Search Results (24)

Background: Chronic wounds represent a persistent clinical challenge and impose a considerable burden on healthcare systems. These lesions often require multidisciplinary management due to underlying factors such as microbial colonization, impaired immunity, and vascular insufficiencies. Regenerative therapies, particularly autologous approaches, have emerged as promising strategies to enhance wound healing. Adipose tissue-derived stem cells (ADSCs) and platelet-rich plasma (PRP) may improve outcomes through paracrine effects and growth factor release. Methods: A prospective observational study was conducted on 31 patients with chronic wounds that were unresponsive to conservative treatment for over six weeks. Clinical and photographic evaluations were employed to monitor healing. All patients underwent surgical debridement, with adjunctive interventions—negative pressure wound therapy, grafting, or flaps—applied as needed. PRP infiltration and/or autologous adipose tissue transfer were administered based on wound characteristics. Wound area reduction was the primary outcome measure. Results: The cohort included 17 males and 14 females (mean age: 59 years). Etiologies included venous insufficiency (39%), diabetes mellitus (25%), arterial insufficiency (16%), and trauma (16%). Most lesions (84%) were located on the lower limbs. All patients received PRP therapy; five underwent combined PRP and fat grafting. Over the study period, 64% of the patients exhibited >80% wound area reduction, with complete healing in 48.3% and a mean healing time of 49 days. Conclusions: PRP therapy proved to be a safe, effective, and adaptable treatment, promoting substantial healing in chronic wounds. Autologous adipose tissue transfer did not confer additional benefit. PRP may warrant inclusion in national treatment protocols. Full article

Introduction: Acrodermatitis chronica atrophicans (ACA) is a late-stage cutaneous manifestation of Lyme borreliosis, primarily caused by Borrelia afzelii. It mainly affects the distal limbs and leads to progressive skin atrophy. Unlike other Lyme disease rashes, ACA does not resolve on its own and can worsen into severe atrophy and fibrosis if left untreated. Diagnosing ACA can be difficult due to its delayed onset and subtle symptoms, requiring clinical evaluation, multiple blood tests, and skin biopsy. Case presentation: We present the case of a 48-year-old female with a history of pulmonary sarcoidosis who presented to our clinic with multiple erythemato-violaceous patches over her left lower leg and was initially misdiagnosed with venous insufficiency. Histopathological and serological analyses confirmed ACA in its inflammatory phase. The patient responded well to a 30-day course of doxycycline, achieving complete resolution. This report underscores the importance of considering ACA in differential diagnoses and provides a comprehensive review of its pathogenesis, clinical progression, histopathological features, and epidemiology. Conclusions: This case emphasizes the need to consider acrodermatitis chronica atrophicans (ACA) in the differential diagnosis of chronic skin lesions. Clinicians should maintain a high index of suspicion for ACA, particularly in atypical presentations. When the diagnosis is uncertain but clinical suspicion persists, skin biopsy is recommended for histopathologic confirmation. Early diagnosis and appropriate antibiotic therapy are essential to prevent disease progression and irreversible cutaneous atrophy. Accurate diagnosis and effective management require a multidisciplinary approach, involving close collaboration between dermatologists, pathologists, and infectious disease specialists. Full article

Background/Objectives: Venous ulcers are the most common type of ulcerated wounds in the lower limbs and result from chronic venous insufficiency. The treatment of venous ulcers is multidisciplinary, with physiotherapy intervention serving as an adjuvant therapy in managing these wounds. This study investigated physiotherapeutic interventions for the management of venous ulcers. Methods: This was an exploratory and descriptive study using the Delphi method. The panel comprised 12 experts in wound care, including 25.0% physicians, 41.7% nurses, and 33.3% physiotherapists. Two rounds of analysis were conducted. A quantitative analysis was performed to assess the level of agreement in responses, while qualitative analysis was applied to the experts’ comments. Results: In the first round, consensus varied between 80% and 100%, and in the second round, it ranged from 83.3% to 100%. In the second round, all interventions obtained at least 80% consensus. The interventions included the use of compression therapy and therapeutic exercise: resistance training (2–3 sets of 10–25 repetitions, 3 times/day, for at least 12 weeks), aerobic exercise (at least 30 min, 3 times/week, for 12 weeks), stretching, balance training, and the use of a vibrating platform. Conclusions: Physiotherapy may be beneficial as an adjuvant therapy alongside specific local treatments for venous ulcers. Therapeutic exercise and compression therapy are commonly utilized interventions that could support overall treatment outcomes. Full article

Soft tissue reconstruction in the lower limbs presents a significant challenge, particularly when addressing defects in the distal third of the leg, ankle, and foot. The reverse sural flap reliant on the perforating branches of the peroneal artery has emerged as a versatile option, offering a solution for patients for whom microsurgical techniques are not feasible. Despite its advantages, the procedure carries inherent risks, especially in populations with underlying conditions, such as venous insufficiency, cardiovascular disease, and diabetes, as well as in elderly patients, where the likelihood of flap necrosis is elevated. This report details a case of reverse sural flap necrosis in a patient with lupus-like syndrome, a complex scenario that underscores the need for meticulous preoperative assessment and planning. The case illustrates not only the technical considerations and challenges associated with the reverse sural flap but also the broader implications of systemic autoimmune disorders on postoperative outcomes. Through a comprehensive review of the literature, we explore the relationship between vascularization, autoimmune profiles, and the success of reverse sural flap procedures. We highlight the critical need for surgeons to adopt a holistic approach to patient evaluation, considering both local and systemic factors that may influence the viability of the flap and the overall reconstructive success. Full article

Background/Objective: The endovenous embolization of insufficient abdominal/pelvic veins is the preferred method of treatment. Also, it seems to be crucial in the treatment of lower limb vein insufficiency, particularly in recurrent disease. This study aimed to evaluate of pelvic vein embolization safety and its impact on the short-term outcome in the sequential treatment of venous disease. Methods: A retrospective analysis involved data from 506 female patients with venous disease involving abdominal and pelvic veins. All records were extracted from the medical database and included patient history, imaging reports as well as pre- and post-operative surveys. Results: Among the patients analyzed, 37.2% underwent some venous intervention in the past, with significant differences in symptom severity between groups. The embolization procedure revealed a high safety profile, with no serious complications. Pain during and after the procedure was generally low, with significantly lower pain scores in patients with recurrence. In patients who required left renal vein venoplasty a 1.7-fold increased risk of lumbar pain after embolization and venoplasty procedure was observed. Overall, 66.6% of patients reported improvement in pelvic symptoms and 72.1% experienced improvement in leg symptoms. The full sequential treatment protocol (abdominal, pelvic, and leg compartment) demonstrated superior outcomes in leg symptom improvement compared to embolization alone. Conclusions: Pelvic vein embolization is a safe and effective method of treatment, significantly improving both pelvic and leg symptoms, particularly in patients with a history of previous interventions in lower limb veins. Further studies are warranted to validate our findings and further refine treatment protocols. Full article

We analyzed the medical condition of 360 women affected by lipedema of the lower limbs in stages 1, 2, and 3. The data were assessed for the whole population and compared between different clinical stages, distinguishing between obese and non-obese patients. The most frequent clinical signs were pain when pinching the skin, subcutaneous nodules, and patellar fat pads. The most frequently painful site of the lower limbs was the medial lower third of the thigh. The pain score obtained on lower limb points increased progressively with the clinical stage. In all points evaluated, the thickness of the subcutaneous tissue increased with the clinical stage. Analyzing the data on the lower medial third of the leg and considering only patients with type 3 lipedema, the difference between stages was statistically significant after correction for age and BMI. We found higher levels of C-reactive protein at more severe clinical stages, and the difference was significant after correction for age and BMI between the stages. Overall, the prevalence of alterations of glucose metabolism was 34%, with a progressive increase in prevalence with the clinical stage. The most frequent comorbidities were vitamin D insufficiency, chronic venous disease, allergies, dyslipidemia, headache, and depression of mood. Interestingly, in comparison with the general population, we found higher prevalence of chronic autoimmune thyroiditis and polycystic ovary syndrome. Finally, the clinical stage and the involvement of the upper limbs or obesity suggest a worse clinical, anthropometric, and endocrine–metabolic profile. Full article

One of the early symptoms of chronic venous disease (CVD) is varicose veins (VV) of the lower limbs. There are many etiological environmental factors influencing the development of chronic venous insufficiency (CVI), although genetic factors and family history of the disease play a key role. All these factors induce changes in the hemodynamic in the venous system of the lower limbs leading to blood stasis, hypoxia, inflammation, oxidative stress, proteolytic activity of matrix metalloproteinases (MMPs), changes in microcirculation and, consequently, the remodeling of the venous wall. The aim of this review is to present current knowledge on CVD, including the pathophysiology and mechanisms related to vein wall remodeling. Particular emphasis has been placed on describing the role of inflammation and oxidative stress and the involvement of extracellular hemoglobin as pathogenetic factors of VV. Additionally, active substances used in the treatment of VV were discussed. Full article

Background: Post-thrombotic syndrome (PTS) is a common and debilitating sequela of lower limb deep vein thrombosis (DVT). There is significant heterogeneity in reported PTS incidence due to lack of standardised diagnostic criteria. This review aimed to develop diagnostic criteria for PTS and subsequently refine the reported incidence and severity. Methods: PRISMA principles were followed; however, the review was not registered. The Cochrane CENTRAL database, MEDLINE, Embase, the NHS NICE Healthcare Databases Advanced Search interface, and trial registers including isrctn.com and clinicaltrials.gov were searched for studies addressing areas of interest (PTS definition, epidemiology, assessment). An experienced Clinical Librarian undertook the systematic searches, and two independent reviewers agreed on the relevance of the papers. Conflicts were resolved through panel review. Evidence quality was assessed using a modified Coleman scoring system and weighted according to their relevance to the aforementioned areas of interest. Results: A total of 339 abstracts were retrieved. A total of 33 full-text papers were included in this review. Following qualitative analysis, four criteria were proposed to define PTS: (1) a proven thrombotic event on radiological assessment; (2) a minimum 24-month follow-up period after an index DVT; (3) assessment with a validated score; and (4) evidence of progression of venous insufficiency from baseline. Four papers conformed to our PTS definition criteria, and the incidence of mild to moderate PTS ranged from 7 to 36%. On reviewing the studies which utilised the recommended Villalta scale, PTS incidence narrowed further to 23–36%. Incidence and severity reached a plateau at 24 months. Conclusions: Four diagnostic criteria were developed from qualitative synthesis. When these criteria were applied to the literature, the range of reported PTS incidence narrowed. These four criteria may standardise PTS diagnosis in future studies, facilitating the pooling of data for meta-analysis and synthesis of higher levels of evidence. Full article

Pregnancy is a well-known risk factor for venous insufficiency. However, even nulliparous women experience venous problems. Therefore, we aimed to assess the possible associations between the number of pregnancies, veins condition and treatment outcome in women with venous disease. The retrospective assessment concerned data of 297 women with diagnosed venous insufficiency. Based on their pregnancy history, the patients’ records were divided into: nulliparous women (15.5%), those after 1–2 term pregnancies (57.9%) and those after ≥3 pregnancies (26.6%). The analysis concerned data from the diagnostics of the abdominal/pelvic and leg veins and the treatment results expressed as a symptoms/satisfaction score. Most of the nulliparous women developed venous disease due to mild anatomic abnormalities of the abdominal/pelvic veins. They responded to treatment (mostly unilateral embolization) very well. In the second group, the majority of the combined venous abnormalities responded to treatment with significant improvement, even after embolization alone, although nearly two-thirds still required further leg treatment. The third group was comprised of more advanced cases; nearly 40% of them with recurrence. In order to improve their condition, three-fourths of the cases required sequential treatment in both the pelvic and leg veins compartments. In conclusion, the number of pregnancies is a potent modifying factor in the pathogenesis of venous disease, especially in multiparous women. Together with abnormal venous anatomy, it may determine the treatment outcome. Full article

Pelvic venous insufficiency is a common problem in multiparous women. Besides burdensome symptoms, it correlates with the development of venous disease in the lower limbs. Therefore, the sequential treatment of abdominal/pelvic before leg veins could improve treatment effectiveness. The medical records of 243 patients with venous disease who were subjected to sequential treatment were analyzed retrospectively. The symptoms and patient satisfaction were assessed using dedicated questionnaires, both before and after treatment. Clinical effectiveness was verified using a Doppler scan, both before and after treatment. Among 243 analyzed cases, 195 underwent whole treatment; however, 48 women after embolization did not require further intervention. The total-symptom-score change (11.6 vs. 13.0, respectively) and the satisfaction score (1.6 vs. 1.5, respectively) did not differ between groups. After embolization, some patients, besides symptoms improvement, experienced reflux reduction and, hence, might avoid further intervention. A better explanation for this beneficial effect of the sequential/descending approach requires further studies. Full article

Objectives: The broad spectrum of chronic venous disease encompasses varicose veins, edema, hyperpigmentation and venous ulcers. Radiofrequency thermal ablation is indicated for the treatment of superficial venous reflux of the lower limb. Our research is a comparative clinical study that aims to identify the most effective and safest therapeutic method in the management of chronic venous insufficiency of the lower limbs. Materials and methods: Patients admitted to the Department of Surgery of the University of Medicine and Pharmacy in Cluj-Napoca, Romania, with the clinical diagnosis of varicose veins of the lower limbs, treated by thermal ablation with radiofrequency or by open surgical techniques during the year 2022, were included. Results: A percentage of 50.9% of the patients were treated by the radiofrequency thermal ablation procedure and 49.1% by surgical treatment. More than half of them were hospitalized for 2 days. The duration of hospitalization was significantly longer in patients who had postoperative complications (p < 0.001). The chance of being treated by open surgical treatment for a small saphenous vein is 10.11 times higher than by radiofrequency thermal ablation. Conclusion: According to the applied tests, there is no statistical difference between the group treated by radiofrequency thermal ablation and the one surgically treated in terms of sex, age, origin, CEAP clinical stage at hospitalization, clinical diagnosis at hospitalization and affected lower limb. Full article

Hemorrhagic shock (HS) management is based on a timely, rapid, definitive source control of bleeding/s and on blood loss replacement. Stopping the hemorrhage from progressing from any named and visible vessel is the main stem fundamental praxis of efficacy and effectiveness and an essential, obligatory, life-saving step. Blood loss replacement serves the purpose of preventing ischemia/reperfusion toxemia and optimizing tissue oxygenation and microcirculation dynamics. The “physiological classification of HS” dictates the timely management and suits the ‘titrated hypotensive resuscitation’ tactics and the ‘damage control surgery’ strategy. In any hypotensive but not yet critical shock, the body’s response to a fluid load test determines the cut-off point between compensation and progression between the time for adopting conservative treatment and preparing for surgery or rushing to the theater for rapid bleeding source control. Up to 20% of the total blood volume is given to refill the unstressed venous return volume. In any critical level of shock where, ab initio, the patient manifests signs indicating critical physiology and impending cardiac arrest or cardiovascular accident, the balance between the life-saving reflexes stretched to the maximum and the insufficient distal perfusion (blood, oxygen, and substrates) remains in a liable and delicate equilibrium, susceptible to any minimal change or interfering variable. In a cardiac arrest by exsanguination, the core of the physiological issue remains the rapid restoration of a sufficient venous return, allowing the heart to pump it back into systemic circulation either by open massage via sternotomy or anterolateral thoracotomy or spontaneously after aorta clamping in the chest or in the abdomen at the epigastrium under extracorporeal resuscitation and induced hypothermia. This is the only way to prevent ischemic damage to the brain and the heart. This is accomplishable rapidly and efficiently only by a direct approach, which is a crush laparotomy if the bleeding is coming from an abdominal +/− lower limb site or rapid sternotomy/anterolateral thoracotomy if the bleeding is coming from a chest +/− upper limbs site. Without first stopping the bleeding and refilling the heart, any further exercise is doomed to failure. Direct source control via laparotomy/thoracotomy, with the concomitant or soon following venous refilling, are the two essential, initial life-saving steps. Full article

Objectives: To evaluate indirect criteria of pelvic venous insufficiency (PVI) of a short tau inversion recovery (STIR) sequence retrospectively compared with phlebographic findings. Methods: Between 2008 and 2018, 164 women who had received MRI and phlebography for pelvic congestion syndrome (60), varicose veins in the lower limbs (45), both (43), or other symptoms (16) were included. The presence of periuterine varicosities and perivaginal varicosities were compared to the findings of phlebography: grading of left ovarian vein reflux and presence of internal pudendal or obturator leak. Results: There was a correlation between the grading of LOV reflux on phlebography and the diameter of periuterine varicosities on STIR sequence (p = 0.008, rho = 0.206, CIrho [0.0549 to 0.349]). Periuterine varicosities had a positive predictive value of 93% for left ovarian reflux (95% CI [88.84% to 95.50%]). Obturator or internal pudendal leaks were found for 118 women (72%) and iliac insufficiency for 120 women (73%). Conclusions: Non-injected MRI offers a satisfactory exploration of PVI with STIR sequence. STIR sequences alone enabled the detection of left ovarian and iliac insufficiency. Full article

(1) Background: Musculoskeletal disorders can be associated with advanced clinical stages of chronic venous insufficiency (CVI). The aim of the study is to investigate the effect of active stretching (AS) training on lower limb venous function and quality of life in patients affected by CVI. (2) Methods: A prospective two-armed pilot randomized controlled was conducted. Twenty (20) CVI patients were randomly assigned to an AS training or to a control group (C) who did not receive any exercise indication. At baseline and after three months all the participants were tested for leg volumetry (LV), air plethysmography (APG), and quality of life (QoL) measured by a disease specific validated questionnaire (VVSymQ), ankle range of motion (ROM), and postural deformities using an optoelectronic body posture machine. (3) Results: At the end of the training in the AS group a significant leg volume reduction was detected (from 2340 ± 239 mL to 2239 ± 237 mL (4.3%); p < 0.0001), whereas in the C group no significant volume changes were found. The ejection fraction rate (EF%) increased significantly from 49.3 ± 9.3 to 61.1 ± 14.5, p < 0.005. A moderate-strong linear correlation with EF% and ankle ROM variation was found (R² = 0.6790; p < 0.0034). Several postural outcomes such as pelvic tilt, pelvic torsion, and lordotic angle significantly improved in the AS group (p < 0.01, p < 0.04, p < 0.01 respectively). (4) Conclusion: The AS training impacts on the APG parameters related to the musculoskeletal pump efficiency, opening a further possibility in the management of CVI patients by means of an appropriate adapted physical exercise program. Full article

Background: There is no clear consensus on the optimal surgical strategy for providing safe coverage in salvage free flap surgery after total free flap failure. Methods: A retrospective study was conducted to evaluate patients with total failure of the primary free flap in lower extremity reconstruction between 2000 and 2017. Results: In a cohort of 1.016 patients, we identified 43 cases of total flap failure (4.2%). A total of 30 patients received a salvage free flap with a success rate of 83.3% (25/30). One patient received a secondary salvage free flap. Overall limb salvage after primary free flap loss was 83.7% (36/43). Conclusions: Microsurgical management of free flap loss in the lower extremity is challenging and requires a decisive re-evaluation of risk factors and alternative strategies. This should include reconsidering the flap choice with a tendency towards traditional and safe workhorse flaps, a low-threshold switch to different recipient vessels, including arteriovenous (AV) loops, bypasses (especially in case of venous insufficiency) and back-up procedures, such as negative pressure wound therapy or dermal regeneration templates with skin grafting in cases of lower demand and critically ill patients. We derived one suggestion from our previous practice: replacing perforator flaps with axial pattern flaps (“safe workhorses”). Full article