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Kim J, Stechmiller J, Weaver M, Lyon D, Garrett TJ, Yi F, Park J, Rezende de Carvalho M, Kelly DL. Association of Tryptophan: Kynurenine Metabolites with Healing in Chronic Venous Leg Ulcers. Adv Wound Care (New Rochelle) 2024. [PMID: 38511520 DOI: 10.1089/wound.2023.0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVE Chronic wound healing is a complex process that is still not well understood. The tryptophan (TRP)-L-Kynurenine (KYN) pathway has recently been under increased scrutiny in regards to wound healing. The study applied metabolomics to elucidate the TRP-L- KYN pathway associated with wound healing in chronic venous leg ulcers (CVLUs). APPROACH This study used a longitudinal comparative design of 60 serum samples collected from 30 older adult patients with CVLUs, receiving weekly sharp debridement at a wound clinic. The serum samples were collected at baseline and week 4 (healed wounds) or week 8 (non-healed wounds). Liquid chromatography-mass spectrometry (LC-MS) metabolomics was used to analyze targeted metabolites. A Bayesian approach was employed to examine robust correlations between changes in metabolite values and linear healing slope and to compare by group. RESULTS The mean age was 71.13 (±9.46). Half of the sample were female and the minority (17%) were Black. The mean values of evaluated metabolites for the non-healed group were consistently lower than those for the healed group. The healed group (n=12) had higher KYN values; Those on a healing trajectory (n=23) had lower KYN levels and higher TRP levels at baseline and over time. There was moderate support (Bayes Factor = 3.70) for a negative association between change in Kynurenic Acid and linear healing slope (r = -0.35, CrI = -0.62, -0.04, PD= 98%). Results suggest KYN and TRP may be markers for healing in individuals with CVLUs. INNOVATION AND CONCLUSION Gaining a better understanding of the associations between the TRP-L- KYN pathway and the healing of CVLUs may help to clarify the links of inflammation with the rate and success of wound healing. Biomarker development focused on the TRP-L- KYN pathway could be pursued, if the associations are further supported by focused research studies.
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Affiliation(s)
- Junglyun Kim
- Chungnam National University, 26715, College of Nursing, Yuseong, Daejeon, Korea (the Republic of), 305764;
| | - Joyce Stechmiller
- University of Florida College of Nursing, 16096, Gainesville, Florida, United States;
| | - Michael Weaver
- University of Florida, 3463, Gainesville, Florida, United States;
| | - Debra Lyon
- University of Florida College of Nursing, 16096, Gainesville, Florida, United States;
| | - Timothy J Garrett
- University of Florida College of Medicine, 12233, Gainesville, Florida, United States;
| | - Fan Yi
- University of Idaho College of Science, 123393, Moscow, Idaho, United States;
| | - Jungmin Park
- University of Florida College of Nursing, Gainesville, Florida, United States;
| | - Magali Rezende de Carvalho
- University of Florida College of Nursing, 16096, 1225 Center Dr, Gainesville, Florida, United States, 32603;
| | - Debra Lynch Kelly
- University of Florida College of Nursing, 16096, Gainesville, Florida, United States;
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Patton D, Avsar P, Sayeh A, Budri A, O'Connor T, Walsh S, Nugent L, Harkin D, O'Brien N, Cayce J, Corcoran M, Gaztambide M, Moore Z. A systematic review of the impact of compression therapy on quality of life and pain among people with a venous leg ulcer. Int Wound J 2024; 21:e14816. [PMID: 38445749 PMCID: PMC10915825 DOI: 10.1111/iwj.14816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 02/12/2024] [Accepted: 02/18/2024] [Indexed: 03/07/2024] Open
Abstract
AIM To gain a greater understanding of how compression therapy affects quality of life, this systematic review appraised existing published studies measuring the impact of compression therapy on health quality of life (HRQoL), and pain, among people with venous leg ulcers (VLU). METHOD Five databases were searched, and two authors extracted data and appraised the quality of selected papers using the RevMan risk of bias tool. Due to heterogeneity in the types of compression and instruments used to evaluate HRQoL, meta-analysis was not appropriate; thus, a narrative synthesis of findings was undertaken. RESULTS Ten studies were included, 9 RCTs and one before-after study. The studies employed nine different HRQoL tools to measure the impact of a variety of compression therapy systems, with or without an additional exercise programme, versus other compression systems or usual care, and the results are mixed. With the use of the Cardiff Cardiff Wound Impact Schedule, the SF-8 and the SF-12, study authors found no differences in QoL scores between the study groups. This is similar to one study using QUALYs (Iglesias et al., 2004). Conversely, for studies using EuroQol-5D, VEINES-QOL, SF-36 and CIVIQ-20 differences in QoL scores between the study groups were noted, in favour of the study intervention groups. Two further studies using QUALYs found results that favoured a two-layer cohesive compression bandage and the TLCCB group, respectively. Results for the five studies that assessed pain are also mixed, with one study finding no difference between study groups, one finding that pain increased over the study period and three studies finding that pain reduced in the intervention groups. All studies were assessed as being at risk of bias in one or more domains. CONCLUSION Results were varied, reflecting uncertainty in determining the impact of compression therapy on quality of life and pain among people with a venous leg ulcer. The heterogeneity of the compression systems and the measures used to evaluate HRQoL make it a challenge to interpret the overall evidence. Further studies should strive for homogeneity in design, interventions and comparators to enhance both internal and external validity.
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Affiliation(s)
- Declan Patton
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland
- School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
- Fakeeh College of Health SciencesJeddahSaudi Arabia
- School of Nursing and MidwiferyGriffith UniversityBrisaneQueenslandAustralia
- Faculty of Science, Medicine and HealthUniversity of WollongongWollongongAustralia
| | - Pinar Avsar
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland
| | - Aicha Sayeh
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland
| | - Aglecia Budri
- School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
| | - Tom O'Connor
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland
- School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
- Fakeeh College of Health SciencesJeddahSaudi Arabia
- School of Nursing and MidwiferyGriffith UniversityBrisaneQueenslandAustralia
- Lida InstituteShanghaiChina
| | - Simone Walsh
- Study Feasibility and Activation Manager, RCSI Clinical Research CentreRCSI University of Medicine and Health SciencesDublinIreland
| | - Linda Nugent
- School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
- Fakeeh College of Health SciencesJeddahSaudi Arabia
| | - Denis Harkin
- RCSI University of Medicine and Health SciencesDublinIreland
| | - Niall O'Brien
- The Royal College of Surgeons in Ireland (RCSI)University of Medicine and Health SciencesDublinIreland
| | | | | | | | - Zena Moore
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland
- School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
- Fakeeh College of Health SciencesJeddahSaudi Arabia
- School of Nursing and MidwiferyGriffith UniversityBrisaneQueenslandAustralia
- Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia
- Department of Public Health, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
- University of WalesCardiffUK
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound CareMenzies Health Institute QueenslandSouthportQueenslandAustralia
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Hu Z, Wang S, Yang H, Xv H, Shan B, Lin L, Han X. Efficacy and safety of platelet-rich plasma in the treatment of venous ulcers: A systematic review and meta-analysis of randomized controlled trials. Int Wound J 2024; 21:e14736. [PMID: 38361238 PMCID: PMC10869651 DOI: 10.1111/iwj.14736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/23/2024] [Indexed: 02/17/2024] Open
Abstract
Considering the substantial impact of venous ulcers on quality of life and healthcare systems, this study evaluated the efficacy and safety of platelet-rich plasma (PRP) in comparison to conventional therapy. A systematic review of four databases identified 16 randomized clinical trials, including 20 study groups. PRP significantly enhanced complete ulcer healing, exhibiting an odds ratio (OR) of 5.06 (95% confidence interval [CI]: 2.35-10.89), and increased the percentage of healed ulcer area by a mean difference of 47% (95% CI: 32%-62%). Additionally, PRP shortened the time required for complete healing by an average of 3.25 months (95% CI: -4.06 to -2.43). Although pain reduction was similar in both groups, PRP considerably decreased ulcer recurrence rates (OR = 0.16, 95% CI: 0.05-0.50) without increasing the risks of infection or irritative dermatitis. These results suggest PRP as a viable, safe alternative for venous ulcer treatment, providing significant improvements in healing outcomes.
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Affiliation(s)
- Zhonglin Hu
- Plastic Surgery HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Senmao Wang
- Plastic Surgery HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Hao Yang
- Beijing Friendship HospitalCapital Medical UniversityBeijingChina
| | - Haona Xv
- Plastic Surgery HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Baozhen Shan
- Plastic Surgery HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Lin Lin
- Plastic Surgery HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Xuefeng Han
- Plastic Surgery HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
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Lu Y, Zhao D, Liu M, Cao G, Liu C, Yin S, Song R, Ma J, Sun R, Wu Z, Liu J, Wang Y. Gongying-Jiedu-Xiji recipe promotes the healing of venous ulcers by inhibiting ferroptosis via the CoQ-FSP1 axis. Front Pharmacol 2023; 14:1291099. [PMID: 38161691 PMCID: PMC10755008 DOI: 10.3389/fphar.2023.1291099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/05/2023] [Indexed: 01/03/2024] Open
Abstract
Objective: Gongying-Jiedu-Xiji recipe (DDL, batch number Z01080175) reduces body temperature, detoxifies, activates the blood circulation, reduces swelling, and dispels decay and pus. The aim of this study was to investigate the mechanism of action by which DDL functions in the treatment of venous ulcers (VUs). Methods: Normal tissues as well as VU tissues before and after DDL treatment were collected from nine VU patients in the hospital with ethical approval. These three tissues were subjected to Prussian blue iron staining, immunoblotting, immunohistochemistry, immunofluorescence, and quantitative real-time PCR to detect the expression of ferroptosis suppressor protein 1 (FSP1), coenzyme Q (CoQ), 4-hydroxynonenal (4-HNE), and glutathione peroxidase 4 (GPX4). After successful validation of the heme-induced human foreskin fibroblast (HFF) ferroptosis model, lyophilized DDL powder was added to the cells, and the cells were subjected to viability assays, immunoblotting, flow cytometry, glutathione (GSH) and malonaldehyde (MDA) assays, electron microscopy and qPCR assays. Results: Ferroptosis in VU tissues was stronger than that in normal tissues, and ferroptosis in VU tissues after DDL treatment was weaker than that before treatment. Inhibition of CoQ and FSP1 and transfection of FSP1 influenced the effects of DDL. Conclusion: Our results suggest that DDL may promote healing by attenuating ferroptosis in VUs and that DDL may promote VU healing by modulating the CoQ-FSP1 axis.
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Affiliation(s)
- Yongpan Lu
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Dejie Zhao
- Department of Vascular Surgery, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Ming Liu
- Department of Vascular Surgery, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Guoqi Cao
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
- Department of Plastic Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Chunyan Liu
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
- Department of Plastic Surgery, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Siyuan Yin
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
- Department of Plastic Surgery, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Ru Song
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
- Department of Plastic Surgery, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Jiaxu Ma
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
- Department of Plastic Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Rui Sun
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
- Department of Plastic Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Zhenjie Wu
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
- Department of Plastic Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Jian Liu
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
- Department of Plastic Surgery, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Yibing Wang
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
- Department of Plastic Surgery, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
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5
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Karppinen JJ, Kallio M, Lappalainen K, Lagus H, Matikainen N, Isoherranen K. Clinical characteristics of Martorell hypertensive ischaemic leg ulcer. J Wound Care 2023; 32:797-804. [PMID: 38060417 DOI: 10.12968/jowc.2023.32.12.797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
OBJECTIVE We sought to characterise the clinical picture of Martorell hypertensive ischaemic leg ulcer (HYTILU) by describing the ulcer borders with three clinical features: 'the red lipstick sign'; purple border; and livedo racemosa. We also aimed to characterise comorbidities and determinants of healing time. METHOD A single-centre, retrospective cohort study was conducted between 2015-2020. We scrutinised ulcer photographs for relevant clinical signs. Data on comorbidities, medication and ulcer treatments, as well as method of diagnosis and healing time, were collected from patients' electronic medical records. RESULTS In total, 38 female patients and 31 male patients (mean age 73 years) were assessed, with a mean follow-up time of 174 days. The 'red lipstick-like' margin covered 0-50% of the ulcer margin in 56.5% of the ulcers, and 51-100% of the ulcer margin in 43.5% of the ulcers. Purple border or livedo racemosa was observed in 70.5% of the ulcers. All patients had hypertension and 52.2% of patients had type 2 diabetes. A heavy cardiovascular disease burden and frequent concomitant vascular pathologies were found. Infections requiring systemic antibiotics, ulcer size and duration of symptoms before diagnosis were strongly associated with healing time. We also found that use of systemic corticosteroids and severity of hypertension (measured by the number of antihypertensive medications used) delayed healing. CONCLUSION Our data suggest that 'the red lipstick sign' could be a novel diagnostic feature in HYTILUs alongside purple border, livedo racemosa and necrotic/fibrinous ulcer bed. The results also elucidated HYTILU comorbidities, and showed that infections and delay in diagnosis impeded healing.
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Affiliation(s)
- Jesse Jm Karppinen
- Department of Dermatology and Allergology, Inflammation Center, Helsinki University Hospital, University of Helsinki, Finland
| | - Milla Kallio
- Vascular Surgery, Abdominal Center, Helsinki University Hospital, University of Helsinki, Finland
| | - Katriina Lappalainen
- Department of Dermatology and Allergology, Inflammation Center, Helsinki University Hospital, University of Helsinki, Finland
| | - Heli Lagus
- Wound Center, Department of Plastic and Reconstructive Surgery, Helsinki University Hospital, University of Helsinki, Finland
| | - Niina Matikainen
- Endocrinology, Abdominal Center, Helsinki University Hospital and Research Program for Clinical and Molecular Metabolism, University of Helsinki, Finland
| | - Kirsi Isoherranen
- Department of Dermatology and Allergology, Inflammation Center, Helsinki University Hospital, University of Helsinki, Finland
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Vieira Santos E Santos L, Netto Maia J, de Vasconcelos CR, Lima de Andrade D, Marques Lins E, Schmidt C, Andrade MDA. The relationship between the clinical severity of chronic venous insufficiency and the calf muscle pump: A cross-sectional study. J Bodyw Mov Ther 2023; 36:153-157. [PMID: 37949553 DOI: 10.1016/j.jbmt.2023.04.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 06/07/2022] [Accepted: 04/15/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE To investigate the connection between the clinical severity of chronic venous insufficiency (CVI) and the biomechanics of the calf muscle pump (CMP). MATERIAL AND METHODS Through a cross-sectional observational study, we analyzed women on the age range between 30 and 80 years with chronic venous insufficiency, stratified according to the clinical classification. Ninety-nine women were assessed and classified into groups with different levels of severity: C1 (n = 22); C2 (n = 22); C3 (n = 22); C4 (n = 22); C5 (n = 8); C6 (n = 3). The main purpose was to investigate the strength of the calf muscle pump through total work (TW) and peak torque (PT), and the range of motion (ROM) of the ankle joint. For a secondary analysis, the fatigue index was assessed. All results were run through the Humac®/NORMT isokinetic dynamometer to obtain the data. RESULTS Our findings pointed out that as the clinical severity of CVI increases, there is a reduction on the PT, the TW, the maximum active ROM and the ROM at 120°/sec. As severity increased, there was a reduction of 24Nm in the TW at 30°/sec.and a reduction of 3Nm in the PT at 30°/sec. OUTCOMES When increased, clinical severity of CVI may trigger downgrading in the strength of the CMP and the ROM in the ankle. These findings are of relevance to the clinician, since through these findings, individuals with venous insufficiency may be treated more precisely for each classification.
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Affiliation(s)
- Luiza Vieira Santos E Santos
- Departamento de fisioterapia e Laboratório de Cinesiologia e Avaliação Funcional, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Juliana Netto Maia
- Departamento de fisioterapia e Laboratório de Cinesiologia e Avaliação Funcional, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Cinthia Rodrigues de Vasconcelos
- Departamento de fisioterapia e Laboratório de Cinesiologia e Avaliação Funcional, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Danielly Lima de Andrade
- Departamento de fisioterapia e Laboratório de Cinesiologia e Avaliação Funcional, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Esdras Marques Lins
- Departamento de cirurgia vascular, CSS, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Cristine Schmidt
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina, Universidade do Porto, CIAFEL, Faculdade de Desporto, Universidade do Porto, Portugal
| | - Maria do Amparo Andrade
- Departamento de fisioterapia e Laboratório de Cinesiologia e Avaliação Funcional, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
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Yang WT, Ren HL, Zheng K, Jin ZY, Wen JH, Wang SX, Zhang WD, Li CM. Development and validation of a graduated compression stockings adherence scale. Phlebology 2023; 38:605-612. [PMID: 37651292 DOI: 10.1177/02683555231200109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
OBJECTIVE Compression therapy with the use of graduated compression stockings (GCSs) is a common treatment strategy for chronic venous disease (CVD). However, there is no uniform and objective standard to assess adherence to the use of GCSs. The aim of this study is to develop and validate a GCS Compliance Scale (GCSAS) to fill gaps in internationally recognized comprehensive scales and provide a useful tool for future research. METHODS The items included in the GCSAS were based on a review of the literature and open-ended interviews with experts, who screened the initial items using an item-level content validity index. Then, pilot tests were conducted three times with 50 participants. After exclusion of redundant and cross-loading items by exploratory factor analysis, 290 subjects were recruited to evaluate the reliability and validity of the proposed GCSAS. Analyses included internal consistency, test-retest reliability, split-half reliability, construct validity, criterion validity, convergent validity, and discriminant validity. RESULTS The final GCSAS consisted of 17 items and 5 dimensions. The results of the exploratory factor analysis indicated that the variances of each factor explained were 22.03%, 14.85%, 14.74%, 14.16%, and 13.35%, and all 5 factors explained 79.13% of the variance among the 17 items. The factor loadings of all items were >0.7. Confirmatory factor analysis indicated that the indices were adequate. A significant positive correlation was found between the GCSAS and the Venous Insufficiency Epidemiological and Economic Study - Quality of Life questionnaire scores (r = 0.76, p < 0.001). The Cronbach's alpha coefficient was 0.90, test-retest reliability was 0.81, and split-half reliability was 0.92. CONCLUSIONS The GCSAS showed good validity and reliability to assess compliance with the use of GCSs among patients with CVD.
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Affiliation(s)
- Wen-Tao Yang
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hua-Liang Ren
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Kai Zheng
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Zhen-Yi Jin
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jia-Hao Wen
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Sheng-Xing Wang
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wang-De Zhang
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Chun-Min Li
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Cacua Sanchez MT, Vargas Abello LM, Orrego Á, Ortiz P, Segura H, Berrio Caicedo JJ, Zuluaga LM, Ordoñez J, Fernández Montequin JI, Ulloa J. Use of Intralesional and Perilesional Human Recombinant Epidermal Growth Factor (hrEGF) in the Local Treatment of Venous Ulcer - Review Article - Expert Recommendation. Vasc Health Risk Manag 2023; 19:595-603. [PMID: 37701155 PMCID: PMC10494861 DOI: 10.2147/vhrm.s417447] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 08/25/2023] [Indexed: 09/14/2023] Open
Abstract
Venous Ulcers (VU) represent 60-80% of all leg ulcers and are the final stage of the disease secondary to venous hypertension or valve insufficiency. Conventional treatment that focuses on its etiological factors continues to be the gold standard; however, 30% of ulcers do not heal with this treatment; thus, it has been seen that the use of growth factor can be used as an adjuvant for this pathology. A literature review was carried out to evaluate the evidence from systematic reviews, meta-analyses, case studies, and quantitative studies that respond to the objective of this analysis review in the different databases with specific inclusion criteria with publications between 2002 and 2022, initially finding the topical application of the factor and later, more recently, the intralesional and perilesional application, the latter being an alternative treatment for this type of pathology and generating some recommendations for using the Factor.
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Affiliation(s)
| | | | | | - Paola Ortiz
- Uruguay Vein Center, Universidad de la República Oriental de Uruguay, Montevideo, Uruguay
| | - Héctor Segura
- Vascular and Endovascular Surgery Department, Hospital Español, Mexico City, Mexico
| | | | | | - José Ordoñez
- Department of Vascular Surgery, Fundación Santa Fe, Bogotá, Colombia
| | | | - Jorge Ulloa
- Department of Vascular Surgery, Fundación Santa Fe de Bogotá, Universidad de los Andes, Bogota, Colombia
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Borges D, Pires R, Ferreira J, Dias-Neto M. The effect of wound electrical stimulation in venous leg ulcer healing-a systematic review. J Vasc Surg Venous Lymphat Disord 2023; 11:1070-1079.e1. [PMID: 37196922 DOI: 10.1016/j.jvsv.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/25/2023] [Accepted: 05/08/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE The benefit of using electric stimulation therapy (EST) to heal venous leg ulcers (VLUs) is not well established. The main aim of this systematic review was to evaluate the effects of ulcer EST in VLU healing. METHODS A systematic search of the literature was conducted using the databases PubMed, Scopus, and Web of Science and included original studies that reported VLU healing after EST. The inclusion criteria were at least two surface electrodes placed on or near the wound or a planar probe covering the ulcer area to be treated. The Cochrane risk of bias tool for randomized control trials (RCTs) and Joanna Briggs Institute critical appraisal checklist for case series were used to evaluate the risk of bias. RESULTS This review included eight RCTs and three case series involving a total of 724 limbs in 716 patients with VLUs. The mean patient age was 64.2 years (95% confidence interval, 62.3-66.2), and 46.2% (95% confidence interval, 41.2%-50.4%) were men. The active electrode was placed on the wound with the passive electrode placed on healthy skin (n = 6), the two electrodes were placed on either side of the wound edges (n = 4), or a planar probe was used (n = 1). The pulsed current was the most used waveform (n = 9). The change in the ulcer size was the main method used to determine ulcer healing (n = 8), followed by the ulcer healing rate (n = 6), exudate levels (n = 4), and the time to healing (n = 3). Five RCTs detected a statistically significant improvement in at least one VLU healing outcome, after EST compared with the control group. In two of these, EST was better than the control but only for patients who had not undergone surgical treatment of VLU. CONCLUSIONS The findings from the present systematic review support the use of EST to accelerate wound healing of VLUs, especially for patients who are not surgical candidates. However, the significant variation in electric stimulation protocols represents an important limitation to its use and should be addressed in future studies.
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Affiliation(s)
- Daniela Borges
- Faculdade de Medicina da Universidade do Porto, University of Porto, Porto, Portugal.
| | - Raquel Pires
- Escola Superior de Biotecnologia, Universidade Católica do Porto, Porto, Portugal
| | - Joana Ferreira
- Department of Angiology and Vascular Surgery, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Marina Dias-Neto
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
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Mohamady HM, Taha MM, Aneis YM, Aldhahi MI, Attalla AF. Effect of Combined Electromagnetic Field and Plantar Flexion Resistance Exercise on Wound Healing in Patients with Venous Leg Ulcers: A Randomized Controlled Trial. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1157. [PMID: 37374361 DOI: 10.3390/medicina59061157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/16/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: Venous ulcers are recognized to be more painful and resistant to therapy than ulcers of other etiologies. Various methods have been used for the conservative treatment of venous ulcers, such as pulsed electromagnetic field (PEMF) and plantar exercise, which promote wound healing due to a range of physiological effects. The study aimed to examine the effect of combined pulsed electromagnetic field therapy and plantar flexion resistance exercise (PRE) on patients with venous leg ulcers (VLUs). Materials and Methods: The study was a prospective, randomized controlled trial. A total of 60 patients between the ages of 40 and 55 with venous ulcers were randomly assigned to 1 of 3 groups. For up to 12 weeks, the first group received PEMF therapy and plantar flexion resistance exercise (PRE) therapy in addition to conservative ulcer treatment for up to 12 weeks. The second group received only PEMF therapy in addition to conservative ulcer treatment, while the third group served as the control and received only conservative ulcer treatment. Results: At the four-week follow-up, the two experimental groups revealed a considerable variation in ulcer surface area (USA) and ulcer volume (UV), with no significant change in the control group. At the 12-week follow-up, there were significant differences between the three groups, while group A underwent the most significant changes, with mean differences at [95% confidence interval] of (-4.75, -3.82, -0.98) for USA and (-12.63, -9.55, -2.45) for UV, respectively. Conclusions: On a short-term basis, adding a plantar resistance exercise to the PEMF had no appreciable short-term effects on ulcer healing; however, their combination had more pronounced medium-term effects.
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Affiliation(s)
- Heba Mohamed Mohamady
- Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Giza 11432, Egypt
| | - Mona Mohamed Taha
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Yasser M Aneis
- Department of Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza 11432, Egypt
- Department of Basic Sciences, Faculty of Physical Therapy, Delta University for Science and Technology, Gamasa City 11152, Egypt
| | - Monira I Aldhahi
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Asmaa Fawzy Attalla
- Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Giza 11432, Egypt
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11
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Schmidt LJ, Parker CN, Parker TJ, Finlayson KJ. Clinical correlates of pain in adults with hard-to-heal leg ulcers: a cross-sectional study. J Wound Care 2023; 32:S27-S35. [PMID: 37300866 DOI: 10.12968/jowc.2023.32.sup6.s27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Pain is a complex symptom associated with hard-to-heal (chronic) leg ulcers that is often poorly managed. The objective of this study was to gain greater understanding by investigating relationships between physical and psychosocial factors, and pain severity in adults with hard-to-heal leg ulcers. METHOD A secondary analysis of data collected for a longitudinal, observational study of adults with hard-to-heal leg ulcers was undertaken. Data were collected over a 24-week period, including variables relating to sociodemographics, clinical variables, medical status, health, ulcer and vascular histories, and psychosocial measures. Multiple linear regression modelling was used to determine the independent influences of these variables on pain severity, as measured with a Numerical Rating Scale (NRS). RESULTS Of 142 participants who were recruited, 109 met the inclusion criteria for this study, of whom: 43.1% had venous ulcers; 41.3% had mixed ulcers; 7.3% had arterial ulcers; and 8.3% had ulcers from some other cause. The final model explained 37% (adjusted r2=0.370) of the variation in the pain NRS scores. Controlling for analgesic use, salbutamol use (p=0.005), clinical signs of infection (p=0.027) and ulcer severity (p=0.001) were significantly associated with increased pain, while the presence of diabetes (p=0.007) was significantly associated with a decrease in pain. CONCLUSION Pain is a highly complex and pervasive symptom associated with hard-to-heal leg ulcers. Novel variables were identified as being associated with pain in this population. The model also included wound type as a variable; however, despite being significantly correlated to pain at the bivariate level of analysis, in the final model, the variable did not reach significance. Of the variables included in the model, salbutamol use was the second most significant. This is a unique finding that, to the authors' knowledge, has not been previously reported or studied. Further research is required to better understand these findings and pain in general.
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Affiliation(s)
- Luke J Schmidt
- School of Biomedical Sciences, Tissue Repair and Translational Physiology Group, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Christina N Parker
- School of Nursing, Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Tony J Parker
- School of Biomedical Sciences, Tissue Repair and Translational Physiology Group, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Kathleen J Finlayson
- School of Nursing, Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia
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12
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Kim J, Stechmiller J, Weaver M, Gibson DJ, Horgas A, Kelly DL, Lyon DE. The association of wound factors and symptoms of fatigue and pain with wound healing in chronic venous leg ulcers. Int Wound J 2023; 20:1098-1111. [PMID: 36181308 PMCID: PMC10031222 DOI: 10.1111/iwj.13966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/31/2022] [Accepted: 09/11/2022] [Indexed: 11/30/2022] Open
Abstract
The purpose of this study was: (1) to characterise the association of wound area, wound exudate C-reactive protein (CRP), broad-spectrum matrix metalloprotease protein (MMPs), and symptoms of fatigue and pain in individuals with chronic venous leg ulcers (CVLUs) over time and (2) to identify factors associated with the wound healing trajectory in CVLUs. Seventy four participants with CVLU who received weekly sharp debridement were recruited from a wound care clinic during the 8-week study period. To examine associations among wound CRP, MMPs, pain, fatigue, and wound healing trajectory over time, we calculated Bayes factors (BF) based on a linear mixed model. The mean age of participants was 71.8 (SD = 9.8) and the mean wound area was 2278 mm2 (SD = 7085 mm2 ) at baseline. Higher fatigue was strongly associated with higher MMPs (BF = 9, 95% HDI: [-.05, .43]), lower CRP (BF = 11, 95% HDI: [-.02, .002]), and large areas of wound (BF = 20, 95% HDI: [-.001, .01]). Higher CRP and MMPs activity in wound exudate and higher fatigue were associated with a larger wound area. To facilitate wound healing, clinicians need to utilise the multifactorial approach, which includes wound treatment and management of symptoms such as pain and fatigue, because of the molecular and psycho-behavioural factors involved in wound healing.
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Affiliation(s)
- Junglyun Kim
- College of Nursing, Chungnam National University College of Nursing, Daejeon, South Korea
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, Florida, USA
| | - Joyce Stechmiller
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, Florida, USA
| | - Michael Weaver
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, Florida, USA
| | - Daniel J Gibson
- University of Alabama Capstone College of Nursing, Tuscaloosa, Alabama, USA
| | - Ann Horgas
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, Florida, USA
| | - Debra L Kelly
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, Florida, USA
| | - Debra E Lyon
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, Florida, USA
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Schul MW, Melin MM, Keaton TJ. Venous leg ulcers and prevalence of surgically correctable reflux disease in a national registry. J Vasc Surg Venous Lymphat Disord 2023; 11:511-516. [PMID: 36681297 DOI: 10.1016/j.jvsv.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/20/2022] [Accepted: 11/28/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Chronic venous disorders are common, with varicose veins occurring in ∼40% of the population. Venous leg ulcers affect 1% to 2% of the population, with the prevalence increasing ≤4% for those aged >65 years. Both conditions are expensive and together are responsible for ≤2% of the annual healthcare budget expenditure of Western societies. The ESCHAR (effect of surgery and compression on healing and recurrence) and EVRA (early venous reflux ablation) trials demonstrated that surgical correction of superficial venous reflux reduced ulcer recurrence, resulted in faster healing times (EVRA), and was proved cost-effective. Largescale data regarding patients with chronic venous leg ulcers presenting to venous centers with treatable superficial venous insufficiency has not been previously reported. Our study was designed to evaluate the percentage of patients with leg ulcers presenting to dedicated vein centers who were found to have surgically correctable superficial venous insufficiency. METHODS The American Vein & Lymphatic Society Patient Reported Outcome Venous Registry began collecting data in 2014 and is one of two national registries focused on chronic venous disorders. The database was queried first for the presence of an ulcer using the CEAP (clinical, etiologic, anatomic, pathophysiologic) classification (C6 status). These de-identified data were further correlated by crossing the number of ulcers for the same limb using the revised venous clinical severity score (rVCSS). The demographics, index duplex ultrasound details, and rVCSS features for ulcer duration and compression use were analyzed. Once the presence of an ulcer had been validated by CEAP and rVCSS, the population was divided into groups according to the ultrasound-reported anatomic pathology (eg, normal, reflux, obstruction, reflux plus obstruction). The query was directed toward all patients seeking a venous evaluation at participating centers from January 2018 through January 2022. RESULTS More than 270,000 unique patient records were reviewed. Of the 270,000 records, 163,027 (60%) had had duplex ultrasound scans available, for 1794 unique patients (1879 limbs), representing 1.1% with a leg wound. Of these patients, 55.4% were men and 44.6% were women. Group S included patients with isolated superficial pathology (n = 1291; 68.7%). Group M included patients with mixed superficial and deep pathology (n = 238; 12.7%). Group D included patients with isolated deep vein pathology (n = 58; 3.1%). Finally, group N included patients with leg wounds but no venous pathology (n = 292; 15.5%). The rVCSSs for groups S and M were significantly higher than those for group N. In group S, the dominant patterns involved the great saphenous vein (GSV) above the knee (54.8%), the small saphenous vein (30.7%), and the anterior accessory GSV (14.4%). The frequency of single, double, and triple axial vein reflux identified 1.45 vessels eligible for ablation treatment per limb. In group M, the dominant patterns involved the GSV above the knee (61.7%), the small saphenous vein (26.2%), and the anterior accessory GSV (12.1%), for 1.52 axial segments per limb. Of the 84.4% of venous ulcer patients, duplex ultrasound analysis revealed that 97% of this large subset had had surgically correctable disease. CONCLUSIONS The American Vein & Lymphatic Society Patient Reported Outcome Venous Registry demonstrated that 85% of the leg wounds in the present study were venous in origin and 97% possessed surgically correctable disease. Our findings support early referral to dedicated vein centers with appropriate venous reflux management as a part of the multidisciplinary team caring for patients with venous leg ulcers.
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Affiliation(s)
| | - M Mark Melin
- M Health Fairview Wound Healing Institute, Edina, MN
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14
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Protocol and algorithm for diagnosis, treatment and early referral of lower limb ulcers. ANGIOLOGIA 2023. [DOI: 10.20960/angiologia.00435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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15
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Yang WT, Zheng K, Ren HL, Wang SX, Sun MS, Gong C, Zhang WD, Li CM, Jiang HJ. Three-dimensional laser scanner as a new tool for measuring lower limb volume in patients with chronic venous diseases. J Vasc Surg Venous Lymphat Disord 2023; 11:127-135. [PMID: 35940450 DOI: 10.1016/j.jvsv.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 05/21/2022] [Accepted: 06/11/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Measurement of lower limb volume in patients with chronic venous disease (CVD) is necessary for assessing severity at the time of diagnosis and evaluating response to therapy administered. Existing methods have some limitations in clinical application and accuracy. The study aimed to investigate the reliability and validity of a three-dimensional laser scanner (3DLS) in measuring the lower limb volume of patients with CVD. METHODS A total of 30 patients with CVD (mean age, 55.6 ± 8.07 years; mean body mass index, 24.61 ± 1.87) were recruited in a vascular surgery clinic. The lower limb volumes of all participants were measured using the 3DLS and circumferential method (CM). Statistical analysis was conducted to compare the 3DLS and CM. RESULTS There was a strong correlation between the CM and 3DLS method (r2 = 0.9065). The 3DLS had a high intraoperator and interoperator reliability. A Bland-Altman plot showed satisfactory agreement between the two methods. The 3DLS demonstrated greater bilateral limb differences than CM. CONCLUSIONS There was satisfactory agreement between the two investigated methods. The 3DLS method was confirmed to be accurate, repeatable, and rapid in measuring the lower limb volume in patients with CVD and is, therefore, suitable for clinical use.
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Affiliation(s)
- Wen-Tao Yang
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Kai Zheng
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hua-Liang Ren
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Sheng-Xing Wang
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ming-Sheng Sun
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Chi Gong
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wang-De Zhang
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Chun-Min Li
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
| | - Han-Jun Jiang
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; School of Integrated Circuits, Tsinghua University.
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Bar L, Marks D, Brandis S. Developing a Suite of Resources to Improve Patient Adherence to Compression Stockings: Application of Behavior Change Theory. Patient Prefer Adherence 2023; 17:51-66. [PMID: 36636284 PMCID: PMC9831124 DOI: 10.2147/ppa.s390123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/13/2022] [Indexed: 01/06/2023] Open
Abstract
PURPOSE Poor patient adherence to compression stockings remains a difficult and pervasive problem for clinicians, with costly repercussions for patients and health-care systems. The purpose of this paper was to describe the application of behavior change theory to the systematic development of a suite of resources, aimed at improving patient adherence to wearing compression stockings. METHODS Employing a non-empirical approach, behavior-change theory was used to develop an innovative intervention as part of a multi-phase project. Target behaviors, barriers and potential enablers were identified in relation to stocking adherence. An impact-likelihood matrix for behavior prioritization was used to identify possible areas for intervention within occupational therapy outpatient clinics. Selection of suitable resources and their consequent development were based on a narrative and problem-solving process by a panel of clinical experts. RESULTS Of 14 potential domains embedded in the Theoretical Domains Framework, the key target behaviors and barriers were associated with eight domains. Michie's Behavior Change Wheel revealed recommendations in six subdivisions and of these, four intervention functions were selected by the panel, based on their potential impact and likelihood of adoption in clinical practice. Findings led to the development of a suite of resources comprising a new questionnaire, a clinical decision tree, augmented by clinical answer sheets corresponding to each of the barriers. CONCLUSION Application of behavior change theory informed the design of a behavior change intervention comprising an integrated suite of resources for novice and experienced clinicians. PRACTICE IMPLICATIONS These novel resources have potential to improve patient adherence to compression stockings and consequently generate health-care savings through reduced need for wound care products, and medical interventions with translation to other settings and conditions requiring compression stockings. Patient outcomes will likely be improved with reduced pain, improved quality of life and earlier resumption of usual occupations.
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Affiliation(s)
- Laila Bar
- Department of Occupational Therapy, Bond University, Faculty of Health Science and Medicine, Robina, Queensland, Australia
- Department of Occupational Therapy, Gold Coast University Hospital, Southport, Queensland, Australia
- Correspondence: Laila Bar, Department of Occupational Therapy, Level 4, Bond Institute of Health and Sport, 2 Promethean Way, Robina, Queensland, 4226, Australia, Tel +61 413 855 090, Email
| | - Darryn Marks
- Department of Physiotherapy, Bond University, Faculty of Health Science and Medicine, Robina, Queensland, Australia
| | - Susan Brandis
- Department of Occupational Therapy, Bond University, Faculty of Health Science and Medicine, Robina, Queensland, Australia
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Getting Ready for Wound Certification: Factors Impeding Wound Healing. J Wound Ostomy Continence Nurs 2022; 49:570-571. [PMID: 36417382 DOI: 10.1097/won.0000000000000934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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18
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BEYAZ MO, URFALI S, KOYUNCU O, FANSA İ. Thermal Ablation, Nonthermal Ablation And Surgical Striping Applications: 1-Year Single Center Early Results. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2022. [DOI: 10.17944/mkutfd.1121446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
ABSTRACT:
Objectives : Starting from the 1900's minimally invasive methods such as endovenous laser ablation (EVLA), radiofrequency ablation (RFA), and ultrasound-guided foam sclerotherapy (UGFS) developed.
Methods: This study includes a total of 136 patients (81 women/55 men), of whom 22 (10 women/12 men) were treated with classic surgical stripping, 54 (32 women/22 men) with thermal ablation and 60 (39 women/55 men) with non-thermal ablation.
Results: Twenty-two patients (10 women/12 men) were treated with surgical stripping. In one female patient a hematoma arose in the medial crural region postoperatively. A radiofrequency catheter (ThermoBLOCK TM) was used in the thermal ablation procedures in 54 patients (32 female/22 male). It is believed that permanent paresthesia occured in one female patient after the procedure. In 3 male patients temporary paresthesia occured postoperatively. Non- thermal ablation was performed in 60 patients(39 female/55 male). Even through a severe burning sensation was present in 6 patients (5 female/1 male) during the procedure, this symptom was only transient. In one of the patients, deep venous thrombosis (DVT) occured at the level of the popliteal vein postoperatively at the sixth day.
Conclusion: Even if thermal and non-thermal ablation and surgical procedures have the same pain decreasing rates, hematomas and a longer hospital stay are more frequent in surgical procedures.
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Affiliation(s)
| | - Senem URFALI
- HATAY MUSTAFA KEMAL ÜNİVERSİTESİ, TAYFUR ATA SÖKMEN TIP FAKÜLTESİ, TAYFUR ATA SÖKMEN TIP PR
| | - Onur KOYUNCU
- HATAY MUSTAFA KEMAL ÜNİVERSİTESİ, TAYFUR ATA SÖKMEN TIP FAKÜLTESİ, TAYFUR ATA SÖKMEN TIP PR
| | - İyad FANSA
- HATAY MUSTAFA KEMAL ÜNİVERSİTESİ, TAYFUR ATA SÖKMEN TIP FAKÜLTESİ, TAYFUR ATA SÖKMEN TIP PR
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Senet P, Addala A, Léger P, Chahim M, Malloizel J, Blaise S, Sauvadet A, Tacca O, Stücker M, Dissemond J. A new compression system for treatment of venous leg ulcers: a prospective, single-arm, clinical trial (FREEDOM). J Wound Care 2022; 31:734-747. [PMID: 36113543 DOI: 10.12968/jowc.2022.31.9.734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the efficacy, tolerability and acceptability of a new multicomponent compression system in one bandage for the local treatment of patients with venous leg ulcers (VLUs). METHOD This was an international, prospective, non-comparative, clinical trial, conducted in France and Germany. Eligible participants had a VLU with a wound area of 2-20cm2, lasting for a maximum of 24 months. For a period of 6 weeks, patients were treated with a new multicomponent compression system in one bandage which was worn day and night, providing high working pressure and moderate resting pressure (UrgoK1). Clinical assessments, wound measurement and photographs were planned at weeks 1, 2, 4 and 6. The primary endpoint was the relative wound area reduction (RWAR) after 6 weeks of treatment. Secondary endpoints included wound closure rate, oedema resolution, change in patient's health-related quality of life (HRQoL), acceptability, adherence to the compression therapy, local tolerance, and physician's overall satisfaction with the evaluated compression system. RESULTS A cohort of 52 patients (52% female, mean age 75.4±13.0 years) with VLUs, including oedema in 58% of cases, were recruited from 22 centres. At baseline, 42 patients had already been treated with a different compression system. VLUs had been present for 5.6±4.9 months and had a mean area of 5.7±4.3cm2. After 6 weeks of treatment, a median RWAR of 91% (interquartile range: 39.4; 100.0) was achieved. Wound closure was reported in 35% of patients. A RWAR ≥40% at week 4, predictive of wound healing at 12 weeks, was achieved in 62% of patients. At the final visit, oedema present at baseline was resolved in 57% of patients. Substantial improvements in the HRQoL of the patients were reported with a decrease of the pain/discomfort and anxiety/depression dimensions. Comfort in wearing the evaluated system was reported as 'very good' or 'good' by 79% of patients, resulting in a high patient adherence to compression therapy. Compared to previous compression systems, half of the patients reported more ease in wearing shoes, and greater satisfaction and comfort with this new system. Nine non-serious adverse events related to the device or its procedure occurred in seven patients. At the final visit, the majority of the physicians were 'very satisfied' or 'satisfied' with the new compression system overall. CONCLUSION The new multicomponent compression system in one bandage has been shown to promote rapid healing of VLUs, reduce oedema, improve HRQoL and to be well tolerated and accepted. It appears to be a viable alternative to existing compression systems.
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Affiliation(s)
- Patricia Senet
- Department of Dermatology, Paris Est University Hospitals (AP-HP) - Tenon Hospital, Paris, France
| | - Azeddine Addala
- Department of Vascular Medicine, Edouard Herriot Hospital, Lyon, France
| | - Philippe Léger
- Wound and Wound Healing Centre, Pasteur Clinic, Toulouse, France
| | - Maxime Chahim
- Department of Vascular Medicine, Corentin Celton Hospital, Issy Les Moulineaux, France
| | - Julie Malloizel
- Department of Vascular Medicine, Rangueil University Hospital, Toulouse, France
| | - Sophie Blaise
- Department of Vascular Medicine, Albert Michalon University Hospital, Grenoble, France
| | - Anne Sauvadet
- Clinical Development Department, URGO Research Innovation and Development, Chenove, France
| | - Olivier Tacca
- Clinical Development Department, URGO Research Innovation and Development, Chenove, France
| | - Markus Stücker
- Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - Joachim Dissemond
- Department of Dermatology, Venerology and Allergology, University Hospital Essen, Essen, Germany
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Coelho Rezende G, O'Flynn B, O'Mahony C. Smart Compression Therapy Devices for Treatment of Venous Leg Ulcers: A Review. Adv Healthc Mater 2022; 11:e2200710. [PMID: 35734815 DOI: 10.1002/adhm.202200710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/10/2022] [Indexed: 01/27/2023]
Abstract
Venous leg ulcers can have significant social and economic impacts, and are generally treated by applying compression to the lower limb, which aids in promoting blood return to the heart. Compression therapies commonly involve the use of passive bandages that suffer from issues associated with incorrect application, and although automated solutions have begun to appear; these are often bulky and hinder mobility. Emerging microtechnologies and new materials enable the development of "smart" compression therapy devices, which are defined as systems that use miniaturized and lightweight actuators and electronics to control the applied pressure. This paper reviews the state of the art in smart compression therapy research. A total of seventeen different devices has been identified, categorized as using one of three actuation mechanisms: pneumatic compression, motor-driven mechanisms, and smart materials (including shape memory alloys, shape memory polymers, and electroactive polymers). The field is still in its relative infancy and further refinements are required to create mass manufacturable compression dressing systems that meet medical, ergonomic, and economic standards. The use of miniaturized actuators has immense potential for the development of smart compression dressings, which will ultimately lead to higher compliance, increased patient comfort, enhanced mobility, and better treatment outcomes.
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Affiliation(s)
| | - Brendan O'Flynn
- Tyndall National Institute, University College Cork, Cork, T12 R5CP, Ireland
| | - Conor O'Mahony
- Tyndall National Institute, University College Cork, Cork, T12 R5CP, Ireland.,SWaT Research Network Member, RCSI University of Medicine and Health Sciences, Dublin, D02 YN77, Ireland
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21
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Patton D, Avsar P, Sayeh A, Budri A, O'Connor T, Walsh S, Nugent L, Harkin D, O'Brien N, Cayce J, Corcoran M, Gaztambide M, Moore Z. A meta-review of the impact of compression therapy on venous leg ulcer healing. Int Wound J 2022; 20:430-447. [PMID: 35855678 PMCID: PMC9885475 DOI: 10.1111/iwj.13891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/20/2022] [Accepted: 06/25/2022] [Indexed: 02/03/2023] Open
Abstract
This meta-review aimed to appraise and synthesise findings from existing systematic reviews that measured the impact of compression therapy on venous leg ulcers healing. We searched five databases to identify potential papers; three authors extracted data, and a fourth author adjudicated the findings. The AMSTAR-2 tool was used for quality appraisal and the certainty of the evidence was appraised using GRADEpro. Data analysis was undertaken using RevMan. We identified 12 systematic reviews published between 1997 and 2021. AMSTAR-2 assessment identified three as high quality, five as moderate quality, and four as low quality. Seven comparisons were reported, with a meta-analysis undertaken for five of these comparisons: compression vs no compression (risk ratio [RR]: 1.55; 95% confidence interval [CI] 1.34-1.78; P < .00001; moderate-certainty evidence); elastic compression vs inelastic compression (RR: 1.02; 95% CI: 0.96-1.08; P < .61 moderate-certainty evidence); four layer vs <four-layer bandage systems (RR: 1.07; 95% CI: 0.82-1.40; P < .63; moderate-certainty evidence); comparison between different four-layer bandage systems (RR: 1.08; 95% CI: 0.93-1.25; P = .34; moderate-certainty evidence); compression bandage vs compression stocking (RR 0.95; 95% CI 0.87-1.03; P = .18; moderate-certainty evidence). The main conclusion from this review is that there is a statistically significant difference in healing rates when compression is used compared with no compression, with moderate-certainty evidence. Otherwise, there is no statistically different difference in healing rates using elastic compression vs inelastic compression, four layer vs <four-layer bandage systems, different four-layer bandage systems, or compression bandages vs compression stockings.
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Affiliation(s)
- Declan Patton
- Skin Wounds and Trauma Research CentreThe Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health SciencesDublinIreland,School of Nursing and MidwiferyThe Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health SciencesDublinIreland,Fakeeh College of Medical SciencesJeddahSaudi Arabia,School of Nursing and MidwiferyGriffith UniversitySouthportQueenslandAustralia,Faculty of Science, Medicine and HealthUniversity of WollongongWollongongNew South WalesAustralia
| | - Pinar Avsar
- Skin Wounds and Trauma Research CentreThe Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health SciencesDublinIreland,School of Nursing and MidwiferyThe Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health SciencesDublinIreland
| | - Aicha Sayeh
- Skin Wounds and Trauma Research CentreThe Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health SciencesDublinIreland
| | - Aglecia Budri
- Skin Wounds and Trauma Research CentreThe Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health SciencesDublinIreland,School of Nursing and MidwiferyThe Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health SciencesDublinIreland
| | - Tom O'Connor
- Skin Wounds and Trauma Research CentreThe Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health SciencesDublinIreland,School of Nursing and MidwiferyThe Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health SciencesDublinIreland,Fakeeh College of Medical SciencesJeddahSaudi Arabia,School of Nursing and MidwiferyGriffith UniversitySouthportQueenslandAustralia,Lida InstituteShanghaiChina
| | - Simone Walsh
- Skin Wounds and Trauma Research CentreThe Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health SciencesDublinIreland
| | - Linda Nugent
- Skin Wounds and Trauma Research CentreThe Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health SciencesDublinIreland,School of Nursing and MidwiferyThe Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health SciencesDublinIreland,Fakeeh College of Medical SciencesJeddahSaudi Arabia
| | - Denis Harkin
- The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Faculty of Medicine and Health SciencesDublinIreland
| | - Niall O'Brien
- The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health SciencesDublinIreland
| | | | | | | | - Zena Moore
- Skin Wounds and Trauma Research CentreThe Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health SciencesDublinIreland,School of Nursing and MidwiferyThe Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health SciencesDublinIreland,Fakeeh College of Medical SciencesJeddahSaudi Arabia,School of Nursing and MidwiferyGriffith UniversitySouthportQueenslandAustralia,Lida InstituteShanghaiChina,Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia,Department of Public Health, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium,University of WalesCardiffUK,National Health and Medical Research Council Centre of Research Excellence in Wiser Wound CareMenzies Health Institute QueenslandSouthportQueenslandAustralia
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22
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Compression for Lower Extremity Venous Disease and Lymphedema (CLEVDAL): Update of the VLU Algorithm. J Wound Ostomy Continence Nurs 2022; 49:331-346. [PMID: 35809009 DOI: 10.1097/won.0000000000000889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The Wound, Ostomy and Continence Nurses (WOCN) Society charged a task force with updating the venous leg ulcer (VLU) algorithm to include the addition of lymphedema with the new title of "Compression for Lower Extremity Venous Disease and Lymphedema (CLEVDAL)." As part of the process, the task force was charged to develop consensus-based statements to serve as clinical guidance related to CLEVDAL. The 3-member task force assisted by a moderator completed a scoping literature review to identify recommendations supported by research to qualify as evidence-based and to identify areas where guidance is needed to provide CLEVDAL. Based on the findings of the scoping review, the WOCN Society convened a panel of experts to develop consensus statements to direct care for those with lower extremity venous disease and lymphedema. These consensus statements underwent a second round of content validation with a different panel of clinicians with expertise in venous disease and lymphedema management. This article reports on the scoping review and subsequent evidence-based statements, along with the generation and validation of consensus-based statements to assist clinical decision-making in the CLEVDAL algorithm.
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23
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Wickramasekera N, Palfreyman S, Lumley E, Dosanjh A, Shackley P. Managing the delivery of venous leg ulcer services: A willingness to pay study. Health Sci Rep 2022; 5:e715. [PMID: 35782302 PMCID: PMC9240381 DOI: 10.1002/hsr2.715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 06/10/2022] [Accepted: 06/15/2022] [Indexed: 11/12/2022] Open
Abstract
Background and Aims Methods Results Conclusions
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Affiliation(s)
| | - Simon Palfreyman
- Faculty of Nursing University of Alberta Edmonton Alberta Canada
| | - Elizabeth Lumley
- School of Health and Related Research University of Sheffield Sheffield UK
| | - Arvind Dosanjh
- School of Health and Related Research University of Sheffield Sheffield UK
| | - Phil Shackley
- School of Health and Related Research University of Sheffield Sheffield UK
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24
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Weigelt MA, Lev-Tov HA, Tomic-Canic M, Lee WD, Williams R, Strasfeld D, Kirsner RS, Herman IM. Advanced Wound Diagnostics: Toward Transforming Wound Care into Precision Medicine. Adv Wound Care (New Rochelle) 2022; 11:330-359. [PMID: 34128387 DOI: 10.1089/wound.2020.1319] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Significance: Nonhealing wounds are an ever-growing global pandemic, with mortality rates and management costs exceeding many common cancers. Although our understanding of the molecular and cellular factors driving wound healing continues to grow, standards for diagnosing and evaluating wounds remain largely subjective and experiential, whereas therapeutic strategies fail to consistently achieve closure and clinicians are challenged to deliver individualized care protocols. There is a need to apply precision medicine practices to wound care by developing evidence-based approaches, which are predictive, prescriptive, and personalized. Recent Advances: Recent developments in "advanced" wound diagnostics, namely biomarkers (proteases, acute phase reactants, volatile emissions, and more) and imaging systems (ultrasound, autofluorescence, spectral imaging, and optical coherence tomography), have begun to revolutionize our understanding of the molecular wound landscape and usher in a modern age of therapeutic strategies. Herein, biomarkers and imaging systems with the greatest evidence to support their potential clinical utility are reviewed. Critical Issues: Although many potential biomarkers have been identified and several imaging systems have been or are being developed, more high-quality randomized controlled trials are necessary to elucidate the currently questionable role that these tools are playing in altering healing dynamics or predicting wound closure within the clinical setting. Future Directions: The literature supports the need for the development of effective point-of-care wound assessment tools, such as a platform diagnostic array that is capable of measuring multiple biomarkers at once. These, along with advances in telemedicine, synthetic biology, and "smart" wearables, will pave the way for the transformation of wound care into a precision medicine. Clinical Trial Registration number: NCT03148977.
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Affiliation(s)
- Maximillian A. Weigelt
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Hadar A. Lev-Tov
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Marjana Tomic-Canic
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - W. David Lee
- Precision Healing, Inc., Newton, Massachusetts, USA
| | | | | | - Robert S. Kirsner
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ira M. Herman
- Precision Healing, Inc., Newton, Massachusetts, USA
- Graduate School of Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts, USA
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25
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Yammine K, Ghanimeh J, Jil Agopian S, Assi C, Hayek F. PRP Versus Standard of Care for Venous leg Ulcers: A Systematic Review and Meta-Analysis of Prospective Comparative Studies. INT J LOW EXTR WOUND 2022:15347346221094424. [PMID: 35422142 DOI: 10.1177/15347346221094424] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Venous leg ulcers (VLUs) are chronic and recalcitrant lower limb wounds that affect millions of patients annually, severely reducing their quality of life, and causing a significant burden on the health care system. Recently, Platelet rich plasma (PRP) has been used to improve healing of VLUs. This systematic review aimed at evaluating the effectiveness of PRP versus the standard of care commonly used to treat VLUs. Ten prospective studies (8 randomized) met the inclusion criteria comprising 451 patients with 527 VLUs. Results were as follows: a) the weighted Odds Ratio (OR) of the mean healing rate was 2.84 (95% CI = 1.160 to 5.056, I2 = 41.4%, p = 0.0004), b) the mean healed ulcer areas were 79.2 ± 19% for the PRP group and 51.7 ± 36% for the control group (p = 0.007) in favor of the PRP group, and c) the weighted infection OR showed no significant difference between both groups. Additionally, negative correlations were found between healing rate and duration of VLUs and initial size of the ulcers. This meta-analysis demonstrated significant beneficial effects of PRP versus standard of care on healing rate, reduction in surface, and reduction in healing time of VLUs. Infection and other complications were similar to standard of care. Therefore, our analytical data would support the use of PRP as a safe and effective treatment for VLUs.
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Affiliation(s)
- Kaissar Yammine
- Department of Orthopedic Surgery, 502749Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Lebanon
- Diabetic Foot Clinic, 502749Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
- Center for Evidence-Based Anatomy, Sport & Orthopedics Research
| | - Joe Ghanimeh
- Observer doctor at the Department of Orthopedic Surgery, 502749Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Lebanon
| | - Sira Jil Agopian
- Observer doctor at the Department of Orthopedic Surgery, 502749Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Lebanon
| | - Chahine Assi
- Department of Orthopedic Surgery, 502749Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Lebanon
- Center for Evidence-Based Anatomy, Sport & Orthopedics Research
| | - Fady Hayek
- Vascular Division, Department of General Surgery, 502749Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Lebanon
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26
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Ma X, Bian Q, Hu J, Gao J. Stem from nature: Bioinspired adhesive formulations for wound healing. J Control Release 2022; 345:292-305. [DOI: 10.1016/j.jconrel.2022.03.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/13/2022] [Accepted: 03/14/2022] [Indexed: 12/27/2022]
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27
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Aloweni F, Mei CS, Lixuan NL, Fook-Chong S, Yobas P, Yuh AS, Xian TW, Maniya S. Healing outcomes and predictors among patients with venous leg ulcers treated with compression therapy. J Wound Care 2022; 31:S39-S50. [PMID: 35199559 DOI: 10.12968/jowc.2022.31.sup3.s39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study aimed to compare the healing outcomes between three types of compression therapy-two-layer bandage (2LB), four-layer bandage (4LB), and compression stockings, and to identify the predictors of venous leg ulcer (VLU) healing. METHOD A retrospective review of the medical records of patients diagnosed with VLU between 2011 and 2016 in Singapore was conducted. Univariate and multivariate analyses were done between healed and unhealed VLU patients at three and six months, based on potential factors, ranging from demographic profile to comorbidities and treatment-related variables. RESULTS Data from 377 patients' medical records were analysed. The healing rates with the three types of compression system, 4LB, 2LB and compression stockings, were 22.3%, 34.9% and 8.7% respectively at three months; at six months they were 44.2%, 41.9% and 34.8% respectively. Patients on 2LB reported a significantly higher proportion of healed ulcers at three months (p=0.003) but at six months there was no difference in healing rates between the three types of therapy. At three and six months, the duration of compression therapy was found to be an independent predictor of healing (p<0.001). CONCLUSION In this study, the 2LB appeared to show the most favourable healing outcome in the short-term but as VLUs persisted beyond the months, the type of compression system used did not make a difference in the healing outcome. Our findings suggested that, as the duration became more prolonged, VLUs became more resistant to healing despite compression therapy. Therefore, it may be necessary for clinicians to consider adjuvant therapies for hard-to-heal ulcers at an earlier stage.
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Affiliation(s)
| | - Chew Suet Mei
- Nursing Division, Singapore General Hospital, Singapore
| | | | | | - Piyanee Yobas
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore
| | - Ang Shin Yuh
- Nursing Division, Singapore General Hospital, Singapore
| | - Tan Wei Xian
- Nursing Division, Singapore General Hospital, Singapore
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28
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Weber B, Marquart E, Deinsberger J, Tzaneva S, Böhler K. Comparative analysis of endovenous laser ablation versus ultrasound-guided foam sclerotherapy for the treatment of venous leg ulcers. Dermatol Ther 2022; 35:e15322. [PMID: 35040545 PMCID: PMC9285388 DOI: 10.1111/dth.15322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/10/2022] [Accepted: 01/16/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Endovenous thermal and non-thermal therapeutic approaches have become standard of care for the treatment of venous insufficiency. However, comparative studies on its use in the population of venous leg ulcer patients are scarce. METHODS The present study aimed at a comparison of the efficacy of endovenous laser ablation (EVLA) and ultrasound-guided foam sclerotherapy (UGFS) for the treatment of venous leg ulcers (VUs). We retrospectively analyzed patient records of 68 patients with active VUs (C6 of the CEAP-classification), who underwent EVLA (n=33) or UGFS (n=35) between January 2001 and January 2021. RESULTS In 68 patients, 97 venous segments (GSV: 43, SSV: 17:, NSV: 37) were treated. Ulcer surface area at initial presentation did not differ significantly between both treatment groups (EVLA: 7.7±10.7 vs. UGFS: 8.5±16.3 cm2 ; p=0.73). No significant difference regarding patient characteristics was found, with the exception of age, as patients receiving UGFS treatment were significantly older (EVLA: 61±17 vs. UGFS: 70±14 years; p=0.018). The rate of ulcer resolution was not significantly different between EVLA and UGFS groups (97.0% vs. 85.7%; p=0.20). Also, the mean time to complete ulcer healing after endovenous intervention was comparable (EVLA: 59±37 vs. UGFS: 63±41 days; p=0.68). However, the relapse rate was significantly higher for UGFS than for EVLA treated patients (31.4% vs. 3.0%; p=0.002). CONCLUSION Rates of ulcer resolution and ulcer healing time after endovenous intervention were comparable between both treatment modalities. However, a significantly higher relapse rate was observed in UGFS treated patients.
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Affiliation(s)
- Benedikt Weber
- Department of Dermatology, Medical University of Vienna, Austria
| | - Elias Marquart
- Department of Dermatology, Medical University of Vienna, Austria
| | | | | | - Kornelia Böhler
- Department of Dermatology, Medical University of Vienna, Austria
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29
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Bernatchez SF, Eysaman-Walker J, Weir D. Venous Leg Ulcers: A Review of Published Assessment and Treatment Algorithms. Adv Wound Care (New Rochelle) 2022; 11:28-41. [PMID: 33848433 PMCID: PMC8573799 DOI: 10.1089/wound.2020.1381] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Significance: Chronic venous disease (CVD) is prevalent in the aging population and leads to venous leg ulcers (VLUs). These wounds can last and recur for years, significantly impacting quality of life. A large body of literature exists on CVD and VLU diagnosis and treatment. Multiple algorithms, guidelines, and consensus documents have been published on this topic, highlighting the importance of this issue in clinical practice. However, these documents are not fully aligned with each other. Recent Advances: The latest update of the internationally used classification system for CVD was recently published. Our review aims to summarize the existing information to provide an educational tool for clinicians new to this topic, and to highlight the commonalities between the published recommendations. Critical issues: VLUs need to be treated with consideration for the extent of venous disease present in the patient. This requires a good understanding of the various components involved and the possible additional concomitant conditions by the first-line clinician who encounters the patient. A multidisciplinary team is necessary for a successful overall treatment plan, and this plan should be tailored to each patient's specific needs and lifestyle. Future Directions: Compression is still the mainstay of treatment for CVD and VLUs. Compression is needed long term, but it does not suffice by itself to prevent recurrences without interventional correction. Venous intervention should be offered early to prevent or slow disease progression and reduce recurrence.
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Affiliation(s)
| | | | - Dot Weir
- Saratoga Hospital Center for Wound Healing and Hyperbaric Medicine, Saratoga Springs, New York, USA
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30
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Lee Y, Lee MH, Phillips SA, Stacey MC. Growth factors for treating chronic venous leg ulcers: A systematic review and meta-analysis. Wound Repair Regen 2021; 30:117-125. [PMID: 34783408 DOI: 10.1111/wrr.12982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/13/2021] [Accepted: 10/18/2021] [Indexed: 01/20/2023]
Abstract
Chronic venous leg ulcers (VLU) are wounds that commonly occur due to venous insufficiency. Many growth factors have been introduced over the past two decades to treat VLU. This systematic review and meta-analysis evaluates the impact of growth factor treatments of VLU in comparison to control for complete wound healing, percent reduction in wound area, time to wound healing, and adverse events. A systematic review and meta-analysis of randomised trials was conducted. MEDLINE and EMBASE were searched up to December 2020. Studies were included if they compared a growth factor versus placebo or standard care in patients with VLU. From 1645 articles, 13 trials were included (n = 991). There was a significant difference between any growth factor and placebo in complete wound healing (P = 0.04). Any growth factor compared to placebo significantly increased the likelihood of percent wound reduction by 48.80% (P = <0.00001). There was no difference in overall adverse event rate. Most comparisons have low certainty of evidence according to Grading of Recommendations, Assessment, Development, and Evaluation. This meta-analysis suggests that growth factors have a beneficial effect in complete wound healing of VLU. Growth factors may also increase percent reduction in wound area. The suggestion of benefit for growth factors identified in this review is not a strong one based on the low quality of evidence.
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Affiliation(s)
- Yung Lee
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Michael H Lee
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Steven A Phillips
- Division of Vascular Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Michael C Stacey
- Division of Vascular Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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31
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Chen MK, Sebaratnam DF. A non-healing ulcer: amelanotic melanoma. Med J Aust 2021; 215:405. [PMID: 34622449 DOI: 10.5694/mja2.51294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/26/2021] [Accepted: 07/07/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Michelle Ky Chen
- University of New South Wales, Sydney, NSW.,Liverpool Hospital, Sydney, NSW
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32
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Serini S, Calviello G. New Insights on the Effects of Dietary Omega-3 Fatty Acids on Impaired Skin Healing in Diabetes and Chronic Venous Leg Ulcers. Foods 2021; 10:foods10102306. [PMID: 34681353 PMCID: PMC8535038 DOI: 10.3390/foods10102306] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/23/2021] [Accepted: 09/26/2021] [Indexed: 02/06/2023] Open
Abstract
Long-chain Omega-3 polyunsaturated fatty acids (Omega-3 PUFAs) are widely recognized as powerful negative regulators of acute inflammation. However, the precise role exerted by these dietary compounds during the healing process is still largely unknown, and there is increasing interest in understanding their specific effects on the implicated cells/molecular factors. Particular attention is being focused also on their potential clinical application in chronic pathologies characterized by delayed and impaired healing, such as diabetes and vascular diseases in lower limbs. On these bases, we firstly summarized the current knowledge on wound healing (WH) in skin, both in normal conditions and in the setting of these two pathologies, with particular attention to the cellular and molecular mechanisms involved. Then, we critically reviewed the outcomes of recent research papers investigating the activity exerted by Omega-3 PUFAs and their bioactive metabolites in the regulation of WH in patients with diabetes or venous insufficiency and showing chronic recalcitrant ulcers. We especially focused on recent studies investigating the mechanisms through which these compounds may act. Considerations on the optimal dietary doses are also reported, and, finally, possible future perspectives in this area are suggested.
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33
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Burian EA, Karlsmark T, Nørregaard S, Kirketerp-Møller K, Kirsner RS, Franks PJ, Quéré I, Moffatt CJ. Wounds in chronic leg oedema. Int Wound J 2021; 19:411-425. [PMID: 34258856 PMCID: PMC8762561 DOI: 10.1111/iwj.13642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 12/31/2022] Open
Abstract
Wounds and chronic oedema are common disorders, but rarely studied together. The objective of this cross-sectional study was to investigate the point-prevalence and risk factors of wounds on the leg, in chronic leg oedema. Forty sites in nine countries were included. Of 7077 patients with chronic leg oedema, 12.70% had wounds. Independent risk factors were: peripheral arterial disease (odds ratio (OR) 4.87, 95% confidence intervals (CI) 3.63-6.52), cellulitis within the past 12 months (OR 2.69, 95% CI 2.25-3.21), secondary lymphoedema (OR 2.64, 95% CI 1.93-3.60), being male (OR 2.08, 95% CI 1.78-2.44), being over 85 years of age (OR 1.80, 95% CI 1.23-2.62), underweight (OR 1.79, 95% CI 1.14-2.79), bed bound (OR 1.79, 95% CI 1.01-3.16), chair bound (OR 1.52, 95% CI 1.18-1.97), diabetes (OR 1.47, 95% CI 1.23-1.77), and walking with aid (OR 1·41, 95% CI 1.17-1.69). 43.22% of those with wounds had clinically defined well-controlled oedema, associated with a significantly lower risk of wounds (OR 0.50, 95% CI 0.42-0.58, P < .001). Hard/fibrotic tissue (OR 1.71, 95% CI 1.19-2.48), and a positive Stemmers sign (OR 1.57, 95% CI 1.05-2.35) were associated with wounds. The study reinforces the importance of measures to control oedema, as controlled swelling was associated with a 50% lower risk of wounds.
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Affiliation(s)
- Ewa Anna Burian
- Department of Dermato-Venereology, Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | - Tonny Karlsmark
- Department of Dermato-Venereology, Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | - Susan Nørregaard
- Department of Dermato-Venereology, Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | - Klaus Kirketerp-Møller
- Department of Dermato-Venereology, Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | - Robert Scott Kirsner
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Peter John Franks
- Centre for Research and Implementation of Clinical Practice, London, UK
| | - Isabelle Quéré
- Department of Vascular Medicine, Montpellier University Hospital Centre, University of Montpellier, Montpellier, France
| | - Christine Joy Moffatt
- Department of Dermato-Venereology, Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark.,Centre for Research and Implementation of Clinical Practice, London, UK.,Nottingham University Hospitals NHS Trust, Nottingham, UK
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Garrigues-Ramón M, Julián M, Zaragoza C, Barrios C. Inability of Laplace's law to estimate sub-bandage pressures after applying a compressive bandage: a clinical study. J Wound Care 2021; 30:276-282. [PMID: 33856905 DOI: 10.12968/jowc.2021.30.4.276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of the current study was to compare pressures exerted on the lower limb by a high compression bandage as recorded by sub-bandage sensors and those estimated by Laplace's law. The correlation between pressures obtained in each anatomical zone and the corresponding limb perimeters were explored. METHOD For the measurement of sub-bandage pressures, four anatomical zones in the lower right limb were determined. Pressures were recorded by nine pneumatic sensors and a PicoPress transducer. A two-layer compression bandage system (UrgoK2, Urgo Group, France) was used for the dressing. Pressures were registered in supine position. Sensor pressures were compared with those estimated by a modified Laplace's equation. RESULTS A total of 47 female volunteers were recruited (mean age: 21.9±2.3 years) to the study. In the four anatomical segments studied, pressures obtained by the sensors were lower than would be expected by applying Laplace's law (p<0.05). The biggest difference between the two methods was found at the supramalleolar level (42.1% lower by sensors compared with Laplace's equation). The correlation coefficient between pressure recorded by the sensors and that calculated at the perimeters was very weak, ranging from 0.5233 to 0.9634. CONCLUSION Laplace's law, used to predict the sub-bandage pressure after applying a compressive bandage in the lower limb, was not useful, providing significantly higher pressures than those obtained by pneumatic sensors. Laplace's law underestimates the variable musculoskeletal components at the different segments of lower limb that act as compression damping forces.
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Affiliation(s)
- Marta Garrigues-Ramón
- School of Doctorate, Valencia Catholic University Saint Vincent Martyr, Valencia, Spain
| | - Mariano Julián
- School of Nursing and Podiatry, University of Valencia, Valencia, Spain
| | - Cristóbal Zaragoza
- Department of Surgery, School of Medicine, University of Valencia, Valencia, Spain
| | - Carlos Barrios
- Institute for Research on Musculoskeletal Disorders, Valencia Catholic University Saint Vincent Martyr, Valencia, Spain
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Safety of Silk-elastin Sponges in Patients with Chronic Skin Ulcers: A Phase I/II, Single-center, Open-label, Single-arm Clinical Trial. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3556. [PMID: 33936917 PMCID: PMC8081464 DOI: 10.1097/gox.0000000000003556] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 03/10/2021] [Indexed: 01/22/2023]
Abstract
Background: Although traditional wound dressings such as collagen scaffolds promote granulation tissue formation, the efficacy of these dressings in chronic wounds is limited because of high susceptibility to bacterial growth. Biomaterials that can be applied to chronic wounds should have an anti-bacterial function. We previously reported that administering a silk-elastin solution that forms moisturizing hydrogels to wound surfaces of diabetic mice reduced bacterial growth and promoted granulation tissue formation compared with control or carboxymethyl cellulose hydrogels. We hypothesized that silk-elastin promotes wound healing in human chronic wounds by suppressing bacterial growth. Methods: An open-label, clinical case series was conducted with a prospective, single-arm design at Kyoto University Hospital in Kyoto, Japan. In this study, 6 patients with chronic skin ulcers of any origin (2 < ulcer area (cm2) < 25) on their lower extremities were included; patients with critical ischemia were excluded. Silk-elastin sponges were applied and covered with a polyurethane film without changing the dressing for 14 days. Inflammation triggered treatment discontinuation due to fear of infection. The primary study endpoint was adverse events, including inflammation and infection. Results: Poor hydrogel formation, possibly due to continuous exudation, was observed. No serious adverse events were noted. Two patients discontinued treatment on day 6 and day 7, respectively, due to inflammation, but they were not infected. The other 4 patients completed the 14-day silk-elastin sponge treatment without infection. Conclusion: Silk-elastin sponge is safe for chronic skin ulcers, and its ability to promote wound healing should be determined by confirmatory clinical trials.
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Zenjari L, Hali F, Chiheb S. Trichloroacetic acid (50%) in the treatment of venous leg ulcers. JOURNAL DE MÉDECINE VASCULAIRE 2021; 46:139-143. [PMID: 33990288 DOI: 10.1016/j.jdmv.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 03/22/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Leg ulcers are a chronic and disabling condition that is difficult, time-consuming and costly to treat. We report a study evaluating the efficacy of trichloroacetic acid in the treatment of venous leg ulcers. PATIENTS AND METHODS We treated 19 patients with leg ulcers with 50% trichloroacetic acid with one application per week for 6 weeks. The primary evaluation criteria was healing, assessed by measuring the surface area of the ulcer before and after treatment. RESULTS We included 13 men and 6 women, with venous leg ulcers, with an average age of 57 years. The mean ulcer duration was 2.9 years. Complete healing was achieved in 2 patients, good healing in 9 patients, moderate healing in 6 patients, and poor healing in 2 patients. DISCUSSION Our study supports the data in the literature from two published series, and suggests that 50% trichloroacetic acid would be a good therapeutic alternative with satisfactory wound healing, low cost, and absence of adverse effects.
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Affiliation(s)
- L Zenjari
- Department of dermatology and venerology, CHU Ibn Rochd, Casablanca, Morocco.
| | - F Hali
- Department of dermatology and venerology, CHU Ibn Rochd, Casablanca, Morocco
| | - S Chiheb
- Department of dermatology and venerology, CHU Ibn Rochd, Casablanca, Morocco
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Geisler AN, Taylor N. Venous Stasis Ulcers: an Update on Diagnosis and Management. CURRENT GERIATRICS REPORTS 2020. [DOI: 10.1007/s13670-020-00344-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Healing Rates of Venous Leg Ulcers Managed With Compression Therapy. J Wound Ostomy Continence Nurs 2020; 47:477-483. [DOI: 10.1097/won.0000000000000693] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Urbanek T, Juśko M, Kuczmik WB. Compression therapy for leg oedema in patients with heart failure. ESC Heart Fail 2020; 7:2012-2020. [PMID: 32710511 PMCID: PMC7524111 DOI: 10.1002/ehf2.12848] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/16/2020] [Accepted: 06/02/2020] [Indexed: 01/24/2023] Open
Abstract
The presence of chronic heart failure (CHF) results in a significant risk of leg oedema. Medical compression (MC) treatment is one of the basic methods of leg oedema elimination in patients with chronic venous disease and lymphedema, but it is not routinely considered in subjects with CHF‐related swelling. In the study, an overview of the current knowledge related to the benefits and risk of using MC in the supportive treatment of leg oedema in CHF patients is presented. The available studies dedicated the comprehensive management of leg swelling using MC in CHF patients published in the English language literature till December 2019 were evaluated in term of the treatment efficacy and safety. In studies performed on CHF populations, manual lymphatic drainage, MC stocking, multilayer bandaged, as well as intermittent pneumatic compression or electric calf stimulations were used. The current evidence is based on non‐randomized studies, small study cohorts, as well as very heterogenous populations. The use of the intermittent pneumatic compression in CHF patients significantly increases the right auricular pressure and mean pulmonary artery pressures as well as decreases systemic vascular resistance in most patients without the clinical worsening. The transient and rapid increase in the human atrial natriuretic peptide, after an application of the MC stocking in New York Heart Association (NYHA) class II patients was observed without clinical exacerbation. An application of the multilayer bandages in NYHA classes III and IV patients lead a significant increase in the right arterial pressure and lead to transient deterioration of the right and the left ventricular functions. In the manual lymphatic drainage study, aside from expected leg circumference reduction, no clinical worsening was observed. In a pilot study performed in a small cohort of CHF patients, electrical calf stimulation use resulted in a reduction in the lean mass of the legs without cardiac function worsening. The use of local leg compression can be considered stable CHF patients without decompensated heart function for both CHF‐related oedema treatment and for treatment of the concomitant diseases leading to leg swelling occurrence. The use of MC in more severe classes of CHF (NYHA III and IV) should be the subject of future clinical studies to select the safest and most efficient compression method as well as to select the patients who benefit most from this kind of treatment.
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Affiliation(s)
- Tomasz Urbanek
- Department of General Surgery, Vascular Surgery, Angiology and Phlebology, Medical University of Silesia, Katowice, Poland
| | - Maciej Juśko
- Department of General Surgery, Vascular Surgery, Angiology and Phlebology, Medical University of Silesia, Katowice, Poland
| | - Wacław B Kuczmik
- Department of General Surgery, Vascular Surgery, Angiology and Phlebology, Medical University of Silesia, Katowice, Poland
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Thyroxine restores severely impaired cutaneous re-epithelialisation and angiogenesis in a novel preclinical assay for studying human skin wound healing under "pathological" conditions ex vivo. Arch Dermatol Res 2020; 313:181-192. [PMID: 32572565 PMCID: PMC7935818 DOI: 10.1007/s00403-020-02092-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 02/14/2020] [Accepted: 03/28/2020] [Indexed: 01/18/2023]
Abstract
Impaired cutaneous wound healing remains a major healthcare challenge. The enormity of this challenge is compounded by the lack of preclinical human skin wound healing models that recapitulate selected key factors underlying impaired healing, namely hypoxia/poor tissue perfusion, oxidative damage, defective innervation, and hyperglycaemia. Since organ-cultured human skin already represents a denervated and impaired perfusion state, we sought to further mimic “pathological” wound healing conditions by culturing experimentally wounded, healthy full-thickness frontotemporal skin from three healthy female subjects for three days in either serum-free supplemented Williams’ E medium or in unsupplemented medium under “pathological” conditions (i.e. hypoxia [5% O2], oxidative damage [10 mM H2O2], absence of insulin, excess glucose). Under these “pathological” conditions, dermal–epidermal split formation and dyskeratosis were prominent in organ-cultured human skin, and epidermal reepithelialisation was significantly impaired (p < 0.001), associated with reduced keratinocyte proliferation (p < 0.001), cytokeratin 6 expression (p < 0.001) and increased apoptosis (p < 0.001). Moreover, markers of intracutaneous angiogenesis (CD31 immunoreactivity and the number of of CD31 positive cells and CD31 positive vessel lumina) were significantly reduced. Since we had previously shown that thyroxine promotes wound healing in healthy human skin ex vivo, we tested whether this in principle also occurs under “pathological” wound healing conditions. Indeed, thyroxine administration sufficed to rescue re-epithelialisation (p < 0.001) and promoted both epidermal keratinocyte proliferation (p < 0.01) and angiogenesis in terms of CD31 immunoreactivity and CD31 positive cells under “pathological” conditions (p < 0.001) ex vivo. This demonstrates the utility of this pragmatic short-term ex vivo model, which recapitulates some key parameters of impaired human skin wound healing, for the preclinical identification of promising wound healing promoters.
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Cifuentes Rodriguez JE, Guerrero Gamboa S. Nursing Interventions Aimed at Persons with Venous Ulcers: an Integrative Review. AQUICHAN 2020. [DOI: 10.5294/aqui.2020.20.1.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives: This work sought to identify and describe the theoretical foundations, components, duration, delivery mode, and results of the nursing interventions aimed at persons with venous ulcers as available in the literature.
Materials and method: Integrative review between 2000 and 2018 in the Pubmed, Ovidnursing, and EBSCOhost electronic databases.
Results: This review includes 16 articles. Most of the interventions were of educational nature; three were developed in the community (through the Leg Club model) and the other ones were delivered by a nursing professional, face to face. The minimum time of duration for these was eight weeks, with telephone follow up. The most-common result variables were venous ulcer healing and reduction of the wound area.
Conclusions: Diversity existed in relation with the components of the interventions and the results expected. Report of the interventions must be reinforced, along with the use of nursing theories that support their design.
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Velozo BC, Colenci R, Abbade LPF. Multilayer elastic compression for the treatment of a 30-year venous ulcer. An Bras Dermatol 2020; 95:263-264. [PMID: 32151409 PMCID: PMC7175401 DOI: 10.1016/j.abd.2019.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 08/26/2019] [Indexed: 11/30/2022] Open
Affiliation(s)
- Bruna Cristina Velozo
- Department of Nursing, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista Júlio de, Botucatu, SP, Brazil.
| | - Raquel Colenci
- Department of Nursing, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista Júlio de, Botucatu, SP, Brazil
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McDaniel JC, Rausch J, Tan A. Impact of omega-3 fatty acid oral therapy on healing of chronic venous leg ulcers in older adults: Study protocol for a randomized controlled single-center trial. Trials 2020; 21:93. [PMID: 31948466 PMCID: PMC6966808 DOI: 10.1186/s13063-019-3970-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/06/2019] [Indexed: 12/15/2022] Open
Abstract
Background This trial addresses the global problem of chronic venous leg ulcers (CVLUs), wounds that cause significant infirmity for an estimated 9.7 million people annually, mainly older adults with comorbidities. Advanced therapies are needed because standard topical therapies are often ineffective or yield only short-term wound healing. Thus, we are testing a new oral therapy containing the bioactive elements of fish oil, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), for targeting and reducing the high numbers of activated polymorphonuclear leukocytes (PMN) in wound microenvironments that keep CVLUs “trapped” in a chronic inflammatory state. Methods This double-blind RCT will include 248 eligible adults ≥ 55 years of age with CVLUs receiving standard care at a large Midwest outpatient wound clinic. Participants are randomized to two groups: 12 weeks of daily oral therapy with EPA + DHA (1.87 g/day of EPA + 1.0 g/day of DHA) or daily oral therapy with placebo. At 0, 4, 8, and 12 weeks, across the two groups, we are pursuing three specific aims: Aim 1. Compare levels of EPA + DHA-derived lipid mediators, and inflammatory cytokines in blood and wound fluid; Subaim 1a. Compare inflammatory cytokine gene expression by PMNs in blood; Aim 2. Compare PMN activation in blood and wound fluid, and PMN-derived protease levels in wound fluid; Aim 3. Compare reduction in wound area, controlling for factors known to impact healing, and determine relationships with lipid mediators, cytokines, and PMN activation. Subaim 3a. Compare frequency of CVLU recurrence and levels of study variables in blood between the randomly assigned two subgroups (continuing EPA + DHA therapy versus placebo therapy beyond week 12) within the EPA + DHA group with healed CVLUs after 3 months of therapy. Subaim 3b. Compare symptoms of pain at all time points and quality of life at first and last time points across the two groups and two subgroups. Discussion This trial will provide new evidence about the effectiveness of EPA + DHA oral therapy to target and reduce excessive PMN activation systemically and locally in patients with CVLUs. If effective, this therapy may facilitate healing and thus be a new adjunct treatment for CVLUs in the aging population. Trial registration ClinicalTrials.gov, NCT03576989; Registered on 13 June 2018.
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Affiliation(s)
- Jodi C McDaniel
- College of Nursing, The Ohio State University, 372 Newton Hall, 1585 Neil Avenue, Columbus, OH, 43210-1289, USA.
| | - Jamie Rausch
- College of Nursing, The Ohio State University, 372 Newton Hall, 1585 Neil Avenue, Columbus, OH, 43210-1289, USA
| | - Alai Tan
- College of Nursing, The Ohio State University, 372 Newton Hall, 1585 Neil Avenue, Columbus, OH, 43210-1289, USA
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Paranhos T, Paiva CSB, Cardoso FCI, Apolinário PP, Figueiredo Azevedo F, Saidel MGB, Oliveira HC, Dini AP, Kumakura ARSO, Melo Lima MH. Assessment of the use of Unna boot in the treatment of chronic venous leg ulcers in adults: systematic review protocol. BMJ Open 2019; 9:e032091. [PMID: 31874878 PMCID: PMC7008408 DOI: 10.1136/bmjopen-2019-032091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 10/29/2019] [Accepted: 11/11/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Chronic venous insufficiency (CVI) is an anomaly of the normal functioning of the venous system caused by valvular incompetence with or without the obstruction of venous flow. This condition can affect either or both of the superficial and the deep venous systems. Venous dysfunction can even result in congenital or acquired disorders, and its complications include venous leg ulcers (VLUs). The objective of this systematic review is to determine the effectiveness of Unna boot in the treatment of wound healing of VLU by assessing the quality of the available evidence. METHODS AND ANALYSIS A literature search in PubMed, CINAHL, Scopus, Web of Science, Cochrane Library, BVS/BIREME, Embase, ProQuest, BDTD, Thesis and Dissertation Catalog, Sao Paulo Research Foundation/Thesis and dissertation, OPEN THESIS, A service of the US National Institute of Health, Center for Reviews and Dissemination-University of New York and SciElo published in the last 10 years, the period from January 1999 to March 2019. The review will include primary studies (original), and Controlled Trials or Observational studies (cross-sectional, case-control or longitudinal studies) with VLU. The exclusion will include leg ulceration due to different causes, such as pressure, arterial, diabetic or mixed-aetiology leg ulcers. Data synthesis will be performed using a narrative summary and quantitative analysis. ETHICS AND DISSEMINATION This systematic review does not require approval by the ethics committee, as individual patient data will not be collected. Dissemination of findings will be through publications in peer-reviewed journals and/or via conference presentations. PROSPERO REGISTRATION NUMBER CRD42019127947.
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Affiliation(s)
- Thalita Paranhos
- School of Nursing, State University of Campinas, Campinas, São Paulo, Brazil
| | - Caroline S B Paiva
- School of Nursing, State University of Campinas, Campinas, São Paulo, Brazil
| | | | | | | | - Maria G B Saidel
- School of Nursing, State University of Campinas, Campinas, São Paulo, Brazil
| | - Henrique C Oliveira
- School of Nursing, State University of Campinas, Campinas, São Paulo, Brazil
| | - Ariane P Dini
- School of Nursing, State University of Campinas, Campinas, São Paulo, Brazil
| | - Ana R S O Kumakura
- School of Nursing, State University of Campinas, Campinas, São Paulo, Brazil
| | - Maria H Melo Lima
- School of Nursing, State University of Campinas, Campinas, São Paulo, Brazil
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Yan R, Zhao W, Sun Q. Research on a physical activity tracking system based upon three-axis accelerometer for patients with leg ulcers. Healthc Technol Lett 2019; 6:147-152. [PMID: 31839971 PMCID: PMC6863144 DOI: 10.1049/htl.2019.0008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/10/2019] [Accepted: 07/01/2019] [Indexed: 01/04/2023] Open
Abstract
Venous leg ulcerations are a common problem, with high prevalence in the middle-aged and elderly population, and more attention on research of their physical activities has been paid, as they have great effects on the blood circulation of the lower limb. With enough, appropriate training, the chronic venous ulcerations in the lower limb can be avoided and alleviated, and venous hypertension can be reduced effectively. The study deals with a physical activity tracking system for the patients based on a three-axis accelerometer. The system uses a three-axis accelerometer, a microcontroller, and a wireless Bluetooth module to form a data acquisition platform to acquire accelerations of the lower limb movement, and sends it to a smart mobile phone via the wireless Bluetooth module. The system takes advantages of the smart mobile phone to guide the chronic venous leg ulcers to do prescribed rehabilitation exercises for the lower limb muscles, perform acceleration data preprocessing, wavelet transform and reconstruction, denoising and feature extraction, obtain the results of the rehabilitation exercises, and then give reasonable evaluation and judgment. It is helpful to treat underlying venous reflux, create such an environment that allows skin to grow across an ulcer, and accelerate ulcer healing process consequently.
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Affiliation(s)
- Rongguo Yan
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, 200093, People's Republic of China
| | - Weibing Zhao
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, 200093, People's Republic of China
| | - Qi Sun
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, 200093, People's Republic of China
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Stone RC, Stojadinovic O, Sawaya AP, Glinos GD, Lindley LE, Pastar I, Badiavas E, Tomic-Canic M. A bioengineered living cell construct activates metallothionein/zinc/MMP8 and inhibits TGFβ to stimulate remodeling of fibrotic venous leg ulcers. Wound Repair Regen 2019; 28:164-176. [PMID: 31674093 DOI: 10.1111/wrr.12778] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/11/2019] [Accepted: 10/15/2019] [Indexed: 12/23/2022]
Abstract
Venous leg ulcers (VLU) represent a major clinical unmet need, impairing quality of life for millions worldwide. The bioengineered bilayered living cell construct (BLCC) is the only FDA-approved therapy demonstrating efficacy in healing chronic VLU, yet its in vivo mechanisms of action are not well understood. Previously, we reported a BLCC-mediated acute wounding response at the ulcer edge; in this study we elucidated the BLCC-specific effects on the epidermis-free ulcer bed. We conducted a randomized controlled clinical trial (ClinicalTrials.gov NCT01327937) enrolling 30 subjects with nonhealing VLUs, and performed genotyping, genomic profiling, and functional analysis on wound bed biopsies obtained at baseline and 1 week after treatment with BLCC plus compression or compression therapy (control). The VLU bed transcriptome featured processes of chronic inflammation and was strikingly enriched for fibrotic/fibrogenic pathways and gene networks. BLCC application decreased expression of profibrotic TGFß1 gene targets and increased levels of TGFß inhibitor decorin. Surprisingly, BLCC upregulated metallothioneins and fibroblast-derived MMP8 collagenase, and promoted endogenous release of MMP-activating zinc to stimulate antifibrotic remodeling, a novel mechanism of cutaneous wound healing. By activating a remodeling program in the quiescent VLU bed, BLCC application shifts nonhealing to healing phenotype. As VLU bed fibrosis correlates with poor clinical healing, findings from this study identify the chronic VLU as a fibrotic skin disease and are first to support the development and application of antifibrotic therapies as a successful treatment approach.
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Affiliation(s)
- Rivka C Stone
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami-Miller School of Medicine, Miami, Florida.,The Research Residency Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami-Miller School of Medicine, Miami, Florida
| | - Olivera Stojadinovic
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami-Miller School of Medicine, Miami, Florida
| | - Andrew P Sawaya
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami-Miller School of Medicine, Miami, Florida.,Molecular and Cellular Pharmacology Graduate Program in Biomedical Sciences, University of Miami-Miller School of Medicine, Miami, Florida
| | - George D Glinos
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami-Miller School of Medicine, Miami, Florida
| | - Linsey E Lindley
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami-Miller School of Medicine, Miami, Florida
| | - Irena Pastar
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami-Miller School of Medicine, Miami, Florida
| | - Evangelos Badiavas
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami-Miller School of Medicine, Miami, Florida.,Interdisciplinary Stem Cell Institute, University of Miami-Miller School of Medicine, Miami, Florida
| | - Marjana Tomic-Canic
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami-Miller School of Medicine, Miami, Florida.,John P. Hussman Institute for Human Genomics, University of Miami-Miller School of Medicine, Miami, Florida
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Nunes CADB, Melo PG, Malaquias SG, Amaral KVÁ, Alves GR, Meira AA, Cardoso AL, Pereira LV, Bachion MM. Effectiveness of two bundles in venous leg ulcer healing: A randomized controlled trial. JOURNAL OF VASCULAR NURSING 2019; 37:232-245. [DOI: 10.1016/j.jvn.2019.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 09/13/2019] [Accepted: 09/14/2019] [Indexed: 01/08/2023]
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Papismadov B, Tzur I, Izhakian S, Barchel D, Swarka M, Phatel H, Livshiz-Riven I, Gorelik O. High compression leg bandaging prevents seated postural hypotension among elderly hospitalized patients. Geriatr Nurs 2019; 40:558-564. [DOI: 10.1016/j.gerinurse.2019.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/19/2019] [Accepted: 04/25/2019] [Indexed: 10/26/2022]
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50
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Hirt PA, Castillo DE, Yosipovitch G, Keri JE. Skin changes in the obese patient. J Am Acad Dermatol 2019; 81:1037-1057. [DOI: 10.1016/j.jaad.2018.12.070] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 12/31/2022]
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