Improve Healing Rates Research Articles

Venous Insufficiency: Wound Management.

Venous leg ulcers (VLUs) are one of the most common forms of chronic wounds and with nearly half the people having recurrent episodes, this significantly impacts a patient's quality of life. As such, VLU is a chronic disease that requires lifelong maintenance and awareness. A correct diagnosis of VLU is essential for management. VLUs can be of mixed etiology and treatment should be aimed at optimizing the underlying venous hypertension based on its cause. If there is an anatomical venous reflux contributing to the non-healing of the VLU, early treatment of incompetent veins can improve healing rates. All aspects contributing to the patient's ongoing venous hypertension should be addressed to provide appropriate treatment. This can include venous interventions but also through conservative measures. Patient education and their engagement in their own care is essential for good outcomes.

Cost-effectiveness analysis of the geko™ device (an NMES technology) in managing venous leg ulcers in UK healthcare settings.

This study evaluates the cost-effectiveness of the geko device a neuromuscular electro-stimulator technology with standard of care (SoC) versus SoC alone for venous leg ulcer (VLU) treatment, from the UK National Health Service (NHS) perspective over 12 months. Research was conducted across NHS UK facilities, primarily within community services and outpatient leg ulcer clinics, encompassing a total of 51 patients. A partitioned survival model, based on a two-arm randomised controlled trial, assessed wound healing rates using Kaplan-Meier curves and parametric extrapolations over a 12-month time horizon. Costs were derived from UK reference costs the British National Formulary, and the Personal Social Services Research Unit (2021/22). The primary outcome measured was the incremental cost per quality-adjusted life-year gained. The geko device provides additional benefits by stimulating the lateral popliteal nerve, augmenting venous, arterial, and microvascular flow. The addition of the geko device to SoC significantly enhanced outcomes, increasing healing probability by 68% compared to SoC. This integration would result in a cost saving of £774.14 per patient when compared to the SoC alone across the NHS. Economic analyses indicate that integrating the geko device into SoC protocols would reduce the overall NHS expenditure on VLU wound management by as much as 15%. The approach also positively impacted health-related quality of life. The geko™ device when used adjunctively with SoC would be a cost-effective method for managing chronic VLUs within the NHS, improving healing rates and offering economic benefits.

Fibrin clot augmentation of high-risk meniscal repairs may result in clinical healing in up to 90% of cases

ObjectiveWhile meniscal repair is preferable to meniscectomy, some cases may be at higher risk of failure if repaired. Incorporating fibrin clot (FC) into the repair has been proposed to improve healing rates. The purpose of this study was to determine the failure rates, patient reported outcome measures (PROMs) and complications of FC augmented meniscal repair for cases considered to be at higher risk of failure. MethodsA retrospective case series of all patients undergoing FC augmented repair of isolated meniscus tears between January 2016 and September 2021 was undertaken. All cases were thought be at higher risk of failure; they included chronic, radial, complex, horizontal cleavage, and tears not in the red–red zone. Patients were excluded if they had a concomitant anterior cruciate ligament (ACL) reconstruction or if the repair was done through an open incision. The primary outcome was clinical failure defined as further repair or debridement. Secondary outcomes were PROMs and surgical complications. PROMs collected were Lysholm score, Knee injury and Osteoarthritis Outcome Score, Oxford Knee Score and the Tegner score. ResultsFifty one inside-out meniscal repairs using FC were performed in 50 patients (62% male). The mean age was 34 years (range 14–70). The median time from injury to repair was 122 days (range 4–1565). The medial meniscus was repaired in 63% of cases. Tear types included radial (31%) and complex (39%) and 71% of cases included repair of the white–white zone. 16% of cases were revision meniscal repairs. FC was used in 43% of isolated meniscal repairs during the study period. All patients were followed up to a median of 46 months (range 22–87 months). PROMs at a median of 30 months post-operatively showed statistically significant improvements. Five patients (10%) underwent further surgery for failure after median 21 months. Two patients (4%) reported sensory disturbance around their skin wounds, no other complications were reported. 13% of medial meniscal repairs failed, whereas only 5% of lateral meniscal repairs failed (p ​= ​0.4). ConclusionsFC augmented meniscal repair performed for tears considered to be at higher risk of failure may result in acceptably low rates of clinical failure. Level of evidenceLevel IV, case series.

The impact of statin therapy on the healing of diabetic foot ulcers: a case–control series

BackgroundDiabetic foot ulcers (DFU) are a costly complication of diabetes mellitus (DM), with significant implications for the patient and the healthcare professionals that treat them. The primary objective of this study was to evaluate if there were improved healing rates in patients with a DFU that were taking a statin medication compared to those patients with a DFU who were not taking a statin medication. Secondary outcomes assessed were correlations with wound healing or statin use on data obtained from retrospective chart review.MethodsA case–control series was performed to obtain appropriate demographic information, comorbid conditions, laboratory values, and physical examination findings. From the time of presentation with DFU, these patients were followed for 12 weeks to evaluate for healing. Healing was defined as full epithelialization of the DFU with no further drainage. Wound healing and statin use correlation testing was then done for collected variables and each cohort. Chi square and Pearson correlation were then performed to identify any significant correlations. All p-values were two-sided, and findings were considered statistically significant at p < 0.05.ResultsOur study identified 109 patients, 75 patients with a DFU on statin medication and 34 patients with a DFU not on statin medication. The statin cohort was more likely to be older, less than 5-year duration of diabetes, have more comorbidities, decreased low-density lipoprotein (LDL) cholesterol, and decreased total cholesterol (p < 0.05). Among those patients taking a statin medication, 48.0% (36/75) healed their DFU within 12 weeks. Among those patients not taking a statin medication, 44.1% (15/34) healed their DFU within 12 weeks. No correlation was noted between wound healing and statin use (p = 0.7). For wound healing, a negative correlation was noted for prior minor amputations (p < 0.05). For statin use, correlations were noted for age, duration of DM, LDL cholesterol level, total cholesterol level, HTN, CAD, and HLD (p < 0.05).ConclusionsStatin medication use did not influence DFU healing rates between cohorts. There was a correlation noted between wound healing and prior minor amputations and between statin use and age, duration of DM, LDL cholesterol, total cholesterol, HTN, CAD and HLD. Additionally, we observed no correlation between DFU healing rates and use of a statin medication.

High Tibial Osteotomy With Medial Meniscal Posterior Root Tear Reconstruction Yields Improved Radiographic and Functional Outcomes and Healing Rates Compared With Osteotomy Alone

PurposeTo compare pre- and post-operative clinical and radiological outcomes between patients undergoing high tibial osteotomy (HTO) with medial meniscus posterior root tear (MMPRT) reconstruction using gracilis tendon graft versus those without reconstruction MMPRT. MethodsPatients with MMPRT who underwent HTO between January 2018 and December 2021 with minimum 2-year follow-up were included. All the patients were divided into 2 groups based on whether underwent meniscus root reconstruction with tendon graft, HTO alone (33 cases) and HTO with reconstruction MMPRT (21 cases). Clinical evaluation included Lysholm score, international knee documentation committee (IKDC) score, and visual analogue scale (VAS) score. The functional recovery and radiologically outcome of the knee were evaluated preoperatively and at the latest follow-up. Meniscus root healing rates and medial meniscal extrusion (MME) according to the second MRI were compared between the two groups at the latest follow-up. ResultsThe results showed a statistically significant improvement in the postoperative Lysholm score, IKDC score, and VAS score in both groups at the latest follow-up (P<0.001). The analysis of Minimal Clinically Important Difference (MCID) for postoperative outcomes revealed that the percentage of patients who reached MCID thresholds was 100% for Lysholm, 100% for IKDC, and 100% for VAS in the HTO with reconstruction MMPRT group. In comparison, the percentages were 87.9% for Lysholm, 90.9% for IKDC, and 100% for VAS in the HTO alone group. Additionally, compared with the HTO alone group, the HTO with medial meniscus posterior root reconstruction using gracilis tendon graft significantly improved the meniscus root healing rates (Complete healing 85.7% vs. 45.4%, 95%CI: 0.003-0.007, P=0.001) and functional recovery (P<0.005 ) at the final follow-up. Additionally, the HTO with reconstruction MMPRT had a significantly better change in K-L grade (improved knees K-L grade: 10/21 vs. 6/33, P=0.033) and MME (2.1±1.0mm vs. 3.1±1.6mm, 95%CI: 0.3-1.7, P=0.007) compared to the HTO alone group. ConclusionsHTO with reconstruction of the meniscal root using a tendon graft resulted in improved radiographic and patient-reported outcomes as well as improved healing rates compared to the HTO alone.

Arthroscopic Tibiotalar Arthrodesis Using an Arthroscopic Autologous Tissue Collector: A Technique Guide

Tibiotalar arthrodesis is a common procedure performed in patients with ankle arthritis to relieve pain, restore function, and improve the quality of life. Obtaining proper bone-to-bone apposition is crucial to obtaining a solid fusion. Therefore, adequate joint preparation is critical. Open-joint preparation is the standard of care, but arthroscopic arthrodesis is becoming increasingly popular, as it can decrease tissue trauma, postoperative pain, hospital stay, and complications. The addition of bone matrix allograft and autograft also improves healing rates. Use of an arthroscopic autologous tissue collector through standard arthroscopic portals allows harvesting of bone matrix autograft without having to perform additional invasive bone harvesting outside of the affected joint. We present our technique for tibiotalar arthrodesis using an arthroscopic approach with an arthroscopic autologous tissue collector.

Bioaugmentation demonstrates similar outcomes and failure rates for arthroscopic revision rotator cuff repair compared to revision without bioaugmentation

IntroductionArthroscopic revision rotator cuff repairs exhibit lower healing rates and inferior outcomes compared to primary repairs. There is limited evidence regarding the use of bioaugmentation in the setting of revision rotator cuff repairs. Autologous conditioned plasma (ACP) is a promising adjunct that has been shown to improve healing rates and patient report outcomes in the primary setting. In addition, bioinductive patches such as collagen bovine patches have become a popular adjunct for stimulating healing in the primary setting. The aim of this study is to assess the outcomes after use of ACP and collagen bovine patch augmentation for revision arthroscopic rotator cuff repair. We hypothesized improved patient report outcomes and higher healing rates would be observed with bioaugmentation for revision repair compared to without. MethodsThis was an IRB approved, retrospective case-control study from two fellowship-trained surgeons that included all consecutive patients undergoing arthroscopic revision rotator cuff repair from 2010 to 2021. Reconstruction such as superior capsular reconstruction, partial revision repair, and less than one year follow-up were excluded. The bioaugmentation cohort received ACP and/or collagen bovine patch at the time of revision repair. Patient reported outcomes were collected from all patients including: American Shoulder and Elbow Surgeons Standardized Assessment Form (ASES), visual analog scale for pain (VAS), Brophy score, Patient-Reported Outcomes Measurement Information System (PROMIS) mental and physical scores. Failure of revision rotator cuff repair was defined as an ASES postoperative total score less than 60 or a symptomatic re-tear confirmed on MRI. Students T-test was used for all comparisons of continuous variables. Chi-squared used for comparison of all categorical variables. Statistical significance was set at <0.05. ResultsThirty-eight patients met inclusion criteria with average follow-up of 3.5±1.7 years. There was no significant difference in follow-up between patients with and without bioaugmentation. Of the 38 patients, 14 patients met failure criteria. There was no significant difference in the rate of failure between the bioaugmentation cohort (6/19, 31.6%) versus patients who did not receive bioaugmentation (8/19, 42.1%), p=0.74) In addition, no significant differences were identified for ASES (64.6±20.1 versus 57.5±17.2, p=0.32), Brophy (6.4±5.2 versus 6.0±4.1, p=0.84), PROMIS Mental (13.4±3.9 versus 11.7±3.2) or PROMIS Physical (12.8±3.1 versus 11.9±3.2) scores between the bioaugmentation versus no bioaugmentation groups. ConclusionsBioaugmentation with a bioinductive collagen patch or autologous conditioned plasma demonstrated similar failure and patient reported outcomes compared to without bioaugmentation in the setting of revision rotator cuff repair.

Effectiveness of teriparatide in in improving healing rates and bone-turnover markers of osteoporotic hip fracture: a meta-analysis.

To evaluate the effect of subcutaneous teriparatide therapy on fracture healing rate and change in bone mass density in osteoporotic hip fractures. The meta-analysis was done from September to December 2022, and comprised literature search on Wanfang, CNKI, VIP, PubMed, Embase, Cochrane Library, and Web of Science databases from the establishment of the respective database till December 2022. The relevant journals of the library of Macao University of Science and Technology, China, were manually searched for randomised controlled trials of teriparatide in the treatment of osteoporotic hip fractures. The shortlisted studies were subjectd to Cochrane Risk of Bias tool and the Jadad Rating Scale. Meta-analysis was done using the RevMan 5.4 software provided by the Cochrane Collaboration Network. Fracture healing rate and bone mineral density were the primary outcome measures, while mortality, adverse events, malformations, complications, subsequent fractures, timed-up-and-go test, visual analogue scale score, and procollagen type I N-terminal propeptide were the secondary outcome measures. Of the 1,094 articles retrieved, 8(0.7%) randomised controlled trials were analysed. There were 744 patients; 372(50%) in the teriparatide group and 372(50%) in the control group. Fracture healing rate was not significantly different (p=0.82), while bone mineral density was significantly different between the groups (p<0.001). Mortality, adverse events, deformity, and complications were not significantly different (p>0.05), while subsequent fractures, timed-up-and-go score, visual analogue scale score and procollagen type I N-terminal propeptide were significantly different between the groups (p<0.05). The literature did not support teriparatide's ability to improve the healing rate of osteoporotic hip fractures, or to reduce mortality, adverse events, malformations, and complications. In addition, teriparatide could increase bone mineral density of osteoporotic hip fractures and the procollagen type I N-terminal propeptide value, alleviate hip pain, and reduce subsequent fracture rates. This trial is registered with PROSPERO with registration number CRD42022379832.

The use of platelet-rich plasma injections in the treatment of meniscal injuries - review of the literature

Introduction: In the knee joint are two menisci, which are fibrocartilaginous structures. The tears of the meniscus are one of the most common injuries within knee. Arthroscopy with suturing of torn or menisectomy are the most popular methods of treatment, however in long term observation menisectomy often results in osteoarthritis 10-20 years after surgery. For this reason, less invasive treatment methods are being sought, such as platelet-rich plasma injections. Platelet-rich plasma has many growth factors, which stimulates healing. Objective: The aim of this study is to review latest the literature on the use of platelet-rich plasma injections in the patients with meniscus tears. Material and methods: A literature review was conducted on databases such as PubMed and Google Scholar using the terms: ”meniscus”, “meniscus tear”, “platelet-rich plasma”, “platelet-rich plasma injections”, “meniscus injuries treatment’. Conclusions: The injuries of meniscus are very common, and often must be treated by arthroscopy. Platelet-rich plasma has a positive impact on tissue healing. Platelet-rich plasma injuries in the patients with meniscal tears repair lead to improve healing rates compare with patients without PRP injections, but there is no guidelines and further studies are necessary.

Initial Outcome of Lateral Internal Sphincterotomy with or without Fissurectomy in the Surgical Management of Chronic Anal Fissure

Chronic anal fissure is a common proctological condition characterized by severe pain and bleeding during defecation. Surgical intervention is often required for chronic cases unresponsive to conservative treatment. This study aims to compare the outcome of lateral internal sphincterotomy (LIS) with and without fissurectomy. In this single-centered study, 50 purposively selected patients with chronic anal fissures were divided into two groups: Group A underwent LIS with fissurectomy, while Group B underwent only LIS. The primary outcomes measured were postoperative anal pain relief and fissure healing rates, while secondary outcomes included hospital stay duration and the occurrence of complications such as anal discharge, pruritus, bleeding spot, urine &amp; stool incontinence. Group A showed a significant reduction in postoperative pain within 3 days (60% of patients) compared to Group B, which showed relief within 6-8 days (32% of patients). Fissure healing times were faster and hospital stay duration were shorter in Group A, with a mean duration of 5.12±1.616 days versus 8.32±3.18 days in Group B. The incidence of postoperative complications was lower in Group A, with anal discharge occurring in 16% of patients compared to 44% in Group B. These above differences were statistically significant. The study demonstrates that LIS with fissurectomy may offer better outcomes in the treatment of chronic anal fissures than LIS alone, including faster pain relief, improved healing rates and fewer postoperative complications. Given the limitations of a small sample size and single-center design, larger multi-center trials are recommended to confirm these findings and potentially adjust clinical practice guidelines.

Use of a Novel Human Keratin Matrix Improves Healing Rates in Diabetic Lower Extremity Wounds

Background. Lower extremity wounds in patients with diabetes are difficult to heal due to an overabundance of pro-inflammatory M1 macrophages, reduced phagocytosis of necrosed cells, and circulatory issues. Keratin biomaterials have been shown to address some of these concerns by encouraging the proliferation of anti-inflammatory M2 macrophages, thereby creating more favorable conditions for wound healing resembling those of patients without diabetes. Objective. To investigate the effect of a novel human keratin matrix (HKM) on wound healing. Materials and Methods. Ten patients with diabetes with lower extremity wounds at risk for delayed healing underwent wound debridement and application of HKM. Patients received weekly follow-up care and reapplication of HKM until healing occurred; wound size at each visit was used to calculate healing rate. Results. Increased healing rates were noted with HKM compared with standard of care (SOC), including debridement and collagen treatment in all 8 patients who had received SOC prior to HKM treatment. When HKM treatment was alternated with SOC in 2 patients due to other medical conditions, healing rates decreased with SOC and then increased after reintroduction of HKM applications. Conclusions. These results suggest that HKM may help regulate the pathological processes that contribute to wound chronicity to “kick-start” wound healing. This case series demonstrates that HKM is a promising technology to improve healing rates in nonhealing lower extremity wounds in patients with diabetes.

Preoperative assessment of fistula-in-ano using SonoVue enhancement during three-dimensional transperineal ultrasound.

Accurate preoperative evaluation of fistula-in-ano can guide the choice of surgical procedure and may improve healing rates. This prospective study aimed to evaluate the accuracy of conventional 3D transperineal ultrasound (3D-TPUS) compared with SonoVue (SVE)-enhanced 3D-TPUS for the detection and classification of anal fistula. In this prospective study, 3D-TPUS reconstructions were performed before and after SVE enhancement in 60 patients with fistula-in-ano who intended to undergo surgery at the Department of Anorectal Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University (P. R. China) between January 2021 and October 2021. Accuracies of anal fistula classification, complexity classification, detection of anal fistula branches, and detection of internal opening between 3D-TPUS and SVE 3D-TPUS were compared based on a reference standard-intraoperative findings. This study enrolled 60 patients (mean age, 37.1 ± 11.4 years; mean follow-up, 9 ± 3 months). Intraoperative findings showed that the fistula type was intersphincteric in 23 patients (38.3%), trans-sphincteric in 35 (58.3%; 12 high and 23 low), and suprasphincteric in 2 (3.3%). Moreover, 68 internal openings were found. Compared with the accuracy of 3D-TPUS, that of SVE 3D-TPUS was similar in fistula classification [95.0% (57/60) vs 96.7% (58/60), P = 0.392], but significantly higher in internal opening evaluation [80.9% (55/68) vs 97.1% (66/68), P = 0.001], complexity classification [85.0% (51/60) vs 98.3% (59/60), P = 0.018], and detection of fistula branches [70.4% (19/27) vs 92.6% (25/27), P = 0.031]. SVE 3D-TPUS may be a useful examination for patients with perianal fistulae because of its high accuracy and consistency with intraoperative findings, especially in complex fistula-in-ano and difficult cases.

A Facilely Prepared Adhesive Dressing Derived from Non-Ionic Hydrogel for Accelerated Diabetic Wound Healing

Hydrogels are an important category of polymeric materials with physicochemical features such as moisturizability and biocompatibility that are ideal for developing dressings for diabetic wounds. However, conventional non-ionic hydrogel materials generally exhibit poor mechanical properties and poor adhesion, which compromise their ability to self-sustain in mechanically dynamic wound microenvironments. In this research, we developed a hybrid hydrogel as a highly biocompatible adhesive wound dressing that met the mechanical requirements of the skin to promote chronic wound healing in diabetic mouse models. A 7.5% (w/v) hydrogel corresponded to a Young’s modulus of 6.3 kPa. In vitro cell-based and subcutaneous implantation experiments in mice demonstrated the excellent biocompatibility and optimal biodegradability of hydrogel dressings. In a diabetic mouse splint wound model for evaluating wound healing in vivo, the hydrogel dressing showed robust adhesion to the wound and efficiently accommodated mechanical deformations around the wound, resulting in significantly improved healing rates of chronic diabetic wounds. Thus, our work illustrates a newly alternative strategy for the simple and efficacious treatment of chronic wounds in the context of diabetes care.

Antimicrobial hydrocolloid composite sponge with on-demand dissolving property, consisting mainly of zinc oxide nanoparticles, hydroxypropyl chitosan, and polyvinyl alcohol

Abstract Effective anti-infection prophylaxis for chronic wounds can reduce the risk of wound infection and improve healing rates. The use of good anti-infection wound dressings is particularly important. In this paper, an antimicrobial composite hydrocolloid sponge dressing with zinc oxide nanoparticles, hydroxypropyl chitosan, and polyvinyl alcohol as the main components was prepared using freeze-drying of the formulated suspensions. The characterizations by scanning electron microscopy, X-ray diffraction, and Fourier transform infrared spectroscopy were performed; the antibacterial activity was determined; the on-demand dissolving properties were evaluated; and the basic properties such as porosity, vapor permeability, and water absorption were measured. The results showed that, when the mass ratio of HPCs/PVA was 6:4, the porosity, the steam permeability, the water absorption ratio, and dynamic complete dissolving time in 1 % acetic acid aqueous solution, respectively, reached the optimum value of 63.2 %, 57.7 %, 54.4, and 35 min. Antibacterial activity experiments showed that the sponges significantly inhibited Staphylococcus aureus, Escherichia coli, and Candida albicans. In conclusion, the above results indicate that the prepared hydrocolloid composite sponge has good air permeability, water absorption, antibacterial activity, and on-demand dissolving property and has potential applications in anti-infection treatment of hypo-exudative chronic wounds and pressure sore prevention.

Role of Adipose Derived Stem Cells in Patients with Diabetic Foot Ulcers: Systematic Review and Meta-Analysis of Randomised Controlled Trials.

Few studies to date have investigated the role of adipose derived stem cells (ADSCs) in patients with diabetic foot ulcers (DFU). We aimed to conduct a systematic search of the literature to explore the available evidence behind ADSCs application in patients with DFU to establish if it has any added benefit regarding healing rate and healing time in this cohort of patients. The PubMed and Embase databases were searched for eligible studies. Only randomised controlled trials which investigated the impact of ADSCs alone on the healing of DFU were considered eligible and were included for the review. Reported healing rates, time to healing and procedure related complications were collected and analysed. The initial search resulted in 160 papers. Following duplicate removal, 131 papers were screened for eligibility. Only four trials met the study criteria and were included for the final review and analysis. 97 out of 189 patients who were included in the four studies received ADSCs for treatment of DFU whereas the remaining 92 patients received standard measures (control). The median participant age was 62, predominantly male (72.5%). Complete healing was achieved in 83.5% (n = 81) of patients in the ADSC group compared to 52% (n = 48) for patients in the control group at 12 months (OR = 4.8, 95%CI = 2.25 to 10.24, P < 0.0001). Mean healing time in the ADSC group ranged from 31 to 85 days whereas mean healing time in the control group ranged from 42 to 85 days (Pooled weighted mean difference = -10.832856, 95%CI = -22.44 to 0.77, P = 0.0673). No significant procedure related complications were reported in either group. The use of ADSCs in patients with DFU appears to demonstrate improved healing rates. The procedure of ADSC harvest and administration appears to be safe based on the initial reports. Large, randomised trials are needed to establish its role in patients with diabetic foot wounds.

Outcomes of thermal ablation combined with u/s guided foam sclerotherapy in treatment of superficial venous reflux in patients with postphlebitic venous leg ulcer

Background Venous leg ulcers are a considerable health problem because of their high incidence, slow healing, high recurrence rate, and high cost of treatment. Minimally invasive treatments such as endovenous thermal ablation and foam sclerotherapy proved to be safe and effective. However, there is a paucity in studies focusing on the management of postphlebitic venous ulcers using endovenous thermal ablation of the superficial system in combination with foam sclerotherapy. Objectives The aim of our study was to assess the healing time, procedure-related complications and recurrence rate in patients having a postphlebitic venous leg ulcer after being treated with EVLA associated with ultrasound-guided foam sclerotherapy to incompetent perforators with compression therapy. Subjects and methods This is a prospective observational study, conducted at Ain Shams University Hospitals and Nasser institute hospital in Cairo on 30 patients presented with postphlebitic venous leg ulcers. Results After one year, 90% of cases had a totally healed ulcers, 10% with ulcer decrease in size of more than 50%, and recurrence rate 6.7%. The adverse events of this procedure were DVT (6%), hematoma (6%), ecchymosis (43%), thrombophlebitis (6%), and pain (70%). There was significant improvement of the VCSS as regard pain, edema, inflammation, ulcer size, and number. There was highly significant (P &lt; 0.0001) improvement in the mean (SD) VCSS (preoperative 18 [2.808] vs. postoperative 6.367 [2.3449]). Conclusion Patients with totally recanalized deep venous system post deep venous thrombosis, presenting with nonhealing venous leg ulcers, may benefit from thermal ablation of superficial varicose veins combined with ultrasound-guided foam sclerotherapy. This combined approach is a feasible, safe, and effective modality in terms of improved healing rate, low recurrence rate, low complications, and significant improvement in quality of life.

Local Intraoperative Marrow-Derived Augmentation for Primary Rotator Cuff Repair: An Updated Systematic Review and Meta-analysis of Studies From 2010 to 2022

Recurrent tears of the rotator cuff pose a substantial problem despite advances in repair technique. Biologic augmentation via marrow stimulation or vented anchors may strengthen the suture-tendon junction and improve healing rates of native tissue, thereby enhancing outcomes of primary surgical repair. To provide a focused systematic review and meta-analysis of local, intraoperative marrow-derived augmentation techniques in clinical primary rotator cuff repair. Systematic review; Level of evidence, 4. A systematic review of PubMed, Embase, and Cochrane was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 2131 studies from 2010 to 2022, focused on either marrow stimulation or vented anchors, were isolated and classified as either preclinical or clinical. Meta-analysis was performed for comparative marrow stimulation and vented anchor studies. Heterogeneity was tested through calculation of I 2. A total of 13 clinical studies were included in the review. All 9 comparative studies included in the meta-analysis demonstrated high methodologic quality or a low risk of bias. The pooled retear rate across all 9 clinical studies for patients undergoing marrow stimulation was 11%. For the 5 studies in the meta-analysis, the pooled retear rates were 15% for marrow stimulation and 30% for controls. Meta-analysis demonstrated a significant difference in the overall retear rate that favored marrow stimulation (odds ratio [OR], 0.41; 95% CI, 0.25-0.66; P = .0003; I 2 = 0%). Similarly, meta-analysis of the Constant score at final follow-up demonstrated a statistically significant difference between the 2 groups that favored a higher Constant score in the marrow stimulation group (mean difference, 2.84; 95% CI, 1.02-4.66; P = .002; I 2 = 29%). Vented anchors demonstrated improved ossification and bone density at the anchor site, but no difference in outcomes or retear. Pooled retear rates were 22.5% for vented anchors and 27.8% for controls. Current evidence demonstrates that marrow-stimulation techniques may have a positive impact on healing and retear rate, while vented anchors have a muted impact relative to nonvented anchors. Although available evidence is limited and more research is needed, findings to date suggest that marrow stimulation techniques may be an inexpensive, straightforward technique to consider in qualifying patients to prevent rotator cuff retears.

Resorbable Bioinductive Collagen Implant Is Cost Effective in the Treatment of Rotator Cuff Tears

This study was conducted to investigate whether the use of resorbable bioinductive collagen implant (RBI) in addition to conventional rotator cuff repair (conventional RCR) is cost-effective when compared to conventional RCR alone, in the treatment of full-thickness rotator cuff tears (FT RCT). We developed a decision analytic model to compare the expected incremental cost and clinical consequences for a cohort of patients with FT RCT. The probabilities for healing or failure to heal (retear) were estimated from the published literature. Implant and healthcare costs were estimated from a payor's perspective in 2021 U.S. prices. An additional analysis included indirect cost estimations (e.g.,productivity losses). Sensitivity analyses explored the effect of tear size, as well as the impact of risk factors. The base case analysis demonstrated that resorbable bioinductive collagen implant+ conventional rotator cuff repair results in incremental costs of $232,468 and an additional 18 healed RCTs per 100 treated patients over 1 year. The estimated incremental cost-effectiveness ratio (ICER) is $13,061/healed RCT compared to conventional RCR alone. When return to work was included in the model, RBI+ conventional RCR was found to be cost saving. Cost-effectiveness improved with tear size with the largest benefit seen in massive tears compared to large tears, as well as patients at higher risk of retearing. This economic analysis demonstrated that RBI+ conventional RCR delivered improved healing rates at a marginal increase in costs when compared to conventional RCR alone and is, therefore, cost-effective in this patient population. Considering indirect costs, RBI+ conventional RCR resulted in lower costs compared to conventional RCR alone and is, therefore, deemed to be cost saving. Level IV, economic analysis.

Use of the Allgöwer-Donati Suture Technique for Wound Closure Following Transmetatarsal Amputation

Introduction. The Allgöwer-Donati suture technique reportedly has lower incision perfusion impairment compared with other suture techniques. The authors of the present case series hypothesized that suture technique selection to achieve lower incision perfusion impairment may result in improved healing rates and decreased incidence of wound complications in partial foot amputations, specifically TMAs. Objective. To evaluate the efficacy of TMA with skin closure completed using the Allgöwer-Donati suture technique. Materials and Methods. The records of 7 patients (8 limbs) who underwent closure with the Allgöwer-Donati suture technique after TMA between March 2021 and March 2022 were retrospectively reviewed. Only patients with a diagnosis of gangrene were included. Results. Five of 8 limbs (62.5%) healed uneventfully, with an average time to healing of 3.3 weeks. Six of 8 limbs (75%) healed within 4 weeks, and 1 limb was lost to follow-up. Conclusions. The results of this small case series suggest that use of the Allgöwer-Donati suture technique may result in decreased incidence of wound complications by allowing improved perfusion at the amputation site.

Butterfly fragments in diaphyseal tibial fractures heal unpredictably: Should we be adopting other strategies for these high risk fractures?

The natural history of diaphyseal tibial butterfly fragments is poorly documented. Numerous studies have analyzed risk factors for nonunions in the tibial shaft with known factors including Gustilo classification, ASA class, and cortical contact. However, the healing potential and ideal management of nonsegmental butterfly fragments in this setting remains unknown.The aim of this study was to determine the nonunion rate of diaphyseal tibial fractures with a butterfly fragment. A performed a retrospective review of patients at a single academic Level 1 Trauma Center from 2000-2020 who underwent intramedullary nailing of tibial shaft fractures. Those with non-segmental butterfly fragments (OTA/AO: 42-B) and minimum 12 month follow up were included. Morphologic measurements of butterfly fragments were performed to measure location, size, and displacement, and mRust scores at final follow up were calculated. Outcome measures were surgery to promote union, and mRust scores. A total of 99 patients were included with 21 patients requiring revision surgery to promote union. Thirty six patients had open fractures and 77% of patients were male with a mean age of 34 (range: 12-80). Average follow up was 19 months (3 months - 12 years). The most common location of the butterfly fragment was the anterior cortex (42%), with a mean length of 7.8cm (SD: 3.3) and width of 1.8cm (SD: 0.5cm). At final follow-up 37% of fractures had persistent lucency without callus at the site of the butterfly while only 31% of fractures had remodeled cortex. Average time to complete healing was 13.3 months. Open fractures with butterfly fragments were more likely to go on to nonunion than closed (44% vs 9.2%, p=<0.001). The length of the butterfly fragment was not different between the union and nonunion groups (7.7 vs 7.5, P=0.42). Open tibial shaft fractures with a butterfly fragment have a high risk of nonunion. Further research may seek to determine if adjunct treatment of butterfly fragments (ie inter-fragmentary compression) in the acute setting could improve healing rates.