Inflammatory biomarkers, vascular procedures of lower limbs, and wound healing - PubMed (original) (raw)

. 2019 Jun;16(3):716-723.

doi: 10.1111/iwj.13086. Epub 2019 Feb 17.

Affiliations

Inflammatory biomarkers, vascular procedures of lower limbs, and wound healing

Paolo Sapienza et al. Int Wound J. 2019 Jun.

Abstract

Abnormal, persistent inflammation after bypass surgery could prevent healing of an ischaemic foot lesion. In 37 patients with peripheral arterial disease (PAD) (Rutherford Grade III Category 5) who underwent infrapopliteal vein graft and midfoot amputation, plasma levels of fibrinogen, C-reactive protein (CRP), interleukin-1 (IL-1), interleukin-6 (IL-6), tumour necrosis factor-α (TNF-α), and matrix metalloproteinase-2 and -9 (MMP-2 and MMP-9) were determined preoperatively and during the follow up. Nine patients without clinical and Doppler evidence of arterial disease, who underwent post-traumatic midfoot primary amputation, were included in the experiment group, and 15 age-matched healthy volunteers served as control. In patients who had midfoot amputation for trauma, all wounds healed. Seven (19%) wounds in patients with an occluded graft healed, and five (13%) required major amputation because of a non-healing wound. Time required for complete healing of the lesion was similar between trauma and PAD patients (8 ± 2 months vs 11 ± 6, respectively, P = NS). Univariate analysis demonstrated that, in PAD patients, the postoperative high levels of TNF-α, IL-6, and MMP-2 and -9 were predictive for wound healing failure at 3, 6, and 9 months (P < 0.05), respectively. Furthermore, the subgroup of patients who experienced occlusion of the vein graft during follow up had a significant increase of MMP-2, -9, IL-6, and TNF-α at 3, 6, and 9 months (P < 0.05), respectively. Monitoring inflammatory markers allows the determination of patients at risk of healing failure of midfoot amputation after distal revascularisation and might predict the fate of the vein graft.

Keywords: bypass; cytokines; ischaemia; metalloproteinases; trauma.

© 2019 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

PubMed Disclaimer

Figures

Figure 1

Figure 1

Extracellular endopeptidases (Panel A) and cytokines (Panel B) variations at 3‐, 6‐ and 9‐month in PAD patients with patent or occluded vein grafts (*P < 0.0001; **P < 0.0001; ***P < 0.0001; ****P < 0.0001; *****P < 0.0001; ******P < 0.0001; °P < 0.0001; °°P < 0.0001; °°°P < 0.0001; °°°°P < 0.0001; °°°°°P < 0.0001; °°°°°°P < 0.0001)

References

    1. Matsuzaki K, Hayashi R, Okabe K, Aramaki‐Hattori N, Kishi K. Prognosis of critical limb ischemia: major vs. minor amputation comparison. Wound Repair Regen. 2015;23:759‐764. - PubMed
    1. Serra R, Grande R, Scarcello E, Buffone G, de Franciscis S. Angiosome‐targeted revascularisation in diabetic foot ulcers. Int Wound J. 2015;12:555‐558. - PMC - PubMed
    1. Vitti MJ, Robinson DV, Hauer‐Jensen M, et al. Wound healing in forefoot amputations: the predictive value of toe pressure. Ann Vasc Surg. 1994;8:99‐106. - PubMed
    1. Caruana L, Formosa C, Cassar K. Prediction of wound healing after minor amputations of the diabetic foot. J Diabetes Complications. 2015;29:834‐837. - PubMed
    1. Becker F, Robert‐Ebadi H, Ricco JB, et al. Chapter I: Definitions, epidemiology, clinical presentation and prognosis. Eur J Vasc Endovasc Surg. 2011;42(Suppl 2):S4‐S12. - PubMed

MeSH terms

Substances

LinkOut - more resources