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Woo K, Murphy C, Gregg E, Moralejo J, LeBlanc K, Brandys T. Management of Pain in People Living With Chronic Limb Threatening Ischemia: Highlights From a Rapid Umbrella Review. J Wound Ostomy Continence Nurs 2024; 51:371-376. [PMID: 39313972 DOI: 10.1097/won.0000000000001112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2024]
Abstract
Peripheral artery disease is a complex health condition. It is associated with atherosclerotic occlusive lesions in the arteries limiting normal blood flow, mostly involving the lower extremities, leading to chronic limb-threatening ischemia (CLTI). Chronic unrelenting ischemic leg pain can be debilitating and distressing, contributing to poor health-related quality of life. Comprehensive management of pain associated with CLTI requires multimodal approaches that draw on a range of strategies and specialist treatments delivered by an interdisciplinary team across various health care settings. We recognized a significant gap in evidence-based strategies that are accessible, appropriate, acceptable, effective, and safe for the elderly with CLTI-associated pain. We therefore conducted an umbrella review or overview of multiple existing reviews that employ a rigorous and transparent method to comprehensively identify and synthesize relevant literature including systematic, scoping, and narrative reviews. The purpose of this umbrella review was to aggregate and compare various management options to inform best practices and quality indicators for the management of ischemic pain in older patients with peripheral artery disease.
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Affiliation(s)
- Kevin Woo
- Kevin Woo, PhD, RN, NSWOC(C), WOCC(C), Queen's University, University Health Network, Kingston, Ontario
- Christine Murphy, PhD, RN, NSWOC(C), WOCC(C), The Ottawa Hospital, Ottawa, Ontario
- Emily Gregg, MSc, RN, Queen's University, Kingston, Ontario
- Joshua Moralejo, MScCH, RN, NSWOC(C), WOCC(C), University Health Network, Kingston, Ontario
- Kimberly LeBlanc, PhD, RN, NSWOC(C), WOCC(C), Wound, Ostomy and Continence Institute, Nurses Specialized in Wound, Ostomy and Continence Canada (NSWOCC), Ottawa, Ontario
- Tim Brandys, MD, MEd, FRCSC, FACS, The Ottawa Hospital,Ottawa, Ontario
| | - Christine Murphy
- Kevin Woo, PhD, RN, NSWOC(C), WOCC(C), Queen's University, University Health Network, Kingston, Ontario
- Christine Murphy, PhD, RN, NSWOC(C), WOCC(C), The Ottawa Hospital, Ottawa, Ontario
- Emily Gregg, MSc, RN, Queen's University, Kingston, Ontario
- Joshua Moralejo, MScCH, RN, NSWOC(C), WOCC(C), University Health Network, Kingston, Ontario
- Kimberly LeBlanc, PhD, RN, NSWOC(C), WOCC(C), Wound, Ostomy and Continence Institute, Nurses Specialized in Wound, Ostomy and Continence Canada (NSWOCC), Ottawa, Ontario
- Tim Brandys, MD, MEd, FRCSC, FACS, The Ottawa Hospital,Ottawa, Ontario
| | - Emily Gregg
- Kevin Woo, PhD, RN, NSWOC(C), WOCC(C), Queen's University, University Health Network, Kingston, Ontario
- Christine Murphy, PhD, RN, NSWOC(C), WOCC(C), The Ottawa Hospital, Ottawa, Ontario
- Emily Gregg, MSc, RN, Queen's University, Kingston, Ontario
- Joshua Moralejo, MScCH, RN, NSWOC(C), WOCC(C), University Health Network, Kingston, Ontario
- Kimberly LeBlanc, PhD, RN, NSWOC(C), WOCC(C), Wound, Ostomy and Continence Institute, Nurses Specialized in Wound, Ostomy and Continence Canada (NSWOCC), Ottawa, Ontario
- Tim Brandys, MD, MEd, FRCSC, FACS, The Ottawa Hospital,Ottawa, Ontario
| | - Joshua Moralejo
- Kevin Woo, PhD, RN, NSWOC(C), WOCC(C), Queen's University, University Health Network, Kingston, Ontario
- Christine Murphy, PhD, RN, NSWOC(C), WOCC(C), The Ottawa Hospital, Ottawa, Ontario
- Emily Gregg, MSc, RN, Queen's University, Kingston, Ontario
- Joshua Moralejo, MScCH, RN, NSWOC(C), WOCC(C), University Health Network, Kingston, Ontario
- Kimberly LeBlanc, PhD, RN, NSWOC(C), WOCC(C), Wound, Ostomy and Continence Institute, Nurses Specialized in Wound, Ostomy and Continence Canada (NSWOCC), Ottawa, Ontario
- Tim Brandys, MD, MEd, FRCSC, FACS, The Ottawa Hospital,Ottawa, Ontario
| | - Kimberly LeBlanc
- Kevin Woo, PhD, RN, NSWOC(C), WOCC(C), Queen's University, University Health Network, Kingston, Ontario
- Christine Murphy, PhD, RN, NSWOC(C), WOCC(C), The Ottawa Hospital, Ottawa, Ontario
- Emily Gregg, MSc, RN, Queen's University, Kingston, Ontario
- Joshua Moralejo, MScCH, RN, NSWOC(C), WOCC(C), University Health Network, Kingston, Ontario
- Kimberly LeBlanc, PhD, RN, NSWOC(C), WOCC(C), Wound, Ostomy and Continence Institute, Nurses Specialized in Wound, Ostomy and Continence Canada (NSWOCC), Ottawa, Ontario
- Tim Brandys, MD, MEd, FRCSC, FACS, The Ottawa Hospital,Ottawa, Ontario
| | - Tim Brandys
- Kevin Woo, PhD, RN, NSWOC(C), WOCC(C), Queen's University, University Health Network, Kingston, Ontario
- Christine Murphy, PhD, RN, NSWOC(C), WOCC(C), The Ottawa Hospital, Ottawa, Ontario
- Emily Gregg, MSc, RN, Queen's University, Kingston, Ontario
- Joshua Moralejo, MScCH, RN, NSWOC(C), WOCC(C), University Health Network, Kingston, Ontario
- Kimberly LeBlanc, PhD, RN, NSWOC(C), WOCC(C), Wound, Ostomy and Continence Institute, Nurses Specialized in Wound, Ostomy and Continence Canada (NSWOCC), Ottawa, Ontario
- Tim Brandys, MD, MEd, FRCSC, FACS, The Ottawa Hospital,Ottawa, Ontario
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Zhang S, Yang L, Wang Y, Yang G, Li Y, Li Y, Zhu J, Li R, Xie W, Wan Q, Pei X, Chen J, Zhang X, Wang J. Development of a Stretchable and Water-Resistant Hydrogel with Antibacterial and Antioxidant Dual Functions for Wound Healing in Movable Parts. ACS APPLIED MATERIALS & INTERFACES 2023; 15:43524-43540. [PMID: 37695676 DOI: 10.1021/acsami.3c08782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
The treatment of wounds that develop on moving parts of the body, such as joints, is considered a challenge due to poor mechanical matching and secondary injury caused by continuous motion and inflammation. Herein, a stretchable, multifunctional hydrogel dressing utilizing the dual cross-linking of chitosan (CS) and acrylic acid (AA) and modified with caffeic acid (CA) and aloin (Alo) was developed. Mechanical testing demonstrated that the hydrogel possessed excellent stretching capability (of approximately 869%) combined with outstanding adhesion (about 56 kPa), contributing to its compatibility with moving parts and allowing complete coverage of wound sites without limiting joint and organ motion. Bioinformatics analysis confirmed that use of the hydrogel resulted in upregulated expression of multiple genes related to angiogenesis and cell proliferation. Furthermore, antibacterial testing indicated that the dressing suppressed the growth of Escherichia coli and methicillin-resistant Staphylococcus aureus (MRSA), providing a better microenvironment for wound healing. An in vivo wound defect model on movable skin verified that the wound healing observed with the hydrogel dressing was superior to that observed with a commercially available dressing. Taken together, the results suggest that a stretchable multifunctional hydrogel dressing represents a promising alternative wound dressing with therapeutic potential for superior healing, especially for moving parts of the body.
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Affiliation(s)
- Shu Zhang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
- Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Linxin Yang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
- Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Yuting Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
- Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Guangmei Yang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
- Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Yahong Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
- Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Yuanyuan Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
- Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Junjin Zhu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
- Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Ruyi Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
- Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Wenjia Xie
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
- Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Qianbing Wan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
- Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Xibo Pei
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
- Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Junyu Chen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
- Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Xin Zhang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
- Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Jian Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
- Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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Abbade LPF, Frade MAC, Pegas JRP, Dadalti-Granja P, Garcia LC, Bueno Filho R, Parenti CEF. Consensus on the diagnosis and management of chronic leg ulcers - Brazilian Society of Dermatology. An Bras Dermatol 2020; 95 Suppl 1:1-18. [PMID: 33371937 PMCID: PMC7772605 DOI: 10.1016/j.abd.2020.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/03/2020] [Accepted: 06/07/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Chronic leg ulcers affect a large portion of the adult population and cause a significant social and economic impact, related to outpatient and hospital care, absence from work, social security expenses, and reduced quality of life. The correct diagnosis and therapeutic approach are essential for a favorable evolution. OBJECTIVE To gather the experience of Brazilian dermatologists, reviewing the specialized literature to prepare recommendations for the diagnosis and treatment of the main types of chronic leg ulcers. METHODS Seven specialists from six university centers with experience in chronic leg ulcers were appointed by the Brazilian Society of Dermatology to reach a consensus on the diagnosis and therapeutic management of these ulcers. Based on the adapted DELPHI methodology, relevant elements were considered in the diagnosis and treatment of chronic leg ulcers of the most common causes; then, the recent literature was analyzed using the best scientific evidence. RESULTS The following themes were defined as relevant for this consensus - the most prevalent differential etiological diagnoses of chronic leg ulcers (venous, arterial, neuropathic, and hypertensive ulcers), as well as the management of each one. It also included the topic of general principles for local management, common to chronic ulcers, regardless of the etiology. CONCLUSION This consensus addressed the main etiologies of chronic leg ulcers and their management based on scientific evidence to assist dermatologists and other health professionals and benefit the greatest number of patients with this condition.
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Affiliation(s)
- Luciana Patricia Fernandes Abbade
- Department of Infectious Diseases, Dermatology, Diagnostic Imaging and Radiotherapy, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil.
| | - Marco Andrey Cipriani Frade
- Department of Internal Medicine (Dermatology Division), Faculty of Medicine, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - José Roberto Pereira Pegas
- Dermatology Service, Hospital Padre Bento de Guarulhos, Guarulhos, SP, Brazil; Discipline of Dermatology, Faculty of Medicine, Universidade da Cidade de São Paulo, São Paulo, SP, Brazil; Discipline of Dermatology, Faculty of Medicine, Jundiaí, SP, Brazil
| | - Paula Dadalti-Granja
- Department of Clinical Medicine (Discipline of Dermatology), Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Lucas Campos Garcia
- Dermatology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Roberto Bueno Filho
- Dermatology Service, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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