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Venous leg ulcer

Gill Norman, Maggie J Westby, Amber D Rithalia, Nikki Stubbs, Marta O Soares, Jo C Dumville
BACKGROUND: Venous leg ulcers are open skin wounds on the lower leg which can be slow to heal, and are both painful and costly. The point prevalence of open venous leg ulcers in the UK is about 3 cases per 10,000 people, and many people experience recurrent episodes of prolonged ulceration. First-line treatment for venous leg ulcers is compression therapy, but a wide range of dressings and topical treatments are also used. This diversity of treatments makes evidence-based decision-making challenging, and a clear and current overview of all the evidence is required...
June 15, 2018: Cochrane Database of Systematic Reviews
Aileen Y Chang, Edith C Tonui, Douglas Momanyi, Alex R Mills, Paul Wasike, Rakhi Karwa, Toby A Maurer, Sonak D Pastakia
INTRODUCTION: Compression therapy is well-established standard of care for chronic leg ulcers from venous disease and lymphedema. Chronic leg ulcers and lymphedema have a significant impact on quality of life, driven by pain, foul odor, and restricted mobility. Provision of layered compression therapy in resource-limited settings, as in Western Kenya and other regions of sub-Saharan Africa, is a major challenge due to several barriers: availability, affordability, and access to healthcare facilities...
June 15, 2018: Dermatology and Therapy
Ben Cooper, Paul Bachoo
BACKGROUND: Leg ulcers are chronic wounds of the lower leg, caused by poor blood flow, that can take a long time to heal. The pooling of blood in the veins can damage the skin and surrounding tissues, causing an ulcer to form. Venous leg ulcers are associated with impaired quality of life, reduced mobility, pain, stress and loss of dignity. The standard treatment for venous leg ulcers is compression bandages or stockings. Shock wave therapy may aid the healing of these wounds through the promotion of angiogenesis (the formation and development of blood vessels) and reduction of inflammation, though this process is poorly understood at present...
June 11, 2018: Cochrane Database of Systematic Reviews
Natalia Burgos-Alonso, Igone Lobato, Igone Hernández, Kepa San Sebastian, Begoña Rodríguez, Anna Giné March, Adriana Perez-Salvador, Veronica Arce, Arturo Garcia-Alvarez, Maria Cruz Gomez-Fernandez, Gonzalo Grandes, Isabel Andia
OBJECTIVE: To examine the potential efficacy and safety of autologous platelet-rich plasma (PRP) in comparison with the conventional treatment (standard care, SoC) for the treatment of leg ulcers in patients with chronic venous insufficiency, in a primary health-care setting. METHOD: A Phase I-II, open-label, parallel-group, multicentre, randomised pilot study was conducted. The outcome variables at baseline and at weeks five and nine included reduction in the ulcer area, Chronic Venous Insufficiency Quality of Life Questionnaire score, cost of the treatment for up to nine weeks and average weekly cure rate...
June 1, 2018: Journal of Wound Care
Qinglu Cheng, Michelle Gibb, Nicholas Graves, Kathleen Finlayson, Rosana E Pacella
BACKGROUND: Venous leg ulcers (VLUs) are expensive to treat and impair quality of life of affected individuals. Although improved healing and reduced recurrence rates have been observed following the introduction of evidence-based guidelines, a significant evidence-practice gap exists. Compression is the recommended first-line therapy for treatment of VLUs but unlike many other developed countries, the Australian health system does not subsidise compression therapy. The objective of this study is to estimate the cost-effectiveness of guideline-based care for VLUs that includes public sector reimbursement for compression therapy for affected individuals in Australia...
June 7, 2018: BMC Health Services Research
Markos Klonizakis, Anil Gumber, Emma McIntosh, Brenda King, Geoff Middleton, Jonathan A Michaels, Garry A Tew
Despite exercise being included in the recommended advice for patients with venous leg ulcers, there is a fear shared by clinicians and patients that exercise may be either inappropriate or harmful and actually delay rather than promote healing. Therefore, before implementing a larger-scale study exploring the effects of a supervised exercise programme in patients with venous ulcers being treated with compression therapy, it is important to assess exercise safety as well as fidelity and progression in a feasibility study...
June 6, 2018: International Wound Journal
Michael A Towler, Elaine W Rush, Melissa K Richardson, Calvin L Williams
Chronic venous leg ulcers are responsible for significant morbidity and health care costs worldwide. This pilot study evaluated the effectiveness 2 biologically active grafts, TheraSkin and Apligraf, in conjunction with compression therapy. The study, not industry-sponsored, was designed and conducted as a prospective, head-to-head, single-site, randomized clinical trial to assess differences in healing rates, adverse outcomes, and treatment costs. The healing rates were different but not statistically significant, there were no adverse outcomes, and TheraSkin averaged $2495...
July 2018: Clinics in Podiatric Medicine and Surgery
Magali Rezende De Carvalho, Bruno Utzeri Peixoto, Isabelle Andrade Silveira, Beatriz G R Baptista de Oliveria
Compression therapy is the standard of care for venous leg ulcers (VLUs), and some evidence suggests 4-layer compression is more effective than short-stretch bandages. A meta-analysis was conducted to compare the effectiveness of these 2 compression bandages for venous ulcer healing. In March 2016, a systematic review of the literature was conducted to identify randomized controlled trials. Databases used included Pubmed/MEDLINE, EMBASE, Cochrane Central, the Cumulative Index of Nursing and Allied Health Literature, and the Latin American and Caribbean of Health Sciences Information System...
May 2018: Ostomy/wound Management
Teresa J Kelechi, Mary J Dooley, Martina Mueller, Mohan Madisetti, Margie A Prentice
PURPOSE: The purpose of this study was to examine the efficacy of a self-administered cooling treatment on clinically meaningful differences (CMDs) in symptom changes in patients with chronic venous disease. DESIGN: Blinded, prospective, randomized controlled trial. SUBJECTS AND SETTING: Two hundred seventy-six community-dwelling adults 21 years and older with skin changes and/or a healed venous leg ulcer (Clinical-Etiologic-Anatomic-Pathologic [CEAP] 4 and 5 classification) completed the 6-month active treatment period...
May 24, 2018: Journal of Wound, Ostomy, and Continence Nursing
Michael L Sabolinski, Gary Gibbons
AIM: To compare the effectiveness of bilayered living cellular construct (BLCC) and an acellular fetal bovine collagen dressing (FBCD) for the treatment of venous leg ulcers. METHODS: Data from WoundExpert® (Net Health, PA, USA) was used to analyze 1021 refractory venous leg ulcers treated at 177 facilities. RESULTS: Kaplan-Meier analyses showed that BLCC (893 wounds) was superior to FBCD (128 wounds), p = 0.01 for: wound closure by weeks 12 (31 vs 25%), 24 (55 vs 43%) and 36 (68 vs 53%); reduction in time to wound closure of 37%, (19 vs 30 weeks); and improvement in the probability of healing by 45%...
May 29, 2018: Journal of Comparative Effectiveness Research
Elaine Aparecida Rocha Domingues, Uiara Aline Oliveira Kaizer, Maria Helena Melo Lima
This study aimed to evaluate the effect of strategies of a lifestyle orientation programme on patients with venous ulcer in elastic compression therapy. This was a single-blind, 2-arm, randomised clinical controlled trial. The primary outcome included the reduction of the wound surface area. The secondary outcomes included the perception of pain, questionnaire of ulcer status, and quality of life. Seventy-one patients with ulcers of venous aetiology were randomised into 2 arms: control group (CG) and intervention group (IG), with a 12-week follow up...
May 28, 2018: International Wound Journal
Julie Green, Rebecca Jester, Robert McKinley, Alison Pooler
Part 2 in this article series summarises the final two phases of a study which explored the experiences of patients with leg ulcers and the impact of this condition on their quality of life. Early phases of the study revealed a mismatch between issues that affected a patient's quality of life and what they discussed during subsequent health care consultations. In light of this, a nominal group technique was employed to facilitate the development of a new leg ulcer consultation template with patient partners...
June 1, 2018: British Journal of Community Nursing
A Ferris, K Harding
No abstract text is available yet for this article.
May 2018: British Journal of Dermatology
Francislene de Fátima Cordeiro Petz, Marineli Joaquim Meier, Hellen Roehrs, Franciele Soares Pott
The objective of this review is to synthesize the best available evidence on the effectiveness of the application of extracellular matrix products as dressings or in topical form as treatment for venous, arterial and mixed leg ulcers, compared to compression therapy alone, any type of dressings and topical agents, or placebos in adults over 18 years in any care setting.
May 2018: JBI Database of Systematic Reviews and Implementation Reports
Harikrishna K R Nair
OBJECTIVE: The primary aim is to assess the efficacy of microcurrent, a form of electrical stimulation, as an adjunct therapy in accelerating healing in chronic wounds by reducing wound size and pain level. The secondary aim is to assess the qualitative changes in these parameters: inflammatory symptoms, vasodilation, sleep quality, gait and frequency of bowel movement. METHOD: Eligible patients with chronic wounds were enrolled between March and June 2016, from the Wound Care Unit, Hospital Kuala Lumpur in this consecutive case series...
May 2, 2018: Journal of Wound Care
Alai Tan, Brent Sullenbarger, Ruchika Prakash, Jodi C McDaniel
BACKGROUND: High levels of circulating proinflammatory cytokines are characteristic of inflammaging, a term coined to describe age-related chronic systemic inflammation involved in the etiology of many age-related disorders including nonhealing wounds. Some studies have shown that supplementing diets with n-3 polyunsaturated fatty acids (eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA]) lowers systemic levels of key proinflammatory cytokines associated with inflammaging. However, findings from the few studies that have focused exclusively on older adults are inconclusive...
May 2018: Prostaglandins, Leukotrienes, and Essential Fatty Acids
Sophia Tate, Annie Price, Keith Harding
No abstract text is available yet for this article.
May 2, 2018: BMJ: British Medical Journal
Matthew Sabo, Lam Le, Raphael A Yaakov, Marissa Carter, Thomas E Serena
Chronic wounds (ie, wounds that fail to progress through a normal, orderly, timely sequence of repair) continue to pose significant clinical and economic burdens. A prospective, descriptive, 3-week post-marketing surveillance study was conducted across 3 wound care centers in the United States to evaluate the effectiveness of a collagen calcium alginate dressing on chronic wounds in conjunction with standard care (SC) practices (eg, offloading, debridement, compression) to support healing. Eligible participants had to be >18 years of age, have at least 1 chronic wound, and no known sensitivity to collagen...
April 2018: Ostomy/wound Management
Ryan N Rys, Mark D Blostein, Catherine A Lemarié
Venous thrombosis is a common condition affecting 1 - 2% of the population, with an annual incidence of 1 in 500. Venous thrombosis can lead to death through pulmonary embolism or results in the post-thrombotic syndrome, characterized by chronic leg pain, swelling, and ulceration, or in chronic pulmonary hypertension resulting in significant chronic respiratory compromise. This is the most common cardiovascular disease after myocardial infarction and ischemic stroke and is a clinical challenge for all medical disciplines, as it can complicate the course of other disorders such as cancer, systemic disease, surgery, and major trauma...
April 13, 2018: Journal of Visualized Experiments: JoVE
Susan Mayor
No abstract text is available yet for this article.
April 24, 2018: BMJ: British Medical Journal
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