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At least 91 records · Page 5Linked to original sources
PubMed2003

Low-frequency ultrasound to manage chronic venous leg ulcers.

Chronic leg ulceration costs the NHS around pound 500 million per year (Moffatt and Dorman, 1995) so it is not surprising that the condition attracts attention from manufacturers of medical devices. However, the evidence available for many novel technologies is scant and a systematic approach to product evaluation is essential to avoid the adoption of ineffective and therefore costly measures. A low-frequency ultrasound device was presented in clinic as an aid to stimulate and accelerate healing in otherwise recalcitrant wounds. There followed a systematic evaluation of the product including a literature review of the mode of action, safety and efficacy, followed finally by a product evaluation with case studies used as outcome measures. In this case, the product proved to be a useful tool in the management of chronic wounds, not only for healing but also for pain, pigmentation and odour reduction. The importance of understanding fully a novel technology and how it fits with clinical practice cannot be underestimated.

Chronic Disease↗
PubMed2000

Skin grafting for venous leg ulcers.

BACKGROUND: Venous leg ulceration is a common, recurring, disabling condition affecting up to 1% of adults. Treatment is aimed at healing with simple dressings and compression bandages / stockings. Unfortunately in some cases this treatment is unsuccessful with ulcers remaining open for months or years. In order to stimulate healing, some clinicians use skin grafts. These skin grafts may be taken from the patients own uninjured skin (e.g. thigh), may be grown from the patient's skin cells into a dressing, (both known as autografts) or applied as a sheet of bioengineered skin grown from a donor cells (known as an allograft). Preserved skin from other animals, e.g. pigs, have also been used and these are known as xerografts. OBJECTIVES: To assess the effectiveness of skin grafts in the treatment of venous leg ulcers. SEARCH STRATEGY: We searched the Cochrane Wounds Groups specialised register (date of search October 1999), and reference lists of relevant articles. We hand searched relevant journals and conference proceedings, and contacted experts in the field. SELECTION CRITERIA: Randomised controlled trials evaluating skin grafts in the treatment of venous leg ulcers. There was no restriction on articles based on language or publication status. DATA COLLECTION AND ANALYSIS: Data extraction and assessment of study quality was undertaken by two reviewers independently. Trials with similar patients, comparisons, and outcomes were pooled. MAIN RESULTS: Seven RCTs of skin grafts for venous leg ulcers were identified. In 6 trials patients also received compression bandaging. Two trials (98 patients) evaluated split thickness autografts, three trials (92 patients) evaluated cultured keratinocyte allografts, one compared tissue engineered skin (artificial skin) with a dressing (309 patients) and one compared it with a split thickness skin graft (7 patients, 13 ulcers). The trials comparing artificial skin with a dressing reported a significantly higher proportion of ulcers healing with artificial skin. There was insufficient evidence from the remaining trials to determine whether other types of skin grafting increased the healing of venous ulcers. REVIEWER'S CONCLUSIONS: There is limited evidence that artificial skin used in conjunction with compression bandaging, increases the chance of healing a venous ulcer compared to compression alone. Further research is needed to assess whether other forms of skin grafts increase ulcer healing.

Adult↗
PubMed2005

[The role of matrix metalloproteinases in venous leg ulcers development].

Venous leg ulcers are one of the most serious therapeutic and economic problems of current medicine. In spite of the rapid progress in the diagnostics of venous disorders, the pathogenesis of venous leg ulcers remains unclear. Current medicine describes many theories that try to explain the patophysiology of venous ulceration. Recent studies have revealed the role of extracellular matrix degradation processes in venous leg ulcers. The family of enzymes classified as matrix metalloproteinases (MMPs) play the leading role in these processes. The extensive knowledge of MMPs and the role played by them in venous leg ulcers and wound healing may result in development of the new methods of management with many vascular disorders.

Disease Progression↗
PubMed2003

Deciphering the impaired cytokine cascades in chronic leg ulcers (review).

Chronic leg ulcers are typically wounds that do not heal at a normal rate. Impaired healing appears to be due to primary microvascular changes and it is aggravated by ongoing bacteria-driven vasculitis. The various cytokines identified in experimental wounds are also present in leg ulcers. VEGF is strongly implicated as a promoter of blood vessel growth in patients with venous disease. In addition, there is good evidence of increased expression of bFGF, TGF-beta1, and PDGF in lipodermatosclerosis. All of these growth factors are involved in wound healing. Upregulated TGF-beta1 is probably one of the main causes of the fibrosis observed in lipodermatosclerosis. In leg ulcers, cytokines appear to be trapped in the perivascular fibrinoid deposits. It is not the nature and amount of cytokines that are inadequate in leg ulcers, but rather their spatial distribution. Dermal dendrocytes (DD) are resident factor XIIIa-enriched macrophages. They likely play a role in tissue repair when boosted adequately. New therapies aiming at helping the release of cytokines by DD apparently promote and improve the healing phase.

Animals↗
PubMedDate not supplied

Chronic external iliac vein obstruction as a cause of leg ulceration.

Chronic venous leg ulceration, which tends to recur, is difficult to treat and therefore needs special diagnostic and therapeutic care. We recently treated a 45-year-old patient with an obstruction of the left external iliac vein, caused by deep venous thrombosis. We would like to propose that, although rare, the existence of pelvic vein thrombosis and obstruction can cause venous leg ulcers. This case clearly pointed out that in patients with crural leg ulceration, showing no other signs of chronic venous insufficiency and where duplex ultrasound is normal, additional diagnostic evaluation should be performed. Because standard duplex ultrasound investigation can fail to demonstrate the obstruction, phlebography should be used in suspected cases as a secondary test to check both the superficial and the deep venous system for pathology, applying the endovascular therapeutic stent-placement technique.

Acenocoumarol↗
PubMed2005

Upregulation of inducible nitric oxide synthase (iNOS) expression in faster-healing chronic leg ulcers.

OBJECTIVE: Chronic leg ulcers represent a growing clinical problem in the light of today's ageing population. Nitric oxide (NO), which is mostly produced by inducible nitric oxide synthase (iNOS) in healing wounds, exerts beneficial effects on many processes of healing, including bactericidal effects, angiogenesis, epithelialisation and ECM formation. This study sought to investigate whether iNOS expression in chronic leg ulcers can be correlated with the healing process. METHOD: Sixteen patients with chronic leg ulcers were recruited and attempts were made to take punch biopsies at two separate time points (however, a second biopsy could not be obtained on seven patients). A linear healing rate was derived using the obtained ulcer area and perimeter. The iNOS levels in the biopsy samples were assessed using immunoblotting. RESULTS: The mean linear healing rate of patients with high iNOS levels was significantly higher (p < 0.01) than that of patients with low iNOS levels. An incidental finding was that the linear healing rate was significantly higher (p < 0.05) post-biopsy than before biopsy in the same patients. CONCLUSION: This study therefore shows for the first time that high iNOS levels are associated with higher healing rates and have the potential to be used in prognostication. This also opens the possibility of augmentation of ulcer healing through the manipulation of wound NO levels.

Aged↗
PubMedDate not supplied

Randomized, double-blind, placebo-controlled, dose- ranging study of granulocyte-macrophage colony stimulating factor in patients with chronic venous leg ulcers.

Chronic venous leg ulcers are a common ailment with no ideal treatment. Recent reports have shown granulocyte- macrophage colony stimulating factor to be of use in the healing of these chronic wounds. Therefore, we conducted a double-blind, randomized, placebo-controlled study which enrolled 60 patients with chronic venous leg ulcers, whom we treated with placebo or with 200 or 400 microg of granulocyte-macrophage colony stimulating factor by perilesional injections of the drug in four weekly treatment episodes. Observations were conducted at each treatment visit, at weeks 5, 9, 13, and six months after the inclusion in the protocol. The number of healed wounds in the placebo and the treated arms were significantly different (p = 0.05), with 4 of 21 (19%) in the first group having healed at week 13, as compared to 12 of 21 (57%) and 11 of 18 (61%), in the 200 microg and the 400 microg groups, respectively. There were only minor side-effects attributable to the treatment, and the reobservation at 6 months showed that none of the treated ulcers recurred during that period. We conclude that granulocyte-macrophage colony stimulating factor injected perilesionally may be a useful drug for the treatment of chronic venous leg ulcers.

Adult↗
PubMed2006

Dressings for healing venous leg ulcers.

BACKGROUND: Venous leg ulcers, sometimes called varicose or stasis ulcers, are a consequence of damage to the valves in the veins of the legs, leading to raised venous pressure. Venous ulcers are characterised by a cyclical pattern of healing and recurrence. The main treatment is the application of compression, either in the form of compression bandages or hosiery. Dressings are usually applied beneath the compression to aid healing, comfort and to control exudate. Wounds heal quicker in a moist environment and dressings are used to absorb excess fluid or retain fluid in an otherwise dry wound in order to achieve a 'moist wound environment'. There are a large number of dressing products and types available. It is unclear whether particular dressings aid healing of leg ulcers. OBJECTIVES: To assess the effectiveness of wound dressings for the treatment of venous leg ulcers. SEARCH STRATEGY: We searched the Cochrane Wounds Group Specialised Register (April 2006) and CENTRAL (issue 1, 2006) and several other electronic databases (up to April 2005). Manufacturers of dressing products were contacted for unpublished studies. SELECTION CRITERIA: Randomised controlled trials that evaluated dressings for the treatment of venous leg ulcers. There was no restriction in terms of source, date of publication or language. Ulcer healing was the primary endpoint. DATA COLLECTION AND ANALYSIS: Data from eligible studies were extracted and summarised using a data extraction sheet by two authors independently. MAIN RESULTS: 42 randomised controlled studies were identified that met the inclusion criteria. The main dressing types that were evaluated were hydrocolloids (n = 23), foams (n = 6), alginates (n = 4), hydrogel dressings (n = 6) and a group of miscellaneous dressings (n = 3). In none of the comparisons was there evidence that any one dressing type was better than others in terms of number of ulcers healed. Current evidence does not suggest that hydrocolloids are more effective than simple low adherent dressings used beneath compression (9 trials; relative risk for healing with hydrocolloid 1.09 (95% CI 0.89 to 1.34)). For other comparisons there was insufficient evidence. AUTHORS' CONCLUSIONS: The type of dressing applied beneath compression has not been shown to affect ulcer healing. For the majority of dressing types there was insufficient data to allow us to draw strong conclusions except for hydrocolloid compared with a low adherent dressing. The result of the meta-analysis indicate no significant difference in healing rates between hydrocolloid dressings and simple, low-adherent dressings when used beneath compression. Decisions regarding which dressing to apply should be based on local costs of dressings and practitioner or patient preferences.

Bandages↗
PubMed2005

Compression and peri-ulcer skin in outpatients' venous leg ulcers: results of a French survey.

OBJECTIVE: To evaluate concordance with compression therapy in ambulatory patients with venous leg ulcers. METHOD: This was a prospective observational survey conducted in general practice. Consecutive patients with venous leg ulcers about to receive a non-adherent primary dressing and with no contraindication to compression bandaging were selected. At the inclusion visit, size, local aspect of the ulcer and the peri-ulcer skin were scored. Patients were asked about concordance with compression and were given a questionnaire to be completed at home. If patients were seen at a three-week follow-up visit, ulcer and peri-ulcer characteristics and concordance were reassessed. RESULTS: A total of 2842 patients were included, of whom 2532 were re-evaluated at three weeks and 1397 (49%) returned their questionnaire. A compression bandage was already available for 62.9% of these patients, and 62.7% said they used it on a daily basis, 23.3% wore it one or two days per week and 13.7% wore it irregularly or never. There was a statistically significant correlation between concordance with compression and ulcer and peri-ulcer skin severity scores (p < 0.001 and p = 0.042 respectively). At the follow-up visit, concordance with compression therapy improved (80.1% were wearing it regularly). Ulcer, peri-ulcer skin severity scores and ulcer size were significantly lower (p < 0.001) when concordance with compression therapy was good. However, 65.6% of patients considered applying compression very difficult; 45% considered it very unaesthetic and 23% judge wearing it to be very painful, while 9% thought it may worsen their ulcer. CONCLUSION: On a short-term basis, concordance with compression can be substantially improved by simple measures with a clear favourable consequence on both ulcer status and peri-ulcer skin aspect when a non-adherent primary dressing is used. However, the acceptability of compression to patients is poor, and continuous effort is required to convince them of its importance.

Adolescent↗
PubMed1994

A pioneering service to the community. The Riverside Community Leg Ulcer Project.

1. Leg ulceration is an extensive problem that is often poorly managed. 2. Research-based treatment of leg ulceration results in rapid improvements in healing rates. 3. A systematic, multidisciplinary approach optimises the effectiveness of services. 4. Effective services must be underpinned by comprehensive training programmes.

Community Health Nursing↗
PubMedDate not supplied

[Contact eczema in patients with leg ulcers].

Patients with leg ulcers or varicose eczema suffer much more often from contact eczema due to the local application of pharmaceutical preparations than patients suffering from other dermatological problems (even those of eczematous origin). This contact allergy may concern not only the active ingredient but also the excipient, the preservative, or even the perfume. In all cases of leg ulcers, of varicose eczema, but also of badly healed ulcers, epicutaneous tests should be carried out with all the components of the pharmaceutical preparations concerned. Moreover, the pharmaceutical industry really must perfect non-allergenic preparations.

Administration, Topical↗
PubMed2002

Leg ulcers in the tropics.

Leg ulcers are an important clinical condition and are often difficult to treat. The treatment has to continue for long periods, and the associated morbidity leads to significant loss of work. The successful treatment of leg ulcers or chronic wounds depends upon accurate diagnosis and treatment of the underlying cause. In Western societies, most leg ulcers are due to venous insufficiency, arterial disease, neuropathy (usually diabetic), or some combination of these factors. In tropical countries, however, there have been no large series of leg ulcers reported. The prevalence of leg ulcers and etiology are unknown. In this article, a short review is presented of the etiology and management of lower extremity ulcers as seen in the tropical countries.

Journal Article↗
PubMed1992

Allow the ulcer to heal. Treatment of leg ulcers.

A key priority when treating leg ulcers is to identify the underlying cause and reduce any exacerbating factors. A problem-solving approach, which allows the ulcer to heal, will achieve optimum results.

Bandages↗
PubMed2000

Compression therapy for venous leg ulcers.

Venous (gravitational) leg ulcers are unsightly, sometimes painful and often difficult to heal. They are associated with incompetence of valves in the deep leg veins and venous hypertension. The main approaches in the management of venous leg ulcers have been to reduce the 'back pressure' in the veins by surgical removal of any varicose veins, postural drainage (elevation of the legs when the patient is lying or seated), and use of compression therapy with bandages, hosiery or intermittent pneumatic compression. In this article, we review the efficacy and discuss correct use of compression therapy.

Bandages↗
PubMed1997

[Activated protein C resistance in patients with venous leg ulcer].

Patients with venous leg ulcers often show evidence of previous deep venous thrombosis. Resistance to activated protein C (APC-resistance) is an autosomal dominant inherited defect in the anticoagulant system which is a significant risk factor for development of venous thrombosis. APC-resistance was determined in plasma samples obtained from 46 unselected, consecutively admitted patients with venous leg ulcers, included during a six-month period. Twelve of the 46 patients (26%) (95% confidence limits: 14%-41%) had APC-resistance. APC-resistance is thus a common anticoagulant deficiency among venous leg ulcer patients and should be considered a risk factor for development of venous leg ulcer disease.

Aged↗