The Society for Vascular Surgery Objective Performance Goals for Critical Limb Ischemia are attainable in select patients with ischemic wounds managed with wound care alone

Crowner, Jason; Marston, William A.; Freeman, Nikki L. B.; Sperger, John; Austin, Haley D.; Steffan, Michael; Chung, Jayer; McGinigle, Katharine L.

doi:10.1016/j.avsg.2021.06.034

Cited by 7 publications

(4 citation statements)

References 22 publications

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“…Patients seeking care at the UNC Wound Care Clinic receive comprehensive wound management based on protocols that have been fully described elsewhere 12,13 . The protocol includes optimising wound debridement, control of wound infection, and occasional use of hyperbaric oxygen and living cellular wound therapies 14 . At every visit, wound sizes are monitored by measuring the maximum length, width, and depth.…”

Section: Methodsmentioning

confidence: 99%

“…Podiatrists assist in the design and prescription of offloading devices for personalised wound offloading treatment. Digital photography is used at every visit to document wound healing and allow for timestamped confirmation of complete wound healing 14 . Patients with severe ischaemia (toe pressure < 30 mmHg) are offered immediate revascularization (either endovascular or open surgery) unless their medical comorbidities prohibit invasive procedures.…”

Section: Methodsmentioning

confidence: 99%

“…12,13 The protocol includes optimising wound debridement, control of wound infection, and occasional use of hyperbaric oxygen and living cellular wound therapies. 14 At every visit, wound sizes are monitored by measuring the maximum length, width, and depth.…”

Section: Wound Carementioning

confidence: 99%

“…Digital photography is used at every visit to document wound healing and allow for timestamped confirmation of complete wound healing. 14 Patients with severe ischaemia (toe pressure < 30 mmHg) are offered immediate revascularization (either endovascular or open surgery) unless their medical comorbidities prohibit invasive procedures. Patients with mild-moderate ischaemia most often undergo a trial of wound healing prior to consideration of revascularization; however, revascularization is offered to patients with wounds that do not respond to initial wound management and those that worsen at any time during therapy.…”

Section: Wound Carementioning

confidence: 99%

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Differential impact of missed initial wound clinic visit on 6‐month wound healing by race/ethnicity among patients with chronic limb‐threatening ischemia

Browder

Yohann

Filipowicz³

et al. 2023

Wound Repair Regeneration

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Chronic limb‐threatening ischemia (CLTI) is associated with significant morbidity, including major limb amputation, and mortality. Healing ischemic wounds is necessary to optimize vascular outcomes and can be facilitated by dedicated appointments at a wound clinic. This study aimed to estimate the association between successful wound care initiation and 6‐month wound healing, with specific attention to differences by race/ethnicity. This retrospective study included 398 patients with CLTI and at least one ischemic wound who scheduled an appointment at our wound clinic between January 2015 and July 2020. The exposure was the completion status of patients' first scheduled wound care appointment (complete/not complete) and the primary outcome was 6‐month wound healing (healed/not healed). The analysis focused on how this association was modified by race/ethnicity. We used Aalen‐Johansen estimators to produce cumulative incidence curves and calculated risk ratios within strata of race/ethnicity. The final adjustment set included age, revascularization, and initial wound size. Patients had a mean age of 67 ± 14 years, were 41% female, 46% non‐White and had 517 total wounds. In the overall cohort, 70% of patients completed their first visit and 34% of wounds healed within 6‐months. There was no significant difference in 6‐month healing based on first visit completion status for White/non‐Hispanic individuals [RR (95% CI) = 1.18 (0.91, 1.45); p‐value = 0.130], while non‐White individuals were roughly 3 times more likely to heal their wounds if they completed their first appointment [RR (95% CI) = 2.89 (2.66, 3.11); p‐value<0.001]. In conclusion, non‐White patients were approximately three times more likely to heal their wound in six months if they completed their first scheduled wound care appointment while White/non‐Hispanic individuals' risk of healing was similar regardless of first visit completion status. Future efforts should focus on providing additional resources to ensure minority groups with wounds have the support they need to access and successfully initiate wound care.This article is protected by copyright. All rights reserved.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%