title: Tibial corticotomy and periosteal elevation induce angiogenesis in chronic critical limb ischaemia.
abstract: Corticotomy and periosteal elevation as a surgical procedure for management of chronic critical limb ischaemia is a relatively new technique. The current study aimed at assessing its safety, efficiency and cost/benefit ratio. The procedure was performed in 36patients. Preoperative documentation for age, sex, co-morbidities, ankle systolic pressure, and magnetic resonance contrast angiography was obtained. Early results included evaluation of skin perfusion. Late results involved assessment of wound healing, which was documented with photographs and was graded (healed, healing, resistant, recurrent), pain (intermittent claudication and pain at rest), Kelkar score, procedure morbidity, patient satisfaction and quality of life. Mean age was 68.03 +/- 5.5 years; 23 patients were males (63.9%) and 13 females (36.1%). Twenty (55.6%) patients had ankle systolic pressure < 50 mmHg and 29 (80.5%) had infra-inguinal vascular disease. Skin perfusion improved in 33/36 patients (91.7%). At final follow-up, 34 patients (94.1%) achieved complete wound healing. Relief from ischaemic rest pain and intermittent claudication was achieved in 86.1% and 55.6% respectively, with 20 (55.6%) patients having an excellent Kelkar score. Only one patient required a major amputation. Morbidity was noted in 17.7% of cases. Patient satisfaction scores at 12 months and at final follow-up were 7.1 +/- 1.3, and 8.7 +/- 1.7 respectively, on a scale from 0 to 10. Quality of life was markedly improved as compared to the preoperative status (overall score: p = 0.05, mental health scale: p <0.05 and pain/anxiety domain: p < 0.001). The procedure appears to represent an interesting tool, which should be evaluated in randomised studies. Our findings support the postulated angiogenic effect of the fracture haematoma.
authors.affiliation: Department of Surgery, Mansoura University, Mansoura, Egypt.
authors.forename: Saleh
authors.initials: S
authors.lastname: El-Awady
authors.forename: Ayman M
authors.initials: AM
authors.lastname: Ali
authors.forename: Osama
authors.initials: O
authors.lastname: Kumber
authors.forename: Sied Abd
authors.initials: SA
authors.lastname: El-Maksoud
authors.forename: Mohamed
authors.initials: M
authors.lastname: Fareed
mesh_terms: D000368:Aged; D002908:Chronic Disease; D003346:Corticotropin-Releasing Hormone / Q000031:analogs & derivatives; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000628:therapy; D007511:Ischemia / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010521:Periosteum / Q000601:surgery; D011788:Quality of Life; D013977:Tibia / Q000601:surgery*
chemical_list: C055243:corticotropin-releasing hormone, Nle(21,38)-Arg(36)-; D003346:Corticotropin-Releasing Hormone