knowledge, this is the first description of SCS having a strong positive effect on an acute exacerbation of neuropathic pain. At follow-up 12 months later, assessment of the patient's pain diary revealed a modal pain intensity of 3/10 on the numeric rating scale over the preceding 3 months. The Brief Pain Inventory (Short Form) scores at this time were 10/40 in the pain severity domain and 18/70 in the interference with function domain, demonstrating the long-term effectiveness of this SCS strategy. CONCLUSION While SCS has hitherto been untested as a therapy for acute-onset pain, this report demonstrates its utility as a salvage treatment in select cases of uncontrollable postoperative pain.
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Affiliation(s)
- Aaron Lawson McLean
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, Jena University Hospital, Jena, Germany
| | - Rolf Kalff
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, Jena University Hospital, Jena, Germany
| | - Rupert Reichart
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, Jena University Hospital, Jena, Germany
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Effectiveness of Transcutaneous Electrical Nerve Stimulation Energy in Older Adults: A Pilot Clinical Trial. Adv Skin Wound Care 2018; 31:462-469. [PMID: 30234576 DOI: 10.1097/01.asw.0000544614.18501.b4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of a transcutaneous electric nerve stimulation (TENS) device typically used for pain suppression (analgesia) during pressure injury (PI) healing, peripheral vascularization, and secondary pain in older adults with chronic PIs and cognitive impairment. DESIGN AND SETTING This pilot clinical trial followed patients from 6 nursing homes. PATIENTS AND INTERVENTION Twenty-two patients with PIs in the distal third of their lower limbs (7 men, 15 women) were included in this study. The control group completed standard wound care (SWC), whereas the experimental group received SWC and TENS. A total of 20 sessions were conducted for each group over 2 months, 3 times a week. MAIN OUTCOME MEASURE PI area, PI healing rate, blood flow, skin temperature, oxygen saturation, and level of pain at baseline and posttreatment. MAIN RESULTS Significant improvements were achieved in PI area (mean difference, 0.92; 95% confidence interval [CI], 0.15-1.67; P =.024), healing rate (3; 95% CI, 1-4.99; P =.009), skin temperature (1.82; 95% CI, 0.35-3.28; P =.021), and pain (1.44; 95% CI, 0.49-2.39; P =.008) in the experimental group, whereas none of the variables revealed a significant change in the control group. CONCLUSIONS The effect of local and spinal TENS combined with the SWC for PI produced a significant improvement in size, healing, skin temperature, and pain levels.
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Spinal cord stimulation may improve not only intractable pain but also necrotic wounds. Turk J Phys Med Rehabil 2018; 64:288-290. [PMID: 31453524 DOI: 10.5606/tftrd.2018.2112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 10/26/2017] [Indexed: 11/21/2022] Open
Abstract
Spinal cord stimulation (SCS), an implantable neuromodulation modality, is one of the most exciting developments in chronic pain syndromes. In addition, SCS may improve intractable pain and may help ischemic wound healing. Herein, we report a 59-year-old female patient with persistent neuropathic pain and peripheral arterial disease in the lower limb which was treated successfully with SCS.
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Liu JT, Su CH, Chen SY, Liew SJ, Chang CS. Spinal Cord Stimulation Improves the Microvascular Perfusion Insufficiency Caused by Critical Limb Ischemia. Neuromodulation 2018; 21:489-494. [PMID: 29377343 DOI: 10.1111/ner.12753] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 11/22/2017] [Accepted: 12/06/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVE This retrospective case-controlled study intended to identify the benefits and efficacy of spinal cord stimulation (SCS) as a therapeutic strategy for patients with perfusion problems caused by critical limb ischemia (CLI). The outcomes of patients who received SCS were compared with those of patients who did not receive SCS. METHODS This study recruited 78 patients who were diagnosed with perfusion problems over the period of 2003-2011. Lower-limb Thallium-201 (201 Tl) scintigraphy revealed that the patients exhibited a perfusion difference of <0.95. Thirty-seven of the recruited patients received SCS treatment and 41 did not receive SCS treatment. All patients received the same medication: 100 mg aspirin once a day and 500 mg paracetamol thrice a day. The outcomes of walking distance, walking time, and sleeping quality were measured and recorded. Pain intensities were evaluated using the visual analog scale (VAS) scoring system. RESULTS Prior to SCS implantation, patients in the SCS treatment group had worse walking distance (64.86 ± 40.80 vs. 613.70 ± 535.00, p < 0.001), walking time (2.65 ± 1.64 vs. 13.90 ± 11.91, p < 0.001), and sleep quality (1.70 ± 0.78 vs. 3.32 ± 1.17, p < 0.001) than patients in the non-SCS treatment group. At the one-year follow-up, however, patients in the SCS treatment group had significantly better walking distance (1595.00 ± 483.60, p < 0.001), walking time (48.92 ± 14.10, p < 0.001), and sleep quality (4.65 ± 0.92, p < 0.001) than patients in the non-SCS treatment group. Moreover, the VAS score of patients in the SCS treatment group improved one week (8.63 ± 0.54 vs. 4.48 ± 0.59, p < 0.001) and one year after SCS implantation (2.35 ± 0.62, p < 0.001). By contrast, at the one-year follow-up, the walking distance (277.60 ± 374.80, p = 0.002), walking time (9.44 ± 10.73, p = 0.078), sleep quality (2.20 ± 1.10, p < 0.001), and VAS score (7.98 ± 0.43, p = 0.020) of patients in the non-SCS treatment group worsened. Furthermore, lower-limb 201 Tl scintigraphy revealed that microcirculation intensity increased in the lower extremities of patients in the SCS treatment group after SCS implantation relative to that before SCS implantation. Most importantly, 10 of the 41 patients in the non-SCS treatment group required the use of wheelchairs, whereas none of the patients in the SCS treatment group required the use of wheelchairs. CONCLUSION Treatment of CLI patient with SCS improved patient's walking ability, pain severity, and sleep quality. SCS should be considered as an effective treatment toward limb salvage in CLI.
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Affiliation(s)
- Jung-Tung Liu
- Department of Neurosurgery, School of Medicine, Chung-Shan Medical University Hospital, Chung-Shan Medical University, Taichung, Taiwan
| | - Chen-Hsing Su
- Department of Neurosurgery, School of Medicine, Chung-Shan Medical University Hospital, Chung-Shan Medical University, Taichung, Taiwan
| | - Se-Yi Chen
- Department of Neurosurgery, School of Medicine, Chung-Shan Medical University Hospital, Chung-Shan Medical University, Taichung, Taiwan
| | - Sang-Jek Liew
- Department of Neurosurgery, School of Medicine, Chung-Shan Medical University Hospital, Chung-Shan Medical University, Taichung, Taiwan
| | - Cheng-Siu Chang
- Department of Neurosurgery, School of Medicine, Chung-Shan Medical University Hospital, Chung-Shan Medical University, Taichung, Taiwan
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Volpe P, Marcuccio D, Stilo G, Alberti A, Foti G, Volpe A, Princi D, Surace R, Pucci G, Massara M. Efficacy of cord blood platelet gel application for enhancing diabetic foot ulcer healing after lower limb revascularization. Semin Vasc Surg 2017; 30:106-112. [PMID: 29793677 DOI: 10.1053/j.semvascsurg.2017.12.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The efficacy of umbilical cord blood platelet gel (CBPG) application on healing foot ulcers was analyzed in 10 diabetic patients treated for critical lower limb ischemia by surgical or endovascular arterial revascularization. During a 9-month period, 20 diabetic patients affected by critical lower limb ischemia with tissue loss were enrolled in this nonblinded, consecutive series, randomized clinical trial. After clinical evaluation, patients underwent endovascular or surgical revascularization of the affected limb, followed by minor amputations or surgical debridement of ischemic lesions. Patients were then randomly divided into two groups: 10 patients in Group A treated with standard wound care and 10 patients in Group B treated with topic application of CBPG. The CBPG protocol consisted of platelet gel application twice a week for 4 weeks and then once a week for an additional 4 weeks. Healing was assessed by direct ulcer dimension tracing onto clear plastic sheet and subsequent computerized planimetry. The mean pretreatment and post-treatment ulcer areas at 30 days for Group A were 15.1 cm2 and 8.1 cm2, respectively, and for Group B were 15.7 cm2 and 3.25 cm2, respectively; resulting in a mean ulcer area reduction of 46% for Group A and 79% for Group B patients (P < .01). These observations suggest CBPG application can promote more rapid wound healing than standard care, and indicate the need for a randomized, multicenter trial to confirm clinical efficacy.
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Affiliation(s)
- Pietro Volpe
- Unit of Vascular Surgery, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | - Daniela Marcuccio
- Calabria Cord Blood Bank, Service of Immunohaematology and Transfusion Medicine, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | - Giuseppe Stilo
- Unit of Vascular Surgery, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | - Antonino Alberti
- Unit of Vascular Surgery, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | - Giovanni Foti
- Calabria Cord Blood Bank, Service of Immunohaematology and Transfusion Medicine, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | | | - Domenica Princi
- Calabria Cord Blood Bank, Service of Immunohaematology and Transfusion Medicine, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | - Rosangela Surace
- Calabria Cord Blood Bank, Service of Immunohaematology and Transfusion Medicine, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | - Giulia Pucci
- Calabria Cord Blood Bank, Service of Immunohaematology and Transfusion Medicine, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | - Mafalda Massara
- Unit of Vascular and Endovascular Surgery, SS Annunziata Hospital, Via Leonida 49, Taranto, Italy.
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Freisinger E, Malyar NM, Reinecke H, Lawall H. Impact of diabetes on outcome in critical limb ischemia with tissue loss: a large-scaled routine data analysis. Cardiovasc Diabetol 2017; 16:41. [PMID: 28376797 PMCID: PMC5379505 DOI: 10.1186/s12933-017-0524-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 03/25/2017] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Patients with diabetes concomitant to critical limb ischemia (CLI) represent a sub-group at particular risk. Objective of this analysis is to evaluate the actual impact of diabetes on treatment, outcome, and costs in a real-world scenario in Germany. METHODS We obtained routine-data on 15,332 patients with CLI with tissue loss from the largest German health insurance, BARMER GEK from 2009 to 2011, including a follow-up until 2013. Patient data were analyzed regarding co-diagnosis with diabetes with respect to risk profiles, treatment strategy, in-hospital and long-term outcome including costs. RESULTS Diabetic patients received less overall revascularizations in Rutherford grades 5 and 6 (Rutherford grade 5: 45.0 vs. 55.5%; Rutherford grade 6: 46.5 vs. 51.8; p < 0.001) and less vascular surgery (Rutherford grade 5: 13.4 vs. 23.4; Rutherford grade 6: 19.7 vs. 29.6; p < 0.001), however more often endovascular revascularization in Rutherford grade 6 (31.0 vs. 28.1; p = 0.004) compared to non-diabetic patients. Diabetes was associated with a higher observed ratio of infections (35.3 vs. 23.5% Rutherford grade 5; 44.3 vs. 27.4% Rutherford grade 6; p < 0.001) and in-hospital amputations (13.0 vs. 7.3% Rutherford grade 5; 47.5 vs. 36.7% Ruth6; p < 0.001). Diabetes further increased the risk for amputation during follow-up [Rutherford grade 5: HR 1.51 (1.38-1.67); Rutherford grade 6: HR 1.33 (1.25-1.41); p < 0.001], but not for death. CONCLUSIONS Diabetes increases markedly the risk of amputation attended by higher costs in CLI patients with tissue loss (OR 1.67 at Rutherford 5, OR 1.53 at Rutherford 6; p < 0.001), but is associated with lower revascularizations. However, in Rutherford grades 5 and 6, concomitant diabetes does not further worsen the overall poor survival.
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Affiliation(s)
- Eva Freisinger
- Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Albert Schweitzer Campus 1, A1, 48149, Muenster, Germany.
| | - Nasser M Malyar
- Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Albert Schweitzer Campus 1, A1, 48149, Muenster, Germany
| | - Holger Reinecke
- Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Albert Schweitzer Campus 1, A1, 48149, Muenster, Germany
| | - Holger Lawall
- Praxis für Herzkreislauferkrankungen und Akademie für Gefaeßkrankheiten, Ettlingen, Germany
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13
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De Caridi G, Massara M, Spinelli F, David A, Gangemi S, Fugetto F, Grande R, Butrico L, Stefanelli R, Colosimo M, de Franciscis S, Serra R. Matrix metalloproteinases and risk stratification in patients undergoing surgical revascularisation for critical limb ischaemia. Int Wound J 2015; 13:493-9. [PMID: 26012891 DOI: 10.1111/iwj.12464] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 04/20/2015] [Accepted: 04/27/2015] [Indexed: 12/18/2022] Open
Abstract
Critical limb ischaemia (CLI) is the most advanced form of peripheral artery disease (PAD) and it is often associated with foot gangrene, which may lead to major amputation of lower limbs, and also with a higher risk of death due to fatal cardiovascular events. Matrix metalloproteinases (MMPs) seem to be involved in atherosclerosis, PAD and CLI. Aim of this study was to evaluate variations in MMP serum levels in patients affected by CLI, before and after lower limb surgical revascularisation through prosthetic or venous bypass. A total of 29 patients (7 females and 22 males, mean age 73·4 years, range 65-83 years) suffering from CLI and submitted to lower extremity bypass (LEB) in our Institution were recruited. Seven patients (group I) underwent LEB using synthetic polytetrafluoroethylene (PTFE) graft material and 22 patients (group II) underwent LEB using autogenous veins. Moreover, 30 healthy age-sex-matched subjects were also enrolled as controls (group III). We documented significantly higher serum MMPs levels (P < 0·01) in patients with CLI (groups I and II) with respect to control group (group III). Finally, five patients with CLI (17·2%) showed poor outcomes (major amputations or death), and enzyme-linked immunosorbent assay (ELISA) test showed very high levels of MMP-1 and MMP-8. MMP serum levels seem to be able to predict the clinical outcomes of patients with CLI.
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Affiliation(s)
- Giovanni De Caridi
- Department of Dentistry and Medical and Surgical Experimental Sciences, University of Messina, Messina, Italy
| | - Mafalda Massara
- Department of Dentistry and Medical and Surgical Experimental Sciences, University of Messina, Messina, Italy
| | - Francesco Spinelli
- Department of Dentistry and Medical and Surgical Experimental Sciences, University of Messina, Messina, Italy
| | - Antonio David
- Department of Neurosciences, University of Messina, Messina, Italy
| | - Sebastiano Gangemi
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesco Fugetto
- School of Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Raffaele Grande
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Lucia Butrico
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Roberta Stefanelli
- Department of Health Sciences, University of Catanzaro, Catanzaro, Italy
| | - Manuela Colosimo
- Department of Service, Microbiology Unit, Central Lab, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Stefano de Franciscis
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy.,Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Raffaele Serra
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy.,Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, University Magna Graecia of Catanzaro, Catanzaro, Italy
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14
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Spinelli F, Pipitò N, Martelli E, Benedetto F, De Caridi G, Spinelli D, Stilo F. Endo first is not appropriate in some patients with critical limb ischemia because "bridges are burned". Ann Vasc Surg 2014; 29:272-7. [PMID: 25433285 DOI: 10.1016/j.avsg.2014.09.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 09/22/2014] [Accepted: 09/23/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND The aims of this study were to determine the effect of failed prior endovascular treatment (EV) on early and midterm outcomes of subsequent lower extremity open surgical (OS) bypass. METHODS Patients undergoing infrainguinal bypass for critical limb ischemia (CLI) from January 2008 to December 2011 were retrospectively reviewed. The results after first-line bypass and bypass after failure of EV treatment were compared. A total of 213 patients (65.25% men; average age, 73.30 years) underwent bypass. OS patients were then divided into 2 groups: group 1 consisted of 138 patients who underwent primary OS for CLI without prior EV (control group) and group 2 consisted of 75 patients who had OS after a failed attempt at elective EV for peripheral vascular disease. Of the 213 bypass performed, 34% had a prior infrainguinal failed EV. The primary study end points were early and 1-year major amputations and graft occlusion. The secondary outcomes included early and 1-year mortality and the level of distal revascularization. RESULTS Secondary patency and limb salvage rates were significantly better in group 1 up to 1 year (99% vs. 86%; P < 0.001 at 1 month and 95% vs. 76%, P < 0.05 at 12 months, respectively). CONCLUSIONS Previous failed EV should be predictive of poor outcome in patients undergoing distal OS for CLI.
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Affiliation(s)
- Francesco Spinelli
- Division of Vascular Surgery, University of Campus Bio-Medico, Rome, Italy.
| | - Narayana Pipitò
- Division of Vascular Surgery, Department of Cardiovascular and Thoracic Sciences, University of Messina, Messina, Italy
| | - Eugenio Martelli
- Division of Vascular Surgery, University of Sassari, Sassari, Italy
| | - Filippo Benedetto
- Division of Vascular Surgery, Department of Cardiovascular and Thoracic Sciences, University of Messina, Messina, Italy
| | - Giovanni De Caridi
- Division of Vascular Surgery, Department of Cardiovascular and Thoracic Sciences, University of Messina, Messina, Italy
| | - Domenico Spinelli
- Division of Vascular Surgery, Department of Cardiovascular and Thoracic Sciences, University of Messina, Messina, Italy
| | - Francesco Stilo
- Division of Vascular Surgery, University of Campus Bio-Medico, Rome, Italy
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15
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De Caridi G, Massara M, Greco M, Pipitò N, Spinelli F, Grande R, Butrico L, de Franciscis S, Serra R. VAC therapy to promote wound healing after surgical revascularisation for critical lower limb ischaemia. Int Wound J 2014; 13:336-42. [PMID: 24872149 DOI: 10.1111/iwj.12301] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 04/21/2014] [Indexed: 01/04/2023] Open
Abstract
Vacuum-assisted closure (VAC) therapy is a new emerging non-invasive system in wound care, which speeds up wound healing by causing vacuum, improving tissue perfusion and suctioning the exudates, and facilitating the removal of bacteria from the wound. The application of sub-atmospheric pressure on the lesions seems to alter the cytoskeleton of the cells on the wound bed, triggering a cascade of intracellular signals that increase the rate of cell division and subsequent formation of granulation tissue. The aim of this study is to analyse the results of VAC therapy used as an adjuvant therapy for the treatment of foot wounds in patients affected by critical limb ischaemia (CLI) (Rutherford 6 class) after distal surgical revascularisation, to promote and accelerate the healing of ulcers. Twenty-nine patients (20 males, 9 females; mean age 68·4) affected by CLI of Rutherford 6 class, after surgical revascularisation of the lower limb, underwent VAC therapy in order to speed up wound healing. Complete wound healing was achieved in 19 patients (65·51%), in an average period of 45·4 ± 25·6 days. VAC therapy is a valid aid, after surgical revascularisation, to achieve rapid healing of foot lesions in patients with CLI.
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Affiliation(s)
- Giovanni De Caridi
- Cardiovascular and Thoracic Department, 'Policlinico G. Martino' Hospital, University of Messina, Messina, Italy
| | - Mafalda Massara
- Cardiovascular and Thoracic Department, 'Policlinico G. Martino' Hospital, University of Messina, Messina, Italy
| | - Michele Greco
- Cardiovascular and Thoracic Department, 'Policlinico G. Martino' Hospital, University of Messina, Messina, Italy
| | - Narayana Pipitò
- Cardiovascular and Thoracic Department, 'Policlinico G. Martino' Hospital, University of Messina, Messina, Italy
| | - Francesco Spinelli
- Cardiovascular and Thoracic Department, 'Policlinico G. Martino' Hospital, University of Messina, Messina, Italy
| | - Raffaele Grande
- Department of Surgical and Medical Science, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Lucia Butrico
- Department of Surgical and Medical Science, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Stefano de Franciscis
- Department of Surgical and Medical Science, University Magna Graecia of Catanzaro, Catanzaro, Italy.,Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Raffaele Serra
- Department of Surgical and Medical Science, University Magna Graecia of Catanzaro, Catanzaro, Italy.,Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, University Magna Graecia of Catanzaro, Catanzaro, Italy
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