Author + information
- Iram Naz,
- Elliot T. Walters,
- Karen K. Evans,
- Paul J. Kim,
- Cameron M. Akbari and
- Christopher E. Attinger
Tissue ischemia resulting from arterial insufficiency is a major contributing factor to lower extremity wound healing in patients with peripheral arterial diseases (PAD). Rapid wound closure provides a barrier to further infection and limb loss. Split thickness skin grafting (STSG) is relatively common and easy to perform, but outcomes data are scant in the post-endovascular intervention population. In this study, we evaluated factors predictive for complete wound healing following endovascular intervention for PAD.
We retrospectively reviewed all patients with PAD and wounds of the foot and ankle who underwent STSG between January 2014 and December 2016 at MedStar Georgetown University Hospital. Lower extremity revascularizations, percent take rate of STSG, and amputation rate were of particular interest. Wounds with 100% take rate were defined as fully healed.
Thirty-five patients with 48 wounds underwent STSG. There were 21 males and 14 females with a mean age of 64 years. Revascularization was performed in 24 patients (33 limbs) for non-healing wounds and abnormal pedal pulses before STSG. The most common endovascular intervention was balloon angioplasty for tibial lesions. A total of 9 patients had endovascular intervention for SFA and popliteal chronic total occlusion. The presence of a patent pedal arch showed improved wound healing at one month (p<0.05). Initial wound surface area at presentation (20.3cm2 vs. 41.8cm2) was also significant for complete healing at one month (p<0.05). However, at 90 days of follow-up, the initial wound size lost significance. Additionally, at 90 days of follow-up 18 wounds were fully healed, five required revision, 15 were unhealed, and 9 did not return for follow up. Ultimately, a total of 6 limbs had major amputations at an average of 502 days. During this period, 23 wounds eventually healed and the remaining had some degree of breakdown that required both conservative treatment or reoperations for limb salvage and wound closure.
These results show the importance of a patent pedal arch to the healing potential of the foot and ankle wound with STSG and limb salvage efforts in this high-risk patient population.