title: Aggressive Wound Care by a Multidisciplinary Team Improves Wound Healing after Infrainguinal Bypass in Patients with Critical Limb Ischemia.
abstract: BACKGROUND
  A long period is generally required for ischemic ulcer to heal after revascularization. The strategy of postoperative wound care can affect wound healing. This study was conducted to investigate the degree to which aggressive wound care (AWC) by a team of multidisciplinary specialists actually shortens the time to wound healing and increases the rate of wound healing in limbs undergoing surgical bypass for ischemic tissue loss in a real clinical setting.
  
  
  METHODS
  A total of consecutive 126 patients undergoing infrainguinal bypass for tissue loss from April 2011 to March 2015 were reviewed. Prior to March 2013, standard wound care (SWC) including typical daily dressing change with disinfection and irrigation, occasional surgical debridement, and negative pressure wound therapy (when necessary) was performed by vascular surgeons. Thereafter, in addition to SWC, AWC including intense daily bedside surgical debridement under a sciatic nerve block by an anesthesiologist and active skin grafting by a dermatologist, if necessary, was performed. Wound healing and major amputation were defined as the end points. The 1-year outcomes of the 2 groups were calculated using the Kaplan-Meier method and compared, and the significant predictors of each outcome were determined by a Cox proportional hazards analysis.
  
  
  RESULTS
  The wound healing of the AWC group was superior to that of the SWC group (AWC versus SWC, 1-year wound healing rate: 92% vs. 80%; mean wound healing time: 48 days vs. 82 days; P = 0.011), and no significant difference between the 2 regimens in the freedom from major amputation was observed. AWC, Rutherford 5, no wound infection, normal serum albumin, direct angiosome, and cilostazol use were significant predictors of wound healing, and female gender and no cilostazol use were significant predictors of major amputation by a multivariate analysis.
  
  
  CONCLUSIONS
  Aggressive wound care by the team consisting of multidisciplinary specialists remarkably shortened the time to wound healing and increased the rate of wound healing within 1 year.
authors.affiliation: Department of Vascular Surgery, Saiseikai Yahata General Hospital, Kitakyushu-City, Japan; Vascular Center, Steel Memorial Yawata Hospital, Kitakyushu-City, Japan. Electronic address: mii@yahata.saiseikai.or.jp.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Mii
authors.affiliation: Vascular Center, Steel Memorial Yawata Hospital, Kitakyushu-City, Japan; Department of Vascular Surgery, Kokura Memorial Hospital, Kitakyushu-City, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Tanaka
authors.affiliation: Vascular Center, Steel Memorial Yawata Hospital, Kitakyushu-City, Japan; Department of Vascular Surgery, Kyushu Medical Center, Fukuoka, Japan.
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Kyuragi
authors.affiliation: Vascular Center, Steel Memorial Yawata Hospital, Kitakyushu-City, Japan; Sakai Orthopedic Clinic, Fukuoka, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ishimura
authors.affiliation: Vascular Center, Steel Memorial Yawata Hospital, Kitakyushu-City, Japan; Yasukawa Dermatology Clinic, Fukuoka, Japan.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Yasukawa
authors.affiliation: Department of Vascular Surgery, Saiseikai Yahata General Hospital, Kitakyushu-City, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Guntani
authors.affiliation: Department of Vascular Surgery, Saiseikai Yahata General Hospital, Kitakyushu-City, Japan.
authors.forename: Eisuke
authors.initials: E
authors.lastname: Kawakubo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D003131:Combined Modality Therapy; D016638:Critical Illness; D003646:Debridement / Q000379:methods; D018572:Disease-Free Survival; D004203:Disinfection / Q000379:methods; D005260:Female; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D007871:Leg Ulcer / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D015999:Multivariate Analysis; D009407:Nerve Block / Q000379:methods; D010348:Patient Care Team; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016038:Skin Transplantation; D007507:Therapeutic Irrigation; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects; D014945:Wound Healing