Predictive Factors for Limb Salvage and Foot Ulcer Recurrence in Patients with Chronic Limb-Threatening Ischemia After Multidisciplinary Team Treatment: A 6-Year Japanese Single-Center Study

Chronic limb-threatening ischemia (CLTI) is associated with a short-term risk of limb loss. Multidisciplinary teams are often involved in CLTI treatment; however, in Asian countries, multidisciplinary teams that include podiatrists specializing in foot wounds and vascular surgeons who can perform distal bypass surgery are lacking. We investigated predictive factors for limb salvage and foot ulcer recurrence in patients with CLTI treated by a Japanese single-center intensive multidisciplinary team over 6 years. We retrospectively investigated 84 patients with CLTI and foot ulcers who had undergone revascularization and wound treatment between October 2013 and December 2019. Following postrevascularization treatment, including undertaking minor amputations, the healing rate was 77.8%, and the average wound healing time was 75 ± 68 days. To achieve adequate blood supply, 17.7% of patients were treated using a combination of endovascular revascularization and bypass surgeries. Thirty-three (44%) patients had wound recurrence and there was wound recurrence within 6 months in 58.9% of these patients. Multivariate logistic regression analysis showed that postrevascularization skin perfusion pressure was significantly associated with wound healing (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.033-1.243, P = .0078). Diabetes mellitus (OR 9.72, 95% CI 1.855-50.937, P = .0071), and heart disease (OR 3.51, 95% CI 1.052-11.693, P = .0411) were significantly associated with wound recurrence ( P < .05). Treatment within a single-center intensive multidisciplinary team resulted in good patient outcomes. Our study indicates that the revascularization endpoint of CLTI treatment should be marked by attainment of adequate blood supply and wound healing. The timing of revascularization and debridement is of utmost importance for the successful treatment of CLTI wounds.

Hubungan tingkat pengetahuan dengan perilaku pencegahan kekambuhan luka diabetik

ABSTRACTLuka pada pasien diabetes mellitus yang sudah membusuk dan bisa melebar, ditandai dengan jaringan yang mati berwarna kehitaman dan berbau busuk, dan bila tidak tertangani dapat menyebabkan kematian jaringan dan bisa mengakibatkan kematian.Dalam keadan lanjut, amputasi menjadi terapi akhir untuk mencegah pelebaran luka. Penanganan luka pasca operasi dan pengetahuan tentang pencegahan terjadinya luka menjadi hal penting untuk mencegah kekambuhan ulang. Tanpa pengetahuan yang baik tentang perawatan , luka diabetik akan muncul berulang dan mengakibatkan hilangnya bagian tubuh karena kematian jaringan. Tujuan penelitian ini adalah menganalisis hubungan tingkat pengetahuan dengan perilaku pencegahan kekambuhan luka diabetik di Di Ruang Penyakit Dalam RSUD Gambiran Kediri.Desain yang digunakan dalam penelitian ini adalah korelasional. Populasinya pasien Diabed di ruang penyakit Dalam RSUD Gambiran . Sampel diambil dengan teknik consecutive samping sejumlah 29 responden.Variabel independennya adalah tingkat pengetahuan pasien tentang pencegahan luka diabetik dan variable dependennya adalah perilaku pencegahan kekambuhan luka diabetik. Data diambil dengan questioner dan dianalisis dengan Uji Spearman Rank.Hasil penelitian menunjukkan bahwa pengetahuan pasien tentang pencegahan luka diabetik adalah baik sebanyak 24 responden (82,75 %). Perilaku pencegahan luka diabetik sebagian besar adalah cukup 15 orng (51,726 %). Uji Spearman Rank menunjukkan Ada hubungan tingkat pengetahuan dengan perilaku pencegahan luka diabetik di Di Ruang RSUD Gambiran Kota Kediri (spearman rank dengan p = 0,003 < 0,05, artinya H0 ditolak dan H1diterima). Coefficient correlation = 0,404, menunjukkan adanya hubungan ke arah positif artinya semakin baik tingkat pengetahuan maka perilaku pencegahan luka diabetik juga semakin baik. Sebagai tindak lanjut dalam meningkatkan perilaku pencegahan kekambuhan luka dibetik pada pasien yang pernah menderita luka diabetik maupun yang belum pernah, perlu upaya untuk meningkatkan pengetahuan pasien dan kelarga tentang cara perawatan pasien Diabet terutama dalam menjaga kestabilan gula darah dalam batas normal,melalui pola diet dan cara pemeliharaan integritas kulit agar tidak terjadi luka dibetik. Kata Kunci : Pengetahuan, Perilaku, luka Diabetik, kekambuhanABSTRACTWound on diabetic patient signed by blacknumb tissue and badsmell, ifits not hand ledthet issue will numband tousebedie. In advanced circumstances, amputation becomes a final therapy to prevent widening of the wound.Treatment postoperative wounds and knowledge of prevention of injury are important to prevent recurrence. Without good knowledge about treatment, diabetic wounds will recur and cause loss of body parts due to necrotic tissue . The purpose of this study was to analyze the relationship between the level of knowledge with behavioral prevention of diabetic wound recurrence in the Internist Room, Gambiran Kediri Hospital. The design used in this study is correlational. The population is internist patients of Gambiran Hospital. Samples were taken by consecutive techniques totaling 29 respondents. The independent variable is the level of patient knowledge about the prevention of diabetic wounds and the dependent variable is the behavior of diabetic wound recurrence prevention. The data was taken with a questionnaire and analyzed by the Spearman Rank Test. The results showed that the patient's knowledge of the prevention of diabetic wounds was good as many as 24 respondents (82.75%). Preventive behavior of diabetic wounds is mostly 15 people (51.72%). The Spearman Rank test shows that there is a relationship between the level of knowledge with the behavioral prevention of diabetic wounds in the internist room of Gambiran Hospital (spearman rank with p = 0.003 <0.05, meaning that H0 is rejected and H1 is accepted). Coefficient correlation = 0.404, indicating a positive relationship means that the better the level of knowledge, the better the prevention behavior of diabetic wounds. As a follow-up in improving the prevention behavior of randomized wound recurrence in patients who have suffered from diabetic wounds or who have never before, it is necessary to increase the knowledge of patients and family members on how to treat diabetic patients, especially in maintaining blood sugar stability within normal limits, through diet and methods. maintenance of the integrity of the skin so that no wounds occur.Keywords: Knowledge, Behavior, Diabetic wounds, recurrence

Wound healing of critical limb ischemia with tissue loss in patients on hemodialysis

We assessed wound healing in patients on hemodialysis (HD) with critical limb ischemia (CLI). This study enrolled 267 patients (including 120 patients on HD and 147 patients not on HD) who underwent endovascular therapy (EVT) for CLI. The primary endpoint was wound-healing rate at two years. Secondary endpoints were time to wound healing, wound recurrence rate, and limb salvage at two years. The percentage of male and young patients was higher in the HD patients ( p < 0.01). A lower patency of the pedal arch after EVT was observed frequently in HD patients ( p < 0.01). The wound-healing rate was significantly lower in HD patients (79.5% vs. 92.4%, p < 0.001). Time to wound healing was significantly longer in HD patients (median 132 days vs. 82 days, p = 0.005). Wound recurrence was observed more frequently in HD patients (25.0% vs. 10.2%, p = 0.007). Limb salvage (72.8% vs. 86.4%, p = 0.002) was significantly lower in HD patients. In a cox proportional hazard model, HD was an independent predictor of wound healing (risk ratio (RR), 0.46; 95% confidence interval (CI), 0.33–0.62; p < 0.001) and wound recurrence (RR, 1.58; 95% CI, 1.11–2.22; p = 0.01). HD was independently associated with lower and delayed wound healing, and wound recurrence.