Analysis of wound healing time and wound free period in patients with chronic limb threatening ischemia treated with and without revascularization
Katharine L McGinigle, Smith M Ngeve, Sydney E Browder, Melissa E Hammrick, Jacob E Wood, Federico E Parodi, Luigi E Pascarella, Mark A Farber, William A Marston
University of North Carolina, Chapel Hill, NC
INTRODUCTION: Traditionally, reported outcomes in patients with ischemic wounds have centered around amputation free survival; however, that minimizes the importance of other patient-centered outcomes like wound healing time and wound free period. We sought to evaluate the long term wound outcomes of the patients treated for chronic limb threatening ischemia at our institution.
METHODS: We identified all patients diagnosed with CLTI and ischemic wounds by both symptomatic and hemodynamic criteria January 1, 2014 to December 31, 2017. Using retrospective chart review, we documented each patient's wound healing journey for 3 years after first documentation of their wound. Primary data points included wound size, wound location, WIfI score, wound healing, wound healing time (WHT), wound recurrence, wound free period (WFP), minor and major amputation, and death. Wounds were not considered healed if the patient experienced a major amputation or death prior to documentation of wound healing. WHT was calculated as the difference in days between the first note of wound occurrence and when the wound was declared healed. WFP was calculated as the difference in days between when the wound was declared healed and when there was note of wound recurrence, major amputation, death, or the end of the study period. Comparison of wound healing parameters between patients who did and did not undergo revascularization was performed with Student's t-test. A generalized linear model adjusted for age, sex, initial wound size, and WIfI classification was performed to evaluate risk of wound healing with and without revascularization.
RESULTS: There were 211 patients who presented with 317 wounds; 46% of those patients underwent revascularization. The average wound size was 19.1 ± 63.6 cm2, but notably of the 103 (32.5%) wounds that healed the average size was only 4.8 ± 11.6 cm2, p = .01. There was no difference in wound size between those who were revascularized or not (p = .8421). Adjusted for initial wound size, the risk of wound healing was no different whether patients were revascularized (RR 1.114, CI .760 - 1.634, p = .580). For those whose wounds healed, the average WHT and WFP were 143 ± 127 days and 798 ± 321 days, respectively. The WHT was no faster in patients who were revascularized (142 vs 143 days, p=.948), but the WFP was longer in the patients who were revascularized (871 vs 745 days, p <.001) indicating fewer wound recurrences (Table 1). The rate of wound recurrence was 6.1 wounds per 100 person-years in the overall study group. There were 64 minor amputations, 53 major amputations, and 76 deaths during the study period.
CONCLUSIONS: As expected initial wound size is associated with ability to heal an ischemic wound. Even with wound care and revascularization performed in a multi-disciplinary limb salvage center, wound healing rates are low. A combined treatment strategy of wound care and revascularization does not improve WHT, but reduces ischemic wound recurrences.
| Total | Revascularization | No Revascularization | P-value | |
| WHT (days) | 143 ± 127 | 142 ± 132 | 143 ± 118 | 0.948 |
| WFP (days) | 798 ± 321 | 871 ± 248 | 745 ± 352 | <0.001 |
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