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Healing of the perineal wound after proctectomy in Crohn's disease patients: only preoperative perineal sepsis predicts poor outcome. Li W,Stocchi L,Elagili F,Kiran R P,Strong S A Techniques in coloproctology BACKGROUND:The aim of our study was to assess perineal wound healing in patients with Crohn's disease (CD) who undergo proctectomy or proctocolectomy with end ileostomy and to evaluate the influence of various factors including types of perineal dissection on eventual wound healing. METHODS:Data for patients with CD who underwent proctectomy or total proctocolectomy with end ileostomy from 1995 to 2012 were reviewed. The relationship between perineal wound healing and demographics, patient characteristics, and other factors was assessed using univariate and multivariate analyses. RESULTS:The perineal wound healed by 12 weeks in 72 (52.9%) out of 136 patients (63.2% female, mean age 41 ± 13 years); delayed healing occurred in 35 patients (25.7%), and in 29 patients (21.3%), there was non-healing. On multivariate analysis, the only factor associated with delayed healing and non-healing was preoperative perineal sepsis (p = 0.001). CONCLUSIONS:After proctectomy or proctocolectomy for CD, perineal wound healing is poor and poses a particular challenge for patients with preoperative perineal sepsis. These findings support a preoperative discussion regarding CD patients that examines potential outcomes and the consideration of measures such as the initial creation of defunctioning ostomy or control/drainage of local sepsis prior to proctectomy. 10.1007/s10151-017-1695-8
Complex wound-healing problems in neurosurgical patients: risk factors, grading and treatment strategy. Krishnan Kartik G,Müller Adolf,Hong Bujung,Potapov Alexander A,Schackert Gabriele,Seifert Volker,Krauss Joachim K Acta neurochirurgica BACKGROUND:Wound-healing problems in the neurosurgical patient can be particularly bothersome, owing to various specific risk factors involved. These may vary from simple wound dehiscence to complex multi-layer defects with cerebrospinal fluid (CSF) leakage and contamination. The latter is quite rare in practice and requires an individually titrated reconstruction strategy. The objective is to retrospectively analyze neurosurgical patients with complex, recalcitrant wound-healing problems we had treated in our department, attempt to develop a grading system based on the risk factors specific to our specialty and adapt a surgical reconstruction algorithm. METHODS:During an 11-year period, 49 patients were identified to have had complex, recalcitrant wound-healing problems involving the cranial vault (n = 43) and the skull base (n = 6) that required an adapted surgical wound-management strategy. The etiologies of wound healing problems were aftermaths of surgical treatment of: (1) brain tumors (nine cases), (2) aneurysm clipping (ten cases), (3) trauma (27 patients), and (4) congenital malformations (three patients). Local rotational advancement flaps were performed in 18 patients and free microvascular tissue transfer was performed in 37 cases. RESULTS:Major risk factors leading to recalcitrant wound healing problems in the presented group were: prolonged angiographic interventions (20%), ongoing chemotherapy or radiotherapy (47%), prolonged cortisone application (51%), CSF leak (76%) and, above all, multiple failed attempts at wound closure (94%). Stable long-term wound healing was achieved in all patients using vascularized tissue coverage. A ternary grading system was developed based on various risk factors in the presented cohort. Accordingly, the algorithm for reconstruction in neurosurgical patients was adapted. CONCLUSIONS:Primary disease, treatment history, and distorted anatomical structures are major concerns in the management of complex wound-healing problems in neurosurgical patients. The higher the risk factors involved, the more complex is the surgical strategy. Free microvascular tissue transfer offers stable long-term results in recalcitrant cases. However, this may be indicated only in patients with a good prognosis of the underlying disease. 10.1007/s00701-011-1221-0
Association of time in range with postoperative wound healing in patients with diabetic foot ulcers. International wound journal Time in range (TIR) is a novel indicator of glycaemic control that has been reported to have an association with diabetic complications. The objective of the study was to explore the association of TIR with postoperative wound healing in patients with diabetic foot ulcers (DFUs). We retrospectively analysed the data of DFU patients who had undergone surgical treatment from 2015 to 2019. A 1:1 ratio in propensity score matching (PSM) was adopted to compare patients with TIR ≥50% with those <50%. Data were summarised using chi-squared, Fisher's exact, and Mann-Whitney U tests. Patients with TIR <50% underwent a higher rate of secondary surgery within a month (P = .032) and had a longer hospital stay (P = .045) with greater hospital charges (P < .001) than the TIR ≥50% group. Multivariate analysis revealed that TIR (P = .034), Wagner score (P = .009), diabetes treatment (P = .006), and type of surgery (P = .013) were independent risk factors for secondary surgery. Additionally, patient subgroups with TIR <50% and baseline HbA1c < 7.5% (P = .025), albumin level ≥ 30 g/L (P = .039), HDL < 1.16 (P = .021), or Wagner score ≥ 3 (P = .048) also experienced a higher incidence of secondary surgery. TIR was correlated with postoperative wound healing in patients with DFUs. Strict glycaemic targets should be established for surgical patients. 10.1111/iwj.13725
Risk factor analysis on the healing time and infection rate of diabetic foot ulcers in a referral wound care clinic. Kee Khaw Kher,Nair Harikrishna K R,Yuen Ng Pei Journal of wound care OBJECTIVE::Objectives. To determine the prevalence and risk factors for diabetic foot infection (DFI), and to identify factors associated with delayed wound healing of diabetic foot ulcer (DFU). METHOD::The retrospective study was performed in a referral wound care clinic in Hospital Kuala Lumpur. Data was collected from January 2014 to October 2016 on DFU patients who attended this clinic. RESULTS::Of the 340 patients (216 male and 124 female) DFU patients who attended the clinic (mean age: 58.1±10.8 years old), 41.5% presented with infection with a mean cross-sectional ulcer area of 21.5±33.2cm. Binary logistic regression analysis revealed that patients of Chinese ethnicity (OR: 3.39; 95%CI 1.49 to 7.70), with fasting blood glucose ≥7mmol/l (OR: 3.41; 95%CI 1.57 to 7.39), ulcer size ≥10cm (OR: 2.90; 95%CI 1.45 to 5.82) and blood pressure ≥140/90mmHg (OR: 2.52; 95%CI 1.54 to 4.14) were more likely to develop DFI. The median healing time for patients with DFUs was three months. There were six variables identified as significantly associated with prolonged healing time of DFU, namely presence of infection (p<0.001), poor glycaemic control with fasting blood glucose ≥7mmol/l (p<0.001), high blood pressure ≥140/90mmHg (p<0.001), large DFU size ≥2cm (p<0.001), history of amputation (p<0.005) and plantar location of the DFU (p<0.05). CONCLUSION::Large DFU size, poor glycaemic and blood pressure control are common risk factors for both DFU and DFI. Unexpected high prevalence and ethnicity risk factor for DFI urge more comprehensive primary and secondary preventative strategies to reduce its incidence. 10.12968/jowc.2019.28.Sup1.S4
Wound Healing Following Open Groin Hernia Surgery: The Impact of Comorbidity. Rühling Victoria,Gunnarsson Ulf,Dahlstrand Ursula,Sandblom Gabriel World journal of surgery BACKGROUND:The aim of this study was to explore the impact of chronic concomitant disease on the risk for postoperative complications following open groin hernia surgery. METHODS:During the study period (2002-2011), 133,074 open repairs were registered in the Swedish Hernia Register. History of peripheral vascular disorders, connective tissue disease, chronic renal failure, obesity, and liver cirrhosis as well as data on hemorrhage or hematoma, wound dehiscence, postoperative infection, and reoperation for superficial infection or bleeding within 30 days after surgery were obtained by matching with the Swedish Patient Register. RESULTS:In the multivariate logistic regression analysis, a significantly increased risk for hemorrhage or hematoma within 30 days after surgery was seen for older patients, males, liver cirrhosis, peripheral vascular disease, and connective tissue disease (p < 0.05). High age (>80 years), previous history of peripheral vascular disease, connective tissue disease, and male gender were risk factors for wound dehiscence (p < 0.05). Liver cirrhosis, chronic kidney disease, BMI > 25, and male gender were associated with increased risk for postoperative wound infection (p < 0.05). A significantly increased risk for reoperation for superficial infection or bleeding was seen in patients with peripheral vascular disease and elderly patients (p < 0.05). CONCLUSION:Risk for postoperative complications in open groin hernia surgery is increased in elderly patients, patients with liver cirrhosis, and those with peripheral vascular disease. The indications for surgery should be weighed against the risk for wound-healing complications in these patient groups. Watchful waiting may be an alternative, although this carries the risk of emergency surgery. 10.1007/s00268-015-3131-4
"Doctor, how long will it take?" Results from an historical cohort on surgical pressure ulcer healing delay and related factors in persons with spinal cord injury. Gelis Anthony,Morel Juliette,Amara Bouali,Mauri Cécile,Rouays Hélène,Verollet Christine,Almeras Isabelle,Frasson Nicolas,Dupeyron Arnaud,Laffont Isabelle,Daures Jean-Pierre,Herlin Christian Journal of tissue viability BACKGROUND:Flap surgery for deep pelvic pressure ulcers has already shown its effectiveness. Most studies relating to the postoperative period assessed complications rates and associated risk factors, but none focused on delayed wound healing. The objective of this study was to describe wound healing delay after primary flap surgery in patients with spinal cord injury (SCI) and to assess associated risk factors. METHODS:This observational retrospective study based on medical charts included all persons with SCI operated for primary flap surgery for pelvic PU in the Hérault department of France between 2006 and 2014. Overall, 100 biomedical, psychological, socioeconomics and care management factors were studied. The primary outcome was wound healing delay, defined as time from surgery to complete cutaneous closure. RESULTS:85 patients were included. Median healing time was 48 days (R: 20-406). Healing rate was 70% at 3 months and 90% at 4 months. After a multivariate analysis three factors were significantly associated with delayed wound healing: duration of hospitalization in the acute care unit (HR = 2.68; p = 0.004), local post-operative complication (HR = 10.75; p = 0.02), and post-operative sepsis (HR = 2.18; p = 0.02). CONCLUSION:After primary skin flap surgery for PU in persons with SCI, delayed wound healing is related to local or general complications as well as care management organization. The risk of delayed wound healing justifies the implementation of a coordinated pre-operative management to prevent complications and a structured care network for an earlier transfer to a SCI rehabilitation center. 10.1016/j.jtv.2021.02.001
Stratification of chronic and complex wounds according to healing characteristics: a retrospective study. Journal of wound care OBJECTIVE:Wound risk-stratified analyses are clinically relevant as they can assist in identifying hard-to-heal wounds. The aim of the study is to develop risk categories for wound healing based on a limited number of reliably recordable clinical data. METHOD:This retrospective study used observational data. The primary outcome measure was wound healing at the end of treatment and the secondary outcome measure was the time to wound healing. A stratification model using regression analyses was developed to assign the patients to risk categories for wound healing and the time-to-heal. RESULTS:The study cohort comprised of 540 patients. The most common wound diagnoses were diabetic ulcers, wounds in irradiated areas and wound dehiscence after surgery. Average wound duration before starting treatment at the wound centre was 11.7 months. Healing was achieved in 382 (71%) wounds, after an average treatment time of 4.4 months. A total of four risk categories for wound healing were developed by combining wound diagnosis (favourable versus unfavourable) and duration (<3 months versus >3 months). These risk categories demonstrated healing percentages ranging from 69-97% (p=0.0004) and mean time-to-healing varying from 2.7-5.9 months (p=0.01). CONCLUSION:Using two clinical wound variables, diagnosis and duration, stratification categories were identified with significant associations with wound healing outcomes. Longer wound duration and unfavourable diagnoses, when combined into unfavourable risk categories, were associated with a lower percentage of wound healing and a longer treatment time until healing. 10.12968/jowc.2019.28.7.446
Wound healing outcomes in a diabetic foot ulcer outpatient clinic at an acute care hospital: a retrospective study. Lu S H,McLaren A-M Journal of wound care OBJECTIVE:Patients with diabetic foot ulcers (DFU) have an increased risk of lower extremity amputation. A retrospective chart review of patients with DFUs attending the Foot Treatment and Assessment chiropodist-led outpatient clinic at an inner-city academic hospital was conducted to determine wound healing outcomes and characteristics contributing to outcomes. METHOD:We reviewed the complete clinical history of 279 patients with 332 DFUs spanning over a five-year period. RESULTS:The mean age of patients was 61.5±12.5 years and most patients (83.5%) had one DFU. The majority of wounds (82.5%) were in the forefoot. Overall, 267/332 (80.5%) wounds healed. A greater proportion of wounds healed in the forefoot (82.5%) and midfoot (87.1%) than hindfoot (51.9%; p<0.001). Using a logistic regression model, palpable pedal pulse and use of a total contact cast were associated with better wound healing. CONCLUSION:Our findings are the first to demonstrate the benefits of chiropodists leading an acute care outpatient clinic in the management of DFUs in Canada and delivers wound healing outcomes equivalent to or exceeding those previously published. 10.12968/jowc.2017.26.Sup10.S4
Minimally Invasive Treatment of Ankle Fractures in Patients at High Risk of Soft Tissue Wound Healing Complications. Abdelgaid Sherif Mohamed,Moursy Ahmed Fawaz,Elgebaly Eyad Abd Allah,Aboelenien Aly Mohamed The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons The complex nature of ankle fractures is magnified when seen in patients at high risk of soft tissue wound healing complications. The major categories include associated soft tissue injury, diabetes, tobacco use, peripheral vascular disease, malnutrition, alcoholism, and corticosteroid use. Because of the potential for wound dehiscence and infection with open reduction and internal fixation of ankle fractures in these patients, minimally invasive procedures have been described. The aims of the present study were to assess the possibility for, and evaluate the results and complications of, minimally invasive techniques for different types of malleolar fractures in high-risk patients. We report the clinical results of 47 high-risk patients who presented with malleolar fractures from January 2007 to December 2012 and underwent minimally invasive reduction and fixation. One patient (0.5%) developed a superficial infection; however, none of the patients displayed wound dehiscence or deep infection. Five patients (10.6%) required open reduction because of intraoperative failure to achieve anatomic reduction. Using the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale, 15 of the patients (36%) treated with minimally invasive techniques experienced an excellent outcome. In contrast, 23 patients (55%) had a good, 3 (7%) a fair, and 1 (2.5%) a poor outcome. The results of our study have shown that minimally invasive fixation appears to be a satisfactory method for the management of malleolar fractures in high-risk patients and could be helpful in the avoidance of the complications associated with conventional open reduction and internal fixation. 10.1053/j.jfas.2017.11.041
Predictors of delayed wound healing after successful isolated below-the-knee endovascular intervention in patients with ischemic foot ulcers. Das Sushant Kumar,Yuan Yi Feng,Li Mao Quan Journal of vascular surgery OBJECTIVE:The purpose of this study was to explore the predictors of delayed wound healing and their use in risk stratification for endovascular treatment (EVT) of patients with critical limb ischemia (CLI) due to isolated below-the-knee lesions. METHODS:Wound healing rates were analyzed retrospectively in patients who underwent successful below-the-knee percutaneous transluminal balloon angioplasty for CLI with tissue loss between May 2008 and June 2013. We also analyzed the independent predictors of delayed wound healing and their use in risk stratification. RESULTS:The cumulative wound healing rates were 13.9%, 43.8%, 57.7%, and 65.7% at 3, 6, 9, and 12 months, respectively. Multivariate Cox proportional hazards analysis revealed the following as independent predictors of wound nonhealing after initial successful EVT: patients with end-stage renal disease receiving dialysis (hazard ratio [HR], 2.6; 95% confidence interval [CI], 1.0-6.3; P  = .04); albumin level <3.0 g/dL (HR, 2.0; 95% CI, 1.1-3.8; P  = .02); C-reactive protein level >5.0 mg/dL (HR, 3.9; 95% CI, 1.6-9.6; P = .003); major tissue loss (HR, 2.1; 95% CI, 1.3-3.4; P = .003); wound infection (HR, 1.9; 95% CI, 1.2-2.9; P = .005); gangrene (HR, 1.8; 95% CI, 1.2-2.8; P = .008); wound depth (University of Texas grade 3; HR, 3.4; 95% CI, 1.4-8.6; P = .009); duration of ulcer (≥2 months; HR, 2.9; 95% CI, 1.0-8.4; P = .048); insulin use (HR, 1.7; 95% CI, 1.0-2.8; P = .04); and lack of below-the-ankle runoff (HR, 1.9; 95% CI, 1.0-3.4; P = .04). CONCLUSIONS:The general status of the patient and the target limb's condition are important predictors of wound nonhealing. Regarding the limb's condition, information on wound depth and duration in addition to wound extent and infection would further enable the selection of suitable CLI patients for EVT. Such information would also enable optimal wound management, leading to successful wound healing and improved limb salvage and survival rates. 10.1016/j.jvs.2017.08.077
Wound outcomes and factors associated with wound healing after first-time femoropopliteal artery intervention in patients with ischemic tissue loss. Roh Young-Nam,Lee Hyun Yong,Park Ui Jun,Kim Hyoung Tae Asian journal of surgery BACKGROUND/OBJECTIVE:This study's goal is to describe wound outcomes at 2 years following intervention for atherosclerotic femoropopliteal lesions in patients with ischemic tissue loss. METHODS:A retrospective review of 135 first-time endovascular procedures for chronic femoropopliteal atherosclerotic lesions related to ischemic tissue loss was performed. The final wound outcomes were categorized according to the initial wound healing, recurrence and the need of major/minor amputation. RESULTS:At 2-years of follow up, 76 limbs (56.3%) showed complete wound healing without recurrence, however, wound development occurred at other sites on the same foot following complete primary healing in 11 limbs (8.1%). Tolerable wounds persisted or wounds recurred at the same site in 30 limbs (22.2%), and 18 limbs (13.3%) needed major amputations. Independent factors that prevented wound healing without recurrence at 2 years were renal insufficiency (HR = 0.225, 95% C.I. = 0.091-0.556, p = 0.001), ankle pressure < 50 mmHg or flat forefoot PVR (HR = 0.328, 95% C.I. = 0.124-0.867, p = 0.025) and functional performance < 4 metabolic equivalents (MET) (HR = 0.150, 95% C.I. = 0.063-0.360, p < 0.001). CONCLUSION:Wound outcome classifications showed detailed information regarding clinical outcomes in patients with ischemic tissue loss. Renal insufficiency, ischemia grade 3 and poor functional performance were independent risk factors that prevented wound healing. 10.1016/j.asjsur.2020.11.017
Determinants of wound healing in patients hospitalized for diabetic foot ulcer: results from the MEDFUN study. Ezeani Ignatius U,Ugwu Ejiofor T,Adeleye Funmi O,Gezawa Ibrahim D,Okpe Innocent O,Enamino Marcelina I Endocrine regulations OBJECTIVE:The high amputation rates from diabetic foot ulcer (DFU) in Nigeria and prolonged hospitalization due to poor wound healing is a source of concern. Furthermore, factors that affect wound healing of DFUs have not yet been well studied in Nigeria, whereas knowing these factors could improve DFU outcomes. Therefore, the objective of this study was to determine the factors that are associated with the wound healing in patients hospitalized for DFU. METHODS:The Multi-Center Evaluation of Diabetic Foot Ulcer in Nigeria (MEDFUN) was an observational study involving 336 diabetic patients hospitalized for DFU and managed by a multi-disciplinary team until discharge or death. Demographic, clinical, and biochemical characteristics were documented. Test statistics used were chi square, t-test, univariate, and multivariate logistic regression. The study endpoints were ulcer healing, LEA, duration of hospitalization, and mortality. Here we present data on wound healing. RESULTS:The mean ± SD age was 55.9±12.5 years. Univariate predictors of wound healing were ulcer duration more than 1 month prior to hospitalization (p<0.001), peripheral arterial disease (PAD) (p<0.001), foot gangrene (p<0.001), Ulcer grade ≥3 (p=0.002), proteinuria (p=0.005), anemia (p=0.009), renal impairment (p=0.021), glycated hemoglobin ≥7% (0.012), and osteomyelitis (p<0.001). On multivariate regression, osteomyelitis was the strongest independent predictor of wound healing after adjusting for all other variables (OR 0.035; 95% CI 0.004-0.332). This was followed by PAD (OR 0.093; 95% CI 0.028-0.311), ulcer duration >1 month (OR 0.109; 95% CI 0.030-0.395), anemia (OR 0.179; 95% CI 0.056-0.571). CONCLUSION:Presence of osteomyelitis, duration of ulcer greater than 1 month, PAD, Wagner grade 3 or higher, proteinuria, presence of gangrene, anemia, renal impairment, and HbA1c ≥7% were the significant predictors of wound healing in patients hospitalized for DFU. Early identification and prompt attention to these factors in a diabetic foot wound might significantly improve healing and reduce adverse outcomes such as amputation and death. 10.2478/enr-2020-0023
[Risk Factors for Wound Healing of Infective Surgical Incision after Radical Cystectomy in Patients of Muscle Invasive Bladder Cancer]. He Qi-Ying,Deng Shi,Liao Bang-Hua,Deng Lan,Dou Wei-Chao,Li Xiang,Liu Ling,Ma Li,Fan Dong-Ping Sichuan da xue xue bao. Yi xue ban = Journal of Sichuan University. Medical science edition OBJECTIVE:To evaluate the risk factors for wound healing of infective surgical incision in patients of muscle invasive bladder cancer undergoing radical cystectomy. METHODS:This study retrospectively collected clinical data of the patients who received radical cystectomy and experienced incisional infection after operation between January 2009 and December 2016. The patients were divided into early healing group and delayed healing group (the healing time is less or more than 14 d after operation). The risk factors for wound healing and infection were analyzed by single factor and multivariate logistic regression. RESULTS:A total of 171 patients with wound infection after radical cystectomy were included in the study. The average time of wound healing time was (17.9±16.9) d. There were 118 and 53 patients in early healing group and delay healing group respectively. Age, body mass index (BMI), operative incision type, preoperative albumin level, diabetes mellitus, infection wound size, infection wound with sinus, postoperative intestinal fistula and urinary fistula were statistically significant differences between the two groups (<0.05).Univariate logistic regression analysis indicated that male, older than 65 yr., T stage, Type-Ⅲ surgical incision (infective incision), low preoperative albumin level (<30 g/L), hemoglobin level (<90 g/L), diabetes, wound size (>30 mm), intestinal fistula, urinary fistula were risk factors for delayed wound-healing. Multivariate logistic regression analysis revealed that Type-Ⅲ surgical incision and wound size (>30 mm) were independent risk factors for delayed wound healing. CONCLUSION:Type-Ⅲ surgical incision and the size of wound (>30 mm) are independent risk factors for delayed wound healing after radical cystectomy in bladder cancer patients.
Wound healing of cutaneous substance losses based on infectious, inflammatory and traumatic skin disorders: The experience of a center. Khoshim K,Hersant B,Hotz C,SidAhmed-Mezi M,Meningaud J P Annales de chirurgie plastique et esthetique INTRODUCTION:There is no reference available concerning the standard healing time based on dermatological diseases responsible for cutaneous substance losses. The aim of our study was to assess the healing time after surgical debridement of necrotizing fasciitis (NF), hidradenitis suppurativa (HS) and skin necrosis due to trauma (SNT) based on multiples existing co-morbidities among these patients to provide surgeons with accurate scientific data in order to inform and educate patients and nurses who are practicing care under the supervision of the surgeon. MATERIALS AND METHODS:This was a retrospective study. The primary endpoint was the time for complete wound healing, which was calculated from the time of the last surgical procedure to the complete wound healing corresponding to the time of complete reepithelialization, when daily dressings were no longer needed. RESULTS:A total of 107 patients were included. The mean time for complete wound healing was 64.94±31.55 days in patients with NF, 45.70±21.40 days in patients with SNT and 75.02±26.41 days in patients with HS (SNT versus NF, P=0.004** and SNT versus HS, P<0.0001**). CONCLUSION:The mean time for complete wound healing was 64.94 days in patients with NF, 45.70 days in patients with SNT, 75.02 days in patients with HS. This study can be considered as a referential based on the experience of a reference centre for these 3 pathologies (NF, HS, and SNT) whose aim is to inform plastic surgeons in order to anticipate the management or educate the patient. 10.1016/j.anplas.2017.10.009
Prediction of Wound Healing in Diabetic Foot Ulcers: an Observational Study in Tertiary Hospital in Indonesia. Soewondo Pradana,Suyono Slamet,Sastrosuwignyo Mpu Kanoko,Harahap Alida R,Sutrisna Bambang,Makmun Lukman H Acta medica Indonesiana AIM:to evaluate the role of clinical characteristics, functional markers of vasodilation, inflammatory response, and atherosclerosis in predicting wound healing in diabetic foot ulcer. METHODS:a cohort study (February - October 2010) was conducted from 40 subjects with acute diabetic foot ulcer at clinical ward of Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia. Each subject underwent at least two variable measurements, i.e. during inflammatory phase and proliferation phase. The studied variables were clinical characteristics, complete peripheral blood count (CBC) and differential count, levels of HbA1c, ureum, creatinine, lipid profile, fasting blood glucose (FBG), marker of endothelial dysfunction (asymmetric dimethylarginine/ADMA, endothelin-1/ET-1, and flow-mediated dilation/FMD of brachial artery), and marker of vascular calcification (osteoprotegerin/OPG). RESULTS:median of time achieving 50% granulation tissue in our study was 21 days. There were nine factors that contribute in the development of 50% granulation tissue, i.e. family history of diabetes mellitus (DM), previous history of wound, wound area, duration of existing wound, captopril and simvastatin medications, levels of ADMA, ET-1, and OPG. There were three out of the nine factors that significantly correlated with wound healing, i.e. wound area, OPG levels, and simvastatin medications. CONCLUSION:in acute diabetic foot ulcers, wound area and OPG levels had positive correlation with wound healing, whereas simvastatin medications had negative correlation with wound healing.
Clinical parameters of wound healing in patients with advanced illness. Lai Theresa Tze-Kwan,Yip Oi-Mei,Sham Michael M K Annals of palliative medicine BACKGROUND:Pressure injury is a common clinical parameter of patient care outcome. Various risk factors increase the risk of palliative care patients to pressure injuries and difficult wound healing. Healthcare professionals are aware that wound healing is difficult, but they still focus on this process instead of providing the needs of patients with unhealed wounds. METHODS:This study aims to identify the clinical parameters of pressure injuries in relation to patients with advanced illness. A retrospective analysis of the records of patients with pressure injuries admitted over 18 months was performed. Descriptive analysis and Spearman's correlation coefficient were used. RESULTS:A total of 127 clinical records were reviewed. The study revealed that patients of old age, high creatinine level, advanced wound age, reduced palliative performance scale (PPS) and low Norton scores are prone to suffer from unhealed wounds. CONCLUSIONS:Pressure injuries are prone to non-healing in patients with old age, high creatinine level, advanced wound stage, low PPS and low Norton scores. Further studies involving patients in earlier stage can be considered. 10.21037/apm.2019.01.05
A retrospective investigation of abdominal visceral fat, body mass index (BMI), and active smoking as risk factors for donor site wound healing complications after free DIEP flap breast reconstructions. Timmermans Floyd W,Westland Pèdrou B,Hummelink Stefan,Schreurs Joep,Hameeteman Marijn,Ulrich Dietmar J O,Slater Nicholas J Journal of plastic, reconstructive & aesthetic surgery : JPRAS BACKGROUND:The deep inferior epigastric artery perforator (DIEP) flap is one of the most common techniques for breast reconstruction. Body mass index (BMI) is considered as an important predictor of donor site healing complications such as wound dehiscence. The use of computed tomography (CT) proved to be a precise and objective method to assess visceral adipose tissue. It remains unclear whether quantification of visceral fat provides more accurate predictions of abdominal wound healing complications than BMI. PATIENTS AND METHODS:A total of 97 patients with DIEP flap were retrospectively evaluated. Patients' abdominal visceral fat (AVF) was quantified on CT angiography (CTA). The patients were postoperatively assessed for abdominal wound healing complications. We analyzed for the correlations between AVF, BMI, and dehiscence and established a logistic regression model to assess the potential high-profile predictors in anatomic and patient characteristics such as weight, smoking, and diabetes. RESULTS:We included 97 patients, and of them, 24 patients (24.7%) had some degree of abdominal dehiscence. No significant differences were observed between the dehiscence group and the non-dehiscence group, except for smoking (p = 0.002). We found a significant correlation between AVF and BMI (R = 0.282, p = 0.005), but neither was significant in predicting donor site dehiscence. Smoking greatly increased the likelihood of developing wound dehiscence (OR = 11.4, p = < 0.001). CONCLUSIONS:AVF and BMI were not significant predictors of abdominal wound healing complications after DIEP flap reconstruction. This study established active smoking (OR = 11.4, p = < 0.001) as the significant risk factor that contributed to the development of abdominal wound dehiscence in patients with DIEP. 10.1016/j.bjps.2018.03.003
Predicting complex acute wound healing in patients from a wound expertise centre registry: a prognostic study. Ubbink Dirk T,Lindeboom Robert,Eskes Anne M,Brull Huub,Legemate Dink A,Vermeulen Hester International wound journal It is important for caregivers and patients to know which wounds are at risk of prolonged wound healing to enable timely communication and treatment. Available prognostic models predict wound healing in chronic ulcers, but not in acute wounds, that is, originating after trauma or surgery. We developed a model to detect which factors can predict (prolonged) healing of complex acute wounds in patients treated in a large wound expertise centre (WEC). Using Cox and linear regression analyses, we determined which patient- and wound-related characteristics best predict time to complete wound healing and derived a prediction formula to estimate how long this may take. We selected 563 patients with acute wounds, documented in the WEC registry between 2007 and 2012. Wounds had existed for a median of 19 days (range 6-46 days). The majority of these were located on the leg (52%). Five significant independent predictors of prolonged wound healing were identified: wound location on the trunk [hazard ratio (HR) 0·565, 95% confidence interval (CI) 0·405-0·788; P = 0·001], wound infection (HR 0·728, 95% CI 0·534-0·991; P = 0·044), wound size (HR 0·993, 95% CI 0·988-0·997; P = 0·001), wound duration (HR 0·998, 95% CI 0·996-0·999; P = 0·005) and patient's age (HR 1·009, 95% CI 1·001-1·018; P = 0·020), but not diabetes. Awareness of the five factors predicting the healing of complex acute wounds, particularly wound infection and location on the trunk, may help caregivers to predict wound healing time and to detect, refer and focus on patients who need additional attention. 10.1111/iwj.12149
The Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification system predicts wound healing but not major amputation in patients with diabetic foot ulcers treated in a multidisciplinary setting. Mathioudakis Nestoras,Hicks Caitlin W,Canner Joseph K,Sherman Ronald L,Hines Kathryn F,Lum Ying W,Perler Bruce A,Abularrage Christopher J Journal of vascular surgery OBJECTIVE:The Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) threatened limb classification has been shown to correlate well with risk of major amputation and time to wound healing in heterogeneous diabetic and nondiabetic populations. Major amputation continues to plague the most severe stage 4 WIfI patients, with 1-year amputation rates of 20% to 64%. Our aim was to determine the association between WIfI stage and wound healing and major amputation among patients with diabetic foot ulcers (DFUs) treated in a multidisciplinary setting. METHODS:All patients presenting to our multidisciplinary DFU clinic from July 2012 to December 2015 were enrolled in a prospective database. Wound healing and major amputation were compared for patients stratified by WIfI classification. RESULTS:There were 217 DFU patients with 439 wounds (mean age, 58.3 ± 0.8 years; 58% male, 63% black) enrolled, including 28% WIfI stage 1, 11% stage 2, 33% stage 3, and 28% stage 4. Peripheral arterial disease and dialysis were more common in patients with advanced (stage 3 or 4) wounds (P ≤ .05). Demographics of the patients, socioeconomic status, and comorbidities were otherwise similar between groups. There was a significant increase in the number of active wounds per limb at presentation with increasing WIfI stage (stage 1, 1.1 ± 0.1; stage 4, 1.4 ± 0.1; P = .03). Mean wound area (stage 1, 2.6 ± 0.6 cm; stage 4, 15.3 ± 2.8 cm) and depth (stage 1, 0.2 ± 0.0 cm; stage 4, 0.8 ± 0.1 cm) also increased progressively with increasing wound stage (P < .001). Minor amputations (stage 1, 18%; stage 4, 56%) and revascularizations (stage 1, 6%; stage 4, 55%) were more common with increasing WIfI stage (P < .001). On Kaplan-Meier analysis, WIfI classification was predictive of wound healing (P < .001) but not of major amputation (P = .99). For stage 4 wounds, the mean wound healing time was 190 ± 17 days, and risk of major amputation at 1 year was 5.7% ± 3.2%. CONCLUSIONS:Among patients with DFU, the WIfI classification system correlated well with wound healing but was not associated with risk of major amputation at 1 year. Although further prospective research is warranted, our results suggest that use of a multidisciplinary approach for DFUs may augment healing time and reduce amputation risk compared with previously published historical controls of standard wound care among patients with advanced stage 4 disease. 10.1016/j.jvs.2016.12.123
The Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification independently predicts wound healing in diabetic foot ulcers. Hicks Caitlin W,Canner Joseph K,Mathioudakis Nestoras,Sherman Ronald,Malas Mahmoud B,Black James H,Abularrage Christopher J Journal of vascular surgery OBJECTIVE:Previous studies have reported correlation between the Wound, Ischemia, and foot Infection (WIfI) classification system and wound healing time on unadjusted analyses. However, in the only multivariable analysis to date, WIfI stage was not predictive of wound healing. Our aim was to examine the association between WIfI classification and wound healing after risk adjustment in patients with diabetic foot ulcers (DFUs) treated in a multidisciplinary setting. METHODS:All patients presenting to our multidisciplinary DFU clinic from June 2012 to July 2017 were enrolled in a prospective database. A Cox proportional hazards model accounting for patients' sociodemographics, comorbidities, medication profiles, and wound characteristics was used to assess the association between WIfI classification and likelihood of wound healing at 1 year. RESULTS:There were 310 DFU patients enrolled (mean age, 59.0 ± 0.7 years; 60.3% male; 60.0% black) with 709 wounds, including 32.4% WIfI stage 1, 19.9% stage 2, 25.2% stage 3, and 22.4% stage 4. Mean wound healing time increased with increasing WIfI stage (stage 1, 96.9 ± 8.3 days; stage 4, 195.1 ± 10.6 days; P < .001). Likelihood of wound healing at 1 year was 94.1% ± 2.0% for stage 1 wounds vs 67.4% ± 4.4% for stage 4 (P < .001). After risk adjustment, increasing WIfI stage was independently associated with poor wound healing (stage 4 vs stage 1: hazard ratio, [HR] 0.44; 95% confidence interval, 0.33-0.59). Peripheral artery disease (HR, 0.73), increasing wound area (HR, 0.99 per square centimeter), and longer time from wound onset to first assessment (HR, 0.97 per month) also decreased the likelihood of wound healing, whereas use of clopidogrel was protective (HR, 1.39; all, P ≤ .04). The top three predictors of poor wound healing were WIfI stage 4 (z score, -5.40), increasing wound area (z score, -3.14), and WIfI stage 3 (z score, -3.11), respectively. CONCLUSIONS:Among patients with DFU, the WIfI classification system predicts wound healing at 1 year in both crude and risk-adjusted analyses. This is the first study to validate the WIfI score as an independent predictor of wound healing using multivariable analysis. 10.1016/j.jvs.2017.12.079
Wound-Healing Issues Following Rotational Ankle Fracture Surgery: Predictors and Local Management Options. Saleh Hesham,Konda Sanjit,Driesman Adam,Stranix John,Ly Catherine,Saadeh Pierre,Egol Kenneth Foot & ankle specialist . The incidence and risk factors of wound-healing complications following rotational ankle fracture surgery are well documented in the literature. However, there is a paucity regarding management options following these complications. The goal of this study was to provide a descriptive analysis of one surgeon's experience managing wound complications in patients who have undergone ankle fracture surgery. . A total of 215 patients who were operatively treated for an unstable ankle were retrospectively identified. Patient demographics, medical histories, initial injury characteristics, surgical interventions, and clinical follow-up were collected. Twenty-five of these patients developed postoperative wound problems. . Of the original cohort of 215 patients, 25 (11.6%) developed wound-healing complications. Their average age was 53.6 ± 18.0 years; there were 12 males (48.0%). Connective tissue/inflammatory disease (odds ratio [OR] 3.9), cardiovascular disease (OR 3.6), and active smoking (OR 3.3) were associated with an increased likelihood of developing postoperative wound complications. With regard to injuries, open fractures (OR 17.9) had the highest likelihood of developing postoperative complications, followed by type 44-C (OR 2.8) and trimalleolar fractures (OR 2.0). . Wound complications following open treatment of ankle fractures occurred with an incidence of 11.6% in this series, of which only about half required operative intervention. A third of wounds were managed by orthopaedics in conjunction with plastic surgery. Level III: Retrospective comparative study. 10.1177/1938640018810422
Wound healing after revascularization for critical limb ischemia. Sano Masaya,Yamamoto Kota,Seo Akihiko,Akai Atsushi,Akagi Daisuke,Takayama Toshio,Hoshina Katsuyuki International angiology : a journal of the International Union of Angiology BACKGROUND:Wound healing is one of the most important endpoints after revascularization for critical limb ischemia. The purpose of this study was to evaluate the risk factors for wound healing after revascularization for critical limb ischemia (CLI). METHODS:A retrospective study was conducted at a single university hospital, and data were collected retrospectively between January 2005 and September 2016. All admitted patients who were diagnosed with CLI and underwent revascularization for the first time were enrolled. The risk factors for wound healing were analyzed. RESULTS:The risk factors for wound healing were analyzed in 153 patients. The cumulative rate of wound healing at 12 months after revascularization was 79%. The independent risk factors for wound healing were non-ambulatory status (hazard ratio, 1.95; 95% CI [1.22-3.21], P=0.004), and wound, ischemia and foot infection (WIfI) stage 4 (hazard ratio, 1.89; 95% CI [1.25-2.91], P=0.002). CONCLUSIONS:In our study, non-ambulatory status and WIfI stage 4 were independent risk factors for wound healing after revascularization. WIfI criteria well reflected the prognosis of patients with CLI in wound healing, as well as limb salvage. 10.23736/S0392-9590.19.04096-3
Risk analysis of poor wound healing in forceps delivery. Feng Yi,Zhou Li The journal of obstetrics and gynaecology research AIM:This study aims to explore the risk factors leading to poor wound healing after forceps delivery. METHOD:In this retrospective study, 74 patients undergoing forceps delivery with poor wound healing were compared with contemporary randomly selected 74 patients undergoing forceps delivery but with normal wound healing. RESULTS:Compared to the normal healing group, the poor healing group had larger birthweight (p = 0.01), longer labor length (805.9 ± 356.4 min vs. 572.9 ± 306.3 min, p < 0.001), more virginal checks (4.0 ± 1.5 vs. 3.4 ± 1.7, p = 0.029), and more contaminated amniotic fluid (p = 0.043). More patients in poor healing group suffered from postpartum fever (52.7% vs. 21.6%, p < 0.001), postpartum hemorrhage (p < 0.001), and anemia after delivery (p < 0.001). Labor length (odds ratio (OR) 1.125, 95% confidence interval [CI] = 1.033-1.226), anemia after delivery (OR 3.621, 95% CI = 2.077-6.314), postpartum fever (OR 7.100, 95% CI = 2.505-20.124), and degree of laceration (OR 3.067, 95% CI = 1.258-7.479) were the risk factors of poor healing of perineal wound after forceps delivery, while postpartum antibiotics (OR 0.303, 95% CI = 0.098-0.937) and suture removal days (OR 0.272, 95% CI = 0.133-0.556) were the protective factors. CONCLUSION:To promote the wound healing from the forceps delivery, obstetricians may consider to control the patient's labor length and degree of laceration, increase patient's nutrition, apply prophylactic antibiotics, and prolong the suture removal days. 10.1111/jog.14906
Preoperative Japanese Society for the Surgery of the Foot Lesser toe score and erythrocyte sedimentation rate influence wound healing following rheumatoid forefoot surgery. Ohta Koji,Fukushi Jun-Ichi,Ikemura Satoshi,Kamura Satoshi,Miyahara Hisa-Aki,Nakashima Yasuharu Modern rheumatology OBJECTIVES:Delayed wound healing is one of the most common complications following forefoot surgery in patients with rheumatoid arthritis. We aimed to identify the risk factors for delayed wound healing following rheumatoid forefoot surgery. METHODS:Consecutive patients who underwent primary rheumatoid forefoot surgery (86 feet; 53 patients) between April 2008 and February 2019 were retrospectively evaluated. Clinical data, including smoking history, duration of the disease, presence of diabetes mellitus, medication, white blood cell count, erythrocyte sedimentation rate (ESR), C-reactive protein, the surgical procedure performed, and the Japanese Society for Surgery of the Foot (JSSF) scores, were collected. RESULTS:Delayed wound healing was identified in 20 of 86 (23.3%) feet. In univariate analysis, participants showing delayed healing were older at the time of surgery ( = .04), their ESR was higher ( = .0006), and their total ( = .019) and pain ( = .016) scores on the JSSF Lesser toe scale were lower than those showing normal healing. In multivariable analysis, both the total preoperative JSSF Lesser toe scale score ( = .0239) and ESR ( = .0126) remained significant risk factors for delayed wound healing. CONCLUSIONS:After rheumatoid forefoot surgery, surgeons should pay more attention to wound care in patients with lower preoperative JSSF Lesser toe score and high ESR. 10.1080/14397595.2020.1775960
The Effect of Comorbidities on Wound Healing. Beyene Robel T,Derryberry Stephen Lentz,Barbul Adrian The Surgical clinics of North America Wound healing is affected by several factors. Preexisting diagnoses may significantly alter, delay, or inhibit normal wound healing. This is most commonly seen with chronic disorders, such as diabetes and renal failure, but also occurs secondary to aging and substance abuse. Less commonly, genetic or inflammatory disorders are the cause of delayed wound healing. In some cases, it is not the illness, but the treatment that can inhibit wound healing. This is seen in patients getting chemotherapy, radiation, steroids, methotrexate, and a host of other medications. Understanding these processes may help treat or avoid wound healing problems. 10.1016/j.suc.2020.05.002
Association of sleep-disordered breathing and wound healing in patients with diabetic foot ulcers. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine STUDY OBJECTIVES:Sleep-disordered breathing (SDB) is prevalent and associated with an increased risk of morbidity and mortality. However, whether SDB has an adverse impact on wound healing in patients with diabetic foot ulcers (DFUs) is uncertain. The purpose of this study was to investigate the association of SDB with wound healing in patients with DFUs. METHODS:A total of 167 patients with DFUs were enrolled between July 2013 and June 2019 at West China Hospital (Chengdu, China) to assess the association of SDB with wound healing, ulcer recurrence, and all-cause mortality. RESULTS:Whereas there was no significant association between apnea-hypopnea index (AHI) and wound healing, total sleep time (per hour: hazard ratio [HR], 1.15; 95% confidence interval [CI], 1.01-1.30; P = .029), sleep efficiency (per 10%: HR, 1.20; 95% CI, 1.04-1.37; P = .012), and wakefulness after sleep onset (per 30 minutes: HR, 0.89; 95% CI, 0.82-0.97; P = .008) were associated with wound healing. Total sleep time (per hour: odds ratio, 0.71; 95% CI, 0.51-0.97; P = .035) and sleep efficiency (per 10%: odds ratio, 0.68; 95% CI, 0.47-0.97; P = .033) were also associated with ulcer recurrence. Mean oxygen saturation (per 3%: HR, 0.68; 95% CI, 0.49-0.94; P = .021) and percentage of sleep time with oxygen saturation < 90% (per 10%: HR, 1.25; 95% CI, 1.03-1.53; P = .026) were significantly associated with mortality. CONCLUSIONS:SDB is highly prevalent in patients with DFUs but its severity, as conventionally measured by AHI, is not associated with wound healing. Sleep fragmentation and hypoxemia are stronger predictors of poor wound healing, high ulcer recurrence, and increased risk of death in patients with DFUs. 10.5664/jcsm.9088
Impact of compression stockings on wound healing and complications in ankle fractures: A retrospective cohort study. Abrahamsen Charlotte,Stork-Hansen Jesper,Joanroy Rajzan,Arndt Kristine Bollerup,Jordy Anders,Viberg Bjarke International journal of orthopaedic and trauma nursing INTRODUCTION:Ankle fractures treated with open reduction and internal fixation (ORIF) have a high incidence of wound complications. By reducing oedema, wound complications can, in theory, be minimized. This study investigates the impact of compression stocking (CS) on such complications after treatment with ORIF. METHODS:Compression stockings were introduced as a standard postoperative treatment for all ankle fracture patients treated operatively with ORIF on February 1, 2013. Data were retrieved from medical records two years prior to and following the introduction date. The primary outcome was wound healing status after six weeks and secondary outcomes were wound-healing and major complications up to one year after surgery. RESULTS:In total, 187 patients were studied, 74 in the CS group and 113 in the control (non-CS) group. Six weeks after the operation, wound-healing problems occurred in 23% and 13% of the patients in the CS group and the non-CS group (p < 0.0001) respectively. In total, 34% and 19% of the patients in the CS group and non-CS group experienced wound-healing complications one year after the operation (p < 0.02) respectively. Furthermore, major complications within one year occurred in 3% and 4% of patients respectively (p < 0.77). CONCLUSION:An increase in wound-healing complications after six weeks and one year when using CS was found. However, owing to baseline differences in the two groups, it is only possible to caution against the use of CS. 10.1016/j.ijotn.2021.100866