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Venous Leg Ulcers (venous + leg_ulcer)

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Medical Sciences	100%

Selected Abstracts

Serum Iron and Matrix Metalloproteinase-9 Variations in Limbs Affected by Chronic Venous Disease and Venous Leg Ulcers

DERMATOLOGIC SURGERY, Issue 6 2005
Paolo Zamboni MD
Background. Severe chronic venous disease (CVD) is characterized by both dermal hemosiderin accumulation and matrix metalloproteinase (MMP) hyperactivation. The iron-driven pathway is one of the recognized mechanisms of MMP hyperactivation. Objective. To investigate the potential consequences of leg hemosiderin deposits on both iron metabolism and activation of MMPs. Methods. We contemporaneously assessed the following in the serum of the arm and ankle veins of 30 patients (C4,6) with CVD and 14 normal subjects: ferritin, transferrin, iron, percentage of transferrin iron binding capacity (%TIBC), and MMP-9. Optical microscopy examinations with Perls' staining of chronic wounds were also performed. Results. Histology consistently revealed iron deposits. Serum ferritin, iron, and %TIBC were significantly increased in the legs affected by severe CVD compared with the arm of the same subjects or the controls. In addition, iron and %TIBC were significantly elevated in the legs of ulcer patients. The rate of activation of MMP-9 was significantly elevated in CVD. Conclusions. The increased iron deposition in legs affected by CVD seems to be more instable in ulcer patients, leading to iron release in the serum of the affected leg. Our data suggest the iron-driven pathway as a further mechanism for MMP hyperexpression leading to tissue lesion. [source]

Venous leg ulcers: patient concordance with compression therapy and its impact on healing and prevention of recurrence

INTERNATIONAL WOUND JOURNAL, Issue 5 2009
Christine Moffatt
ABSTRACT This study aimed to review available data on the reasons attributed to patient non concordance with compression therapy for the treatment of venous leg ulcers (VLUs), the frequency of non concordance and its effects on clinical outcomes. The biomedical literature was searched for publications on VLUs, compression therapy and concordance over the past 20 years. Physical, aesthetic and cosmetic factors, patient lack of education about VLUs, cost of therapy and issues with treatment by clinicians were all reported to influence concordance with compression therapy. The search identified 10 studies reporting patient concordance with compression stockings or bandages; while non concordance ranged from 2% to 42% of patients in three randomised controlled trials, it was generally higher in real-world studies, ranging from 9.7% to 80%. Another set of six studies indicated that the healing rate was half and the median time to complete healing was twice as long when patients were not concordant. Further, recurrence rates were 2,20 times greater when patients did not comply with the use of stockings following VLU healing. In conclusion, published biomedical literature has documented that non concordance with compression therapy negatively impacts the outcome of VLUs, highlighting the need to improve patient concordance to maximise therapeutic benefits. [source]

A systematic review of health-related quality of life instruments used for people with venous ulcers: an assessment of their suitability and psychometric properties

JOURNAL OF CLINICAL NURSING, Issue 19-20 2010
Simon J Palfreyman
Aims and objectives., To review the quality of life questionnaires used to measure the impact of venous ulceration and to evaluate their psychometric properties. Background., Venous leg ulcers have a negative impact on quality of life. Health-related quality of life can be measured using structured questionnaires. Nurses are the primary care providers for patients with venous ulceration and are ideally placed to assess and develop these types of questionnaires. There may also be an opportunity to use such quality of life instruments to measure the impact of nursing interventions in other areas where nurses are the key care providers. Design., Systematic review. Method., Studies were sought that used quality of life instruments to evaluate the impact of venous ulceration. Fourteen electronic bibliographical databases and 11 Internet-based health services research related resources were searched. In addition, grey literature was sought and the reference lists of relevant articles checked. Data were extracted regarding the type of instrument used, sample, number of items and domains and psychometric performance of the instrument. Results., The initial search identified a total of 338 potential citations. After review, a total of 31 studies were included: 17 used generic and 14 used disease-specific instruments. Five different types of generic and seven disease-specific instruments were identified. There was significant heterogeneity between the studies in terms of study design, aetiology of ulceration and times of assessment. The disease-specific instruments showed limitations in relation to their applicability to venous ulcer patients because of flaws in design or validation. Conclusions., The literature on quality of life related to venous ulceration failed to sufficiently distinguish between those with different causes of leg ulceration. There appeared to be problems with the ability of current quality of life instruments to detect changes in quality of life related to ulcer healing. Relevance to clinical practice., There appears to be an opportunity for nurses to develop a health-related quality of life health-related quality of life instruments to evaluate their impact on patient outcomes. Such instruments could potentially allow nursing interventions to be assessed more effectively than the recently proposed nursing metrics. [source]

Use of the sensory nerve stimulator to accelerate healing of a venous leg ulcer with sensory nerve dysfunction: a case study

INTERNATIONAL WOUND JOURNAL, Issue 3 2005
Article first published online: 7 SEP 200
Utilisation d'un stimulateur nerveux sensitif pour accélerer la cicatrisation des ulcères veineux avec dysfonctionnement nerveux sentitif: à propos d'un cas Un nouveau traitement utilisant la stimulation nerveuse sensitive (International Patent Appliction Number PCT/AU2004/001079 , nerve dysfunction and tissue healing"(Khalil Z) a été développé dans notre laboratoire de physiologie vasculaire. Ce traitemeent a montré une amélioration de la fonction nerveuse sensitive et les déficiences en cicatrisation associées chez des personnes agées par rapport à des personnes jeunes. Un homme de 82 ans présentant un ulcère de jambe petit mais persistant depuis 18 mois, en dépit d'un traitement approprié en pansements et en contention., a été vu dans un service specialisé en traitement des plaies. Les functions sensitives et microvasculaires etaient évaluées avec beaucoup de details gràce à l'utilisation de techniques de laboratoire de physiologie vasculaire, et il a bénéficié d'un traitement par stimulation en complément d'un traitement conventionnel. Sa plaie a cicatrisé après 4 semaines. Nous rapportons ce cas ici. Avant traitement par stimulation nerveuse, la sensation cutanée, le flux sanguin microcirculatoire et la tension d'oxygène ont été trouvées diminuées près de l'ulcère en comparaison avec le membre oppose non ulcéré. Après traitement, la tension d'oxygène et la flux sanguin microcirculatoire étaient améliorés. Ce cas apporte une preuve supplémentaire que le traitement par stimulation nerveuse sensitive dans des conditions bien définies améliore la cicatrisation. L'observation d'une amélioration de la fonction nerveuse sensitive supporte la nition qu'une amélioration de la cicatrisation est liée à une amélioration de la fonction nerveuse. Anwendung eines sensiblen Nervenstimulationsgerätes zur beschleunigten Wundheilung eines venösen Beinulcus mit begleitender neurologischer Dysfunktion: eine Fallstudie Eine neue Therapieform zur Stimulation der Nervensensibilität wurde in den eigenen Laboratorien entwickelt. Diese Behandlungsform zeigte eine Verbesserung der insbesondere bei älteren Patienten vorliegenden eingeschränkten Nervenfunktion und der damit verbundenen verzögerten Wundheilung. Wir berichten über den Fall eines 82 jährigen Patienten mit einem kleinen, über 18 Monaten persistierenden venösen Ulkus am Unterschenkel trotz Anwendung verschiedener Wundauflagen und einer begleitenden Kompressionsbehandlung. In unserem Labor wurden unter Anwendung vaskulärerer und physiologsicher Messungen die Sensibilität und die mikrovaskuläre Funktion erfasst und eine Nervenstimulationstherapie in Verbindung mit Wundauflagen und Kompressionsbehandlung durchgeführt. Die Wundheilung war nach 4 Wochen abgeschlossen. Vor der Nervenstimulationstherapie war die Hautsensibilität, der mikrovaskuläre Blutfluss sowie der Sauerstoffdruck im Gewebe im Vergleich zur gesunden Gegenseite vermindert. Nach der Therapie zeigten sich alle drei Parameter verbessert. Dieser Fall stellt einen weiteren Beweis dar, dass eine zusätzliche Nervenstimulation zu den etablierten Behandlungsstrategien die Wundheilung positiv beeinflusst. Die Beobachtung dass sich die sensible Nervenfunktion verbessert hat lässt zusätzlich den Schluss zu, dass eine Optimierung der Wundheilung auch durch eine verbesserte Nervenfunktion erreicht wird. Impiego della stimolazione di nervi sensoriali per accelerare la guarigione di ulcere venose della gamba con disfunzione dei nervi sensoriali: studio di un caso Nel nostro laboratorio di fisiologia vascolare è stata sviluppata una nuova terapia che utilizza la stimolazione dei nervi sensoriali (brevetto internazionale di applicazione numero: PCT/AU2004/001079: riparazione del tessuto e della funzione del nervo (Khalil, Z). Questo trattamento ha mostrato di migliorare la carente funzione dei nervi sensoriali e la ridotta riparazione tessutale di ferite in persone anziane se paragonate ai livelli di guarigione di persone giovani.. Un uomo di 82 anni con una piccola ma persistente ulcera delle gambe presente da 18 mesi, nonostante un apparente ed appropriato trattamento con medicazioni e compressione, è stato visitato in un servizio specialistico per la cura delle ferite. Le funzioni sensoriali del paziente e la microcircolazione sono state monitorizzate in grande dettaglio utilizzando le tecniche del laboratorio di fisiologia vascolare, ed è stata fornita la terapia di stimolazione dei nervi sensoriali in aggiunta alla terapia convenzionale.. La sua ferita è guarita in quattro settimane. Noi riportiamo qui un caso. Prima del trattamento con stimolazione dei nervi, sono state riscontrate ridotte la sensibilità cutanea, il flusso ematico microcircolatorio e la tensione di ossigeno vicino alla lesione ulcerativa, se comparate con la sede controlaterale non ulcerata. Dopo la terapia, la tensione di ossigeno ed il flusso microcircolatorio sono migliorati. Questo caso fornisce una ulteriore evidenza che la terapia con stimolazione del sensorio migliora la riparazione tessutale di ferite seguendo determinati parametri. L'osservazione di una migliore funzione sensoriale fornisce supporto per la nozione che una migliore riparazione tessutale è mediata da una migliore funzionalità dei nervi. Uso del estimulador nervioso sensitivo para acelerar la cicatrización de una úlcera vascular venosa con disfunción nerviosa sensitiva: estudio de un caso En nuestro laboratorio de fisiología vascular se ha desarrollado un nuevo tratamiento basado en la estimulación nerviosa sensitiva [Número de Solicitud de Patente Internacional: PCT/AU2004/001079: ,Función nerviosa y cicatrización tisular"(Khalil, Z)]. Se ha comprobado que este tratamiento mejora la función nerviosa sensitiva deficiente y la subsiguiente curación deficiente de heridas en personas de edad avanzada hasta alcanzar los niveles observados en personas jóvenes. En un servicio de tratamiento de heridas especializado se visitó a un hombre de 82 años con una úlcera vascular venosa pequeña, pero persistente durante 18 meses a pesar de la aplicación de apósitos aparentemente apropiados y tratamiento compresivo. Se evaluaron muy por debajo las funciones sensitiva y microvascular del paciente por medio de técnicas de laboratorio de fisiología vascular y se le aplicó tratamiento de estimulación nerviosa sensitiva además de tratamiento convencional. Su herida curó al cabo de 4 semanas. En este artículo describimos el caso. Antes de proceder al tratamiento de estimulación nerviosa se comprobó que la sensibilidad cutánea, el flujo sanguíneo microvascular y la concentración de oxígeno estaban reducidos en la proximidad de la úlcera en comparación con la pierna contralateral, no ulcerada. Después del tratamiento, la concentración de oxígeno y el flujo sanguíneo microvascular habían mejorado. Este caso proporciona pruebas adicionales de que el tratamiento de estimulación nerviosa sensitiva, con los parámetros especificados, mejora la curación de las heridas. La observación de la mejoría de la función nerviosa sensitiva respalda el concepto de que la mediación de una cicatrización más óptima reside en la mejoría de la función nerviosa. Användandet av känselnerv stimulator för att påskynda läkning av venösa bensår med känselnerv dysfunktion: en fallstudie En ny terapi som använder känselnerv stimulering [Internationellt Patent Ansökningsnummer PCT/AU2004/001079: ,nervfunktion och vävnadsläkning'(Khalil, Z)] har utvecklats i vårt laboratorium för vaskulär fysiologi. Denna behandling har visat sig förbättra försämrad känselnervfunktion och ansluten nedsatt sårläkning hos äldre personer till nivåer iakttagna hos yngre personer. En 82-årig man med ett litet venöst bensår som emellertid fortbestått i 18 månader, trots klart tillbörliga sårförband och kompressionsterapi, sågs på en specialist sårvårdsmottagning. Patientens känslofunktion och mikrovskulära funktion undersöktes ingående med hjälp av vaskulärfysiologiska laboratorie tekniker, och han erhöll känselnerv stimuleringsterapi samt konventionell terapi. Hans sår läktes efter 4 veckor. Vi rapporterar detta fall här. Jämfört med det andra sårfria benet iakttogs i området runt såret nedsatt känsla i huden, nedsatt mikrovaskulärt blodflöde och syre tryck före insättandet av nervstimuleringsterapi. Efter terapin hade syretrycket och mikrovaskulära blodflödet förbättrats. Denna fallstudie utgör ett ytterligare bevis för att känselnerv stimuleringsterapi förbättrar sårläkning i de parameter som stipulerats. Observationen att känselnervfunktionen förbättrades utgör ett stöd för uppfattningen att förbättrad nervfunktion åstadkommer förbättrad sårläkning. [source]

Changes in quality of life for patients with chronic venous insufficiency, present or healed leg ulcers

JOURNAL DER DEUTSCHEN DERMATOLOGISCHEN GESELLSCHAFT, Issue 11 2009
Regina Renner
Summary Background: Patients with chronic leg ulcers are handicapped in daily life, both by physical complaints and social problems. The aim of our study was not only to assess a possible impairment of quality of life (QOL) of leg ulcer patients but also to evaluate if there is a real improvement of QOL after healing of the ulcer. Patients with chronic venous insufficiency served as the control group. We further analyzed if there were significant differences in the response between patients who were and were not performing compression therapy. Patients and method: We interviewed three groups of patients (active venous leg ulcer, healed venous leg ulcer and patients with chronic venous insufficiency using the ,Freiburger Life Quality Assessment für Venenerkrankungen" (FLQAv). Results: Physical problems, daily handicaps and social problems all increased with age. Contrary to our expectations, healing of a leg ulcer did not lead to a significant increase in QOL. Instead, patients with active ulcers did not regard their QOL as lower than those in the other groups. Compression therapy also did not impair QOL in the three groups. Conclusion: Even though ulcer healing is an admirable goal, it does not necessarily lead to an improved QOL, probably because of the numerous comorbidi-ties in this patient group. Nonetheless, it is important to control problems associated directly with the wound to allow ulcer patients to participate actively in everyday life and minimize social problems. [source]

Fear-avoidance beliefs and pain as predictors for low physical activity in patients with leg ulcer

PHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 3 2009
Kirsti Skavberg Roaldsen
Abstract Background and Purpose.,Previous studies have shown that patients with chronic venous insufficiency are deconditioned and physically inactive. The present study aimed to examine the occurrence of fear-avoidance beliefs in patients with chronic venous insufficiency, and to investigate the role of fear-avoidance beliefs and pain severity in predicting the low level of physical activity in these patients.,Method.,Data were collected by a postal questionnaire sent to 146 patients with chronic venous insufficiency and current or previous venous leg ulcer. Complete data were collected from 98 patients aged 60,85 years , 63% women , giving a response rate of 67%. Fear-avoidance beliefs were assessed by the Fear-Avoidance Beliefs Questionnaire, physical activity subscale. Pain and physical activity were assessed by the Six-point Verbal Rating Scale of Pain Assessment and the Physical Activity Questionnaire, respectively.,Results.,Fear-avoidance beliefs were present in 81 (83%) of the patients with chronic venous insufficiency (range 0,24, median 12). Forty patients (41%) had strong fear-avoidance beliefs. One-third of the patients with healed ulcers had strong fear-avoidance beliefs. Patients with low physical activity had significantly stronger fear-avoidance beliefs and more severe pain than patients with high physical activity. Multiple logistic regression showed that the odds ratio (OR) for low physical activity were about three times higher for patients with strong fear-avoidance beliefs (OR 3.1, 95% confidence interval 1.1,8.3; p = 0.027) than for patients with weak fear-avoidance beliefs.,Conclusions.,Fear-avoidance beliefs were present in most patients with chronic venous insufficiency and were associated with low physical activity. Clinical implications ought to include a better recognition of fear-avoidance beliefs, early information about the negative consequences of such beliefs, and the importance of physical activity to counteract poor mobility. Copyright © 2009 John Wiley & Sons, Ltd. [source]

Functional ability in female leg ulcer patients , a challenge for physiotherapy

PHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 4 2006
Kirsti Skavberg Roaldsen
Abstract Background and Purpose.,Venous leg ulceration represents a global health problem affecting predominantly elderly women. Traditionally, functional problems in this group of patients have attracted modest attention from wound care providers and physiotherapists. The aim of the present study was to describe and quantify disease consequences in female leg ulcer patients as a background for future physiotherapy interventions, using the nomenclature of the WHO International Classification of Functioning, Disability and Health (ICF).,Method.,A prospective study was conducted in 34 women aged 60,85 years with current or previous venous leg ulcer as compared to 27 age-matched non-ulcer subjects. The outcome variables were pain, ankle range of motion, walking speed, walking endurance, self-perceived exertion, mobility, activities of daily living (ADL), physical activity, general health, life satisfaction and use of walking aids and community services. Established instruments were utilized and categorized within ICF domains to provide a conceptual framework and basis for physiotherapeutic research.,Results.,Leg ulcer patients showed significantly reduced values of ankle range of motion, walking speed and endurance, self-perceived exertion, mobility, ADL and physical activity level as compared to control subjects. Patients suffering from active ulceration were more negatively affected, and more of them had pain than post-ulcer fellows. By contrast, general health and life satisfaction were similarly rated by the two study groups.,Conclusions.,Elderly females in our study with chronic leg ulcer of venous aetiology had significant mobility impairments, but the reasons and consequences of these impairments remain to be elucidated. The potential of preventive measures and physical rehabilitation to aid functioning and prospects of leg ulcer repair need to be investigated in future studies. Copyright © 2006 John Wiley & Sons, Ltd. [source]

Development of a client-generated health outcome measure for community nursing

AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 5 2000
Rhonda Griffiths
Objective:To develop a client-generated outcome measure for use in community nursing. Method:Participants for the study were identified from the case load of community health nurses, from a nursing home service and from residents of a retirement village. All participants had a diagnosis of venous leg ulcer (VLU) and/or type 2 diabetes. Preliminary development of the measure involved focus groups of community clients and health professionals, and pilot testing of an existing quality of life (QoL) measure, the Patient-Generated Index. The resulting Client-Generated Index was tested for reliability and validity. Results:The Pearson's correlation coefficient between administration of the CGI at T1 and T2 was 0.526 (n=51; p=0.0001). The CGI correlated significantly with four of eight dimensions of the SF-36, and with pain as a clinical marker for VLU r=0.54 (p=0.001). Overall, participants with VLU reported a lower QoL (mean CGI score 2.8) compared to those with diabetes (mean CGI score 4.1). Conclusions:The CGI was developed to measure outcomes in community health settings. Some measures of its reliability and validity are demonstrated and further research is needed to validate the instrument using other client groups. Implications:If routine assessment and evaluation is to contribute to measures of outcome, the instruments need to be concise and acceptable to health care providers. The CGI has all these properties. [source]

Venous leg ulcers: patient concordance with compression therapy and its impact on healing and prevention of recurrence

Evaluation of the nano-oligosaccharide factor lipido-colloid matrix in the local management of venous leg ulcers: results of a randomised, controlled trial

INTERNATIONAL WOUND JOURNAL, Issue 2 2008
Jean-Luc Schmutz
Abstract The nano-oligosaccharide factor (NOSF) is a new compound aiming to promote wound closure mainly through inhibition of matrix metalloproteinase (MMP) activity. This factor is incorporated within a lipido-colloid matrix (Techonology Lipido-Colloid-NOSF matrix) and locally released in the wound. The objective of this study was to document the performance (non inferiority or superiority) of the NOSF relative to the Promogran® matrix (oxidised regenerated cellulose, ORC) effect in the local management of venous leg ulcers (VLUs). This was a 12-week, open, two-arm, multicentre, randomised study. Patients were selected if the area of their VLU [ankle brachial pressure index ,0·80] ranged from 5 to 25 cm2 with a duration ,3 months. Ulcers had to be free from necrotic tissue. In addition to receiving compression bandage therapy, patients were randomly allocated to either NOSF matrix or ORC treatment for 12 weeks. The VLUs were assessed on a weekly basis and wound tracings were recorded. Percentage wound relative reduction (%RR) was the primary efficacy criterion. Secondary objectives were wound absolute reduction (AR), healing rate (HR) and % of wounds with ,40% reduction compared with baseline. A total of 117 patients were included (57 NOSF matrix and 60 ORC). Mean population age was 71·3 ± 13·5 years, body mass index was ,30 kg/m2 in 39·3% and 15·4% were diabetics. Fifty-six per cent of the VLUs were present for >6 months, 61% were recurrent and 68% were stagnating despite appropriate care. Mean wound area at baseline was 11·2 ± 7·4 cm2. At the last evaluation, mean difference between the groups for %RR was 33·6 ± 15·0% in favour of NOSF matrix with a unilateral 95% confidence interval (CI) lower limit of 8·6% not including the null value. Therefore, a superiority of NOSF matrix effect compared with ORC was concluded (P = 0·0059 for superiority test). The median of the wound area reduction was 61·1% and 7·7% in the NOSF matrix and control groups, respectively (per-protocol analysis), or 54·4% versus 12·9% in intent-to-treat analysis (p = 0·0286). Median AR was 4·2 cm2 in the NOSF group and 1·0 cm2 with ORC (P = 0·01). Median HR was ,0·056 and ,0·015 cm2/day in NOSF and ORC groups, respectively (P = 0·029). By logistic regression, the NOSF versus control odds ratio to reach 40% area reduction was 2·4 (95% CI: 1·1,5·3; P = 0·026). In the oldest and largest VLUs, a strong promotion of healing effect was particularly observed in the NOSF matrix group compared with the control group. NOSF matrix is a very promising option for the local management of chronic wounds, especially for VLUs with poor healing prognosis. [source]

Is there an easier way to autograft skin in chronic leg ulcers? ,Minced micrografts', a new technique

JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 10 2008
P Boggio
Abstract Background Chronic venous leg ulcers represent an urgent and increasing problem for public health. The use of skin autografts results in a greater therapeutic success in healing chronic ulcers. Objective A simple method of skin autografting that could permit a wider use of skin grafts in outpatients is needed. A new technique allowing skin autografting in a simple one-step process, without complex surgical procedures or expensive technical supplies, is presented. Methods A small, full-thickness skin specimen taken from the patient is finely minced and spread on his leg ulcer bed allowing to cover a surface many times wider than the sample itself. Results This method induces faster re-epithelization of chronic leg ulcers that failed to heal despite good conservative local therapy and give the possibility to repair very large ulcers with small fragments of skin. A clinical case is shown as an example out of 20 ulcers we recently treated. Conclusion Our preliminary report shows that this technique results in a greater therapeutic success (18 of 20 cases) in healing chronic leg ulcers, a common pathology that often affects outpatients treated for very long periods at home or in the Dermatologist's office. In our experience, this new and successful reparative possibility makes ,mince grafting' a recommendable procedure. [source]

A novel method of comparing the healing properties of two hydrogels in chronic leg ulcers

JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 2 2006
M De La Brassinne
Abstract Skin ulcers on the legs have a chronic, relapsing course and are often a significant management challenge. Novel methods of measuring and comparing the effects of different treatments can be of assistance in addressing this situation. A clinical pilot study using original methods was undertaken to compare the healing properties of the alginate gel Flaminal® (test) and the hydrocolloid gel Intrasite® (control) on chronic leg ulcers. The study was performed over a period of 28 days with two parallel groups of 10 patients. Both the surface (acetate tracing and planimetry) and the volume (Jeltrate® mould impression and weighting) of each wound were measured at baseline and after 7, 14 and 28 days of treatment. On both parameters results were superior with the test product compared to the control, with volume reduction being the first parameter to change. Between groups, difference in wound volume reduction was detected as early as day 7 whereas difference in surface reduction was clearly apparent only at day 28. Correlation between wound surface and volume reductions was also better in the test group (r = 0.843 vs. 0.421) than in the control. In conclusion, this pilot study suggests that combining wound surface and volume evaluations allows a more precise analysis of the healing process in venous leg ulcers and that this method is able to detect very early differences in treatments even with limited sample size. [source]

Granulocyte/macrophage colony-stimulating factor treatment of human chronic ulcers promotes angiogenesis associated with de novo vascular endothelial growth factor transcription in the ulcer bed

BRITISH JOURNAL OF DERMATOLOGY, Issue 1 2006
F. Cianfarani
Summary Background, Granulocyte/macrophage colony-stimulating factor (GM-CSF), a cytokine with pleiotropic functions, has been successfully employed in the treatment of chronic skin ulcers. The biological effects underlying GM-CSF action in impaired wound healing have been only partly clarified. Objectives, To investigate the effects of GM-CSF treatment of chronic venous ulcers on lesion vascularization and on the local synthesis of the angiogenic factors vascular endothelial growth factor (VEGF) and placenta growth factor (PlGF). Methods, Patients with nonhealing venous leg ulcers were treated with intradermal injection of recombinant human GM-CSF, and biopsies were taken at the ulcer margin before and 5 days after administration. Wound vascularization was analysed by immunohistochemistry using antiplatelet endothelial cell adhesion molecule-1/CD31 and anti-,-smooth muscle actin antibodies. VEGF and PlGF transcription was assessed by in situ hybridization. To identify the cell populations transcribing VEGF within the ulcer bed, the VEGF hybridization signal was correlated with the immunostaining for different cell type markers on serial sections. Direct induction of VEGF transcription by GM-CSF was investigated in GM-CSF-treated cultured macrophages and keratinocytes. Results, Blood vessel density was significantly increased in the ulcer bed following GM-CSF treatment. VEGF transcripts were localized in keratinocytes at the ulcer margin both before and after GM-CSF treatment, whereas a VEGF hybridization signal was evident within the ulcer bed only following administration. PlGF mRNA was barely detectable in keratinocytes at the ulcer margin and was not visibly increased after treatment. Unlike VEGF, a specific PlGF hybridization signal could not be detected in cells within the ulcer following GM-CSF administration. Monocytes/macrophages were the main cell population transcribing VEGF after GM-CSF treatment. In vitro analysis demonstrated that VEGF transcription can be directly stimulated by GM-CSF in a differentiated monocytic cell line, but not in keratinocytes. Conclusions, Our data show that increased vascularization is associated with GM-CSF treatment of chronic venous ulcers and indicate that inflammatory cell-derived VEGF may act as an angiogenic mediator of the healing effect of GM-CSF in chronic ulcers. [source]

Management of mixed arterial and venous leg ulcers,

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 9 2007
M. L. Humphreys
Background: The aim was to assess healing in patients with mixed arterial and venous leg ulcers after protocol-driven treatment in a specialist leg ulcer clinic. Methods: The study included consecutive patients referred with leg ulceration and venous reflux over 6 years. Legs without arterial disease (ankle : brachial pressure index (ABPI) above 0·85) were treated with multilayer compression bandaging and patients with severe disease (ABPI 0·5 or less) were considered for immediate revascularization. Those with moderate arterial compromise (ABPI above 0·5 up to 0·85) were initially managed with supervised modified compression and considered for revascularization if their ulcer did not heal. Healing rates were determined using life-table analysis. Results: Of 2011 ulcerated legs, 1416 (70·4 per cent) had venous reflux. Of these 1416, 193 (13·6 per cent) had moderate and 31 (2·2 per cent) had severe arterial disease. Healing rates by 36 weeks were 87, 68 and 53 per cent for legs with insignificant, moderate and severe arterial disease respectively (P < 0·001). Seventeen legs with moderate and 15 with severe arterial disease were revascularized. Of these, ulcers healed in four legs with moderate and seven with severe disease within 36 weeks of revascularization (P = 0·270). Combined 30-day mortality for revascularization was 6·5 per cent. Conclusion: A protocol including supervised modified compression and selective revascularization achieved good healing rates for mixed arterial and venous leg ulceration. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Economic analysis of VenUS I, a randomized trial of two bandages for treating venous leg ulcers

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 10 2004
C. P. Iglesias
Background: The study investigated the cost-effectiveness of four-layer and short-stretch compression bandages for treating venous leg ulcers. Methods: Cost-effectiveness and cost-utility analyses were performed using patient-level data collected alongside the VenUS I leg ulcer study. The perspective for the economic analysis was that of the UK National Health Service (NHS) and Personal Social Service. The time horizon for the analysis was 1 year after recruitment. Health benefit was measured as differences in ulcer-free days and quality-adjusted life years (QALYs). Results: The mean healing time for ulcers treated with four-layer bandages was 10·9 (95 per cent confidence interval (c.i.) ,6·8 to 29·1) days less than that for ulcers treated with short-stretch bandages. Mean average difference in QALYs between compression systems was ,0·02 (95 per cent c.i. ,0·08 to 0·04). The four-layer bandage cost a mean of £227·32 (95 per cent c.i. £16·53 to £448 ·30) less per patient per year than the short-stretch bandage. Conclusion: On average, four-layer bandaging was associated with greater health benefits and lower costs than short-stretch bandaging. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]