| 121 |
Clinical Research
|
ÒNo-reflowÓ another borrowed term from cardiology that has direct wound care implications William J. Ennis, DO, Martin Borhani, MD, Suren Avula, MD, Claudia Lee, MPT, Mary Vargas, LPN, Patricio Meneses, PhD Introduction: In 2000 we introduced the term Òstunned woundÓ to describe the phenomena of a sudden interruption in a previously normal wound healing trajectory. This concept was ÒborrowedÓ from the cardiology literature in which temporary cardiac dysfunction could be reversed with appropriate therapeutic resuscitation. The concept of Òno-reflowÓ introduced in 1967, describes the incomplete return of perfusion to the microcirculation despite adequate restoration of the macrovascular status. There are frequent reports and studies both with animal and human models describing this phenomena. In addition, there is confirmation of this phenomena existing post peripheral bypass surgery in diabetic patients Methods: Most of the current literature describes a post revasculariztion period of approximately 30 days until the microcirculatory dysfunction auto-regulates. We developed a method of limb preservation that includes initial debridement of the wound with immediate revascularization. A patients wound, for example trans-metatarsal amputation site, is left open post-operatively for 2-4 weeks. During this time the patient is treated in an inpatient, sub-acute wound care unit with modalities that enhance microcirculation along with supplemental nasal oxygen, nutritional support, edema management, and antibiotics as clinically indicated. We report on 4 cases over 8 months that were treated with this technique. All 4 were successful with limb salvage now at 1 year follow-up Summary: This presentation will describe the physiology of the no-reflow phenomena along with the clinical implications for the treatment of chronic ischemic wounds. A hypothesis is proposed that implicates the no-reflow phenomena as a primary mechanism for the stunned wound. Implications for the timing of wound debridement and the use of modalities that enhance the microcirculation will also be addressed. Ennis WJ, Meneses P. Issues impacting wound healing at a local level: the stunned wound. Ostomy Wound Manage. 2000;46(suppl 1A);39SÐ48S Ames A 3rd, Wright RL, Kowada M, Thurston JM, Majno G. Cerebral ischemia. The no-reflow phenomenon. Am J Path. 1968;52(2):437Ð453 Arora S, Pomposelli F, LoGerfo FW, Veves A. Cutaneous microcirculation in the neuropathic diabetic foot improves significantly but not completely after successful lower extremity. J Vasc Surg. 2002;35(3):501Ð515. |
|