Background/Objectives: Spinal cord injury (SCI) is a complex medical condition with widespread effects that extend beyond motor and sensory impairments. In addition to nervous system damage, SCI patients experience various secondary complications, including vascular dysfunction, altered body composition, and metabolic disturbances. Among the most common secondary pathologies is the development of pressure injuries (PIs), chronic wounds that significantly affect quality of life and can be challenging to treat. Understanding the physiological and cellular mechanisms behind these complications is crucial for improving care and therapeutic outcomes. Methods: We conducted a comprehensive literature search in PubMed, Scopus, and Google Scholar using keywords related to spinal cord injury, pressure ulcer/pressure injuries, metabolic and vascular dysfunction, biomechanics, and regenerative therapies. Studies were selected based on their relevance to the pathophysiology, risk factors, and novel therapeutic approaches for PIs in SCI patients. Results: Vascular dysfunction, characterized by impaired blood flow and microcirculatory issues, predisposes SCI patients to ischemia and tissue necrosis, particularly in areas subjected to prolonged pressure. Additionally, changes in body composition, such as increased adiposity and muscle atrophy, further compromise tissue integrity and healing capacity. The inflammatory response, mediated by cytokines such as IL-1, IL-6, and TNF-α, exacerbates these effects by sustaining a pro-inflammatory environment that delays the transition of macrophages to the M2 phenotype, critical for wound healing. External factors, such as poor nutrition, infections, and immobility, also play a significant role in worsening the wound healing process. Conclusions: Chronic SCI induces a cascade of physiological changes that predispose patients to the development of PIs and complicate their recovery. The intricate interplay of vascular, metabolic, and inflammatory responses creates a hostile environment for wound healing. A deeper understanding of these systemic effects is essential not only for developing targeted therapeutic strategies to improve chronic wound healing but also for refining preventive approaches that minimize their occurrence. Advancing this knowledge will ultimately help enhance the quality of life for individuals with SCI.

The risk of complications following surgical procedures is significantly increased in patients with SARS-CoV-2 infection. However, the mechanisms underlying these correlations are not fully known. Spinal cord injury (SCI) patients who underwent reconstructive surgery for pressure ulcers (PUs) before and during the COVID-19 pandemic were included in this study. The patient’s postoperative progression was registered, and the subcutaneous white adipose tissue (s-WAT) surrounding the ulcers was analyzed by proteomic and immunohistochemical assays to identify the molecular/cellular signatures of impaired recovery. Patients with SCI and a COVID-19-positive diagnosis showed worse recovery and severe postoperative complications, requiring reintervention. Several proteins were upregulated in the adipose tissue of these patients. Among them, CKMT2 and CKM stood out, and CKM increased for up to 60 days after the COVID-19 diagnosis. Moreover, CKMT2 and CKM were largely found in MGCs within the s-WAT of COVID patients. Some of these proteins presented post-translational modifications and were targeted by autoantibodies in the serum of COVID patients. Overall, our results indicate that CKMT2, CKM, and the presence of MGCs in the adipose tissue surrounding PUs in post-COVID patients could be predictive biomarkers of postsurgical complications. These results suggest that the inflammatory response in adipose tissue may underlie the defective repair seen after surgery.

Background/Objectives: Arteriovenous fistulas are the preferred vascular access for hemodialysis, but difficult or unsuccessful cannulation may cause pain, complications, and access dysfunction. This review evaluated whether ultrasound-guided cannulation improves outcomes compared with standard cannulation. Methods: A systematic review was conducted according to PRISMA guidelines. PubMed, Web of Science, Scopus, CINAHL, Cochrane Library, and ClinicalTrials.gov were searched for randomized controlled trials comparing ultrasound-guided and standard arteriovenous fistula cannulation in hemodialysis patients. Findings were synthesized narratively. Risk of bias was assessed using RoB 2, and certainty of evidence using GRADE. Results: Of 1210 records identified, five randomized trials involving 142 patients were included. Some trials reported improved cannulation success or lower pain with ultrasound guidance, but findings varied across populations and outcome measures. Three of four trials reporting procedure time found longer durations with ultrasound guidance. A consistent reduction in complications or improvement in patient satisfaction was not established. Staff findings mainly concerned confidence and acceptability. The certainty of evidence was low. Conclusions: The effects of ultrasound-guided AVF cannulation on pain varied across trials. These uncertain findings should be interpreted alongside the longer procedure times reported in several trials. Larger randomized trials with clearly defined outcomes and analyses accounting for repeated observations are needed before recommending routine use.

Background: Dialysis adequacy is commonly assessed using Kt, a measure of urea clearance. Vascular access dysfunction, particularly thrombosis and access recirculation, may compromise dialysis efficiency despite apparently adequate treatment parameters. Ultrasound assessment of vascular anatomy can help identify individualized cannulation strategies to optimize dialysis delivery. Case Presentation: We report the case of a 78-year-old man undergoing maintenance hemodialysis who exhibited persistently low Kt values despite adequate dialysis time and blood flow. Doppler ultrasound revealed complete occlusive thrombosis involving the cephalic vein, resulting in altered venous drainage. Based on these findings, the conventional cannulation configuration was reversed by exchanging the arterial and venous needle positions. Dialysis adequacy during 11 consecutive sessions using reverse cannulation was compared with that of the previous 12 conventional sessions matched for treatment duration and dialysis volume. Results: Reverse needle cannulation was associated with improved dialysis adequacy. Mean Kt increased from 46.9 ± 6.7 L with conventional cannulation to 57.3 ± 5.8 L after reverse cannulation (p = 0.002), while dialysis duration and processed blood volume remained comparable between both periods. Conclusions: In selected patients with complex vascular anatomy secondary to arteriovenous fistula thrombosis, ultrasound-guided reverse needle cannulation may improve dialysis adequacy without changing treatment duration or the prescribed extracorporeal blood flow rate. This case highlights the value of individualized vascular access assessment and tailored cannulation strategies in patients with vascular access dysfunction.