SLR - January 2024 - Keane
Title: Analysis of wound healing time and wound-free period in patients with chronic limb-threatening ischemia treated with and without revascularizationReference: Browder SE, Ngeve SM, Hamrick ME, Wood JE, Parodi FE, Pascarella LE, Farber MA, Marston WA, McGinigle KL. Analysis of wound healing time and wound-free period in patients with chronic limb-threatening ischemia treated with and without revascularization. J Vasc Surg. 2022 Dec;76(6):1667-1673.e1. doi: 10.1016/j.jvs.2022.05.025. Epub 2022 Jul 8. PMID: 35810955.
Level of Evidence: III
Reviewed By: Spencer Keane, DPM
Residency Program: Emory University School of Medicine Podiatric Medicine and Surgery Residency
Podiatric Relevance: Chronic limb ischemia is routinely seen in Podiatric patients, especially with chronic wounds. Podiatry and Vascular surgery work hand-in-hand with these types of patients. Having an understanding of the algorithm, used by Vascular Surgery, for working up a patient with chronic limb ischemia can help aid the Podiatrist in patient communication and patient care. Patients with this condition commonly undergo revascularization procedures to help restore blood flow in a hope to heal chronic non-healing wounds. This article helps shine a light on the success rates of healing for patients both undergoing revascularization and not undergoing revascularization.
Methods: A level III retrospective single-institution cohort study was evaluated for the long-term wound outcomes of patients treated for chronic limb ischemia treated with and without revascularization. Data was collected from 2014-2017, which included wound size, wound location, WIfI (wound, ischemia, foot infection) grade, WHT (wound healing time), WFP (wound free period), minor and major amputations, and death. The final sample size was 256 patients with 372 wounds. The wounds were followed from initial presentation for 3 years. All patients did receive wound care, which was documented. The primary measurement of success was whether they received revascularization or not, and if this aided in the WHT and WFP.
Results: Although, some minor differences the author’s found no statistical difference in WHT and WFP between the non revascularized and revascularized group. Of the 256 patients 48% had undergone revascularization and 42% of the wounds had healed. However, for the 155 wounds that healed the average size was 4.0 +/- 9.6 cm2. 97 of the patients underwent minor amputations, 100 underwent major amputations, and 132 died. Of the 141 patients who underwent revascularization, 36 required further intervention within 3 years. Those with less severe WIfI and less severe ischemia were more likely to experience wound healing (55%, 49%, and 33% of wounds with ischemia grade 1,2, and 3, respectively). No wounds for patients with WIfI stage 4 healed without revascularization. WHT was shorter for the non revascularization group, but not statistically different. WFP was longer for those who had been revascularized vs not it was still not statistically different. When stratified by revascularization status, the rate of wound recurrence was 8.9 wounds/100 person-years for the no revascularization group compared with 4.6 wounds/100 person years for the revascularization group.
Conclusions: Overall no statistical significance was found between the revascularized and non revascularized group for healing time. Except for patients with severe ischemia, revascularization was not associated with improved rates of wound healing. Limitations to the study include a single institution which may have aided in bias. Revascularization methods were at the surgeons discretion. A larger national representative study is needed. It is important to consider which stage each patient’s wound is in determining the need for vascular intervention to aid in wound healing.