Abstract：
OBJECTIVE: Peripheral arterial disease (PAD) can reduce wound healing rates by ≤30%. Current literature suggests wound outcomes are improved when management is driven by vascular providers. However, whether this benefit is derived solely from early vascular provider involvement remains unclear.
METHODS: A retrospective analysis was performed of 80 limbs with chronic wounds and underlying PAD seen at our institution\'s wound center between July 2022 and July 2023. Arterial disease was defined by the following criteria: (1) prior PAD diagnosis, (2) ankle-brachial-index of <0.9 or toe pressure of <70 mm Hg, or (3) absent peripheral pulses. Patients were divided into early (<6 week) vascular provider exposure (EVE; n = 45) or late/no vascular exposure (LNVE; n = 35). Providers included vascular surgeons and affiliated advanced practitioners. The primary outcome studied was overall time to wound healing. Statistical analysis included χ2 tests, t test, Pearson correlation, Kaplan-Meier analysis, and Cox regression modeling (variables included in a multivariate model if univariate effect on healing was associated at P < .1).
RESULTS: Baseline demographic profiles were similar between groups with exception of lower baseline albumin (P = .037), more heart failure (P = .013), and more prior peripheral endovascular interventions (P = .013) in the EVE group. Although the initial wound locations and sizes were similar, EVE wounds had significantly higher WIfI wound scores (1.9 ± 0.1 vs 1.6 ± 0.1; P = .039). Although more LNVE patients developed radiographic osteomyelitis (31.8% vs 55.6%; P = .033), fewer underwent operative debridement or amputation (100% vs 63.2%; P = .008). On univariate analysis, healing time tended to be shorter in EVE, but not significantly (P = .089). When controlled for comorbidities, however, healing rates were nearly two-fold higher in EVE (hazard ratio, 2.42; 95% confidence interval, 1.21-4.84). LNVE wounds also took significantly longer to reach checkpoints including time to >75% granulation (P = .05), 15% weekly size decrease (P = .044), and epithelialization (P = .026). LNVE patients required more wound center visits (P = .024) and procedures (P = .005) with a longer time to intervention (P = .041). All EVE patients obtained ankle-brachial indices, with 90.9% of them available at their first wound care visit (P < .001). Although a slightly greater proportion of patients underwent a major amputation in EVE (15.6% vs 11.4%; P = .595), this difference did not attain significance; additionally, 100% of EVE patients had documented discussion of nonsalvageable limbs before amputation.
CONCLUSIONS: Early exposure to vascular practitioners improves wound healing time, timeliness to intervention, and wound center and hospital resource use in patients with PAD. Further investigation into benefits of vascular involvement within community wound center models could significantly improve awareness and accessibility of arterial wound care in smaller/remote communities.
METHODS: A retrospective analysis was performed of 80 limbs with chronic wounds and underlying PAD seen at our institution\'s wound center between July 2022 and July 2023. Arterial disease was defined by the following criteria: (1) prior PAD diagnosis, (2) ankle-brachial-index of <0.9 or toe pressure of <70 mm Hg, or (3) absent peripheral pulses. Patients were divided into early (<6 week) vascular provider exposure (EVE; n = 45) or late/no vascular exposure (LNVE; n = 35). Providers included vascular surgeons and affiliated advanced practitioners. The primary outcome studied was overall time to wound healing. Statistical analysis included χ2 tests, t test, Pearson correlation, Kaplan-Meier analysis, and Cox regression modeling (variables included in a multivariate model if univariate effect on healing was associated at P < .1).
RESULTS: Baseline demographic profiles were similar between groups with exception of lower baseline albumin (P = .037), more heart failure (P = .013), and more prior peripheral endovascular interventions (P = .013) in the EVE group. Although the initial wound locations and sizes were similar, EVE wounds had significantly higher WIfI wound scores (1.9 ± 0.1 vs 1.6 ± 0.1; P = .039). Although more LNVE patients developed radiographic osteomyelitis (31.8% vs 55.6%; P = .033), fewer underwent operative debridement or amputation (100% vs 63.2%; P = .008). On univariate analysis, healing time tended to be shorter in EVE, but not significantly (P = .089). When controlled for comorbidities, however, healing rates were nearly two-fold higher in EVE (hazard ratio, 2.42; 95% confidence interval, 1.21-4.84). LNVE wounds also took significantly longer to reach checkpoints including time to >75% granulation (P = .05), 15% weekly size decrease (P = .044), and epithelialization (P = .026). LNVE patients required more wound center visits (P = .024) and procedures (P = .005) with a longer time to intervention (P = .041). All EVE patients obtained ankle-brachial indices, with 90.9% of them available at their first wound care visit (P < .001). Although a slightly greater proportion of patients underwent a major amputation in EVE (15.6% vs 11.4%; P = .595), this difference did not attain significance; additionally, 100% of EVE patients had documented discussion of nonsalvageable limbs before amputation.
CONCLUSIONS: Early exposure to vascular practitioners improves wound healing time, timeliness to intervention, and wound center and hospital resource use in patients with PAD. Further investigation into benefits of vascular involvement within community wound center models could significantly improve awareness and accessibility of arterial wound care in smaller/remote communities.
摘要：
目的：外周动脉疾病（PAD）可使伤口愈合率降低≤30％。目前的文献表明，当血管提供者推动管理时，伤口结局得到改善。然而,这种获益是否仅来自于早期血管提供者的参与仍不清楚.
方法：对2022年7月至2023年7月在我们机构的伤口中心观察到的80条具有慢性伤口和潜在PAD的肢体进行了回顾性分析。动脉疾病由以下标准定义：（1）先前的PAD诊断，（2）踝臂指数<0.9或脚趾压力<70mmHg，或（3）缺乏外周脉冲。患者分为早期（<6周）血管提供者暴露（EVE;n=45）或晚期/无血管暴露（LNVE;n=35）。提供者包括血管外科医生和附属高级从业者。研究的主要结果是伤口愈合的总时间。统计分析包括χ2检验，t测试,皮尔逊相关性，Kaplan-Meier分析,和Cox回归模型（变量包括在多变量模型，如果单变量对愈合的影响在P<1相关）。
结果：除基线白蛋白较低（P=0.037）外，组间基线人口统计学特征相似，更多的心力衰竭（P=.013），在EVE组中，先前的外周血管内干预更多（P=.013）。尽管最初的伤口位置和大小相似，EVE伤口的WIfI伤口评分明显更高（1.9±0.1vs1.6±0.1；P=.039）。尽管更多的LNVE患者发展为放射学骨髓炎（31.8％vs55.6％；P=0.033），接受手术清创或截肢的患者较少(100%vs63.2%;P=.008).在单变量分析中，EVE的愈合时间往往较短，但不显著(P=.089)。当控制合并症时，然而,EVE的治愈率几乎高出两倍(风险比，2.42；95%置信区间，1.21-4.84)。LNVE伤口也需要更长的时间才能达到检查点，包括超过75％肉芽的时间（P=0.05），每周大小减少15%(P=.044)，和上皮化（P=0.026）。LNVE患者需要更多的伤口中心就诊（P=.024）和手术（P=.005），干预时间更长（P=.041）。所有EVE患者均获得踝臂指数，其中90.9%的患者在第一次伤口护理就诊时可用(P<.001)。尽管在EVE中接受大截肢的患者比例略高（15.6％vs11.4％；P=.595），这种差异没有达到显著性；此外，100％的EVE患者在截肢前有过关于不可挽救的四肢的讨论。
结论：早期接触血管从业者可改善伤口愈合时间，及时干预，以及PAD患者伤口中心和医院资源的使用。进一步调查社区伤口中心模型中血管受累的益处可以显着提高较小/偏远社区对动脉伤口护理的认识和可及性。
方法：对2022年7月至2023年7月在我们机构的伤口中心观察到的80条具有慢性伤口和潜在PAD的肢体进行了回顾性分析。动脉疾病由以下标准定义：（1）先前的PAD诊断，（2）踝臂指数<0.9或脚趾压力<70mmHg，或（3）缺乏外周脉冲。患者分为早期（<6周）血管提供者暴露（EVE;n=45）或晚期/无血管暴露（LNVE;n=35）。提供者包括血管外科医生和附属高级从业者。研究的主要结果是伤口愈合的总时间。统计分析包括χ2检验，t测试,皮尔逊相关性，Kaplan-Meier分析,和Cox回归模型（变量包括在多变量模型，如果单变量对愈合的影响在P<1相关）。
结果：除基线白蛋白较低（P=0.037）外，组间基线人口统计学特征相似，更多的心力衰竭（P=.013），在EVE组中，先前的外周血管内干预更多（P=.013）。尽管最初的伤口位置和大小相似，EVE伤口的WIfI伤口评分明显更高（1.9±0.1vs1.6±0.1；P=.039）。尽管更多的LNVE患者发展为放射学骨髓炎（31.8％vs55.6％；P=0.033），接受手术清创或截肢的患者较少(100%vs63.2%;P=.008).在单变量分析中，EVE的愈合时间往往较短，但不显著(P=.089)。当控制合并症时，然而,EVE的治愈率几乎高出两倍(风险比，2.42；95%置信区间，1.21-4.84)。LNVE伤口也需要更长的时间才能达到检查点，包括超过75％肉芽的时间（P=0.05），每周大小减少15%(P=.044)，和上皮化（P=0.026）。LNVE患者需要更多的伤口中心就诊（P=.024）和手术（P=.005），干预时间更长（P=.041）。所有EVE患者均获得踝臂指数，其中90.9%的患者在第一次伤口护理就诊时可用(P<.001)。尽管在EVE中接受大截肢的患者比例略高（15.6％vs11.4％；P=.595），这种差异没有达到显著性；此外，100％的EVE患者在截肢前有过关于不可挽救的四肢的讨论。
结论：早期接触血管从业者可改善伤口愈合时间，及时干预，以及PAD患者伤口中心和医院资源的使用。进一步调查社区伤口中心模型中血管受累的益处可以显着提高较小/偏远社区对动脉伤口护理的认识和可及性。
