Analysis of factors delaying healing of ischemic foot wounds in patients who undergo lower limb revascularization

Abstract

Objective: Complete ulcer healing is one of the most important goals of treatment for chronic limb-threatening ischemia (CLTI). The purpose of this study was to analyze the factors of delayed wound healing in CLTI after successful revascularization. Methods: We analyzed factors affecting ischemic wound healing following successful revascularization through a prospective, nonrandomized, single–center, observational study conducted at Jain Institute of Vascular Sciences, Bengaluru, Karnataka, India. We have also analyzed wound healing rate, wound healing time (WHT), and limb salvage rate based on wound locations and WIfI stage in this study. 113 patients with CLTI (Rutherford category 5 and 6) who had undergone successful primary revascularization between August 2017 and August 2018 (13 months) were included in this study with a follow-up of 6 months. Results: The wound healing rates were 0% (1st month), 36.3% (3rd month), and 40.7% (6th month), and the cumulative wound healing rate was 77%. The median WHT was 95 days (WIfI Stage 3) and 105 days (WIfI Stage 4) and the overall limb salvage rate was 91.2%. Multivariate Cox proportional hazards analysis revealed the following as independent predictors of wound nonhealing after initial successful revascularization: WIfI stage 4 (hazard ratio [HR], 0.32; 95% confidence interval [CI], 0.2–0.4; P ≤ 0.001); diabetes mellitus (HR, 6.5; 95% CI, 1.3–32.08; P = 0.020); HbA1C >6.5 (HR, 5.1; 95% CI, 1.0–24.9; P = 0.043); and serum albumin <3.20 g/dl (HR, 2.9; 95% CI, 1.3–6.2; P = 0.008). Conclusions: Hence, we recommend that successful revascularization alone does not contribute to complete wound healing and other factors influencing ischemic wound healing have to be addressed and be a part of treatment armamentarium.

Keywords

• chronic
• ischemia
• revascularization
• salvage
• wifi