How Can A Biodegradable Matrix Offer Limb-Saving Options for Chronic Limb Threatening Ischaemia? Editorial Summary Chronic limb-threatening ischaemia, marked by severely reduced blood flow, poses a major wound healing challenge and threat of amputation.1-3 Emerging biotechnology however brings new promise through biodegradable matrices. These innovative extracellular matrix products aim to stimulate angiogenesis and neovascularization in limbs previously deemed unsalvageable.4 Findings suggest biodegradable temporising matrices (BTM), properly integrated with standard of care, can achieve significant wound closure and limb salvage.
Introduction
F
or wound specialists, chronic limb ischaemia is among our most recalcitrant diagnoses. This limb-threatening condition results from severe arterial blockages depriving tissues of su"cient perfusion for cell viability and healing. Critical limb ischaemia (CLI), now known as chronic limb-threatening ischaemia (CLTI), represents the most advanced state of peripheral arterial disease (PAD) and manifests as rest pain, non-healing ulcers, and/ or gangrene. More than 10% of patients with PAD may develop CLTI, and 55% of patients hospitalised with CLTI are readmitted within one year. It is vital that these patients are identified early in our clinical practice. 1-4
Table
1:
Features
of
Chronic
Ischaemia.
Rest pain Numbness Absent/diminished pulses legs/feet Non-healing ulcers Gangrene
Ms Victoria Bristow Vascular Specialist Nurse, Cambridge University Hospitals Cambridge, United Kingdom
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Wound Masterclass - Vol 3 - September 2024
Limb-Threatening
It is reported 10% of PAD patients may progress to develop CLTI, the most severe form of PAD. PAD itself is very common, affecting over 200 million people worldwide, so this translates to a large number of patients at risk for CLTI. 2
Readmission Rates The one-year readmission rate for patients hospitalized with CLTI is 55%, which indicates the chronic and complex nature of this condition. Readmissions are often due to recurrent pain, non-healing wounds, infections, or other complications.3
Importance of Early Identification: Identifying PAD patients who are progressing towards CLTI is crucial for preventing major limb amputation, disability, and death. Earlier diagnosis allows for more aggressive risk factor modification (e.g. smoking cessation, lipid and glycaemic control in diabetes) and treatment (e.g. revascularization procedures). Patients should also be placed on antiplatelet and statins for cardiovascular protection. All clinicians should assess for PAD signs and symptoms like intermittent claudication, non-healing ulceration, absent pulses, and incorporate tools like the ankle-brachial index, or the use of toe pressures. In summary, identifying these high-risk patients early is essential for improving outcomes and reducing the very high rates of readmission and complications. Increasing awareness of CLTI among clinicians across specialties who care for patients with vascular disease is an important priority. 1-3