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International Angiology 2002 December;21(4):360-6


lingua: Inglese

Intermittent compression pump for nonhealing wounds in patients with limb ischemia. The Mayo Clinic experience (1998-2000)

Montori V. M. 1, Kavros S. J. 2, 3, Walsh E. E. 4, Rooke T. W. 3, 5

1 Division of Endocrinology, Diabetes, Metabolism, Nutrition, and Internal Medicine, Mayo Clinic, Rochester, MN, USA 2 Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA 3 Vascular Ulcer and Wound Healing Clinic, Gonda Vascular Center, Mayo Clinic Rochester, MN, USA 4 Mayo Medical School, Mayo Clinic and Foundation, Rochester, MN, USA 5 Division of Vascular Medicine and Internal Medicine, Mayo Clinic, Rochester, MN, USA


Background. The aim of this ret­ro­spec­tive obser­va­tion­al study was to ­review the use of an inter­mit­tent pneu­mat­ic com­pres­sion ­device on non­heal­ing ­wounds in ­patients with crit­i­cal limb ische­mia at Mayo Clinic Rochester.
Methods. The set­ting was a com­mu­nity and refer­ral mul­ti­dis­ci­pli­nary wound care clin­ic. The ­authors ana­lysed 107 ­patients, ­median age 73, with crit­i­cal limb ische­mia and ­active ­ulcers start­ed using a com­pres­sion ­device ­between 1998 and 2000; 101 ­patients had lower extrem­ity ­ulcers, and 25% had a his­to­ry of ampu­ta­tion, and 64% had dia­betes. Of all the ­wounds, 64% were mul­ti­fac­to­ri­al in eti­ol­o­gy, and 60% had asso­ciat­ed trans­cu­ta­ne­ous oxy­gen ten­sion lev­els below 20 mmHg. Patients were typ­i­cal­ly asked to use the devi­ce at home on the affect­ed limb(s) for 6 hours daily. The main out­come cri­ter­ion was com­plete wound heal­ing with limb pres­er­va­tion.
Results. The ­median fol­low-up after initi­a­tion of treat­ment was 6 ­months. Complete wound heal­ing with limb pres­er­va­tion was ­achieved by 40% of ­patients with TcPO2 lev­els below 20 mmHg; by 48% with osteo­my­e­li­tis or ­active wound infec­tion; by 46% with dia­betes treat­ed with insu­lin; and by 28% with a pre­vi­ous ampu­ta­tion. Half of all ampu­ta­tions ­occurred in ­patients with prior ampu­ta­tions. Seven ­patients dis­con­tin­ued the ­device ­because of pain expe­ri­enced with its use.
Conclusions. Patients with crit­i­cal limb ische­mia and non­heal­ing ­wounds at high risk of ampu­ta­tion can ­achieve com­plete wound heal­ing and limb pres­er­va­tion by using an inter­mit­tent pneu­mat­ic com­pres­sion ­device.

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