PMID- 37939747
OWN - NLM
STAT- MEDLINE
DCOM- 20240226
LR  - 20240307
IS  - 1097-6809 (Electronic)
IS  - 0741-5214 (Linking)
VI  - 79
IP  - 3
DP  - 2024 Mar
TI  - Impact of wound management strategies after revascularization for chronic 
      limb-threatening ischemia.
PG  - 632-641.e3
LID - S0741-5214(23)02202-4 [pii]
LID - 10.1016/j.jvs.2023.11.003 [doi]
AB  - OBJECTIVE: There is no established consensus or guidelines for wound management 
      after revascularization for patients with chronic limb-threatening ischemia 
      (CLTI) without severe infection. This study is designed to evaluate the clinical 
      effect of the wound management strategy on toe wounds after revascularization for 
      CLTI. METHODS: This retrospective cohort study was performed at eight 
      institutions affiliated with Keio University School of Medicine in Japan and 
      included 261 patients who underwent revascularization for CLTI between April 2019 
      and July 2021. We identified 132 patients with toe wounds from the database who 
      had restored in-line blood flow to the foot. Patients were divided into two 
      groups by the timing of toe resection after revascularization, which dictated the 
      wound management policy. Group A (62 patients) underwent early toe amputation for 
      suspected osteomyelitis, whereas group B (70 patients) underwent watchful 
      waiting. The primary outcome was wound healing after revascularization; the 
      secondary outcome was major amputation. We compared outcomes between groups A and 
      B after propensity score matching. RESULTS: Using propensity score matching, each 
      patient in group A (33 patients) was matched with a patient in group B (33 
      patients). Wound healing in matched group A was significantly better than that in 
      matched group B (respectively: 1-year wound healing rate: 90.0% vs 68.2%, P < 
      .001; median wound healing time: 65 days vs 258 days, P < .01). Although five 
      major amputations were necessary in matched group B, none were required in 
      matched group A (P = .05). The high rate of major amputations in group B was 
      attributed to the sudden exacerbation of infection. Limb salvage rate in matched 
      group A exceeded matched group B (100.0% vs 90.5%: 1-year limb salvage rate, P = 
      .02). CONCLUSIONS: Early toe amputation for highly suspected osteomyelitis in 
      patients with CLTI with toe wounds may expedite wound healing compared with 
      watchful waiting, potentially avoiding unnecessary major amputation. Considering 
      the wound management strategy is crucial when evaluating wound healing outcomes 
      in patients with CLTI with revascularization.
CI  - Copyright (c) 2023 Society for Vascular Surgery. Published by Elsevier Inc. All 
      rights reserved.
FAU - Shintani, Tsunehiro
AU  - Shintani T
AD  - Department of Vascular Surgery, Shizuoka Red Cross Hospital, Shizuoka, Japan.
FAU - Obara, Hideaki
AU  - Obara H
AD  - Department of Surgery, Keio University School of Medicine, Tokyo, Japan. 
      Electronic address: obara.z3@keio.jp.
FAU - Matsubara, Kentaro
AU  - Matsubara K
AD  - Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
FAU - Hayashi, Masanori
AU  - Hayashi M
AD  - Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
FAU - Kita, Hidenori
AU  - Kita H
AD  - Department of Vascular Surgery, Shizuoka Red Cross Hospital, Shizuoka, Japan.
FAU - Ono, Shigeshi
AU  - Ono S
AD  - Department of Surgery, Tokyo Dental College Ichikawa General Hospital, Ichikawa, 
      Japan.
FAU - Watada, Susumu
AU  - Watada S
AD  - Department of Surgery, Kawasaki Municipal Hospital, Kawasaki, Japan.
FAU - Kikuchi, Naoya
AU  - Kikuchi N
AD  - Department of Surgery, Kawasaki Municipal Hospital, Kawasaki, Japan.
FAU - Sekimoto, Yasuhito
AU  - Sekimoto Y
AD  - Department of Surgery, Tokyo Medical Center, Tokyo, Japan.
FAU - Torizaki, Yukiko
AU  - Torizaki Y
AD  - Department of Surgery, Tokyo Medical Center, Tokyo, Japan.
FAU - Asami, Atsunori
AU  - Asami A
AD  - Department of Surgery, Saitama City Hospital, Saitama, Japan.
FAU - Fujii, Taku
AU  - Fujii T
AD  - Department of Surgery, Saitama City Hospital, Saitama, Japan.
FAU - Hayashi, Keita
AU  - Hayashi K
AD  - Department of Vascular Surgery, Hiratsuka City Hospital, Hiratsuka, Japan.
FAU - Harada, Hirohisa
AU  - Harada H
AD  - Department of Vascular Surgery, Saiseikai Central Hospital, Tokyo, Japan.
FAU - Fujimura, Naoki
AU  - Fujimura N
AD  - Department of Vascular Surgery, Saiseikai Central Hospital, Tokyo, Japan.
FAU - Hosokawa, Kyousuke
AU  - Hosokawa K
AD  - Department of Vascular Surgery, Saiseikai Central Hospital, Tokyo, Japan.
FAU - Nakatani, Eiji
AU  - Nakatani E
AD  - Graduate School of Public Health, Shizuoka Graduate University of Public Health, 
      Shizuoka, Japan.
FAU - Kitagawa, Yuko
AU  - Kitagawa Y
AD  - Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
LA  - eng
PT  - Journal Article
DEP - 20231107
PL  - United States
TA  - J Vasc Surg
JT  - Journal of vascular surgery
JID - 8407742
SB  - IM
MH  - Humans
MH  - Chronic Limb-Threatening Ischemia
MH  - Retrospective Studies
MH  - Treatment Outcome
MH  - Risk Factors
MH  - Ischemia/diagnostic imaging/surgery
MH  - Limb Salvage/adverse effects
MH  - *Osteomyelitis
MH  - *Peripheral Arterial Disease
MH  - Chronic Disease
MH  - *Endovascular Procedures/adverse effects
OTO - NOTNLM
OT  - CLTI
OT  - Osteomyelitis
OT  - Revascularization
OT  - Wound healing
OT  - Wound management
COIS- Disclosures N.F. has served as a consultant for Japan Lifeline and Cook Medical. 
      S.O. served as a consultant for Medico's Hirata. H.O. received educational grant 
      from Cardinal Health, Japan Blood Products Organization, JMS, Taiho 
      Pharmaceutical, Teijin Pharma Limited, MSD, Kaken Pharmaceutical, Sanofi, 
      Dainippon Sumitomo Pharma, Mitsubishi Tanabe Pharma Corporation, Nihon 
      Pharmaceutical, Japan Lifeline, Limfix, Medtronic Japan, Otsuka Pharmaceutical 
      Factory, Daiichi Sankyo Company, Johnson & Johnson, Otsuka Pharmaceutical, Kowa, 
      and W. L. Gore & Associates. Y.K. received lecture fees from Chugai 
      Pharmaceutical, Taiho Pharmaceutical, Asahi Kasei Pharma Corporation, Otsuka 
      Pharmaceutical Factory, Ono Pharmaceutical, Shionogi, AstraZeneca, Ethicon, 
      Bristol-Myers Squibb, Olympus Corporation, Cardinal Health, MSD, Smith & Nephew, 
      Kaken Pharmaceutical, Aska Pharmaceutical, Miyarisan Pharmaceutical, Toray 
      Industries, Daiichi Sankyo Company, Chugai Foundation for Innovative Drug 
      Discovery Science, Nippon Kayaku, EA Pharma, Intuitive Surgical, Takeda 
      Pharmaceutical Company Limited, Sysmex Corporation, and Tsumura; and received 
      educational grant from Chugai Pharmaceutical, Taiho Pharmaceutical, Yakult 
      Honsha, Asahi Kasei Pharma, Otsuka Pharmaceutical, Ono Pharmaceutical, Tsumura, 
      Kaken Pharmaceutical, Dainippon Sumitomo Pharma, EA Pharma, Eisai, Otsuka 
      Pharmaceutical Factory, Kyowa Kirin, Takeda Pharmaceutical, Teijin Pharma, Nippon 
      Covidien, Cardinal Health, and Kowa. All other authors declare that they have no 
      relevant conflicts of interest.
EDAT- 2023/11/09 00:42
MHDA- 2024/02/26 06:45
CRDT- 2023/11/08 19:13
PHST- 2023/08/13 00:00 [received]
PHST- 2023/10/20 00:00 [revised]
PHST- 2023/11/03 00:00 [accepted]
PHST- 2024/02/26 06:45 [medline]
PHST- 2023/11/09 00:42 [pubmed]
PHST- 2023/11/08 19:13 [entrez]
AID - S0741-5214(23)02202-4 [pii]
AID - 10.1016/j.jvs.2023.11.003 [doi]
PST - ppublish
SO  - J Vasc Surg. 2024 Mar;79(3):632-641.e3. doi: 10.1016/j.jvs.2023.11.003. Epub 2023 
      Nov 7.