Critical limb ischemia (CLI) is the most severe form of peripheral arterial disease, significantly impacting quality of life, morbidity and mortality. Common complications include severe limb pain, walking difficulties, ulcerations and limb amputations. For cases of CLI where surgical or endovascular reconstruction is not possible or fails, spinal cord stimulation (SCS) may be a treatment option. Currently, SCS is primarily prescribed as a symptomatic treatment for painful symptoms. It is used to treat intractable pain arising from various disorders, such as neuropathic pain secondary to persistent spinal pain syndrome (PSPS) and painful diabetic neuropathy. Data regarding the effect of SCS in treating CLI are varied, with the mechanism of action of vasodilatation in the peripheral microcirculatory system not yet fully understood. This review focuses on the surgical technique, new modalities of SCS, the mechanisms of action of SCS in vascular diseases and the parameters for selecting CLI patients, along with the clinical outcomes and complications. SCS is a safe and effective surgical option in selected patients with CLI, where surgical or endovascular revascularization is not feasible.

Patients with medical devices or who undergo surgical procedures are at risk for healthcare-associated infections. Surgical site infection (SSI) is the most common healthcare-associated infection and continues to be a major clinical problem in terms of morbidity and mortality, length of hospital stay and financial cost. Guidelines for the prevention of SSIs support healthcare workers in averting infections, by focusing also on control programs regarding both surgical safety and antimicrobial resistance. However, despite the clear evidence and the guidelines, their application in infection, prevention and control is uniformly poor. We therefore suggest the adoption of evidence-based recommendations in clinical practice to improve infection control, by considering its multidimensional aspect.

Approximately 250 million surgical procedures are performed worldwide every year. Most of these procedures lead to good results and an improvement in patient health, but unfortunately not all have such positive outcomes. Surgical site infections (SSI) have a significant clinical and economic impact. SSIs could be prevented by adopting adequate surveillance systems and prevention programs. These programs can contribute to increase awareness of the risk factors and possible improvement actions through the reporting and careful assessment of all infections related to care and therefore subject to reporting and analysis with audits of significant events or mortality and morbidity review. Infection prevention and control can further develop formative peer assessment of infection prevention practices and evaluation control according to clear and measurable standards by management. Clinical surveillance and advanced epidemiological investigations with the support of state-of-the-art information technology systems make it possible to promptly alert healthcare professionals and management to the presence of a case of healthcare-associated infection or an emerging germ and to analyze trends at a territorial or organizational level.

Prosthetic infection is a major concern in surgery. The global epidemiology is difficult to be defined and the incidence is generally underestimated due to the lack of surveillance. A better knowledge of prosthetic infections and a greater understanding of their pathophysiology and risk factors is necessary to implement perioperative measures to prevent this major complication.