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Dueppers P, Bozalka R, Kopp R, Menges AL, Reutersberg B, Schrimpf C, Moreno Rivero FJ, Zimmermann A. The Use of Intact Fish Skin Grafts in the Treatment of Necrotizing Fasciitis of the Leg: Early Clinical Experience and Literature Review on Indications for Intact Fish Skin Grafts. J Clin Med 2023; 12:6001. [PMID: 37762941 PMCID: PMC10532083 DOI: 10.3390/jcm12186001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/10/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Necrotizing fasciitis (NF) is a serious infectious disease that can initially place the patient's life in danger and, after successful surgical and antibiotic treatment, leaves extensive wounds with sometimes even exposed bones and tendons. Autologous skin grafts are not always possible or require adequate wound bed preparation. Novel intact fish skin grafts (iFSGs; Kerecis® Omega3 Wound, Kerecis hf, Isafjördur, Iceland) have already shown their potential to promote granulation in many other wound situations. Faster wound healing rates and better functional and cosmetic outcomes were observed due to their additionally postulated anti-inflammatory and analgesic properties. Therefore, iFSGs may also be essential in treating NF. We present our initial experience with iFSGs in treating leg wounds after NF and review the literature for the current spectrum of clinical use of iFSGs. CASE PRESENTATIONS We present two male patients (aged 60 and 69 years) with chronic or acute postsurgical extensive leg ulcers six weeks and six days after necrotizing fasciitis, respectively. Both suffered from diabetes mellitus without vascular pathologies of the lower limbs. A single application of one pre-meshed (Kerecis® Graftguide) and one self-meshed 300 cm2 iFSG (Kerecis® Surgiclose) was performed in our operation room after extensive surgical debridement and single circles of negative wound pressure therapy. Application and handling were easy. An excellent wound granulation was observed, even in uncovered tibia bone and tendons, accompanied by pain relief in both patients. Neither complications nor allergic reactions occurred. The patients received autologous skin grafting with excellent functional and cosmetic outcomes. CONCLUSIONS iFSGs have the potential to play a significant role in the future treatment of NF due to the fast promotion of wound granulation and pain relief. Our experience may encourage surgeons to use iFSGs in NF patients, although high-quality, large-sized studies are still required to confirm these results. The observed effects of iFSGs on wounds associated with NF may be transferred to other wound etiologies as well.
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Affiliation(s)
- Philip Dueppers
- Department of Vascular Surgery, University Hospital Zurich (USZ), University of Zurich (UZH), Raemistrasse 100, CH-8091 Zurich, Switzerland; (R.B.); (R.K.); (A.-L.M.); (B.R.); (C.S.); (A.Z.)
| | - Roland Bozalka
- Department of Vascular Surgery, University Hospital Zurich (USZ), University of Zurich (UZH), Raemistrasse 100, CH-8091 Zurich, Switzerland; (R.B.); (R.K.); (A.-L.M.); (B.R.); (C.S.); (A.Z.)
| | - Reinhard Kopp
- Department of Vascular Surgery, University Hospital Zurich (USZ), University of Zurich (UZH), Raemistrasse 100, CH-8091 Zurich, Switzerland; (R.B.); (R.K.); (A.-L.M.); (B.R.); (C.S.); (A.Z.)
| | - Anna-Leonie Menges
- Department of Vascular Surgery, University Hospital Zurich (USZ), University of Zurich (UZH), Raemistrasse 100, CH-8091 Zurich, Switzerland; (R.B.); (R.K.); (A.-L.M.); (B.R.); (C.S.); (A.Z.)
| | - Benedikt Reutersberg
- Department of Vascular Surgery, University Hospital Zurich (USZ), University of Zurich (UZH), Raemistrasse 100, CH-8091 Zurich, Switzerland; (R.B.); (R.K.); (A.-L.M.); (B.R.); (C.S.); (A.Z.)
| | - Claudia Schrimpf
- Department of Vascular Surgery, University Hospital Zurich (USZ), University of Zurich (UZH), Raemistrasse 100, CH-8091 Zurich, Switzerland; (R.B.); (R.K.); (A.-L.M.); (B.R.); (C.S.); (A.Z.)
| | - Francisco Jose Moreno Rivero
- Tissue Viability Service (Wound Care), University Hospital Zurich (USZ), Raemistrasse 100, CH-8091 Zurich, Switzerland;
| | - Alexander Zimmermann
- Department of Vascular Surgery, University Hospital Zurich (USZ), University of Zurich (UZH), Raemistrasse 100, CH-8091 Zurich, Switzerland; (R.B.); (R.K.); (A.-L.M.); (B.R.); (C.S.); (A.Z.)
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Gujja K, Purushottam B, Kapur V, Cox‐Alomar PR, Krishnan P. Popliteal Artery Interventions. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Surgical Treatment of Asymptomatic Popliteal Artery Aneurysms and Mid-term Outcome. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02747-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Open Endoaneurysmorrhaphy of 9-cm Ruptured Popliteal Aneurysm 7 Years after Initial Repair. Ann Vasc Surg 2020; 72:665.e9-665.e13. [PMID: 33227480 DOI: 10.1016/j.avsg.2020.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 09/29/2020] [Accepted: 10/05/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND A previously repaired right popliteal artery aneurysm via a medial approach with proximal and distal ligation and interval bypass re-presented 7 years after the initial repair with a ruptured 9 × 25.5 cm right popliteal aneurysm. METHODS Surgical repair was complex due to the large size of the aneurysm. Technique and management of popliteal aneurysm repair are discussed, along with a review of the current literature. RESULTS A 58-year-old male with a 3.5 cm popliteal artery aneurysm was initially treated with end-to-end prosthetic bypass and proximal/distal aneurysm ligation from a medial-approach without complication. Seven years later, he presented with a 9-cm popliteal aneurysm rupture. Posterior approach endoaneurysmorrhaphy repair was far more complicated than expected with massive blood loss. Despite this, he was discharged without complication POD #5, but on POD #19 presented with cellulitis and underwent incision and drainage of retained hematoma with cultures positive for Strep dysgalactiae. With appropriate treatment, he was healed in 3 months. CONCLUSIONS Surgical repair of large popliteal aneurysms can be challenging, but continued aneurysmal degeneration is a potential consequence if the sac continues to be pressurized from patent geniculate arteries. Surgical repair of large popliteal artery aneurysms is complex and requires adjunctive techniques to maximize success. A posterior approach is described and the literature reviewed to support recommendations for primary popliteal artery aneurysm repair and repair of large degenerated popliteal artery aneurysms. We recommend primary popliteal artery aneurysm repair from a posterior approach with endoaneurysmorrhaphy and an interposition bypass. For ruptured large popliteal artery aneurysms, there is a high risk of hemorrhage and wound complications. Therefore, we recommend the use of a tourniquet, surgical drain and to consider the collection of intraoperative cultures to guide potential antibiotic management.
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Sousa RS, Oliveira-Pinto J, Mansilha A. Endovascular versus open repair for popliteal aneurysm: a review on limb salvage and reintervention rates. INT ANGIOL 2020; 39:381-389. [DOI: 10.23736/s0392-9590.20.04387-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Aragão JA, de Miranda FGG, Aragão ICS, Aragão FMS, Reis FP. Treatment of bilateral popliteal artery aneurysms. J Vasc Bras 2019; 19:e20180142. [PMID: 31839798 PMCID: PMC6900880 DOI: 10.1590/1677-5449.180142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Popliteal artery aneurysms are the most frequent type of peripheral aneurysm, accounting for 85% of the all of these aneurysms. Usually asymptomatic, they are generally diagnosed during clinical examination. Incidence is higher among males and seniors. They are bilateral in 50% of the cases and 60% are associated with abdominal aortic aneurysms. This paper describes a 72-year-old male patient who presented with two bilateral pulsatile masses, one in each popliteal region, was otherwise asymptomatic, and had a history of hypertension and dyslipidemia. Clinical examination and ultrasound imaging confirmed a diagnosis of bilateral aneurysms of the popliteal arteries. Popliteal artery aneurysms can be treated with open bypass surgery, with or without aneurysm resection, or with endovascular surgery. This Therapeutic Challenge discusses these possibilities.
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Affiliation(s)
- José Aderval Aragão
- Universidade Federal de Sergipe - UFS, Aracaju, SE, Brasil.,Universidade Tiradentes - UNIT, Aracaju, SE, Brasil
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Golchehr B, Zeebregts CJ, Reijnen MM, Tielliu IF. Long-term outcome of endovascular popliteal artery aneurysm repair. J Vasc Surg 2018; 67:1797-1804. [DOI: 10.1016/j.jvs.2017.09.040] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 09/07/2017] [Indexed: 01/21/2023]
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Gujja K, Punukollu G, Kapur V, Krishnan P. Popliteal Artery Interventions. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Karthik Gujja
- The Zena and Michael A. Weiner Cardiovascular Institute; Icahn School of Medicine at Mount Sinai; New York NY USA
| | | | - Vishal Kapur
- The Zena and Michael A. Weiner Cardiovascular Institute; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - Prakash Krishnan
- The Zena and Michael A. Weiner Cardiovascular Institute; Icahn School of Medicine at Mount Sinai; New York NY USA
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Ballesteros-Pomar M, Menéndez-Sánchez E, Novo-Martínez G, Santos-Alcántara E, Rodríguez-López I, Maqueda-Ara S, Fernández-Samos R, Zorita-Calvo A. Aneurismas poplíteos pequeños. ¿Son todos benignos? ANGIOLOGIA 2016. [DOI: 10.1016/j.angio.2016.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tuveson V, Löfdahl HE, Hultgren R. Patients with abdominal aortic aneurysm have a high prevalence of popliteal artery aneurysms. Vasc Med 2016; 21:369-75. [DOI: 10.1177/1358863x16648404] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients with abdominal aortic aneurysms (AAA) are more prone to develop popliteal artery aneurysms (PAA), but the prevalence is not well known. Our aim was to investigate the prevalence of PAA in patients with AAA, and to determine whether a certain risk factor profile is more commonly found in patients with concurrent aneurysms. All AAA patients (ICD code I71.3, I71.4) attending the outpatient clinic at the Karolinska University Hospital between 2011 and 2013 were included in the study cohort ( n=465); 48% (225) had been subjected to an ultrasound or computed tomography scan of their popliteal arteries. In these patients, three definitions of PAA were considered (⩾ 10.5, ⩾ 12, ⩾ 15 mm), although the overall analysis is based on PAA ⩾ 12 mm. The mean age was 70.7 years (SD 7.5), 89% were men, and the mean AAA diameter was 47 mm (SD 14). The prevalence of PAA was 19% ( n=43) by definition ⩾ 12 mm, and 11% ( n=25) with 15 mm. Claudication was more frequently found in AAA patients with PAA than patients without PAA. Sensitivity between clinical examination and radiology was 26%, and the specificity for clinical examination was 90%. In conclusion, owing to the high prevalence of PAA in AAA patients, described by us and others, the low cost and risks associated with ultrasound and the poor sensitivity at clinical examination, all women and men with AAA should undergo one radiological examination of their popliteal arteries.
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Affiliation(s)
- Viktoria Tuveson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Hedvig E Löfdahl
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Rebecka Hultgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
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Golchehr B, Tielliu I, Verhoeven E, Möllenhoff C, Antonello M, Zeebregts C, Reijnen M. Clinical Outcome of Isolated Popliteal Artery Aneurysms Treated with a Heparin-bonded Stent Graft. Eur J Vasc Endovasc Surg 2016; 52:99-104. [DOI: 10.1016/j.ejvs.2016.04.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 04/12/2016] [Indexed: 10/21/2022]
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