K. Saffaf1, G. S. De Silva1, O. Saffaf1, L. A. Sanchez1, M. A. Zayed1,2 1Washington University In St. Louis,Division Of Vascular Surgery,St. Louis, MO, USA 2Veterans Affairs St. Louis Health Care System,Division Of Vascular Surgery,St. Louis, MO, USA
Introduction:
Over 130,000 major lower extremity amputations are performed in the United States each year for critical limb ischemia (CLI), a severe form of peripheral arterial disease characterized by recalcitrant stenosis, tibial artery calcification, and non-healing, non-salvageable wounds. Unfortunately, many patients will require re-intervention or re-operation due to surgical site necrosis, wound dehiscence, infection, and poor overall healing. Identifying which specific patient characteristics contribute the most to these complications has proven difficult. We aimed to delineate which patient factors contribute to prolonged wound healing times in a cohort of patients undergoing major lower extremity amputation.
Methods:
A cohort of 17 patients (19 limbs) undergoing major lower extremity amputation for CLI at a single institution were retrospectively reviewed following their operation. Post-operative clinical imaging at 2-4 weeks, 4-6 weeks, and 6-8 weeks were scored for wound healing parameters using a modified Bates-Jensen Wound Assessment Tool. Patients with up-trending scores (poor healing) were deemed to be “Prolonged Healers”, whereas patients with lower scores (appropriate healing) were deemed as “Appropriate Healers” over an 8 week period. Descriptive statistics were analyzed using Mann-Whitney U test and summarized as mean ± SEM, while categorical variables were analyzed using Chi-square analysis
Results:
Chi-square analysis demonstrated diabetes as the only significant variable between the two groups (Prolonged Healers VS Appropriate Healers) (p=0.026). Other variables including smoking status, presence of chronic obstructive pulmonary disease, hypertension, coronary artery disease, chronic kidney disease, etc., demonstrated no significance. There were no differences in age, ASA BMI, ASA, or operative time between the two groups.
Conclusion:
In a small cohort of patients undergoing lower extremity amputation for CLI, we determined that diabetes was significantly associated with prolonged healing times. Other patient specific comorbidities demonstrated no significant association to long-term continuous healing. Our analysis demonstrates that patients with diabetes should be closely monitored during their post-operative recovery for wound related complications.
