Angiosome-directed revascularisation and the woundosome paradigm in chronic limb-threatening ischaemia: a narrative review.

This review article explains two related ways of restoring blood flow to legs threatened by chronic limb-threatening ischaemia (CLTI), a severe condition where blocked arteries starve the foot of oxygen and nutrients. CLTI is a major cause of diabetic foot ulcers and amputation, so improving how we open those arteries directly affects whether wounds can heal. Because the review is a narrative review, it does not present new patient data or a trial with a fixed sample size; instead, the authors summarise and interpret existing published evidence. The first concept, angiosome-directed revascularisation, means opening the specific artery that feeds the exact area of skin or tissue where the wound sits, rather than simply improving blood flow anywhere in the leg. The second, newer concept, the woundosome paradigm, expands this idea by recognising that a wound is affected by more than one artery, more than one tissue layer, and factors such as infection and pressure, so successful healing may require treating a whole 'wound zone' rather than a single vessel. The review concludes that these ideas can guide doctors in planning revascularisation more precisely, potentially improving ulcer healing and limb salvage, though the evidence is still limited by inconsistent study designs and the lack of large randomised controlled trials. For patients, the key message is that careful, targeted restoration of blood flow can meaningfully improve the chance that a diabetic foot ulcer will heal and that amputation may be avoided, but this approach is not a guarantee and must be combined with wound care, infection control, and offloading.