(Venous Insufficiency Ulcers) articles in PubMed
- LL-37 but Not 25-Hydroxy-Vitamin D Serum Level Correlates with Healing of Venous Leg Ulcers. [Journal Article]
- Arch Immunol Ther Exp (Warsz) 2016 Sep 23AI
- Human cathelicidin, LL-37, is small antimicrobial peptide, which reveals also some immunomodulatory and proangiogenic properties and, therefore, may promote wound healing. The expression of LL-37 is ...
Human cathelicidin, LL-37, is small antimicrobial peptide, which reveals also some immunomodulatory and proangiogenic properties and, therefore, may promote wound healing. The expression of LL-37 is controlled by various factors, including vitamin D. Thus, any disturbances in vitamin D level may influence LL-37 production and, possibly, affect wound healing. Since deficiency of vitamin D was identified as a common problem in the population, this proof of concept study aimed to verify the relationship between serum levels of LL-37, vitamin D, and healing rate of venous leg ulcers. The study involved small group (n = 19) of patients with venous leg ulcers. Apart from non-venous ulcer aethiology, compression intolerance, active vein thrombosis, and wound infection, the exclusion criteria concerned also kidney insufficiency. The results of the analysis of wound healing rates were correlated with patients' serum levels of 25(OH) vitamin D and LL-37. In addition, serum levels of pro-inflammatory cytokines (IL-6, IL-8, and TNF) were analyzed. We have found strong association between serum concentrations of LL-37 and the healing rates in patients with leg ulcers. Despite the fact that 25(OH) vitamin D levels in all patients were below the normal range, they did not show any correlation with healing rates. Furthermore, no association was observed between serum levels of 25(OH) vitamin D and LL-37. No significant correlation between tested pro-inflammatory cytokines and healing rate, LL-37, or 25(OH) vitamin D levels was also observed. Regardless of small study group, our results suggest that the assessment of serum concentration of LL-37, but not 25-hydroxy vitamin D, may help in predicting the wound healing efficacy. Moreover, this assessment may be useful in pre-selection of patients, which could benefit from local treatment with exogenous LL-37.
- Dehydrated Human Amnion/Chorion Grafts May Accelerate the Healing of Ulcers on Free Flaps in Patients With Venous Insufficiency and/or Lymphedema. [Journal Article]
- Eplasty 2016; 16:e26E
- CONCLUSIONS: Dehydrated human amnion/chorion membrane may accelerate healing of ulcers on lower extremity free flaps in patient with lymphedema and/or venous disease in the treated leg.
- Post Thrombotic Syndrome. [Journal Article]
- Adv Exp Med Biol 2016 Sep 15AE
- Venous insufficiency following deep venous thrombosis is known as the post thrombotic syndrome. Whilst its presentation and symptoms can vary slightly between individuals, it can have a profound effe...
Venous insufficiency following deep venous thrombosis is known as the post thrombotic syndrome. Whilst its presentation and symptoms can vary slightly between individuals, it can have a profound effect on quality of life. Symptoms range from mild limb swelling to severe intractable ulceration. A number of scoring systems have been developed to help monitor the disease progression, response to treatment as well as to classify patients for research purposes.Treatment involves a combination of therapies, including compression stockings, venous stenting for out flow obstruction and in some instances deep venous bypass. A considerable effort is made in preventing post thrombotic syndrome with a number of trials looking into the effect of prompt and stable anticoagulation, the effect of compression stockings, the effect of exercise and the outcomes following early thrombus removal strategies such as catheter directed and pharmacomechanical thrombolysis.
- [First experience with hybrid operations for chronic obstruction of iliac-femoral segment veins in patients with post-thrombotic disease]. [Journal Article]
- Angiol Sosud Khir 2016; 22(3):131-8AS
- The present study was aimed at assessing initial results of hybrid operations in obstructive lesions of the iliac-femoral veins in patients with post-thrombotic disease (PTD). Hybrid operations [open...
The present study was aimed at assessing initial results of hybrid operations in obstructive lesions of the iliac-femoral veins in patients with post-thrombotic disease (PTD). Hybrid operations [open endovenectomy from the common femoral vein (CFV) with creation of an arteriovenous fistula + stenting of iliac veins] were performed carried out in a total of eleven patients with PTD. Of these, there were 7 men and 4 women aged from 34 to 52 years (mean age - 42.8±7 years). All patients had severe-degree chronic venous insufficiency (CVI). The distribution of patients according to the CEAP classification was as follows: C4a - 2 patients, C4b - 4 patients, C5 - 4 subjects, C6 - 1 patient. The time having elapsed since a newly onset episode of acute iliac-femoral venous thrombosis varied from 2 to 12 years (averagely - 7.1±3.3 years). The degree of manifestation of PTD was determined by means of the Villalta-Pradoni scale before and 6 months after the operation. Instrumental methods of study included ultrasound duplex scanning (USDS), magnetic resonance and/or multispiral computed venography, and contrast-enhanced X-ray venography. The technical success of the procedure amounted to 91%. In one patient with occlusion of the common and external iliac veins we failed to perform recanalization and stenting. A further one patient developed in-stent and CFV thrombosis on the second postoperative day. An attempt of catheter thrombolysis turned out unsuccessful. There were no wound complications in the postoperative period. Neither was pulmonary artery thromboembolism registered. The dynamic control was carried out by means of USDS before discharge from hospital and at 1, 3 and 6 months after the intervention. The outcomes of hybrid operations after 6 months were followed up in five patients. Secondary patency rate of the stented iliac veins amounted to 100%. No relapses of trophic ulcers were observed. According to the Villalta-Prandoni scale the value of the median of the composite index decreased from 15 to 7 (p=0.012). The first experience with hybrid operations for obstructive lesions of veins of the iliac-femoral segment demonstrated their high efficacy and safety. Efficiency of the operation was confirmed by significant clinical improvement and good results of patency of the restored-repaired segments of veins.
- [Dangerous mimikry - cutaneous tumours appearing as ulcus cruris]. [Journal Article]
- Dtsch Med Wochenschr 2016; 141(18):1321-3DM
- CONCLUSIONS: Differential diagnoses of chronic wounds on lower legs are diverse and are often missed in clinical routine. Typical causes like chronic venous insufficiency, peripheral arterial occlusive disease or diabetes are found via basic diagnostics, rare diagnoses like the existence of ulcerated skin tumors are often found with a delay which leads to a poor prognosis for these patients. Besides pre-existing tumors also a secondary malignant transformation can be observed, for example towards a squamous skin cancer from an originally vascular long-lasting leg ulcer. In case of recalcitrant leg ulcers despite exhausting all therapeutic options a histological investigation of a tissue sample should be performed and an initially diagnosed cause for the chronic wound has to be scrutinized.
- Modalities to Treat Venous Ulcers: Compression, Surgery, and Bioengineered Tissue. [Journal Article]
- Plast Reconstr Surg 2016; 138(3 Suppl):199S-208SPR
- CONCLUSIONS: Utilizing guidelines that incorporate evidence-based modalities will lead to the highest quality outcomes with the most appropriate resource utilization. A proactive approach to treating venous disease will alleviate suffering and prevent the long-term sequelae of CVI.
- Current Status and Future of Skin Substitutes for Chronic Wound Healing. [Review]
- J Cutan Med Surg 2016 Aug 16JC
- Chronic wounds, including diabetic ulcers, pressure ulcers, venous ulcers, and arterial insufficiency ulcers, are both difficult and expensive to treat. Conventional wound care may sometimes lead to ...
Chronic wounds, including diabetic ulcers, pressure ulcers, venous ulcers, and arterial insufficiency ulcers, are both difficult and expensive to treat. Conventional wound care may sometimes lead to suboptimal wound healing and significant morbidity and mortality for patients. The use of skin substitutes provides an alternative therapy showing superior efficacy and, in some cases, similar cost-effectiveness compared to traditional treatments. This review discusses the different types of currently available commercial skin substitutes for use in chronic wounds as well as the paucity of strong evidence supporting their use. It then delves into the limitations of these skin substitutes and examines the most recent research targeting these limitations.
- Effect of Pycnogenol on the Healing of Venous Ulcers. [Journal Article]
- Ann Vasc Surg 2016 Aug 10AV
- CONCLUSIONS: The results suggest that pycnogenol has an adjuvant effect on the healing of venous ulcers, similar to diosmin/hesperidin.
- Prophylaxis of Recurrent Venous Leg Ulcer. [Journal Article]
- Zentralbl Chir 2016 Aug 8ZC
- Venous leg ulcer (VLU) counts among the most common chronic wounds in Europe. Treatment is lengthy, cumbersome and costly, and there is a high rate of recurrence. This review shows the measures that ...
Venous leg ulcer (VLU) counts among the most common chronic wounds in Europe. Treatment is lengthy, cumbersome and costly, and there is a high rate of recurrence. This review shows the measures that should be offered to every patient with healed VLU to permanently prevent recurrence. To prevent VLU in case of varicose veins, the progression of chronic venous insufficiency (CVI) has to be stopped. There is convincing evidence that the effective treatment of varicose veins reduces the recurrence rate in patients with VLU. In patients with post-thrombotic syndrome (PTS), further thrombosis should be prevented through targeted prophylaxis of new thromboembolic events. The benefit of endovascular revascularization on the VLU recurrence rate in patients with post-thrombotic damage in the pelvic veins has not been proven in clinical studies. On the other hand, it has been clearly demonstrated in several studies that compression therapy is the basic procedure for the prevention of recurrent VLU in patients with varicose veins or PTS, regardless of whether other measures have been implemented or not. Good adherence in patients with compression therapy is more important than choosing the highest possible compression class. Future efforts for patients with VLU must aim to provide therapists with tools and treatment strategies to guide their patients and to increase patients' acceptance and understanding of the importance of self-management, in particular regarding compression therapy for the prevention of recurrent VLU.
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- VENOUS ULCER--A NEW THERAPEUTIC APPROACH. [Journal Article]
- Rev Med Chir Soc Med Nat Iasi 2016 Apr-Jun; 120(2):306-10RM
- Trophic leg ulcer is a major health problem affecting approximately 1-2% of the population, the incidence being higher in the elderly (70-80 years). It is a multifactorial condition, but the most com...
Trophic leg ulcer is a major health problem affecting approximately 1-2% of the population, the incidence being higher in the elderly (70-80 years). It is a multifactorial condition, but the most common cause is chronic venous insufficiency. This can be attributed to reflux in the saphenous system and calf perforator vein incompetence. These were first described by Linton, the first intervention designed to correct perforator vein incompetence bearing his name. Today Linton's operation has been abandoned due to the large unaesthetic incision and great postoperative pain. Also, ulcer healing time is long (2 months) and recurrence rate is high. Currently a series of minimally invasive procedures are used to close these perforator veins, such as ultrasound-guided sclerotherapy. The advantages of these techniques are less discomfort to the patients, low rate of complications, short hospital stay.