Perioperative warming, oxygen, and Ilomedin on oxygenation and healing in infrainguinal bypass surgery.

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dc.contributor.author Chiang, Nathaniel en
dc.contributor.author Rodda, Odette A en
dc.contributor.author Sleigh, James en
dc.contributor.author Vasudevan, Thodur en
dc.date.accessioned 2018-11-26T01:22:01Z en
dc.date.issued 2017-12 en
dc.identifier.issn 0022-4804 en
dc.identifier.uri http://hdl.handle.net/2292/44591 en
dc.description.abstract BACKGROUND:Perioperative adjuncts are utilized across surgical specialities with the goal of improving patient outcomes. High-dose oxygen and extended warming are shown to increase wound collagen deposition during abdominal surgery. Prostacyclin is shown to improve limb salvage and patency rate in infrainguinal bypass (IIB) surgery. This study evaluated the impact of these adjuncts on healing and perfusion post IIB surgery. METHODS:This randomized controlled study allocated patients undergoing IIB surgery into three treatment arms (perioperative high-dose oxygen, extended warming, and a synthetic prostacyclin) or a control group. The primary outcome was accumulation of hydroxyproline (OHP, collagen surrogate marker) as collected in polytetrafluoroethylene implants on day 5. Secondary outcomes included levels of growth factors and cytokines, and tissue oxygenation of the wound and foot as measured by hyperspectral technology and ankle-brachial pressure index. Clinical outcomes were observed to day 30, with long-term follow-up of 12 mo. RESULTS:Seventy-one patients completed the study. Comparing treatment groups with the control at day 5, there were no differences in OHP, growth factors or cytokines levels, or improvement in tissue oxygenation at the surgical incision. However, there was more flow to the foot (HT-SUM (%) change) in the Ilomedin group compared to control (0% versus -14.6%, P = 0.045). HT-deoxy was higher at the peripheries in the oxygen and temperature groups, suggesting decreased tissue oxygenation. CONCLUSIONS:The perioperative treatments did not dramatically improve oxygenation or healing of the surgical wound in IIB surgery; however, Ilomedin may result in greater flow to the peripheries. en
dc.format.medium Print-Electronic en
dc.language eng en
dc.relation.ispartofseries The Journal of surgical research en
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. en
dc.rights.uri https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm en
dc.subject Leg en
dc.subject Humans en
dc.subject Oxygen en
dc.subject Iloprost en
dc.subject Hydroxyproline en
dc.subject Perioperative Care en
dc.subject Wound Healing en
dc.subject Aged en
dc.subject Aged, 80 and over en
dc.subject Middle Aged en
dc.subject Female en
dc.subject Male en
dc.subject Hot Temperature en
dc.subject Vascular Grafting en
dc.title Perioperative warming, oxygen, and Ilomedin on oxygenation and healing in infrainguinal bypass surgery. en
dc.type Journal Article en
dc.identifier.doi 10.1016/j.jss.2017.06.043 en
pubs.begin-page 197 en
pubs.volume 220 en
dc.rights.holder Copyright: The author en
dc.identifier.pmid 29180182 en
pubs.end-page 205 en
pubs.publication-status Published en
dc.rights.accessrights http://purl.org/eprint/accessRights/RestrictedAccess en
pubs.subtype Research Support, Non-U.S. Gov't en
pubs.subtype Randomized Controlled Trial en
pubs.subtype Journal Article en
pubs.elements-id 700901 en
pubs.org-id Medical and Health Sciences en
pubs.org-id School of Medicine en
pubs.org-id Anaesthesiology en
dc.identifier.eissn 1095-8673 en
pubs.record-created-at-source-date 2017-11-29 en
pubs.dimensions-id 29180182 en


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