Comparative Study Between Silver Nanoparticles Dressing (SilvrSTAT Gel) and Conventional Dressing in Diabetic Foot Ulcer Healing: A Prospective Randomized Study.

BACKGROUND: We are trying to evaluate silver nanoparticles' effectiveness (SilvrSTAT Gel) in accelerating healing rate of nonischemic diabetic foot ulcers (DFUs). METHODS: This prospective, double-blind, randomized, controlled study includes 80 patients with nonischemic DFUs classified into 2 groups. Group A was subjected to SilvrSTAT Gel dressing, and group B was subjected to conventional dressing (wet-to-moist dressing with or without povidone-iodine). All cases had minimal debridement before treatment. In both groups, all cases were nonischemic after successful revascularization either by bypass surgery or endovascular therapy. RESULTS: The healing rate of the SilvrSTAT group was significantly higher than that of the conventional group. The healing rate per week of the SilvrSTAT group was considerably higher than that of the conventional group (P < .0001). The rate of complete healing for ulcers in group A was achieved in 22 patients (55%) by the 6th week, while 29 (72.5%), 34 (85%), and 36 (90%) patients were healed entirely by the 8th, 10th, and 12th weeks, respectively. In group B: 20 (50%), 27 (67.5%), and 30 (75%) patients were completeley healed by the 8th, 10th, and 12th weeks, respectively. CONCLUSIONS: SilvrSTATGel is effective in the treatment of DFU.

Straight lateral thigh femoropopliteal-femoral arteriovenous graft an alternative vascular access for patients with exhausted upper limbs dialysis access.

INTRODUCTION: The durability of hemodialysis vascular access remains a troublesome issue for the patients as well as vascular surgeons that requires frequent reinterventions to maintain the access function. AIM: This study aimed to evaluate straight thigh polytetrafluethylene (PTFE) arteriovenous graft (AVG) in patients with exhausted upper extremities dialysis access. METHOD: Our study was a retrospective analysis of prospectively collected data of 30 patients were operated upon for straight pattern lateral thigh PTFE AVG between 2016 and 2018. The primary outcome was efficacy and patency of AVG, and secondary outcome was procedure safety, including infection, thrombosis, ligation, lower limb functional status, and mortality. RESULTS: A 30 patients with 30 Lower Limb AVG with maximum 30-month follow-up period. The mean age was 48 years. Males were (n = 15/30). Thrombophilia patients were (n = 7/30). Primary patency at 6 months was 100%. It declined to 93% at 12 months, 73% at 18 months, 47% at 24 months, and 40% at 30 months. The secondary patency was 97% at 18 months, 83% at 24 months, and 73% at 30 months. More than half of the patients showed complications (n = 18/30), the most frequent was thrombosis (n = 16/18). A secondary procedure was needed for 17 patients, the most frequent was thrombectomy (n = 11/17), adjunctive culprit lesion repair was the key for regaining graft patency. Graft removal was necessary in six patients due to infection (n = 4) and ruptured graft aneurysm (n = 2). CONCLUSION: Lateral straight thigh PTFE AVG is a reliable and durable alternative modality with adequate dialysis efficacy in patients with exhausted upper extremities dialysis accesses. Secondary procedures due to complications were frequent but no significant major bleeding as regard patients with ruptured graft were non-significant and no distal threatening ischemia or related deaths were observed.