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Venous Insufficiency Ulcers [keywords]
- Autologous platelet-rich plasma in treatment of chronic venous leg ulcers: A prospective case series. [JOURNAL ARTICLE]
- Vascular 2014 Dec 9.
We report our results on a case series of 19 patients receiving platelet-rich plasma application in treatment of patients with chronic unhealing venous leg ulcers.There were 16 males and three females with a mean age of 38.55 ± 16.46 years. Planimetric size measurements were performed and pain was tested throughout the treatment period. Follow-up was made in seven-day periods. Patients received 5 ml of platelet-rich plasma for each 5 cm(2) of the wound surface with half of the amount being injected 1-2 mm deep into the wound and the wound surface was covered with the remaining half.Complete wound healing occurred in 18 of 19 patients (94.7%) within a mean of 4.82 ± 2.16 week. There were significant reductions in wound area among all consecutive measurements except for first week. A significant reduction in wound volume was apparent even in first week and sustained among consecutive measurements.Platelet-rich plasma seems effective in terms of promoting healing of venous leg ulcers. Improvement in wound depth was slightly more prominent than that in wound area, indicating a potential role of platelet-rich plasma especially in deep venous ulcers.
- Bacterial spectrum colonizing chronic leg ulcers: A 10-year comparison from a German wound care center. [Journal Article]
- J Dtsch Dermatol Ges 2014 Dec; 12(12):1121-7.
Chronic wounds are colonized by many different bacteria.We analyzed microbiological swabs from chronic leg ulcers from 2012/2013 and matched the results with those from 2002/2003 and 2007/2008 from the same institution.Results from 100 patients from our specialized wound care center were evaluated retrospectively. The etiologies were broadly variable with chronic venous insufficiency being the most common. As the most common bacterium Staphylococcus aureus was found in 53 % of patients; 9 % of patients were positive for methicillin-resistant S. aureus (MRSA). Pseudomonas aeruginosa was detected in 25 % of patients. Different fecal bacteria and Enterobacteriaceae were found in 49 % of the patients; 11 % of the swabs were sterile. The detection rate for S. aureus has regressed by 17.1 % over the past decade and in the case of MRSA by 12.5 %. In contrast, colonization with gram-negative bacteria species significantly increased by 11.7 %. This tendency was also seen in 2007/2008, but with a higher count of P. aeruginosa.Although S. aureus is still the most frequently detected bacterium in our wound care center, there has been a shift in the bacterial spectrum from gram-positive towards gram-negative bacteria over the last decade.
- Wound healing, Angiotensin-converting enzyme inhibition, and collagen-containing products: a case study. [Journal Article]
- J Wound Ostomy Continence Nurs 2014 Nov-Dec; 41(6):611-4.
The effects of multiple medications may impair or enhance wound healing. A review of the literature for drug side effects identified cell culture and case studies of angiotensin-converting enzyme inhibitors (ACEIs) impairing collagen deposition in cutaneous wounds; these medications have also been used to prevent or minimize keloid formation.A 71-year-old male patient presented with a venous leg ulcer (VLU), having incurred a crushing injury and fracture requiring surgical repair 16 years earlier. The patient's history was significant for obesity, smoking 1 cigar daily, hypertension, and lower extremity venous insufficiency; medications included amlodipine and lisinopril. The wound initially responded well to advanced wound products and compression, but wound healing subsequently stalled. A collagen-containing alginate dressing was added to the treatment regimen and the wound closed within 2 weeks.We postulate that lisinopril may have contributed to the observed delayed healing and targeted this potential impediment to wound healing with a readily available topical collagen-containing product resulting in a rapid wound closure after a significant delay in progress toward wound healing.
- [Varicoses: should invasive treatment be standard?]. [English Abstract, Journal Article]
- Ned Tijdschr Geneeskd 2014.:A8299.
The new Dutch multidisciplinary guideline for diagnosis and treatment of venous pathology deals with diagnosis and treatment of varicosis, new surgical techniques in obstruction or insufficiency of the deep venous system, crural ulcers and compression therapy with hosiery or bandages. It also describes classical and new techniques for surgery and endovascular obliteration of varicose veins and evidence based criteria for choosing the optimal therapeutic strategy. Although the working party puts much emphasis on new invasive therapies it neglects to describe the results of conservative therapy such as therapeutic elastic stockings and lifestyle advice including weight loss, exercise and avoiding standing in upright position for long periods. The general advice to choose invasive therapy above conservative therapy except where the result of previous invasive therapy has been insufficient or where invasive therapy is not an option, seems somewhat over the top. Modern elastic stockings are more acceptable as they look good, are transparent and have all kinds of elegant extras and the modern fabrics are comfortable for the wearer. Class I compression stockings have been shown to be effective in uncomplicated cases and are easier to handle than class II, especially for the elderly.
- [The value of radial shock wave therapy in the management of extended crural ulceration. Case report]. [English Abstract, Journal Article]
- Orv Hetil 2014 Nov 1; 155(45):1794-9.
The authors present the history of a 36-year-old woman who had crural ulceration in the ventral side of the left lower limb due to venous circulatory failure for 5 years. In addition to the application of dressing adapted to the actual status of the wound, the authors applied an extracorporal shock wave therapy two times per week. After this treatment the size of the ulcer significantly decreased and it became suitable for mesh-graft cover. The patient is currently asymptomatic. The authors draw attention to the fact that the number of patients having crural ulcer is increasing in developed countries including Hungary. Lower limb ulcers occur in 1-5% of the adult population. Predisposing factors include older age and civilization hazards such as obesity, diabetes and sedentary lifestyle. The main cause of the disease is circulatory failure; venous insufficiency occurs in about two-thirds of the patients, arterial ischemia in 15% and diabetic angiopathy in 15% of the cases. Infections, metabolic diseases and immunological disorders may be also an underlying cause in a small number of patients. In several patients the causative factors occur simultaneously making difficult to find and effective treatment. Despite the use of numerous preventive and therapeutic protocols, treatment is usually long and does not always match expectations of the patients. Orv. Hetil., 2014, 155(45), 1794-1799.
- Chronic venous leg ulcers: Effects of foam sclerotherapy on healing and recurrence. [JOURNAL ARTICLE]
- Phlebology 2014 Oct 28.
Ultrasound-guided foam sclerotherapy is a minimally invasive treatment option used for ablation of axial and perforator reflux for chronic venous ulceration. Active ulceration presents a significant health burden in both the primary and secondary care setting. The objective of this study is to determine ulcer healing rates at 24 weeks and 12 months, and ulcer recurrence rates at one year for chronic venous ulcers after ultrasound-guided foam sclerotherapy.Between 2007 and 2012, 54 patients underwent ultrasound-guided foam sclerotherapy for clinical, aetiological, anatomical and pathological C6 ulcers. All patients were followed up clinically, and venous duplex was performed on all legs before and after treatment. A prospectively maintained database was analysed to determine venous truncal occlusion rates, 24-week and 12-month healing and recurrence rates (using Kaplan-Meier survival analysis).Fifty-seven ulcerated legs, 39 primary and 18 with recurrent superficial venous reflux were analysed. Median time of active ulceration at presentation was 15.2 months (range 5 months to 17 years). At a median follow-up of 2.7 months, 90% (51 legs) achieved full truncal occlusion after one session, 4% (2) short segment occlusion and 5% (3) failed to occlude and one patient died and was lost to follow-up; 13/57 (23%) required a second session of treatment for completion of treatment, recanalisations and to treat perforator disease, 88% (50/57) ulcers healed at a median of 5.3 months (interquartile range 2.9-8.4 months) following their first ultrasound-guided foam sclerotherapy treatment. The 24-week and 12-month estimated healing rates were 53% and 72%, respectively. The estimated 12-month recurrence rate was 9.2%. There were no reported incidences of deep venous thrombosis or neurological symptoms.This study affirms the role of ultrasound-guided foam sclerotherapy as a safe and effective option for abolition of superficial reflux.
- [Ankle brachial index measurement]. [English Abstract, Journal Article]
- Acta Med Croatica 2014 Oct.:123-6.
Ultrasound examinations are noninvasive diagnostic methods which, along with appropriate history and clinical examination, provide basic information on the etiology and spread of the disease, as well as on treatment options required in patients with chronic venous insufficiency and arterial flow impairment. Doppler flow meter offers useful data on venous blood return, primarily in great veins, while both deep and superficial veins as well as arteries can be visualized and data on venous and arterial hemodynamics obtained by duplex ultrasonography. In addition, Doppler flow meter provides data on the peripheral arterial system action through ankle brachial index measurement, which will guide the choice of compression therapy when deciding on the treatment of peripheral arterial disease and mixed arteriovenous leg ulcers. However, diagnosis of arterial insufficiency requires additional examinations.
- [Differential diagnosis and work up of chronic leg ulcers]. [English Abstract, Journal Article]
- Acta Med Croatica 2014 Oct.:25-30.
Many factors contribute to the pathogenesis of leg ulcers. The main causes are chronic venous insufficiency, peripheral arterial occlusive disease (PAOD) and diabetes. Some leg ulcers are caused by combinations of these well-known etiologic factors. The most common cause of PAOD is arteriosclerosis. In diabetic patients, distal symmetric neuropathy and peripheral vascular disease are probably the most important etiologic factors in the development of leg ulcers. Less frequent causes of chronic leg ulcers are hematologic diseases, autoimmune diseases, genetic defects, infections, primary skin disease, cutaneous malignant diseases, use of some medications and therapeutic procedures, and numerous exogenous factors. Diagnosis of leg ulcer is made upon medical history, clinical picture, palpation of arteries, functional testing and serologic testing. Device-based diagnostic testing should be performed for additional clarification. Also, lesion biopsy should be taken for histopathology, direct immunofluorescence, bacteriology and mycology. The knowledge of differential diagnosis is essential for ensuring treatment success in a patient with leg ulcer.
- [Chronic wounds as a public health problem]. [English Abstract, Journal Article]
- Acta Med Croatica 2014 Oct.:5-7.
Chronic wounds represent a significant burden to patients, health care professionals and the entire health care system. Regarding the healing process, wounds can be classified as acute or chronic wounds. A wound is considered chronic if healing does not occur within the expected period according to the wound etiology and localization. Chronic wounds can be classified as typical and atypical. The majority of wounds (95 percent) are typical ones, which include ischemic, neurotrophic and hypostatic ulcers and two separate entities: diabetic foot and decubital ulcers. Eighty percent of chronic wounds localized on lower leg are the result of chronic venous insufficiency, in 5-10 percent the cause is of arterial etiology, whereas the rest are mostly neuropathic ulcers. Chronic wounds significantly decrease the quality of life of patients by requiring continuous topical treatment, causing immobility and pain in a high percentage of patients. Chronic wounds affect elderly population. Chronic leg ulcers affect 0.6-3 percent of those aged over 60, increasing to over 5 percent of those aged over 80. Emergence of chronic wounds is a substantial socioeconomic problem as 1-2 percent of western population will suffer from it. This estimate is expected to rise due to the increasing proportion of elderly population along with the diabetic and obesity epidemic. It has been proved that chronic wounds account for the large proportion of costs in the health care system, even in rich societies. Socioeconomically, the management of chronic wounds reaches a total of 2-4 percent of the health budget in western countries. Treatment costs for some other diseases are not irrelevant, nor are the method and materials used for treating these wounds. Considering etiologic factors, a chronic wound demands a multidisciplinary approach with great efforts of health care professionals to treat it more efficiently, more simply and more painlessly for the patient, as well as more inexpensively for health care funds.