- Association Between Sodium-Glucose Cotransporter 2 Inhibitors and Lower Extremity Amputation Among Patients With Type 2 Diabetes. [Journal Article]
- JIMJAMA Intern Med 2018 Aug 13
- CONCLUSIONS: Use of SGLT-2 inhibitors may be associated with increased risk of amputation compared with some oral treatments for type 2 diabetes. Further observational studies are needed with extended follow-up and larger sample sizes.
- Livedoid vasculopathy: a compelling diagnosis. [Journal Article]
- ACAutops Case Rep 2018 Jul-Sep; 8(3):e2018034
- Reliable self-application of short stretch leg compression: Pressure measurements under self-applied, adjustable compression wraps. [Journal Article]
- PPhlebology 2018 Aug 12; :268355518793467
- Aim Self-application of properly performed compression bandages is generally considered as problematic. Therefore, the aim of this study was to measure the pressure of self-applied short stretch adju...
Aim Self-application of properly performed compression bandages is generally considered as problematic. Therefore, the aim of this study was to measure the pressure of self-applied short stretch adjustable compression wrap compression systems (Juxta fit™) and to compare the results with the pressure achieved by bandaging other legs using the same material. Methods In the two training courses for nurses, specifically interested in leg ulcer treatment, the new bandage type of adjustable compression wrap was explained and workshops were organized, in which the interface pressure achieved by Juxta fit™ was measured. In the first course, the nurses applied the compression system to each other, and in the second course, another group did it on their own legs. Bandagers were instructed to apply the system strongly, with a target range of more than 50-60 mmHg. Results In the first course with mutual application ( n = 34), the median pressure at the medial lower leg was 58.5 mmHg (minimal 31, maximal value 137 mmHg), in the second course in which self-application was tested ( n = 36), the corresponding values were 61.5 mmHg (minimum 35, maximum 102 mmHg). No pressures less than 30 mmHg were seen on the distal calf in either group. Conclusions In contrast to short stretch bandages that are frequently applied by bandagers with too low pressure, the adjustable compression wrap devices handled by the patients themselves produce more appropriate and more consistent pressure.
- Chronic leg ulcers in hospitalized patients in Lomé, Togo: 125 cases. [Journal Article]
- MSMed Sante Trop 2018 Aug 08
- The aim of this study was to document the profile and causes of chronic leg ulcers (CLU) in patients hospitalized in Lomé, Togo. This retrospective study reviewed records from the dermatology departm...
The aim of this study was to document the profile and causes of chronic leg ulcers (CLU) in patients hospitalized in Lomé, Togo. This retrospective study reviewed records from the dermatology departments (CHU Sylvanus Olympio and Campus, and the dermatology center of Gbossimé) from 2000 to 2017 and from the general surgery department of CHU Sylvanus Olympio from 2013 to 2017 to identify cases. In all, 125 cases of CLU were identified during the study period. The patients' mean age was 56.6 years and the sex ratio (M/F) was 0.89. The average time from CLU onset to consultation was 10.9 weeks (range : 7 weeks to 4 years). They were mainly associated with a history of diabetes (32 cases), arterial hypertension (16 cases), varicose veins (14 cases), and malnutrition (14 cases). The main causes were : ulcers of infectious origin in 49.6% of cases (including 38 with phagedenic ulcers), ulcers of vascular origin in 36% (including 21 cases with a venous ulcer) and diabetic ulcers in 8.8% of cases. The ulcer was unilateral in 122 patients (67 on the right and 55 on the left) and bilateral in 3 patients. The locations were the foot in 56 cases, the leg in 37 cases, and leg and foot in 32 cases. In addition to dressings, surgical debridement was performed in 23 patients, followed by skin autografts for 16. Amputation was performed for 31 patients. Sixteen (12.8%) of the 125 patients died. Our study observed a high rate of phagedenic ulcers among CLU in Togo. It also pointed to a problem explaining the very high mortality rate: delayed consultation by patients who arrive only after the onset of complications.
- Use of a National Electronic Health Record Network to Describe Characteristics and Healing Patterns of Sickle Cell Ulcers. [Journal Article]
- AWAdv Wound Care (New Rochelle) 2018 Aug 01; 7(8):276-282
- Objective: Sickle cell ulcers affect as many as 15% of patients with sickle cell disease in the United States and severely impact quality of life. An understanding of baseline healing patterns is im...
Objective: Sickle cell ulcers affect as many as 15% of patients with sickle cell disease in the United States and severely impact quality of life. An understanding of baseline healing patterns is important to inform study design for future trials that test therapies for this disease. Approach: In this study, an electronic wound management system was leveraged to analyze retrospective data on 133 unique sickle cell patients who were treated across 114 wound healing centers, and to describe their characteristics and healing patterns as compared with those of venous ulcer patients. The data included 198 care episodes for 427 wounds. Results: Patients with sickle cell ulcers were younger and had fewer comorbid diseases than those with venous ulcers. Larger size and longer duration were predictors of poor healing. Between the first and fourth assessments, mean change in area for sickle cell ulcers showed a 58% increase, compared with a 13% decrease for venous ulcers. Kaplan-Meier curves showed poorer healing in sickle cell ulcers than in venous ulcers across all categories of size and duration. Patients with sickle cell ulcers had longer care episodes and were more likely to re-present for care. Innovation: This study reports on the largest data set of sickle cell ulcer patients analyzed to date in the published literature to provide a more detailed understanding of wound healing patterns of this disease. Conclusion: A national network of electronic health records can effectively identify a large number of patients with sickle cell ulcers to support analysis of epidemiology, healing patterns, and health care utilization.
- Evaluation of needs and treatment benefits in outpatient care for leg ulcer patients: a pilot study. [Journal Article]
- JWJ Wound Care 2018 Aug 02; 27(8):527-533
- CONCLUSIONS: This pilot study showed the feasibility of using the PBI-w in practice in an outpatient clinic to assess patients' needs, which could help health professionals improve treatment and care for people with leg ulcers. The study also pointed towards the benefits of care for patients who consult specialised outpatient clinics.
- The role of compression therapy in the treatment of venous leg ulcers. [Review]
- ACAdv Clin Exp Med 2018 Aug 07
- Epidemiological data regarding venous leg ulcers, specifically low healing rates and frequent recurrences (occurring in 20-70% of the cases), seems surprising regarding recent progress in the managem...
Epidemiological data regarding venous leg ulcers, specifically low healing rates and frequent recurrences (occurring in 20-70% of the cases), seems surprising regarding recent progress in the management of this complication. The aim of this review is to present the current state of knowledge on venous leg ulcer management, especially compression therapy. Treatment of venous ulcers should be comprehensive and wellorganized, based on modern standards and up-to-date, and should involve elaborated treatment strategies. A thorough diagnostic process followed by adequate treatment may result in marked improvement of the outcomes, with up to 67% healing rate at 12 weeks and up to 81% within 24 weeks. Continuation of therapeutic activities after the ulceration has been healed is reflected by a marked decrease in the recurrence rates, down to 16% whenever the patient is actively involved in the therapeutic process. Furthermore, early diagnosis and appropriate causal treatment may prevent progression of the illness.
- Impact of Gram-negative bacteria on the treatment of venous leg ulcers. [Journal Article]
- IWInt Wound J 2018 Aug 05
- Gram-negative germs with and without multi-resistance are garnering more and more importance. The aim of this study was to investigate the frequency and rate of resistance against antibiotics and to ...
Gram-negative germs with and without multi-resistance are garnering more and more importance. The aim of this study was to investigate the frequency and rate of resistance against antibiotics and to clarify the impact of Gram-negative bacteria, especially with high rates of resistance, for the treatment of venous leg ulcers. This is a retrospective, monocentric, non-randomised open study. Included were all data within 1 year of bacterial swabs of venous leg ulcers. We performed summarization, pooling, and descriptive analysis for frequencies and crossover. We analysed 679 swabs of 285 patients with venous leg ulcers. The mean patient age was 69.78 years. There were 76.1% Gram-positive and 58.2% Gram-negative germs detected; 56.5% of the swabs showed multi-resistance. Gram-negative bacteria were associated with more pain. Exacerbation and relevant aggravation of wounds that led to stationary treatment occurred more frequently. With polihexanid treatment, we saw less Gram-negative flora. This study showed an immediate impact of Gram-negative germs on the patient's pain, the risk for aggravation, and the choice of treatment. Further studies for prophylaxis and treatment of Gram-negative germs in venous leg ulcer therapy are needed.
- Cost-effectiveness of treatments for superficial venous reflux in patients with chronic venous ulceration. [Journal Article]
- BOBJS Open 2018; 2(4):203-212
- Venous leg ulcers impair quality of life significantly, with substantial costs to health services. The aim of this study was to estimate the cost-effectiveness of interventional procedures alongside ...
Venous leg ulcers impair quality of life significantly, with substantial costs to health services. The aim of this study was to estimate the cost-effectiveness of interventional procedures alongside compression therapy versus compression therapy alone for the treatment of chronic venous leg ulceration.
New Search Next
- Chronic venous insufficiency: a new concept to understand pathophysiology at the microvascular level - a pilot study. [Journal Article]
- PPerfusion 2018 Aug 01; :267659118791682
- CONCLUSIONS: Induced venous hypovolemia through regular evacuation of the peripheral venous system improved tissue oxygenation at skin level. Venous hypervolemia may be the main contributing factor for the development of venous hypoxia and microvascular ischemia.