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Ronald Shannon, Andrea Nelson
To compare data on time to healing from two separate cohorts: one treated with a new acellular synthetic matrix plus standard care (SC) and one matched from four large UK pragmatic, randomised controlled trials [venous leg ulcer (VLU) evidence network]. We introduce a new proof-of-concept strategy to a VLU clinical evidence network, propensity score matching and sensitivity analysis to predict the feasibility of the new acellular synthetic matrix plus SC for success in future randomised, controlled clinical trials...
November 20, 2016: International Wound Journal
Kashif Rahim, Shamim Saleha, Xudong Zhu, Liang Huo, Abdul Basit, Octavio Luiz Franco
A wound is damage of a tissue usually caused by laceration of a membrane, generally the skin. Wound healing is accomplished in three stages in healthy individuals, including inflammatory, proliferative, and remodeling stages. Healing of wounds normally starts from the inflammatory phase and ends up in the remodeling phase, but chronic wounds remain in an inflammatory stage and do not show progression due to some specific reasons. Chronic wounds are classified in different categories, such as diabetic foot ulcer (DFU), venous leg ulcers (VLU) and pressure ulcer (PU), surgical site infection (SSI), abscess, or trauma ulcers...
October 14, 2016: Microbial Ecology
Kehua Zhou, Peng Jia
Depression slows wound healing in patients with chronic wounds. The prevalence of depressive symptoms differs in the literature and the current understandings of factors related to depression in patients with wounds have been limited. To investigate the prevalence of depressive symptoms and the associated factors in patients with wounds, we performed this retrospective study in which depressive symptoms were evaluated with the Patient Health Questionnaire 9-item (PHQ-9). Valid PHQ-9 scores were collected from 222 patients (112 males and 110 females; age: 64...
September 26, 2016: Wound Repair and Regeneration
S Ehmann, J C Whitaker, S Hampton, A Collarte
OBJECTIVE: The aim of this small pilot audit was to record the performance of an adjustable Velcro compression wrap, ReadyWrap, and the experiences of patients and health-care professionals using the system as a self-care option for the management of venous and lymphatic leg conditions in both the treatment and maintenance phases. METHOD: This audit was held within a 4-week review period. Participants included venous leg ulcer (VLU) patients with and without oedema, and patients with lymphoedema...
September 2016: Journal of Wound Care
Jan Shepherd
Venous leg ulceration (VLU) is a chronic condition associated with chronic venous insufficiency (CVI), where the most frequent complication is recurrence of ulceration after healing. Traditionally, graduated compression therapy has been shown to increase healing rates and also to reduce recurrence of VLU. Graduated compression occurs because the circumference of the limb is narrower at the ankle, thereby producing a higher pressure than at the calf, which is wider, creating a lower pressure. This phenomenon is explained by the principle known as Laplace's Law...
September 2016: British Journal of Community Nursing
M Sopata, M Kucharzewski, E Tomaszewska
OBJECTIVE: To assess the impact of a two-period treatment on the clinical condition, bacteriological changes and results of treatment of venous leg ulcers (VLU) using octenidine dihydrochloride. METHOD: Patients with a VLU were recruited and treated with octenidine dihydrochloride for one month, after which they were randomised and treated with hydrocolloids or foam dressings. The wounds were clinically assessed for the amount of necrotic tissue, granulation tissue, epithelialisation, amount of exudate and pain level...
August 2016: Journal of Wound Care
K Kroeger, M Storck, P Kujath, E Rabe, J Dissemond
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...
August 8, 2016: Zentralblatt Für Chirurgie
Robert S Kirsner, Wolfgang Vanscheidt, David H Keast, John C Lantis, Cyaandi R Dove, Shawn M Cazzell, Mher Vartivarian, Matthias Augustin, William A Marston, Nicholas D McCoy, D Innes Cargill, Tommy D Lee, Jaime E Dickerson, Herbert B Slade
In 2012 we reported promising results from a Phase 2 clinical trial of HP802-247, a novel spray-applied investigational treatment for chronic venous leg ulcers (VLU) consisting of human, allogeneic fibroblasts and keratinocytes. We now describe Phase 3 clinical testing of HP802-247, its failure to detect efficacy, and subsequent investigation into the root causes of the failure. Two randomized, controlled trials enrolled a total of 673 adult outpatients at 96 centers in North America and Europe. The primary endpoint was the proportion of ulcers with confirmed closure at the end of 12 weeks of treatment...
August 6, 2016: Wound Repair and Regeneration
Daniela Ligi, Giovanni Mosti, Lidia Croce, Joseph D Raffetto, Ferdinando Mannello
Venous leg ulcers (VLUs) produce wound fluid (WF), as a result of inflammatory processes within the wound. It is unclear if WF from different healing phases of VLU has a peculiar biochemical profile and how VLU microenvironment affects the wound healing mechanisms. This study was conducted to evaluate the cytokine/chemokine profiles in WF from distinct VLU phases, in WF- and LPS-stimulated monocytes and treated with glycosaminoglycan Sulodexide, a therapeutic option for VLU healing. WF and plasma were collected from patients with VLU during active inflammatory (Infl) and granulating (Gran) phases...
October 2016: Biochimica et Biophysica Acta
G Mosti, A Cavezzi, G Massimetti, H Partsch
OBJECTIVE/BACKGROUND: Peripheral arterial occlusive disease (PAOD) is reported in about 15-20% of patients with venous leg ulcers (VLU). In such cases arterial recanalization is often recommended, and compression therapy is considered a contraindication when the ankle brachial pressure index (ABPI) is < 0.8. The aim of this study was to compare the outcome of patients with recalcitrant VLU, both without any arterial impairment ("pure venous recalcitrant leg ulcer" [pvRLU]) and with associated PAOD ("mixed arterial and venous recalcitrant leg ulcer" [mavRLU]), by treating only the venous disease...
September 2016: European Journal of Vascular and Endovascular Surgery
Daniela Ligi, Giovanni Mosti, Lidia Croce, Joseph D Raffetto, Ferdinando Mannello
Venous leg ulcers (VLU) are characterized by sustained proteolytic microenvironment impairing the healing process. Wound fluid (WF) reflect the biomolecular activities occurring within the wound area; however, it is unclear if WF from different healing phases have different proteolytic profiles and how VLU microenvironment affects the wound healing mechanisms. We investigated the proteolytic network of WF from distinct VLU phases, and in WF- and LPS-stimulated THP-1 monocytes treated with glycosaminoglycan sulodexide, a well known therapeutic approach for VLU healing...
October 2016: Biochimica et Biophysica Acta
Joseph D Raffetto, Robert T Eberhardt, Steven M Dean, Daniela Ligi, Ferdinando Mannello
Pharmacologic treatment for venous leg ulcers (VLUs) is an adjuvant treatment to compression therapy. It encompasses a variety of plant-derived and synthetic compounds with properties that alter venous microcirculation, endothelial function, and leukocyte activity to promote VLU healing. These compounds are often referred to as venotonics or venoactive drugs but have also been referred to as edema-protective agents, phlebotonics, vasoprotectors, phlebotropics, and venotropics. The exact mechanism of their ability to heal VLUs is not known; however, clinical trials support their efficacy...
July 2016: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Peter J Franks, Judith Barker, Mark Collier, Georgina Gethin, Emily Haesler, Arkadiusz Jawien, Severin Laeuchli, Giovanni Mosti, Sebastian Probst, Carolina Weller
Introduction It is well documented that the prevalence of venous leg ulcers (VLUs) is increasing, coinciding with an ageing population. Accurate global prevalence of VLUs is difficult to estimate due to the range of methodologies used in studies and accuracy of reporting. (1) Venous ulceration is the most common type of leg ulceration and a significant clinical problem, affecting approximately 1% of the population and 3% of people over 80 years of age (2) in westernised countries. Moreover, the global prevalence of VLUs is predicted to escalate dramatically, as people are living longer, often with multiple comorbidities...
June 2016: Journal of Wound Care
Magali Rezende de Carvalho, Isabelle Silveira de Andrade, Alcione Matos de Abreu, Andrea Pinto Leite Ribeiro, Bruno Utzeri Peixoto, Beatriz Guitton Renaud Baptista de Oliveira
Lower extremity ulcers represent a significant public health problem as they frequently progress to chronicity, significantly impact daily activities and comfort, and represent a huge financial burden to the patient and the health system. The aim of this review was to discuss the best approach for venous leg ulcers (VLUs). Online searches were conducted in Ovid MEDLINE, Ovid EMBASE, EBSCO CINAHL, and reference lists and official guidelines. Keywords considered for this review were VLU, leg ulcer, varicose ulcer, compressive therapy, compression, and stocking...
June 2016: Journal of Vascular Nursing: Official Publication of the Society for Peripheral Vascular Nursing
Kristina Heyer, Kerstin Protz, Gerd Glaeske, Matthias Augustin
Chronic venous diseases are the most common causes of leg ulcers. Compression treatment (CT) is a central component of venous leg ulcer (VLU) therapy along with prevention based on guidelines and clinical evidence. However, large-scale data on the use of CT are rare. In particular, there have not yet been published nationwide data for Germany. We analysed data from a large German statutory health insurance (SHI) on incident VLU between 2010 and 2012. VLUs were identified by ICD-10 diagnoses. The status of active disease was defined by wound-specific treatments...
May 19, 2016: International Wound Journal
Keith Harding
The under-utilisation of compression for venous leg ulcer (VLU) management translates into lost opportunities to heal wounds, improve patients' quality of life and maximise health care system efficiency. Although compression therapy is considered gold standard according to clinical guidelines, lack of clinician knowledge, unclear referral pathways, local unavailability of compression and patient unwillingness to receive compression, amongst other reasons, mean many candidates for compression do not receive appropriate treatment...
December 2016: International Wound Journal
Hannah Trøstrup, Per Holstein, Lars Christophersen, Bo Jørgensen, Tonny Karlsmark, Niels Høiby, Claus Moser, Magnus S Ågren
Chronic wounds and in particular diabetic foot ulcers (DFUs) are a growing clinical challenge, but the underlying molecular pathophysiological mechanisms are unclear. Recently, we reported reduced levels of the immunomodulating and antimicrobial S100A8/A9 in non-healing venous leg ulcers (VLUs), while another study found increased S100A8/A9 in DFUs. To clarify these apparently contradictory findings, we compared S100A8/A9 as well as an inducer, lipopolysaccharide (LPS) and selected innate immune response mediators in wound fluids from non-healing DFUs and VLUs with healing wounds...
July 2016: Archives of Dermatological Research
Joshua D Fox, Katherine L Baquerizo-Nole, Freya Van Driessche, Elizabeth Yim, Bernard Nusbaum, Francisco Jimenez, Robert S Kirsner
BACKGROUND: A man in his 60s with recurrent venous leg ulcers (VLUs) presented with an 18-month history of a VLU on his medial left leg measuring 59.3 cm(2). He had been treated with multi- component compression bandages without significant decrease in ulcer size. Given the ulcer's size, refractory nature, and history of recurrence, the authors sought to optimize the patient's healing. METHODS: Approximately 23% of the total wound was treated using punch grafts (PGs) harvested from different locations on the body based on hair density using the "stick and place" method...
April 2016: Wounds: a Compendium of Clinical Research and Practice
Marjolein Birgitte Maessen-Visch, Catherine van Montfrans
Compression therapy and treating venous insufficiency is the standard of care for venous leg ulcers. The need for debridement on healing venous leg ulcers is still debated. Dressings are often used under compression bandages to promote faster healing and prevent adherence of the bandage to the ulcer. A wide range of dressings is available, including modern dressings with different kinds of biological activity. Microbial burden is believed to underlie delayed healing, but the exact role of microbiofilm in wound healing is uncertain...
March 2016: Phlebology
Joseph D Raffetto
Venous leg ulcer (VLU) is one of the most common lower extremity ulcerated wound, and is a significant healthcare problem with implications that affect social, economic, and the well-being of a patient. VLU can have debilitating related problems which require weekly medical care and may take months to years to heal. The pathophysiology of VLU is complex, and healing is delayed in many patients due to a persistent inflammatory condition. Patient genetic and environmental factors predispose individuals to chronic venous diseases including VLU...
March 2016: Phlebology
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