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Journal of Biological Regulators and...To retrieve the history of venous ulcers and of skin lesions in general, we must go back to the appearance of human beings on earth. It is interesting to note that...
To retrieve the history of venous ulcers and of skin lesions in general, we must go back to the appearance of human beings on earth. It is interesting to note that cutaneous injuries evolved parallel to human society. An essential first step in the pathogenesis of ulcers was represented by the transition of the quadruped man to Homo Erectus. This condition was characterized by a greater gravitational pressure on the lower limbs, with consequences on the peripheral venous system. Furthermore, human evolution was characterized by an increased risk of traumatic injuries, secondary to his natural need to create fire and hunt (e.g. stones, iron, fire, animal fighting). Humans then began to fight one another until they came to real wars, with increased frequency of wounds and infectious complications. The situation degraded with the introduction of horse riding, introduced by the Scites, who first tamed animals in the 7th century BC. This condition exhibited iliac veins at compression phenomena, favouring the venous stasis. With time, man continued to evolve until the modern age, which is characterized by increased risk factors for venous wounds such as poor physical activity and dietary errors (1, 2).
Topics: Animals; History, 15th Century; History, 16th Century; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; History, 21st Century; History, Ancient; History, Medieval; Horses; Humans; Lower Extremity; Risk Factors; Varicose Ulcer; Veins
PubMed: 28702971
DOI: No ID Found -
Current Drug Targets 2020Chronic non-healing wounds are estimated to cost the US healthcare $28-$31 billion per year. Diabetic ulcers, arterial and venous ulcers, and pressure ulcers are some of... (Review)
Review
Chronic non-healing wounds are estimated to cost the US healthcare $28-$31 billion per year. Diabetic ulcers, arterial and venous ulcers, and pressure ulcers are some of the most common types of chronic wounds. The burden of chronic wounds continues to rise due to the current epidemic of obesity and diabetes and the increase in elderly adults in the population who are more vulnerable to chronic wounds than younger individuals. This patient population is also highly vulnerable to debilitating infections caused by opportunistic and multi-drug resistant pathogens. Reduced microcirculation, decreased availability of cytokines and growth factors that promote wound closure and healing, and infections by multi-drug resistant and biofilm forming microbes are some of the critical factors that contribute to the development of chronic non-healing wounds. This review discusses novel approaches to understand chronic wound pathology and methods to improve chronic wound care, particularly when chronic wounds are infected by multi-drug resistant, biofilm forming microbes.
Topics: Animals; Biofilms; Chronic Disease; Drug Resistance, Bacterial; Humans; Wound Healing; Wounds and Injuries
PubMed: 32576127
DOI: 10.2174/1389450121666200623131200 -
Annals of Vascular Surgery Jan 2019The necessity of repair remains controversial after major lower extremity venous injuries (MLEVIs). Ligation may cause venous hypertension which should be managed with... (Comparative Study)
Comparative Study
BACKGROUND
The necessity of repair remains controversial after major lower extremity venous injuries (MLEVIs). Ligation may cause venous hypertension which should be managed with fasciotomies. Previous studies have shown that fasciotomy rate is not affected by the type of management of MLEVIs. The aim of this study was to examine the rate of fasciotomy, amputation, and other complications from a difference between ligation and repair of MLEVIs.
METHODS
The National Trauma Data Bank (NTDB) for 2010-2014 was reviewed. Eligible patients were restricted to MLEVI patients who underwent surgical ligation or repair. Data on demographics, rate of fasciotomy, secondary amputation, and other complications were collected. Comparative analysis between ligation and repair on demographics, complications, and outcomes was performed using multivariate logistic regression models.
RESULTS
A total of 2120 patients were identified in NTDB and 1029 (48.5%) underwent ligation while 1091 (51.5%) underwent repair. The overall rate of fasciotomy and secondary amputation was 38.9% (n = 824) and 4.8% (n = 101), respectively. Patients in the ligation group had a higher proportion of university hospital setting and penetrating injury. Otherwise, there was no significant difference in other characteristics between the 2 groups. Patients in the ligation group had significantly higher rates of fasciotomy and secondary amputation and longer hospital length of stay (LOS) than those in the repair group (44.6% vs. 33.5%, risk ratio [RR] 1.33, 6.1% vs. 3.4%, RR 1.81, 11 [6-20] vs. 9 [5-17], respectively). Otherwise, there was no significant difference in all other complications and in-hospital mortality between 2 groups.
CONCLUSIONS
The fasciotomy rate was surprisingly high and affected by venous ligation in patients with MLEVIs. Considering the overall physiological condition, trauma surgeons should perform venous repair aggressively and prepare judiciously for fasciotomy after surgery. Avoiding venous ligation and maintaining venous outflow may contribute to not only reducing the need for fasciotomy and LOS but also saving limbs.
Topics: Adult; Amputation, Surgical; Databases, Factual; Fasciotomy; Female; Humans; Length of Stay; Ligation; Limb Salvage; Lower Extremity; Male; Postoperative Complications; Reoperation; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome; United States; Vascular Surgical Procedures; Vascular System Injuries; Veins; Venous Pressure; Young Adult
PubMed: 30096427
DOI: 10.1016/j.avsg.2018.05.062 -
World Journal of Surgery Jun 2016About 50 cases of azygos venous system injuries following civilian trauma have been published in current literature. The purpose of our study was to investigate the...
BACKGROUND
About 50 cases of azygos venous system injuries following civilian trauma have been published in current literature. The purpose of our study was to investigate the incidence of these injuries, the causative mechanism and type of trauma, the co-existing injuries, and the mortality rate in our institution.
METHODS
We performed a retrospective review of all trauma patients who were admitted to the surgical department of the General Hospital of Rethymno during an 11-year period. Our study included patients arriving at our institution dead or alive with an azygos venous system injury following blunt or penetrating civilian trauma.
RESULTS
Seven patients-five men and two women-were identified with azygos venous system injuries. Five had an azygos vein laceration, one suffered from both azygos and hemiazygos vein lacerations, and the last one had sustained hemiazygos and accessory hemiazygos vein injuries. All of them suffered from a blunt trauma. Three arrived at our hospital in extremis, and all died within 24 h despite our resuscitation attempts. All of our patients were polytrauma patients. All of them had co-existing torso injuries which were severe in all but one case, three of them suffered also from serious head injuries, and all but one had at least serious extremity's injuries.
CONCLUSION
Azygos venous system injuries are rare, although it seems that they are more frequent than current literature would indicate. Blunt trauma mechanism seems to be predominant in civilian trauma setting, and the patients have usually sustained a lot of serious and severe co-existing injuries with high resultant lethality.
Topics: Accidents, Traffic; Adult; Azygos Vein; Female; Greece; Humans; Incidence; Lacerations; Male; Middle Aged; Multiple Trauma; Retrospective Studies; Thoracic Injuries; Trauma Severity Indices; Wounds, Nonpenetrating; Young Adult
PubMed: 26817649
DOI: 10.1007/s00268-016-3411-7 -
Journal of Ayub Medical College,... 2022Penetrating heart injuries are associated with higher mortality rates. Coronary lesions caused by penetrating trauma are considered even rarer and universally fatal. We...
Penetrating heart injuries are associated with higher mortality rates. Coronary lesions caused by penetrating trauma are considered even rarer and universally fatal. We present a case of a fortunate survivor who had complete transection of left anterior descending (LAD) artery with right ventricular (RV) tear after being stabbed by knife, arriving in emergency unit with massively bleeding chest wound. Complex cardiac trauma involving coronaries and cardiac chambers is a challenge to surgeons if patients miraculously reach the hospital alive. This patient had complete transection of LAD artery with penetration into RV cavity, he was successfully managed by timely and prompt surgical intervention by on call team. This case highlights the importance of team dynamics working in harmony during emergency situations, we stress upon conducting routine drills to train surgical residents, perfusionists and operation theatre staff.
Topics: Male; Humans; Wounds, Stab; Wounds, Penetrating; Thoracic Injuries; Heart Injuries; Coronary Vessels
PubMed: 36550672
DOI: 10.55519/JAMC-04-S4-10328 -
Medicina (Kaunas, Lithuania) Aug 2022Background and Objectives: Retrograde free venous flaps represent a separate entity among free venous flaps: their physiology is still unclear, but they provide an...
Background and Objectives: Retrograde free venous flaps represent a separate entity among free venous flaps: their physiology is still unclear, but they provide an immediate visible refill after reconnection, with a similar behaviour to conventional flaps. Therefore, the dimensions and the indications of these flaps can be extended beyond what was previously believed, and they can be easily customized, including with respect to tendons and nerves. Nevertheless, they are still debated and regarded as unsafe. Materials and Methods: From 2012 to 2019, we performed 31 retrograde free venous flaps on 31 patients to reconstruct hands, digits, and in one case the heel. All the flaps were arterialized in a retrograde manner; the donor site was the forearm in 28 cases, the foot in 2 cases, and the calf in 1 case. We recorded the size, vein architecture, donor site, donor artery, donor morbidity, function for composite and non-composite flaps, immediate complications, late complications, survival rate, and the number of revisions. We recorded the hand function when appropriate. A total of 10 flaps were also intraoperatively studied with indocyanine green to monitor their hemodynamical behaviour. Results: All the patients were followed for an average of 8 months (6−15). The flap dimensions ranged from 6 cm2 to 136 cm2. All the flaps, except two that had complete necrosis, survived. Two flaps had partial necrosis. There was no correlation between necrosis and the size of the flap, with one case of necrosis and one of partial necrosis in the small flaps (<10 cm2). None of the cases with partial necrosis needed a new flap. Two flaps developed a late arterio-venous shunt that was ligated. Conclusions: The retrograde free venous flaps proved to be a useful tool for complex reconstructions of the hand and extremities. They can provide a large island of pliable skin and composite tissue with tendons and nerves, but surgeons must be aware of some caveats.
Topics: Forearm; Hand Injuries; Humans; Necrosis; Soft Tissue Injuries; Surgical Flaps; Veins
PubMed: 36013532
DOI: 10.3390/medicina58081065 -
Journal of Vascular and Interventional... Jun 2016To characterize thermal changes induced by rheolytic thrombectomy (RT) within an ex vivo venous model and evaluate resultant changes of endothelial and vessel wall...
PURPOSE
To characterize thermal changes induced by rheolytic thrombectomy (RT) within an ex vivo venous model and evaluate resultant changes of endothelial and vessel wall injury.
MATERIALS AND METHODS
Patent human saphenous vein segments without thrombus were mounted in an ex vivo perfusion system with a temperature probe apposed to the adventitial surface. RT was performed over a guide wire to facilitate device centering. Continuous RT was performed for 4 minutes with temperature recorded every 10 seconds. Pulsed RT was performed for eight cycles of 30 seconds followed by 10 seconds of deactivation. Mean temperature increase, maximum temperature (Tmax), intimal/medial thickness, endothelial cell staining (CD31), and heat shock protein 90 (HSP90) expression were compared between untreated and RT-treated venous segments.
RESULTS
Continuous RT produced a mean 7.6°C increase in temperature above baseline with mean Tmax of 44.1°C. Pulsed RT produced a mean 7.3°C increase in temperature and mean Tmax of 43.8°C. Differences in mean temperature increase (P = .66) and Tmax (P = .71) between the two groups were not statistically significant. RT-treated segments showed intima/media thinning (0.32 mm before RT and 0.18 mm after RT; P = .004) and reduction in intact endothelium (38.8% before RT and 13.8% after RT; P = .002). Staining for HSP90 showed a 3.1% increase in expression after RT (P = .31).
CONCLUSIONS
RT in this venous model showed reproducible increases in vessel temperature and evidence of endothelial and vessel wall injury. Avoiding prolonged RT application to a focal vascular segment during clinical use may be beneficial.
Topics: Endothelium, Vascular; HSP90 Heat-Shock Proteins; Humans; In Vitro Techniques; Perfusion; Platelet Endothelial Cell Adhesion Molecule-1; Saphenous Vein; Temperature; Thrombectomy; Time Factors; Vascular System Injuries
PubMed: 27103145
DOI: 10.1016/j.jvir.2016.02.008 -
Vascular and Endovascular Surgery Aug 2023Iatrogenic injury to the large abdominopelvic veins can he highly morbid, and open surgical repair is technically challenging. Endovascular repair with covered stenting... (Review)
Review
OBJECTIVE
Iatrogenic injury to the large abdominopelvic veins can he highly morbid, and open surgical repair is technically challenging. Endovascular repair with covered stenting across the injured segment offers an alternative to open surgical management. We present a series of patients with operative injury to the inferior vena cava (IVC) and iliac veins who were treated utilizing an endovascular approach and review the available literature on this technique.
METHODS
A PubMed keyword and MeSH term search was performed, and titles were reviewed for relevance by the first author. Studies related to endovascular repair of iatrogenic injury to the IVC and iliac veins were then read in detail for possible inclusion in the review. Those deemed appropriate were further analyzed for interventional approach, stent type and size, technical success, post-procedural pharmacologic management, complications and surveillance strategy.
RESULTS
The initial search resulted in 6221 publications. A total of 17 met criteria for inclusion, all of which were case reports or series. Twenty-six patients were described as suffering iatrogenic injury to the IVC or iliac veins, treated with various types and sizes of stents. All cases achieved technical success with hemorrhage control. Procedural complications occurred in 15.4% of cases, including 3 cases of acute thrombus formation and 1 case of stenosis caudal to the initial stent edge requiring additional stenting. Two additional patients experienced stent occlusion in the surveillance period.
CONCLUSIONS
Endovascular repair of iatrogenic injury to the IVC and iliac veins can be an effective management option. However, due to limited data regarding this approach, many technical questions remain, including ideal size and type of stent graft, necessity and duration of post-procedural anticoagulant or antiplatelet therapy and appropriate surveillance. Additionally, long term outcomes in this population have not yet been described.
Topics: Male; Humans; Vena Cava, Inferior; Iliac Vein; Endovascular Procedures; Treatment Outcome; Vascular System Injuries; Abdominal Injuries; Stents; Iatrogenic Disease; Retrospective Studies
PubMed: 36920124
DOI: 10.1177/15385744231163964 -
The American Surgeon Aug 2023Gunshot wounds account for significant morbidity and mortality in the United States. A rare and potentially fatal complication of a gunshot wound is bullet embolus....
Gunshot wounds account for significant morbidity and mortality in the United States. A rare and potentially fatal complication of a gunshot wound is bullet embolus. Potential complications include distal limb ischemia, coronary infarct, renal infarction, stroke, pulmonary embolization, cardiac valvular injury, thrombophlebitis, and dysrhythmias. Overall, surgical embolectomy and endovascular retrieval are the preferred treatments for bullet emboli. We report one case of venous bullet embolus and one case of arterial bullet embolus, both of which were successfully treated with endovascular retrieval. A thorough physical exam and appropriate imaging are vital to prompt identification and treatment of bullet emboli, as the repercussions of missed injuries can be devastating.
Topics: Humans; Wounds, Gunshot; Embolism; Veins; Embolectomy; Heart Injuries; Foreign-Body Migration
PubMed: 36960753
DOI: 10.1177/00031348231167413 -
Angiogenesis May 2021Endothelial cells display an extraordinary plasticity both during development and throughout adult life. During early development, endothelial cells assume arterial,... (Review)
Review
Endothelial cells display an extraordinary plasticity both during development and throughout adult life. During early development, endothelial cells assume arterial, venous, or lymphatic identity, while selected endothelial cells undergo additional fate changes to become hematopoietic progenitor, cardiac valve, and other cell types. Adult endothelial cells are some of the longest-lived cells in the body and their participation as stable components of the vascular wall is critical for the proper function of both the circulatory and lymphatic systems, yet these cells also display a remarkable capacity to undergo changes in their differentiated identity during injury, disease, and even normal physiological changes in the vasculature. Here, we discuss how endothelial cells become specified during development as arterial, venous, or lymphatic endothelial cells or convert into hematopoietic stem and progenitor cells or cardiac valve cells. We compare findings from in vitro and in vivo studies with a focus on the zebrafish as a valuable model for exploring the signaling pathways and environmental cues that drive these transitions. We also discuss how endothelial plasticity can aid in revascularization and repair of tissue after damage- but may have detrimental consequences under disease conditions. By better understanding endothelial plasticity and the mechanisms underlying endothelial fate transitions, we can begin to explore new therapeutic avenues.
Topics: Animals; Arteries; Cell Differentiation; Endothelial Cells; Hematopoietic Stem Cells; Humans; Lymphatic Vessels; Neovascularization, Physiologic; Veins; Wounds and Injuries; Zebrafish
PubMed: 33449300
DOI: 10.1007/s10456-020-09761-7