Amputation stump perfusion is predictive of post-operative necrotic eschar formation

Silva, Gayan S. De; Saffaf, Khalid; Sánchez, Luis A.; Zayed, Mohamed A.

doi:10.1016/j.amjsurg.2018.05.007

Cited by 5 publications

(11 citation statements)

References 28 publications

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Section: Discussionmentioning

confidence: 99%

“…Therefore, our study builds upon a growing body of evidence showing that treatment with NAC may help improve tissue healing and perfusion -particularly in the setting of severe ischemia and underlying mal-perfusion. 7 Various mechanisms have been proposed for the impact of NAC on tissue healing and regeneration. In cardiac tissue, NAC was observed to induce PI3K/AKT signaling and reduce cardiac ische-mia-reperfusion injury.…”

Section: Discussionmentioning

confidence: 99%

“…All patients throughout the study period had intravenous access to facilitate ICG injections for serial laserassisted fluorescent angiography (LAFA; SPY Elite system) of the amputation stump was performed as previously described. 7,14,15 In an intention-to-treat fashion, patients were evaluated on postoperative day 0 (POD0; intraoperatively), 3, and 5 with LAFA, and anthropo-metric clinical assessments of the amputation stumps were also performed. Patients were discharged from the hospital when they met clinical criteria for discharge.…”

Section: Methodsmentioning

confidence: 99%

“…Based on our prior findings, patients with baseline amputation stump perfusion defects were considered to be higher risk of poor amputation site healing. 7…”

Section: Methodsmentioning

confidence: 99%

“…[3][4][5][6] We previously observed that a proportion of patients with CLTI are especially higher risk of poor amputation stump healing due to poor inflow within the arterial cul-de-sac of a newly created major amputation stump site. 7 However, despite recent advances in care, there are currently no widely accepted management strategies for augmenting perfusion at amputation operative sites in patients who are traditionally more prone to poor healing.…”

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confidence: 99%

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Impact of N-Acetyl-Cysteine on Ischemic Stumps Following Major Lower Extremity Amputation

et al. 2022

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To evaluate the impact of N-acetyl-cysteine (NAC) on amputation stump perfusion and healing in patients with critical limbthreatening ischemia (CLTI). Background: Patients with CLTI are at increased risk of poor amputation site healing leading to increased procedure-associated morbidity. Methods: In a pilot, double-blind, placebo-controlled, randomized controlled trial, patients with CLTI undergoing major elective lower extremity amputation were randomized 1:1 to intravenous NAC (1200 mg twice-daily) or placebo for up to 5 days postoperatively. Primary outcomes were change in stump perfusion at postoperative day 3 (POD3) and POD5, and healing at POD30. Stumps were serially evaluated for wound healing, and tissue perfusion was evaluated using noninvasive laser-assisted fluorescent angiography. Results: Thirty-three patients were randomized to NAC (n = 16) or placebo (n = 17). Thirty-one patients were eligible for intent-to-treat analysis (NAC14; placebo17). Twenty patients (NAC7; placebo13) had amputation stump perfusion defects at POD0 and were considered highrisk for poor healing. Intent-to-treat analysis revealed no significant differences between treatment groups. Subgroup analysis of high-risk patients revealed differences in stump perfusion defect size (NAC-0.53-fold, placebo +0.71-fold; 95% confidence interval -2.11 to-0.35; P < 0.05) and healing (NAC [100%], placebo [46%]; P < 0.01) between study treatments. Conclusions: Postoperative NAC administration may improve amputation stump perfusion and healing in patients with CLTI and tissue perfusion defects at the time of amputation. Intraoperative laser-assisted fluorescent angiogra-phy may help surgeons identify high-risk patients with stump perfusion defects and provide early adjunctive interventions. Future studies can further explore the therapeutic benefits of NAC in the healing and perfusion of other surgical operative sites in high-risk individuals. Trial Registration: clinicaltrials.gov, Identifier: NCT03253328.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…Based on our prior findings, patients with baseline amputation stump perfusion defects were considered to be higher risk of poor amputation site healing. 7…”

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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