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Seeing a Patient with a Wound

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Limb Preservation for the Vascular Specialist

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Abstract

Lower extremity wound management in patients with peripheral vascular disease can be daunting. The initial assessment consists of a physical exam of the wound, vascular status stratification, and risk factor modification (i.e., diabetes, nutrition, and infection). Based on this, the wound can be classified and then managed. Management is an important skill to have in limb preservation, consisting of both wound care techniques and treatment of the underlying causes. There is a wide array of wound care techniques from basic dressings to advanced surgical options. Advancements in surgical options have allowed for improved function, meaningful recovery, and limb preservation in these patients. Many factors related to health status, vascular integrity, and wound characteristics are evaluated to determine the appropriate technique for manage`ment.

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References

  1. Steinburg JS, Kim PJ. Evaluation and Management of the Diabetic foot wound. In: Southerland JT, Boberg JS, Downey MS, Nakra A, Rabjohn LV, editors. McGlamry’s comprehensive textbook of foot and ankle surgery, vol. 2. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2013. p. 986–1007.

    Google Scholar 

  2. Ledoux WR, Shofer JB, Smith DG. Relationship between foot type, foot deformity, and ulcer occurrence in the high-risk diabetic foot. J Rehabil Res Dev. 2005;42(5):665–72.

    Article  PubMed  Google Scholar 

  3. Wagner FW. The diabetic foot. Orthopedics. 1987;10(1):163–72.

    Article  PubMed  Google Scholar 

  4. Meggit B. Surgical management of the diabetic foot. Br J Hosp Med. 1976;16:227–32.

    Google Scholar 

  5. National Pressure Sore Advisory Panel. Consensus Development Conference Staging System, February 2007. http://www.npuap.org/pr2.htm (Accessed August 7, 2011).

  6. Bhrem H, Sheehan P, Boulton AJM. Protocol for treatment of diabetic foot ulcers. Am J Surg. 2004;187(Suppl):1S–10S.

    Google Scholar 

  7. Sheehan P, Jones P, Casselli A, et al. Percent change in wound area of diabetic foot ulcers over a 4 week period is a robust predictor of complete healing in a 12 week prospective trial. Diabetes Care. 2003;26(6):1879–82.

    Article  PubMed  Google Scholar 

  8. Holloway S, Harling KG. Wound dressings. Wound Manage. 2021;10:25–32.

    Google Scholar 

  9. Anderson K, Hamm RL. Factors that impair wound healing. J Am Coll Clin Wound Specialist. 2014;4:84–91.

    Article  Google Scholar 

  10. Haalboom M, Blokhauis-Arkes MHE, Beuk RR, Meerwaldt R, Klont R, Schijffelen MJ, Bowler RB, Burnet M, Sigl E, van der Palen JAM. Culture results from wound biopsy verses swab: does it matter for the assessment of wound infection? Clin Microbiol Infect. 2019;25:629.e7–629.e12.

    Article  CAS  PubMed  Google Scholar 

  11. Snyder RJ, Driver V, Fife CE, Lantis J, Peirce B, Serena T, et al. Using a diagnostic tool to identify elevated protease activity levels in chronic and stalled wounds: a consensus panel discussion. Ostomy Wound Manage. 2011;57:36–46.

    PubMed  Google Scholar 

  12. Eming SA, Martin P, Tomic-Canic M. Wound repair and regeneration: mechanisms, signaling, and translation. Sci Transl Med. 2014;6(265):265sr6. https://doi.org/10.1126/scitranslmed.3009337.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Schultz GS, Chin GA, Moldawer L, et al. Principles of wound healing. In: Fitridge R, Thompson M, editors. Mechanisms of vascular disease: a reference book for vascular specialists [Internet]. Adelaide (AU): University of Adelaide Press; 2011. p. 23. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534261/.

  14. Liu YF, Ni PW, Huang Y, Xie T. Therapeutic strategies for chronic wound infection. Chin J Traumatol. 2022;25(1):11–6. https://doi.org/10.1016/j.cjtee.2021.07.004.

    Article  CAS  PubMed  Google Scholar 

  15. Pappalardo J, Plemmons B, Armstrong D. wound healing simplification: a vertical and horizontal philosophy illustrated. J Wound Technol. 2013;19:38–9.

    Google Scholar 

  16. Snyder RJ, Kirsner RS, Warriner RA 3rd, Lavery LA, Hanft JR, Sheehan P. Consensus recommendations on advancing the standard of care for treating neuropathic foot ulcers in patients with diabetes. Ostomy Wound Manage. 2010;56:S1–S24.

    PubMed  Google Scholar 

  17. Hong WX, Hu MS, Esquivel M, Liang GY, Rennert RC, McArdle A, Paik KJ, Duscher D, Gurtner GC, Lorenz HP, Longaker MT. The role of hypoxia-inducible factor in wound healing. Adv Wound Care. 2014;3(5):390–9. https://doi.org/10.1089/wound.2013.0520.

    Article  Google Scholar 

  18. Gesell LB, editor. Hyperbaric oxygen therapy indications. 12th ed. Durham, NC: Undersea and Hyperbaric Medical Society; 2008.

    Google Scholar 

  19. Bhutani S, Vishwanath G. Hyperbaric oxygen and wound healing. Indian J Plastic Surg. 2012;45(2):316–24. https://doi.org/10.4103/0970-0358.101309.

    Article  Google Scholar 

  20. Shah J. Hyperbaric oxygen therapy. J Am Coll Certified Wound Specialists. 2010;2(1):9–13. https://doi.org/10.1016/j.jcws.2010.04.001.

    Article  Google Scholar 

  21. “New Evidence- Based Therapies for Complex Diabetic Foot Wounds - ADA Compendium Boulton Armstrong et Al 2022.pdf.” n.d.

    Google Scholar 

  22. Nataraj M, Maiya AG, Karkada G, et al. Application of topical oxygen therapy in healing dynamics of diabetic foot ulcers: a systematic review. Rev Diabet Stud. 2019;15:74–82.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Connaghan F, Avsar P, Patton D, O’Connor T, Moore Z. Impact of topical oxygen therapy on diabetic foot ulcer healing rates: a systematic review. J Wound Care. 2021;30:823–9.

    Article  PubMed  Google Scholar 

  24. Armstrong DG, Boulton AJM, Bus SA. Diabetic foot ulcers and their recurrence. N Engl J Med. 2017;376(24):2367–75. https://doi.org/10.1056/NEJMra1615439.

    Article  PubMed  Google Scholar 

  25. Thanigaimani S, Singh T, Golledge J. Topical oxygen therapy for diabetes-related foot ulcers: a systematic review and meta-analysis. Diabet Med. 2021;38:e14585.

    Article  CAS  PubMed  Google Scholar 

  26. Ho J, Walsh C, Yue D, Dardik A, Cheema U. Current advancements and strategies in tissue engineering for wound healing: a comprehensive review. Adv Wound Care. 2017;6(6):191–209. https://doi.org/10.1089/wound.2016.0723.

    Article  Google Scholar 

  27. Figus A, Leon-Villapalos J, Philp B, Dziewulski P. Severe multiple extensive postburn contractures: a simultaneous approach with total scar tissue excision and resurfacing with dermal regeneration template. J Burn Care Res. 2007 Nov-Dec;28(6):913–7. https://doi.org/10.1097/BCR.0b013e318159eb8c.

    Article  PubMed  Google Scholar 

  28. Snyder DL, Sullivan N, Schoelles KM. Skin substitutes for treating chronic wounds. Final report. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2012 Dec 18. 203 p. (Technology assessment report; Also available: http://www.ahrq.gov/research/findings/ta/skinsubs/HCPR0610_skinsubst-final.pdf.

  29. Armstrong DG, Tettelbach WH, Chang TJ, De Jong JL, Glat PM, Hsu JH, Kelso MR, Niezgoda JA, Tucker TL, Labovitz JM. Observed impact of skin substitutes in lower extremity diabetic ulcers: lessons from the Medicare Database (2015–2018). J Wound Care. 2021;30(Sup7):S5–S16. https://doi.org/10.12968/jowc.2021.30.Sup7.S5.

    Article  PubMed  Google Scholar 

  30. Kaye KS, Petty LA, Shorr AF, Zilberberg MD. Current epidemiology, etiology, and burden of acute skin infections in the united states. Clin Infect Dis. 2019;68(Suppl 3):S193–9. https://doi.org/10.1093/cid/ciz002.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Stevens DL, Bisno AL, Chambers HF, Patchen Dellinger E, Goldstein EJC, Gorbach SL, Hirschmann JV, Kaplan SL, Montoya JG, Wade JC. Practice Guidelines for the diagnosis and management of skin and soft tissue infections: 2014 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2014;59(2):e10–52. https://doi.org/10.1093/cid/ciu296.

    Article  PubMed  Google Scholar 

  32. Mills JL, Conte MS, Armstrong DG, Pomposelli FB, Schanzer A, Sidawy AN, Andros G, Society for Vascular Surgery Lower Extremity Guidelines Committee. The Society for Vascular Surgery lower extremity threatened limb classification system: risk stratification based on Wound, Ischemia, and foot Infection (WIfI). J Vasc Surg. 2014;59(1):220–34. based on Wound, Ischemia, and foot Infection (WIfI). Journal of Vascular Surgery. 2014;59(1):220–234.e2

    Article  PubMed  Google Scholar 

  33. Miller JD, Lew EJ, Giovinco NA, et al. How to create a hot foot line to prevent diabetes-related amputations: instant triage for emergency department and inpatient consultations. J Am Podiatr Med Assoc. 2019;109(2):174–9.

    Article  PubMed  Google Scholar 

  34. Black CK, Zolper EG, Ormiston LD, Schwitzer JA, Luvisa K, Attinger CE, et al. Free anterolateral thigh versus vastus lateralis muscle flaps for coverage of lower extremity defects in chronic wounds. Ann Plast Surg. 2020 Jul;85(S1):S54–9.

    Article  CAS  PubMed  Google Scholar 

  35. Hollenbeck ST, Toranto JD, Taylor BJ, Ho TQ, Zenn MR, Erdmann D, et al. Perineal and lower extremity reconstruction. Plast Reconstr Surg. 2011;128(5):551e–63e.

    Article  PubMed  Google Scholar 

  36. Wei FC, Mardini S. Flaps and reconstructive surgery; 2017.

    Google Scholar 

  37. Dumanian GA, Potter BK, Mioton LM, Ko JH, Cheesborough JE, Souza JM, et al. Targeted muscle reinnervation treats neuroma and phantom pain in major limb amputees: a randomized clinical trial. Ann Surg. 2019;270(2):238–46.

    Article  PubMed  Google Scholar 

  38. Chang BL, Mondshine J, Attinger CE, Kleiber GM. Targeted muscle reinnervation improves pain and ambulation outcomes in highly comorbid amputees. Plast Reconstr Surg. 2021;148(2):376–86.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Weil Foot and Ankle Institute, Chicago, IL, USA

    Nicholas Alianello & Hannah K. Park

  2. Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    David G. Armstrong & J. Karim Ead

  3. Department of Surgery, Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL, USA

    Amir Dorafshar, David Kurlander & Idanis Perez-Alvarez

  4. Department of Vascular and Interventional Radiology, Rush University Medical Center, Chicago, IL, USA

    Sreekumar Madassery

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  1. Nicholas Alianello
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  2. David G. Armstrong
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  3. Amir Dorafshar
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  4. J. Karim Ead
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  5. David Kurlander
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  6. Sreekumar Madassery
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  7. Hannah K. Park
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  8. Idanis Perez-Alvarez
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Editor information

Editors and Affiliations

  1. Rush University Medical Center, Chicago, IL, USA

    Sreekumar Madassery

  2. Rush University Medical Center, Chicago, IL, USA

    Aesha Patel

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Alianello, N. et al. (2023). Seeing a Patient with a Wound. In: Madassery, S., Patel, A. (eds) Limb Preservation for the Vascular Specialist. Springer, Cham. https://doi.org/10.1007/978-3-031-36480-8_2

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  • DOI: https://doi.org/10.1007/978-3-031-36480-8_2

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-36479-2

  • Online ISBN: 978-3-031-36480-8

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