ABSTRACT

Introduction: The therapeutic effect of chemical lumbar sympathectomy (CLS) on ischemic diseases of the lower limbs varies greatly among individuals. The time to peak (TTP) response in contrast-enhanced ultrasound (CEUS) can reflflect the perfusion disorder of the calf skeletal muscle and the collateral circulation. In this study we evaluated the predictive value of CEUS in patients treated with CLS for end-stage atherosclerotic occlusive disease of the lower extremity (ASO-LE).

Methods: This was a prospective study that included patients with end-stage ASO-LE and moderate to severe pain who had undergone a CEUS examination and CLS procedure and who were observed for 12 months after surgery. The patients’ characteristics and prognostic factors,including lower limb pain score, skin temperature, walking distance, and ulcer and gangrene healing, were recorded.

Results: Fifty-eight patients with a mean age of 66.24 (range 58–78) years were included in the study, of whom 42 (71.41%) were men. Following the CLS procedure, the numerical rating scale (NRS)-measured pain decreased signififi- cantly, and the skin temperature of the affected limb increased signifificantly (P \0.05). The satisfaction rate of lower limb pain relief 1 year after operation was 53.45%. Correlation analysis showed that preoperative TTP response was correlated with the NRS score and skin temperature of the affected limb at 6 months and 12 months post surgery (P \ 0.05). The binary logistic regression analysis indicated that a longer preoperative TTP response was associated with a higher risk of poor pain relief after CLS (odds ratio 1.126, 95% confifidence interval 1.058–1.205). The receiver operating characteristic curve showed that preoperative TTP response had a certain predictive value on CLS treatment effect, with a sensitivity and speci-fificity of 81.5% and 83.9%, respectively. When the preoperative TTP response was [ 77.5, the risk of poor response after CLS increased.

Conclusions: Preoperative TTP response was able to predict the therapeutic effect of CLS to a certain extent, and thus may aid physicians in determining the choice of CLS treatment for patients with ASO-LE.

Trial Registration: Chinese Clinical Trial Registry: ChicTR1900028424 (principal investigator: Yue Wu; date of registration: 21 December 2019).

Keywords: The time to peak; Peripheral arterial disease; Arteriosclerosis obliterans; Skeletal muscle; Collateral circulation

Abstract:Negative pressure wound therapy with instillation (NPWTi) has the dual function of negative pressure sealing drainage and irrigation, which overcomes the disadvantages of NPWT, such as tube obstruction, inability to apply topical medicine, and poor anti-infection ability. NPWTi has been researched exten sively and widely used in various types of wounds, and certain effects have been achieved. A series of parameters for NPWTi have not been unified at present, including the flushing fluid option, flushing mode, and treatment period. This paper reviews the research progress of these parameters for NPWTi and their application in the treatment of orthopaedic wounds.

KEYWORDS:instillation, negative pressure wound therapy, orthopaedic wounds, treatment parameters

      Objective. To compare the clinical effffects of modifified above-knee and conventional surgery with the stripping of the greatsaphenous vein of varicose veins of the lower extremities. Methods. Clinical data of patients with a varicose vein of the lower extremity from May 2016 to May 2018 were collected. A retrospective study was conducted on the patients receiving modifified above-knee and conventional surgery with the great saphenous vein stripping. The baseline characteristics and long-term follow-up data were compared between the groups. Results. There were no signifificant difffferences in baseline characteristics between the two groups (P > 0:05). The surgeries were successfully performed by the same group of surgeons under local anesthesia and neuraxial anesthesia. The hospital stay, operation time, intraoperative blood loss, total length, and number of incisions in the above-knee group were comparable to those in the conventional surgery group (P > 0:05). The incidence of saphenous nerve injury and subcutaneous hematoma in the above-knee group was lower than that in the conventional surgery group (P < 0:05). There were no signifificant difffferences in recurrent varicose vein incidences (P > 0:05). After surgery, the venous clinical severity score (VCSS) and chronic venous insuffiffifficiency questionnaire (CIVIQ-14) scores of both groups were higher than those before operation (P < 0:05). There was no signifificant difffference in VCSS score or CIVIQ-14 scores between the two groups postoperation (P > 0:05). At 24 months after surgery, the above-knee group (71.8%) and conventional surgery group (73.2%) resulted in changes of at least two CEAP-C clinical classes lower than baseline, respectively. Conclusion. The modifified above-knee technique can ensure clinical outcomes, reduce intraoperative blood loss and complication incidences, and shorten the operative time. This gives evidence that the modifified above-knee technique is worthy of clinical application.

      Wound healing is one of the most complex physiological regulation mechanisms of the human body. Stem cell technology has had a signifificant impact on regenerative medicine. Adipose stem cells (ASCs) have many advantages, including their ease of harvesting and high yield, rich content of cell components and cytokines, and strong practicability. They have rapidly become a favored tool in regenerative medicine. Here, we summarize the mechanism and clinical therapeutic potential of ASCs in wound repair.

Keywords: adipose stem cells, wound healing, regenerative medicine, skin regeneration, inflflammation