Limb salvage procedure in immunocompromised patients with therapy-resistant leg ulcers-The value of ultra-radical debridement and instillation negative-pressure wound therapy.
chronic leg ulcer
negative-pressure wound therapy
skin transplantation
ultra-radical debridement
Journal
International wound journal
ISSN: 1742-481X
Titre abrégé: Int Wound J
Pays: England
ID NLM: 101230907
Informations de publication
Date de publication:
Oct 2020
Oct 2020
Historique:
received:
18
04
2020
revised:
21
05
2020
accepted:
25
05
2020
pubmed:
24
6
2020
medline:
19
8
2021
entrez:
24
6
2020
Statut:
ppublish
Résumé
The purpose of this study was to analyse the outcome of our established triple treatment strategy in therapy-resistant deep-thickness chronic lower leg ulcers. This limb salvage approach consists of ultra-radical surgical debridement, negative-pressure wound therapy (NPWT) with or without instillation, and split-thickness skin grafting. Between March 2003 and December 2019, a total of 16 patients and 24 severe cases of lower leg ulcers were eligible for inclusion in this highly selective population. A total of seven patients received immunosuppressive medication. Complete wound closure was achieved in 25% and almost 90% of included lower leg ulcer cases after 3 and 24 months of our triple treatment strategy, respectively. The overall limb salvage rate was 100%. Bacterial colonisation of these wounds was significantly reduced after multiple surgical debridements and NPWT. Fasciotomy and radical removal of devitalised tissue such as deep fascia, tendons, and muscles combined with NPWT showed promising results in terms of the overall graft take rate. This treatment strategy was considered as last resort for limb salvage in such a critically ill and immunocompromised patient population. Surgeons should be aware of its efficacy and consider the triple treatment strategy especially if no other limb salvage option remains.
Identifiants
pubmed: 32573103
doi: 10.1111/iwj.13428
pmc: PMC7948940
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1496-1507Informations de copyright
© 2020 The Authors. International Wound Journal published by Medicalhelplines.com Inc and John Wiley & Sons Ltd.
Références
Int Wound J. 2019 Apr;16(2):503-510
pubmed: 30604928
Arch Orthop Trauma Surg. 2021 Apr;141(4):543-554
pubmed: 32266517
Clin Hemorheol Microcirc. 2019;72(4):365-374
pubmed: 30909192
Am J Surg. 1990 Nov;160(5):466-71; discussion 471-2
pubmed: 2240379
Phlebology. 2010 Oct;25 Suppl 1:42-51
pubmed: 20870819
J Vasc Surg. 2001 Jan;33(1):17-23
pubmed: 11137919
Wounds. 2012 Jan;24(1):10-7
pubmed: 25875947
J Plast Reconstr Aesthet Surg. 2018 Mar;71(3):394-401
pubmed: 28993127
Australas J Dermatol. 1992;33(2):75-80
pubmed: 1294056
Clin Hemorheol Microcirc. 2019;72(2):139-150
pubmed: 30664503
Int J Low Extrem Wounds. 2009 Mar;8(1):11-8
pubmed: 19189997
J Am Coll Surg. 1996 Jul;183(1):61-4
pubmed: 8673309
Int J Low Extrem Wounds. 2019 Mar;18(1):23-30
pubmed: 30841767
Int Wound J. 2020 Oct;17(5):1496-1507
pubmed: 32573103
Health Technol Assess. 2009 Nov;13(54):1-86, iii-iv
pubmed: 19922726
Int Wound J. 2019 Aug;16(4):1069-1072
pubmed: 31140713
Plast Reconstr Surg Glob Open. 2016 Oct 12;4(10):e1095
pubmed: 27826487
Ostomy Wound Manage. 2010 Jun;56(6):24-31
pubmed: 20567051
Zentralbl Chir. 2006 Apr;131 Suppl 1:S146-50
pubmed: 16575667
J Cutan Med Surg. 2008 Sep-Oct;12(5):223-9
pubmed: 18845091
Int Wound J. 2012 Apr;9(2):199-205
pubmed: 21992173
Ann Plast Surg. 2009 Dec;63(6):676-81
pubmed: 19887926
Expert Rev Med Devices. 2020 Feb;17(2):139-148
pubmed: 31920139
Int Wound J. 2004 Apr;1(1):19-32
pubmed: 16722894
Handchir Mikrochir Plast Chir. 2019 Dec;51(6):410-417
pubmed: 31698484
Int J Low Extrem Wounds. 2008 Jun;7(2):102-7
pubmed: 18492677
Indian J Plast Surg. 2012 May;45(2):266-74
pubmed: 23162226
J Wound Care. 2015 Jun;24(6 Suppl):S8, S10-2
pubmed: 26075514
Ann Epidemiol. 2019 Jan;29:8-15
pubmed: 30497932
Int J Surg. 2018 Feb;50:43-48
pubmed: 29292216
Wound Repair Regen. 2006 Sep-Oct;14(5):548-57
pubmed: 17014666
Acta Derm Venereol. 1994 Nov;74(6):484-5
pubmed: 7701894
Dermatology. 2011;223(1):87-92
pubmed: 21893960
Dtsch Arztebl Int. 2013 Jan;110(3):25-31
pubmed: 23413377
Foot Ankle Spec. 2010 Oct;3(5):231-40
pubmed: 20631059
Int Wound J. 2018 Dec;15(6):978-984
pubmed: 29974664
Int Wound J. 2020 Jun;17(3):790-803
pubmed: 32149471
J Wound Care. 2014 Nov;23(11):590, 592-6
pubmed: 25375407
Int Wound J. 2013 Dec;10 Suppl 1:48-55
pubmed: 24251844
J Med Econ. 2014 May;17(5):347-56
pubmed: 24625244
J Dtsch Dermatol Ges. 2011 Feb;9(2):116-21
pubmed: 20946240
Eur J Vasc Endovasc Surg. 1997 May;13(5):452-9
pubmed: 9166267
Int Wound J. 2017 Apr;14(2):322-330
pubmed: 27229943
J Vasc Surg. 2014 Jun;59(6):1657-63
pubmed: 24518607
Int Wound J. 2008 Jun;5(3):399-413
pubmed: 18593390
Dtsch Arztebl Int. 2011 Apr;108(14):231-7
pubmed: 21547162
Surg Technol Int. 2014 Mar;24:53-62
pubmed: 24574014
Ann Plast Surg. 2011 Mar;66(3):296-300
pubmed: 21233699
Diabetes Metab. 2002 Jun;28(3):223-9
pubmed: 12149603
Int Wound J. 2019 Oct;16(5):1079
pubmed: 31608572
Aust N Z J Surg. 1994 Apr;64(4):258-61
pubmed: 8147778
Int Wound J. 2020 Feb;17(1):107-116
pubmed: 31668019
Ann Plast Surg. 1997 Jun;38(6):563-76; discussion 577
pubmed: 9188971
Int Wound J. 2013 Oct;10(5):502-7
pubmed: 23742102
Ostomy Wound Manage. 2000 Nov;46(11):14-22, 24-8, 30-5; quiz 36-7
pubmed: 11889735
PLoS One. 2011;6(5):e20492
pubmed: 21655269
Int J Low Extrem Wounds. 2019 Mar;18(1):10-22
pubmed: 30663450
Int Wound J. 2020 Apr;17(2):241
pubmed: 32115898
Front Surg. 2019 Jul 02;6:39
pubmed: 31334246
Zentralbl Chir. 2013 Oct;138(5):536-42
pubmed: 23460106
Int Wound J. 2019 Aug;16(4):940-945
pubmed: 31016851
Int Wound J. 2016 Dec;13(6):1193-1197
pubmed: 25818405