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Lichte P, Bläsius FM, Ganse B, Gueorguiev B, Pastor T, Nebelung S, Migliorini F, Klos K, Modabber A, Scaglioni MF, Schopper C, Hildebrand F, Knobe M. Intraoperative pneumatic tourniquet application reduces soft-tissue microcirculation, but without affecting wound healing in calcaneal fractures. Eur J Med Res 2024; 29:462. [PMID: 39289760 PMCID: PMC11406720 DOI: 10.1186/s40001-024-01996-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 07/22/2024] [Indexed: 09/19/2024] Open
Abstract
BACKGROUND Wound healing complications are a major challenge following the extended lateral approach in calcaneal fractures. Soft-tissue microcirculation plays an important role via the delivery of oxygen, nutrients, and the regulation of a local milieu. The aim of this clinical study was to examine the effect of intraoperative pneumatic tourniquet application on skin and subcutaneous microcirculation, and its impact on wound healing progression. METHODS Patients with calcaneal fractures were randomly assigned to two groups defined by a surgery conducted either with use or without use of a tourniquet. Blood flow (BF [AU]), tissue oxygen saturation (SO2[%]) and the relative amount of haemoglobin (rHb[AU]) were intraoperatively measured at two depths (2 and 8 mm) non-invasively by spectrophotometry (Micro-Lightguide O2C®, LEA Medizintechnik, Giessen, Germany). Time points were before and after inflation of the pneumatic tourniquet and also at the end of surgery before deflation. A linear mixed model (LMM) was fitted for statistical analysis. RESULTS Thirty-four patients (3 women and 31 men) with 37 calcaneal fractures were included. In 22 of them, the surgery was conducted with a tourniquet and in the other 15 without its use. A significant decrease of microcirculation, characterized by decreases in blood flow (p = 0.011) and tissue oxygenation (p = 0.023) was measured in 8 mm depth after inflating the tourniquet. However, these changes did not influence the time of postoperative wound healing. CONCLUSION The use of a pneumatic tourniquet reduces deep microcirculation without affecting postoperative wound healing. Trial registration The study was registered in www. CLINICALTRIALS gov (NCT01264146).
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Affiliation(s)
- Philipp Lichte
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany.
| | - Felix M Bläsius
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Bergita Ganse
- Werner Siemens Foundation Endowed Chair of Innovative Implant Development, Saarland University, Homburg, Germany
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Homburg, Germany
| | | | - Torsten Pastor
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne, 6000, Lucerne, Switzerland
| | - Sven Nebelung
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, 52074, Aachen, Germany
| | - Filippo Migliorini
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Kajetan Klos
- Gelenkzentrum Rhein-Main, Hochheim, Germany
- Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, 07747, Jena, Germany
| | - Ali Modabber
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Aachen, Germany
| | - Mario F Scaglioni
- Department of Hand- and Plastic Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Clemens Schopper
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Linz, Austria
| | - Frank Hildebrand
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Matthias Knobe
- Medical Faculty, University of Zurich, 8091, Zurich, Switzerland.
- Medical Faculty, RWTH Aachen University Hospital, 52074, Aachen, Germany.
- Department of Orthopaedic Trauma, Westmuensterland Hospital, 48683, Ahaus, Germany.
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Bläsius FM, Link BC, Beeres FJP, Iselin LD, Leu BM, Gueorguiev B, Klos K, Ganse B, Nebelung S, Modabber A, Eschbach D, Weber CD, Horst K, Knobe M. Impact of surgical procedures on soft tissue microcirculation in calcaneal fractures: A prospective longitudinal cohort study. Injury 2019; 50:2332-2338. [PMID: 31630780 DOI: 10.1016/j.injury.2019.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 09/10/2019] [Accepted: 10/02/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Wound healing complications are a major concern after open reduction and internal fixation (ORIF) in patients with calcaneal fractures. Microcirculation is known to play a key role in bone and soft tissue healing. The present study aimed to characterize and contrast the dynamics of changes in microcirculation comparing two different surgical procedures: A) ORIF and B) a minimally invasive approach (MIA). METHODS Blood flow (BF[AU]), oxygen saturation (sO2[%]) and relative amount of haemoglobin (rHb[AU]) were measured at two depths (2 mm and 8 mm) non-invasively by spectrophotometry (Micro-Lightguide O2C®, LEA Medizintechnik, Giessen, Germany) before surgery and every 24 h after surgery for a duration of six days. A linear mixed model (LMM) was used to analyse longitudinal data and repeated measurements. RESULTS Nineteen patients (44 years, range 21.9-71.0 years) were enrolled in the study. Surgical treatment consisted of ORIF (n = =15) and MIA (n = =9). The postoperative BF and sO2 at the 2 mm and 8 mm depths were higher in the ORIF group (BF: p < 0.001, p = =0.003; sO2: p = =0.001, p = =0.011). The BF at the 2 mm and 8 mm depths increased after surgery (2 mm: p = =0.003, 8 mm: p = =0.001) in both groups. This increase did not correlate with the surgical technique. sO2 and rHb values at the 8 mm depth decreased after surgery (sO2: p = =0.008, rHb: p < 0.001) in both groups, whereas sO2 at the 2 mm depth increased after surgery (p = =0.003). Furthermore, the surgical technique correlated with the postsurgical course of sO2 values at the 2 mm depth (p = =0.042). CONCLUSIONS The spectrophotometry results were in line with the generally accepted phases of soft tissue wound healing. Postsurgical changes in microcirculation are predominantly independent of surgical techniques and may be primarily determined by wound and fracture healing. Future studies should focus on the potential of spectrophotometry to monitor wound healing after surgery. Moreover, studies with longer observation periods are needed in order to examine the changes in microcirculation during all wound-healing phases.
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Affiliation(s)
- Felix M Bläsius
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, D-52074 Aachen, Germany.
| | - Björn-Christian Link
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Switzerland.
| | - Frank J P Beeres
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Switzerland.
| | - Lukas D Iselin
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Switzerland.
| | - Benjamin Moritz Leu
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, D-52074 Aachen, Germany.
| | | | - Kajetan Klos
- Department of Foot and Ankle Surgery, Catholic Hospital Mainz, Germany.
| | - Bergita Ganse
- Research Centre for Musculoskeletal Science & Sports Medicine, Faculty of Science and Engineering, School of Healthcare Science, Manchester Metropolitan University, Manchester, United Kingdom.
| | - Sven Nebelung
- Department of Radiology, University Hospital RWTH Aachen, Germany.
| | - Ali Modabber
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Germany.
| | - Daphne Eschbach
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Germany.
| | - Christian David Weber
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, D-52074 Aachen, Germany.
| | - Klemens Horst
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, D-52074 Aachen, Germany.
| | - Matthias Knobe
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, D-52074 Aachen, Germany; Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Switzerland.
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Trombetta AC, Pizzorni C, Ruaro B, Paolino S, Sulli A, Smith V, Cutolo M. Effects of Longterm Treatment with Bosentan and Iloprost on Nailfold Absolute Capillary Number, Fingertip Blood Perfusion, and Clinical Status in Systemic Sclerosis. J Rheumatol 2016; 43:2033-2041. [PMID: 27744392 DOI: 10.3899/jrheum.160592] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To quantify in patients with systemic sclerosis (SSc) the absolute nailfold capillary number/mm (the absolute number of capillaries, observable in the first row, in 1 mm per field) and fingertip blood perfusion (FBP) during longterm therapy with the endothelin receptor antagonist bosentan (BOSE) and the synthetic analog of prostacyclin PGI2 iloprost (ILO) by multiple diagnostic tools. Observed values were correlated with clinical outcomes. METHODS Thirty patients with SSc already receiving intravenous ILO (80 μg/day) for 5 continuous days (every 3 mos) were recruited in the clinic. Fifteen patients continued such treatment (ILO group), while in 15 patients BOSE (125 mg twice/day) was added (ILO + BOSE group) because of the onset of pulmonary arterial hypertension or digital ulcers (DU). The followup period was 4 years (T0-T4). Every year the following were evaluated: absolute nailfold capillary number/mm by nailfold videocapillaroscopy, FBP by laser Doppler flowmetry, DU incidence, DLCO, systolic pulmonary arterial pressure (sPAP), renal arterial resistive index, and other biomarkers. From T2 to T4, laser speckled contrast analysis was added. Nonparametric tests were used for statistical analysis. RESULTS Limited to the ILO + BOSE group, absolute capillary number/mm and FBP showed a progressive increase independently from other variables. In addition, during followup there was a significant reduction (80%) in the incidence of new DU, whereas DLCO and sPAP did not worsen. CONCLUSION The study shows in patients with SSc with up to 4 years of combined therapy a progressive significant recovery in structure and function of microvasculature linked to improved clinical outcomes, independent of disease severity.
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Affiliation(s)
- Amelia Chiara Trombetta
- From the Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy; Department of Rheumatology, Ghent University Hospital, Ghent University, Ghent, Belgium.,A.C. Trombetta, MD, PhD, Trainee in Clinical and Experimental Immunology, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa; C. Pizzorni, MD, PhD, Assistant Professor of Rheumatology, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa; B. Ruaro, MD, Trainee in Rheumatology, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa; S. Paolino, MD, Assistant Professor of Rheumatology, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa; A. Sulli, MD, Associate Professor of Rheumatology, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa; V. Smith, MD, PhD, Associate Professor of Rheumatology, Head of Clinics in Rheumatology, Ghent University Hospital, Ghent University; M. Cutolo, MD, Full Professor of Rheumatology, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa
| | - Carmen Pizzorni
- From the Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy; Department of Rheumatology, Ghent University Hospital, Ghent University, Ghent, Belgium.,A.C. Trombetta, MD, PhD, Trainee in Clinical and Experimental Immunology, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa; C. Pizzorni, MD, PhD, Assistant Professor of Rheumatology, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa; B. Ruaro, MD, Trainee in Rheumatology, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa; S. Paolino, MD, Assistant Professor of Rheumatology, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa; A. Sulli, MD, Associate Professor of Rheumatology, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa; V. Smith, MD, PhD, Associate Professor of Rheumatology, Head of Clinics in Rheumatology, Ghent University Hospital, Ghent University; M. Cutolo, MD, Full Professor of Rheumatology, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa
| | - Barbara Ruaro
- From the Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy; Department of Rheumatology, Ghent University Hospital, Ghent University, Ghent, Belgium.,A.C. Trombetta, MD, PhD, Trainee in Clinical and Experimental Immunology, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa; C. Pizzorni, MD, PhD, Assistant Professor of Rheumatology, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa; B. Ruaro, MD, Trainee in Rheumatology, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa; S. Paolino, MD, Assistant Professor of Rheumatology, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa; A. Sulli, MD, Associate Professor of Rheumatology, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa; V. Smith, MD, PhD, Associate Professor of Rheumatology, Head of Clinics in Rheumatology, Ghent University Hospital, Ghent University; M. Cutolo, MD, Full Professor of Rheumatology, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa
| | - Sabrina Paolino
- From the Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy; Department of Rheumatology, Ghent University Hospital, Ghent University, Ghent, Belgium.,A.C. Trombetta, MD, PhD, Trainee in Clinical and Experimental Immunology, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa; C. Pizzorni, MD, PhD, Assistant Professor of Rheumatology, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa; B. Ruaro, MD, Trainee in Rheumatology, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa; S. Paolino, MD, Assistant Professor of Rheumatology, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa; A. Sulli, MD, Associate Professor of Rheumatology, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa; V. Smith, MD, PhD, Associate Professor of Rheumatology, Head of Clinics in Rheumatology, Ghent University Hospital, Ghent University; M. Cutolo, MD, Full Professor of Rheumatology, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa
| | - Alberto Sulli
- From the Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy; Department of Rheumatology, Ghent University Hospital, Ghent University, Ghent, Belgium.,A.C. Trombetta, MD, PhD, Trainee in Clinical and Experimental Immunology, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa; C. Pizzorni, MD, PhD, Assistant Professor of Rheumatology, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa; B. Ruaro, MD, Trainee in Rheumatology, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa; S. Paolino, MD, Assistant Professor of Rheumatology, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa; A. Sulli, MD, Associate Professor of Rheumatology, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa; V. Smith, MD, PhD, Associate Professor of Rheumatology, Head of Clinics in Rheumatology, Ghent University Hospital, Ghent University; M. Cutolo, MD, Full Professor of Rheumatology, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa
| | - Vanessa Smith
- From the Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy; Department of Rheumatology, Ghent University Hospital, Ghent University, Ghent, Belgium.,A.C. Trombetta, MD, PhD, Trainee in Clinical and Experimental Immunology, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa; C. Pizzorni, MD, PhD, Assistant Professor of Rheumatology, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa; B. Ruaro, MD, Trainee in Rheumatology, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa; S. Paolino, MD, Assistant Professor of Rheumatology, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa; A. Sulli, MD, Associate Professor of Rheumatology, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa; V. Smith, MD, PhD, Associate Professor of Rheumatology, Head of Clinics in Rheumatology, Ghent University Hospital, Ghent University; M. Cutolo, MD, Full Professor of Rheumatology, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa
| | - Maurizio Cutolo
- From the Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy; Department of Rheumatology, Ghent University Hospital, Ghent University, Ghent, Belgium. .,A.C. Trombetta, MD, PhD, Trainee in Clinical and Experimental Immunology, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa; C. Pizzorni, MD, PhD, Assistant Professor of Rheumatology, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa; B. Ruaro, MD, Trainee in Rheumatology, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa; S. Paolino, MD, Assistant Professor of Rheumatology, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa; A. Sulli, MD, Associate Professor of Rheumatology, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa; V. Smith, MD, PhD, Associate Professor of Rheumatology, Head of Clinics in Rheumatology, Ghent University Hospital, Ghent University; M. Cutolo, MD, Full Professor of Rheumatology, Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa.
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