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Gunasegaran N, Goh WT, Tan WX, Saipollah H, Chong HR, Sunari RN, Chong TT, Ang SY, Aloweni F. Patients with venous leg ulcers can be managed safely in the community ----results of an observational comparison study in Singapore. J Tissue Viability 2024:S0965-206X(24)00114-1. [PMID: 39164151 DOI: 10.1016/j.jtv.2024.07.009] [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: 10/13/2023] [Revised: 07/08/2024] [Accepted: 07/21/2024] [Indexed: 08/22/2024]
Abstract
AIM To examine the healing outcomes of patients with venous leg ulcers requiring compression bandaging in community care versus tertiary care. METHOD This was an analytical observational cohort study. Venous leg ulcer (VLU) patients who required compression bandaging were recruited from an outpatient vascular clinic between May 2021 and August 2022. Eligible patients received two-or four-layer compression bandaging and followed up with the community care or tertiary care centre nurses. The primary outcome was the difference in the total surface area of the VLU after 12 weeks, and the secondary outcome was the patient's quality of life, as measured by the Cardiff Wound Impact Schedule (CWIS). RESULTS Forty-seven VLU patients were recruited; 27 received compression bandaging in the community care and 20 by the tertiary care centre. Mean age 70 years old (SD 11.04). The two most prevalent comorbidities were hypertension (51.06 %) and diabetes mellitus (38.29 %). Among those who completed follow-up (12 weeks), the median difference of the total surface area of the VLU between community-based care (p = 0.02) versus tertiary-based care (0.003) was significant. However, there was no difference in the healing status between community and tertiary-based care (p = 0.68). There was no difference in the quality of life of patients between groups. CONCLUSION This first tropical study comparing VLU healing outcomes between community and tertiary care found no significant difference in healing with compression bandaging by nurses in either setting. However, the small sample size and high dropout rate limit the generalizability of the findings, necessitating a larger-scale study with longer follow-up. Despite these limitations, the study is a crucial step toward improving wound care services in Singapore, and highlights the need for further research to guide future community wound care implementation.
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Affiliation(s)
| | - Wee Ting Goh
- Nursing Division, Singapore General Hospital, Singapore.
| | | | | | - Hui Ru Chong
- Nursing Division, Singapore General Hospital, Singapore.
| | | | - Tze Tec Chong
- Department of Vascular Surgery, Singapore General Hospital, Singapore.
| | - Shin Yuh Ang
- Nursing Division, Singapore General Hospital, Singapore.
| | - Fazila Aloweni
- Nursing Division, Singapore General Hospital, Singapore.
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Alchorne MMDA, Conceição KDC, Barraza LL, Milanez Morgado de Abreu MA. Dermatology in black skin. An Bras Dermatol 2024; 99:327-341. [PMID: 38310012 DOI: 10.1016/j.abd.2023.10.001] [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: 07/23/2023] [Revised: 09/25/2023] [Accepted: 10/17/2023] [Indexed: 02/05/2024] Open
Abstract
The vast majority of publications in dermatology refer to lightly pigmented skin, with few addressing the peculiarities of black skin. In addition there is no consensus on what it means to be black in different regions of the world. The lack of knowledge on the subject makes it difficult to recognize and manage dermatoses in this type of skin. This article aims to review the literature on intrinsic characteristics, as well as epidemiological and clinical aspects of the cutaneous manifestations of different dermatoses in black skin. It was found that there are sometimes striking differences, in the structural, biological, and functional aspects when comparing lightly pigmented and black skin. There are also physiological changes that need to be recognized to avoid unnecessary interventions. Some dermatoses have a higher incidence in black skin, such as acne, eczema, dyschromia and dermatophytosis. On the other hand, several dermatoses are more specific to black skin, such as pseudofolliculitis barbae, keloid, dermatosis papulosa nigra, ulcers caused by sickle-cell anemia, dactylolysis spontanea, confluent and reticulated papillomatosis of Gougerot and Carteaud, and some diseases of the hair and scalp (including fragile and brittle hair, traction alopecia, folliculitis keloidalis nuchae, folliculitis dissecans and central centrifugal cicatricial alopecia). A spectrum of peculiar aspects of specific dermatoses, including sarcoidosis, lichen planus (with emphasis on the pigmentosus variant), psoriasis, lupus erythematosus, vitiligo, syphilis, pityriasis versicolor, and neoplasms are highlighted. In the latter, characteristics of basal cell carcinoma, squamous cell carcinoma, and melanoma are compared, in addition to highlighting unusual aspects of primary cutaneous T-cell lymphoma, endemic Kaposi sarcoma, and dermatofibrosarcoma protuberans.
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Affiliation(s)
| | | | - Leonardo Lora Barraza
- Department of Dermatology, Santa Casa de Misericórdia do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Jacinto MAG, Oliveira ACDS, Martínez CSG, Schlosser TCM, Dantas BADS, Torres GDV. Healing of Venous Leg Ulcers Influenced by Individual Aspects: Cluster Analysis in a Specialist Wound Management Clinic. J Prim Care Community Health 2024; 15:21501319231223458. [PMID: 38288560 PMCID: PMC10826402 DOI: 10.1177/21501319231223458] [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: 10/13/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 02/01/2024] Open
Abstract
INTRODUCTION/OBJECTIVE Venous Leg Ulcers (VLU) present a challenging healing process. Attaining healing is a primary treatment objective, commonly pursued in Primary Health Care (PHC) or Specialist Wound Management Clinics. Our objective was to examine the association and interplay between sociodemographic, health, clinical, and care factors with the outcomes of VLU treatment in patients undergoing care at a Specialist Wound Management Clinic. METHODS Longitudinal, observational study took place in a center for the treatment of chronic injuries linked to PHC. The sociodemographic aspects, health status and habits, clinical and care aspects of patients with VLU were scrutinized over a 1-year period. RESULTS The sample comprised 103 participants, with some still under treatment (Treatment Group-TG/ n = 60) and others having achieved VLU healing (Healing Group-HG/ n = 43). An association between sociodemographic, health, clinical, and care factors and the healing outcome (HG) was identified. A moderate correlation was observed between factors predisposing to healing in the sociodemographic group and health habits. Notably, among sociodemographic factors, the older age group and improvements in health, particularly the reduced use of alcohol/smoking, appeared to exert the most significant influence on healing. Additionally, specialized service monitoring and the application of compression therapy were contributory factors. CONCLUSIONS These findings substantiate the hypothesis that sociodemographic, health, clinical, and care-related aspects are intertwined with VLU healing. Protective factors associated with healing interacted synergistically, fostering a positive outcome over one year of treatment.
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Probst S, Saini C, Gschwind G, Stefanelli A, Bobbink P, Pugliese M, Cekic S, Pastor D, Gethin G. Prevalence and incidence of venous leg ulcers-A systematic review and meta-analysis. Int Wound J 2023; 20:3906-3921. [PMID: 37293810 PMCID: PMC10588327 DOI: 10.1111/iwj.14272] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/24/2023] [Accepted: 05/24/2023] [Indexed: 06/10/2023] Open
Abstract
Venous leg ulcers (VLU) represent a major public health challenge. Little is known about the prevalence and incidence of VLU internationally. Published studies are usually reporting different estimates because of disparities in study designs and measurement methods. Therefore, we conducted a systematic literature review and meta-analysis to identify the prevalence and incidence of VLU internationally and to characterise the population as reported in these studies. Studies were identified from searches in Medline (PubMed), CINAHL Complete (EBSCOhost), Embase, Scopus, Web of Science, LiSSa (Littérature Scientifique en Santé), Google Scholar and Cochrane Database of Systematic Reviews up to November 2022. Studies were included if their primary outcomes were reported as a period prevalence or point prevalence or cumulative incidence or incidence VLU rate. Fourteen studies met the inclusion criteria, 10 reporting estimates of prevalence, three reporting both prevalence and incidence estimates and one incidence. All were included in meta-analyses. The results show a pooled prevalence of 0.32% and a pooled incidence of 0.17%. Our results highlighted an extreme heterogeneity across effect sizes for both prevalence and incidence, which prevent a meaningful interpretation of pooled indexes and argue for further studies with specific prevalence-type reported and target population under study.
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Affiliation(s)
- Sebastian Probst
- Geneva School of Health ScienceHES‐SO University of Applied Sciences and Arts, Western SwitzerlandGenevaSwitzerland
- Care DirectorateUniversity Hospital GenevaGeneva University HospitalsGenevaSwitzerland
- Faculty of Medicine Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia
- College of Medicine Nursing and Health SciencesUniversity of GalwayGalwayIreland
| | - Camille Saini
- Geneva School of Health ScienceHES‐SO University of Applied Sciences and Arts, Western SwitzerlandGenevaSwitzerland
| | - Géraldine Gschwind
- Geneva School of Health ScienceHES‐SO University of Applied Sciences and Arts, Western SwitzerlandGenevaSwitzerland
| | - Alessio Stefanelli
- Geneva School of Health ScienceHES‐SO University of Applied Sciences and Arts, Western SwitzerlandGenevaSwitzerland
| | - Paul Bobbink
- Geneva School of Health ScienceHES‐SO University of Applied Sciences and Arts, Western SwitzerlandGenevaSwitzerland
- Faculty of Biology and Medicine, University Institute of Higher Education and Research in HealthcareUniversity of LausanneLausanneSwitzerland
| | - Marie‐Thérèse Pugliese
- Geneva School of Health ScienceHES‐SO University of Applied Sciences and Arts, Western SwitzerlandGenevaSwitzerland
| | - Sezen Cekic
- Department of PsychologyUniversity of GenevaGenevaSwitzerland
| | - Damien Pastor
- Department of Dermatology and VenereologyGeneva University HospitalsGenevaSwitzerland
| | - Georgina Gethin
- Geneva School of Health ScienceHES‐SO University of Applied Sciences and Arts, Western SwitzerlandGenevaSwitzerland
- College of Medicine Nursing and Health SciencesUniversity of GalwayGalwayIreland
- Alliance for Research and Innovation in WoundsUniversity of GalwayGalwayIreland
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Senft JD, Fleischhauer T, Poß-Doering R, Frasch J, Feißt M, Awounvo S, Müller-Bühl U, Altiner A, Szecsenyi J, Laux G. Primary Care Disease Management for Venous Leg Ulceration in German Healthcare: Results of the Ulcus Cruris Care Pilot Study. Healthcare (Basel) 2023; 11:2521. [PMID: 37761717 PMCID: PMC10531034 DOI: 10.3390/healthcare11182521] [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: 07/21/2023] [Revised: 08/29/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Despite proven effectiveness, compression therapy is applied in only 20-40% of patients with venous leg ulceration, leading to avoidable chronification and morbidity. The Ulcus Cruris Care project was established to develop a new disease-management concept comparable to existing programs for chronic diseases to support evidence-based treatment of venous leg ulceration. This prospective controlled study assessed its first implementation. Interventional elements comprised online training for general practitioner practices, software support for case management, and educational materials for patients. A total of 20 practices and 40 patients were enrolled in a 1:1 ratio to the intervention and control group. Guideline-conform compression therapy was applied more frequently in the intervention group (19/20 [95%] vs. 11/19 [58%]; p = 0.006). For patients with ulcers existing ≤ 6 months, the healing rate at 12 weeks was 8/11 [73%] (intervention) compared to 4/11 [36%] (control; p = 0.087). Patients after intervention had higher scores for self-help and education in the PACIC-5A questionnaire (42.9 ± 41.6 vs. 11.4 ± 28.8; p = 0.044). Treatment costs were EUR 1.380 ± 1.347 (intervention) and EUR 2.049 ± 2.748 (control; p = 0.342). The results of this study indicate that the Ulcus Cruris Care intervention may lead to a significant improvement in care. Consequently, a broader rollout in German healthcare seems warranted.
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Affiliation(s)
- Jonas D. Senft
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Thomas Fleischhauer
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Regina Poß-Doering
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Jona Frasch
- aQua Institute for Applied Quality Promotion and Research in Health Care GmbH, Maschmühlenweg 8-10, 37073 Göttingen, Germany
| | - Manuel Feißt
- Institute of Medical Biometry, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Sinclair Awounvo
- Institute of Medical Biometry, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Uwe Müller-Bühl
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Attila Altiner
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Gunter Laux
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
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Guest JF, Fuller GW. Cost-effectiveness of two reduced pressure compression systems in treating newly diagnosed venous leg ulcers. J Wound Care 2023; 32:348-358. [PMID: 37300861 DOI: 10.12968/jowc.2023.32.6.348] [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 To assess the clinical outcomes and cost-effectiveness of using two different reduced pressure compression systems in treating newly diagnosed venous leg ulcers (VLUs) in clinical practice, from the perspective of the UK's National Health Service (NHS). METHODS This was a modelling study based on a retrospective cohort analysis of the case records of patients with a newly diagnosed VLU, randomly extracted from The Health Improvement Network (THIN) database, who were initially treated with a two-layer cohesive compression bandage (TLCCB Lite; Coban 2 Lite, 3M, US) or a two-layer compression system (TLCS Reduced; Ktwo Reduced, Urgo, France). No significant differences were detected between the groups. Nevertheless, analysis of covariance (ANCOVA) was performed to enable differences in patients' outcomes between the groups to be adjusted for any heterogeneity in baseline covariates. Clinical outcomes and cost-effectiveness of the alternative compression systems were estimated over 12 months after starting treatment. RESULTS Time from wound onset to starting compression was a mean of two months. The probability of healing at 12 months was 0.59 in the TLCCB Lite group and 0.53 in the TLCS Reduced group. Patients in the TLCCB Lite group experienced a marginally better health-related quality of life (HRQoL) of 0.02 quality-adjusted life years (QALYs) per patient compared to those in the TLCS Reduced group. The 12-month NHS wound management cost was £3883 per patient treated with TLCCB Lite and £4235 per patient treated with TLCS Reduced. When the analysis was repeated without ANCOVA, the findings from the base case analysis remained unchanged (i.e., use of TLCCB Lite improved outcomes at lower cost). CONCLUSION Within the study's limitations, treating newly diagnosed VLUs with TLCCB Lite instead of TLCS Reduced potentially affords a cost-effective use of NHS-funded resources in clinical practice, since it is expected to result in an increased healing rate, better HRQoL and a lower NHS wound management cost.
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Guest JF, Fuller GW. Relative cost-effectiveness of three compression bandages in treating newly diagnosed venous leg ulcers in the UK. J Wound Care 2023; 32:146-158. [PMID: 36930185 DOI: 10.12968/jowc.2023.32.3.146] [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: 03/18/2023]
Abstract
OBJECTIVE To assess the clinical outcomes and cost-effectiveness of using a two-layer cohesive compression bandage (TLCCB; Coban 2, 3M, US) compared with a two-layer compression system (TLCS; KTwo, Urgo, France) and a cohesive inelastic bandage system (CIBR; Actico, L&R, Germany) in treating newly diagnosed venous leg ulcers (VLUs) in clinical practice, from the perspective of the UK's National Health Service (NHS). METHOD This was a modelling study based on a retrospective cohort analysis of the case records of patients with a newly diagnosed VLU randomly extracted from the The Health Improvement Network (THIN) database who were treated with TLCCB, TLCS or CIBR. No significant differences were detected between the groups. Nevertheless, analysis of covariance was performed to enable differences in patients' outcomes between the groups to be adjusted for any heterogeneity in baseline covariates. Clinical outcomes and cost-effectiveness of the alternative compression systems were estimated over 12 months after starting treatment. RESULTS There were 250 patients in each group. Time from wound onset to starting compression was a mean of two months. The healing distribution of the TLCCB-treated patients was significantly different from that of the other two cohorts (p=0.003); the probability of healing at 12 months was 0.62, 0.51 and 0.49 in the TLCCB, TLCS and CIBR groups, respectively. Patients treated with TLCCB experienced better health-related quality of life (HRQoL) over 12 months (0.86 quality-adjusted life years (QALYs) per patient), compared with those treated with TLCS and CIBR (0.83 and 0.82 QALYs per patient, respectively). The 12-month NHS wound management cost was £3693, £4451 and £4399 per patient in the TLCCB, TLCS and CIBR groups, respectively. CONCLUSION Within the model's limitations, treating newly diagnosed VLUs with TLCCB instead of the other two compression systems appears to afford a more cost-effective use of NHS-funded resources in clinical practice, since it is expected to result in increased healing, better HRQoL and a lower wound management cost for the NHS.
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MIKOSIŃSKI J, KALOGEROPOULOS K, BUNDGAARD L, LARSEN CA, SAVICKAS S, HAACK AM, PAŃCZAK K, RYBOŁOWICZ K, GRZELA T, OLSZEWSKI M, CISZEWSKI P, SITEK-ZIÓŁKOWSKA K, TWARDOWSKA-SAUCHA K, KARCZEWSKI M, RABCZENKO D, SEGIET A, BUCZAK-KULA P, SCHOOF EM, EMING SA, SMOLA H, AUF DEM KELLER U. Longitudinal Evaluation of Biomarkers in Wound Fluids from Venous Leg Ulcers and Split-thickness Skin Graft Donor Site Wounds Treated with a Protease-modulating Wound Dressing. Acta Derm Venereol 2022; 102:adv00834. [PMID: 36250733 PMCID: PMC9811302 DOI: 10.2340/actadv.v102.325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Venous leg ulcers represent a clinical challenge and impair the quality of life of patients. This study examines impaired wound healing in venous leg ulcers at the molecular level. Protein expression patterns for biomarkers were analysed in venous leg ulcer wound fluids from 57 patients treated with a protease-modulating polyacrylate wound dressing for 12 weeks, and compared with exudates from 10 acute split-thickness wounds. Wound healing improved in the venous leg ulcer wounds: 61.4% of the 57 patients with venous leg ulcer achieved a relative wound area reduction of ≥ 40%, and 50.9% of the total 57 patients achieved a relative wound area reduction of ≥ 60%. Within the first 14 days, abundances of S100A8, S100A9, neutrophil elastase, matrix metalloproteinase-2, and fibronectin in venous leg ulcer exudates decreased significantly and remained stable, yet higher than in acute wounds. Interleukin-1β, tumour necrosis factor alpha, and matrix metalloproteinase-9 abundance ranges were similar in venous leg ulcers and acute wound fluids. Collagen (I) α1 abundance was higher in venous leg ulcer wound fluids and was not significantly regulated. Overall, significant biomarker changes occurred in the first 14 days before a clinically robust healing response in the venous leg ulcer cohort.
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Affiliation(s)
- Jacek MIKOSIŃSKI
- “MIKOMED”, Clinic for Peripheral Vascular Diseases, Łódź, Poland
| | - Konstantinos KALOGEROPOULOS
- DTU Bioengineering, Section for Protein Science and Biotherapeutics, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Louise BUNDGAARD
- DTU Bioengineering, Section for Protein Science and Biotherapeutics, Technical University of Denmark, Kgs. Lyngby, Denmark,Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Cathrine Agnete LARSEN
- DTU Bioengineering, Section for Protein Science and Biotherapeutics, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Simonas SAVICKAS
- DTU Bioengineering, Section for Protein Science and Biotherapeutics, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Aleksander Moldt HAACK
- DTU Bioengineering, Section for Protein Science and Biotherapeutics, Technical University of Denmark, Kgs. Lyngby, Denmark
| | | | | | - Tomasz GRZELA
- Clinic of Phlebology,Medical University of Warsaw, Warsaw
| | - Michał OLSZEWSKI
- Pratia Ostrołęka Embedded Hospital Clinical Research Site, Ostrołęka
| | - Piotr CISZEWSKI
- WILMED Specialist Medical Clinic Non-public Healthcare Centre, Warszaw
| | | | | | - Marek KARCZEWSKI
- CSOLUMED Medical Centre,Poland Department of General and Transplant Surgery, Poznan University of Medical Sciences, Poznan
| | | | | | | | - Erwin M. SCHOOF
- DTU Bioengineering, Section for Protein Science and Biotherapeutics, Technical University of Denmark, Kgs. Lyngby, Denmark
| | | | - Hans SMOLA
- Department of Dermatology, University of Cologne, Cologne,PAUL HARTMANN AG, Heidenheim, Germany
| | - Ulrich AUF DEM KELLER
- DTU Bioengineering, Section for Protein Science and Biotherapeutics, Technical University of Denmark, Kgs. Lyngby, Denmark
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Klejtman T, Lazareth I, Yannoutsos A, Priollet P. Specific management of lipodermatosclerosis (sclerotic hypodermitis) in acute and chronic phase. JOURNAL DE MEDECINE VASCULAIRE 2022; 47:186-190. [PMID: 36344029 DOI: 10.1016/j.jdmv.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/08/2022] [Indexed: 06/16/2023]
Abstract
Lipodermatosclerosis or sclerotic hypodermitis is presented as a complication of venous insufficiency and in particular of post-thrombotic syndrome with a high risk of progression to leg ulcers. However, it has also been described in obese patients without venous insufficiency, and even in the course of various systemic diseases including scleroderma. It most often affects middle-aged women and is usually bilateral, with a typically "inverted champagne bottle" leg appearance. The pathogenic role of venous hypertension explains why compression with bands or stockings is the basis of treatment. In acute phase, which may precede or complicate chronic forms, the pain is so severe that compression is not tolerated. In acute phase, non-steroidal anti-inflammatory drugs, intra-lesional use of triamcinolone, and capsaicin transdermal patches indicated for neuropathic pain have been proposed. In chronic forms, the treatment of superficial venous insufficiency and/or incontinent perforating veins, documented during a Duplex ultrasound scan, is usually proposed, whenever possible. In association with elastic compression, pentoxifylline and colchicine have been used without clear evidence of clinical efficacy. Finally, in the most advanced clinical presentation with the appearance of a sclerotic gaiter associated with ulcerations, surgical treatment with excision-cutaneous grafting associated or not with perforating veins ligation and a fasciotomy may be discussed as a last resort for treatment.
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Affiliation(s)
- T Klejtman
- Vascular medicine department, Saint-Joseph Hospital, 75014 Paris, France.
| | - I Lazareth
- Vascular medicine department, Saint-Joseph Hospital, 75014 Paris, France
| | - A Yannoutsos
- Vascular medicine department, Saint-Joseph Hospital, 75014 Paris, France
| | - P Priollet
- Vascular medicine department, Saint-Joseph Hospital, 75014 Paris, France
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Poß-Doering R, Anders C, Fleischhauer T, Szecsenyi J, Senft J. Exploring healthcare provider and patient perspectives on current outpatient care of venous leg ulcers and potential interventions to improve their treatment: a mixed methods study in the ulcus cruris care project. BMC PRIMARY CARE 2022; 23:229. [PMID: 36076159 PMCID: PMC9453712 DOI: 10.1186/s12875-022-01841-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 08/25/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
The project "Ulcus Cruris Care" aims to improve primary care for patients with venous leg ulcer (VLU) in General Practitioner (GP) practices using a complex intervention comprised of educational components, standardized treatment recommendations, computer-assisted documentation, and case management by non-physician medical assistants (MAs). Prior to implementing and testing the intervention components in general practices, in-depth exploration of current outpatient treatment of VLU patients and relevant implementation determinants was pursued.
Methods
A mixed-methods study explored views of GPs, MAs, and patients regarding current VLU outpatient care and the planned intervention components to identify potential implementation determinants. Data were collected through semi-structured guide-based telephone interviews (n = 29) and a survey questionnaire (n = 28). Interviews were transcribed verbatim. Analysis was inductive initially and finalized in a deductive-inductive approach based on domains of the Theoretical Domains Framework to support structuring of relevant implementation determinants. Survey data were analyzed descriptively.
Results
Current VLU outpatient care was described as frequently tailored to individual wounds and gradient. In general, workload was shared by GPs (diagnostics, counselling) and MAs (wound care). All care providers were aware of compression therapy, yet not all of them considered it essential for VLU care. Standardized operating procedures and educational components including e-learning were considered supportive. Stronger involvement of non-physician assistants was seen as opportunity to optimize VLU care. Concerns were identified regarding integration of software-supported case management into daily practice routines and regarding potential limitations in decision-making autonomy when using standard operating procedures.
Conclusions
Findings in this study emphasize a need for educational interventions addressing VLU care providers as well as patients, particularly with regards to compression therapy. The conception of the planned intervention appears to be adequate and a structured guideline-based case management might be a promising approach for optimization of VLU treatment.
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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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Senft JD, Fleischhauer T, Frasch J, van Rees W, Feißt M, Schwill S, Fink C, Poß-Doering R, Wensing M, Müller-Bühl U, Szecsenyi J. Primary care disease management for venous leg ulceration—study protocol for the Ulcus Cruris Care [UCC] randomized controlled trial (DRKS00026126). Trials 2022; 23:60. [PMID: 35057840 PMCID: PMC8771170 DOI: 10.1186/s13063-021-05944-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/16/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Venous leg ulcers (VLU) have a prevalence of 1–2% in developed countries, and affected patients are severely and long-term impaired in daily activities, work, and social participation. Evidence-based outpatient treatment based on compression therapy is frequently not implemented. The “Ulcus Cruris Care” project was established to develop a disease management concept to improve outpatient treatment for patients with VLU in German primary care. For this purpose, a multifaceted intervention was conceived consisting of an online training for general practitioners and medical assistants, standardized treatment recommendations, e-learning and print-based information for patients, and a software support for case management. The main aims of the Ulcus Cruris Care intervention are to promote standardized treatment according to current scientific knowledge, to facilitate case management for VLU patients exerted by medical assistants, and to support patient education and participation in the treatment process. The UCC trial was designed to evaluate the effectiveness of the Ulcus Cruris Care intervention.
Methods
The UCC trial is a prospective cluster-randomized controlled multicenter trial. Fifty GP practices are intended to be recruited and randomized 1:1 to intervention or control arm. Patients with venous leg ulcers will be recruited by participating GP practices, to include a total of 63 patients in each arm. The primary outcome is time to ulcer healing. Secondary outcomes comprise number and sizes of ulcers, recurrence, pain intensity according to the visual analog scale, health-related quality of life according to EQ-5D-5L, depressiveness according to Patient Health Questionnaire (PHQ-9), patient satisfaction according to the Patient Assessment of Chronic Illness Care (PACIC-5A) query, and adherence to VLU treatment. The outcome analysis of the UCC trial is accompanied by a health economic analysis and a process evaluation.
Discussion
The UCC trial will evaluate whether the Ulcus Cruris Care intervention may lead to faster wound healing, higher health-related quality of life, and lower use of medical resources. If the intervention turns out to have a positive impact on assessed outcomes, comprehensive implementation in primary care may be considered.
Trial registration
The trial protocol (version 1 as of July 19, 2021) has been registered in the German Clinical Trials Register on August 30, 2021 (DRKS00026126).
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13
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Hagenström K, Protz K, Petersen J, Augustin M. Development of a model to predict closure of chronic wounds in Germany: Claims data analysis. Int Wound J 2022; 19:76-85. [PMID: 33949101 PMCID: PMC8684882 DOI: 10.1111/iwj.13599] [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] [Received: 02/10/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 11/29/2022] Open
Abstract
Patients with chronic leg ulcer, pressure ulcer, or diabetic foot ulcer suffer from significant disease burden. With a view to improving healthcare provision sustainably, a predictive model of time to closure (time-to-event analysis) based on claims data was developed. To identify potential predictors of wound closure, clinical information absent from statutory health insurance (SHI) data was modelled. In patients with leg ulcers, age of the patient (hazard ratios [HR] 0.99), increasing number of comorbidities (HR 0.94), inpatient stays (HR 0.74), and treatment by a specialised wound care professional (HR 1.18) were significant predictors of time to closure (adjusted model). In almost all models, the number of inpatient stays and of comorbidities predicted a lower probability of healing. In addition, the age and the sex of the patient were found to be significant predictors in some models (leg ulcer: HR 0.99; pressure ulcer: HR 0.99). Increasing number of comorbidities and inpatient stays were predictors for closure time in all models. Since these predictors may give an indication of wound severity, further clinical information should be considered in future models, as also indicated by the moderate values of the c-statistics. This requires future data linkage between SHI and primary studies (eg, registers).
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Affiliation(s)
- Kristina Hagenström
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP)University Medical Center Hamburg‐Eppendorf (UKE)HamburgGermany
| | - Kerstin Protz
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP)University Medical Center Hamburg‐Eppendorf (UKE)HamburgGermany
| | - Jana Petersen
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP)University Medical Center Hamburg‐Eppendorf (UKE)HamburgGermany
| | - Matthias Augustin
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP)University Medical Center Hamburg‐Eppendorf (UKE)HamburgGermany
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14
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Kerstan A, Dieter K, Niebergall-Roth E, Dachtler AK, Kraft K, Stücker M, Daeschlein G, Jünger M, Görge T, Meyer-Pannwitt U, Erfurt-Berge C, von Engelhardt C, Klare A, Pfeiffer C, Esterlechner J, Schröder HM, Gasser M, Waaga-Gasser AM, Goebeler M, Ballikaya S, Sadeghi S, Murphy GF, Orgill DP, Frank NY, Ganss C, Scharffetter-Kochanek K, Frank MH, Kluth MA. Allogeneic ABCB5 + mesenchymal stem cells for treatment-refractory chronic venous ulcers: a phase I/IIa clinical trial. JID INNOVATIONS 2022; 2:100067. [PMID: 34870260 PMCID: PMC8635035 DOI: 10.1016/j.xjidi.2021.100067] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 12/29/2022] Open
Abstract
A significant number of chronic venous ulcers (CVUs) fail to heal despite of guideline-conform standard of care. Skin-derived ABCB5+ mesenchymal stem cells (MSCs) can dampen the sustained IL-1β-driven inflammation present in chronic wounds. Based on their wound healing-facilitating effects in a mouse CVU model and an autologous first-in-human study, ABCB5+ MSCs have emerged as a potential candidate for cell-based advanced therapy of non-healing CVUs. In the present interventional, multicenter, single-arm, phase I/IIa clinical trial, subjects whose CVU had emerged as standard therapy-resistant received one or two topical applications of 1×106 allogeneic ABCB5+ MSCs/cm2 wound area in addition to standard treatment. Out of 83 treatment-emergent adverse events, only three were judged related to the cell product; they were mild or moderate and recovered without sequelae. Wound size markedly decreased from baseline to week 12, resulting in a median wound size reduction of 76% (full analysis set, N=31), 78% (per-protocol set, N=27) and 87% (subset of responders; n=21). In conclusion, the study treatment was well tolerated and safe. The treatment elicited a profound wound size reduction within 12 weeks, identifying ABCB5+ MSCs as a potential candidate for adjunctive therapy of otherwise incurable CVUs. These results justify the conduct of a larger, randomized, controlled trial to confirm clinical efficacy.
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Affiliation(s)
- Andreas Kerstan
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | | | | | | | | | - Markus Stücker
- Department of Dermatology, St. Josef Hospital, Catholic Clinic Bochum, Ruhr University Bochum, Bochum, Germany
| | - Georg Daeschlein
- Department of Dermatology, University Hospital Greifswald, Greifswald, Germany
- Clinic of Dermatology, Immunology and Allergology, Medical University Brandenburg “Theodor Fontane” Medical Center Dessau, Dessau, Germany
| | - Michael Jünger
- Department of Dermatology, University Hospital Greifswald, Greifswald, Germany
| | - Tobias Görge
- Department of Dermatology, University Hospital Münster, Münster, Germany
| | - Ulrich Meyer-Pannwitt
- pro scientia med at the Department of Clinical Research and Development, MARE Clinic, Kiel, Germany
| | | | | | | | - Christiane Pfeiffer
- Department of Dermatology and Allergic Diseases, University Hospital, Ulm, Germany
| | | | | | - Martin Gasser
- Department of Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Ana M. Waaga-Gasser
- Department of Surgery, University Hospital Würzburg, Würzburg, Germany
- Division of Renal (Kidney) Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthias Goebeler
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | | | | | - George F. Murphy
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Dennis P. Orgill
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Natasha Y. Frank
- Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts, USA
- Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Transplant Research Program, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Stem Cell Institute, Harvard University, Cambridge, Massachusetts, USA
| | | | | | - Markus H. Frank
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Transplant Research Program, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Stem Cell Institute, Harvard University, Cambridge, Massachusetts, USA
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Mark A. Kluth
- RHEACELL, Heidelberg, Germany
- TICEBA, Heidelberg, Germany
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15
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Ramelet AA. Venous ulcer healing: Considerations for an optimal protocol. Ann Dermatol Venereol 2021; 148:209-210. [PMID: 34243983 DOI: 10.1016/j.annder.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- A-A Ramelet
- Department of Dermatology, Inselspital, CH-3011 Bern, Switzerland.
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16
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Baltazard T, Senet P, Momar D, Picard C, Joachim C, Adas A, Lok C, Chaby G. Evaluation of timolol maleate gel for management of hard-to-heal chronic venous leg ulcers. Phase II randomised-controlled study. Ann Dermatol Venereol 2021; 148:228-232. [PMID: 33551214 DOI: 10.1016/j.annder.2020.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/27/2020] [Accepted: 11/05/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Venous leg ulcers (VLUs) often take a very long time to heal. Timolol maleate has been reported as displaying efficacy in healing of VLUs. OBJECTIVES To evaluate the efficacy of timolol maleate gel in the management of hard-to-heal VLUs and to assess its safety as a topical agent during 12 weeks of use in combination with conventional treatment. METHODS A prospective, phase-II randomised-controlled trial with a sample size based on Fleming's one-stage design (P0=0.25, P1=0.45, alpha=0.1, beta=0.2) was planned. Patients with VLUs present for ≥24 weeks and with ≥50% granulation tissue were included. One drop of sustained-release timolol gel (Timoptol® LP 0.5%, Santen, Tampere, Finland) per 6 cm2 VLU area was applied every 2 days for 12 weeks in timolol-treated patients, as adjuvant therapy to the standard care protocol (interface dressing and multilayer venous compression). Controls received standard care alone. The primary endpoint was to obtain ≥40% reduction in ulcer area at week 12 (W12). RESULTS Forty-three patients were randomised to the study, with 40 receiving at least one treatment and included in the analysis: 21 timolol-treated patients and 19 controls (females: 70%; median age: 72.5 [range 35-93] years). At W12, ≥40% ulcer-area reduction was achieved in 14/21 (67%) timolol-treated patients vs. 6/19 (32%) controls. No serious adverse events occurred. Local wound infections not requiring systemic antibiotics occurred in 5 cases in the timolol group and in one case in the controls. CONCLUSIONS These results support the benefit and safety of using timolol maleate to manage hard-to-heal VLUs, but confirmation is required in a larger multicentre randomised phase-III study.
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Affiliation(s)
- T Baltazard
- Department of dermatology, university hospital of Amiens Picardy, université Picardie Jules-Verne, 80054 Amiens cedex 1, France
| | - P Senet
- Department of dermatology, allergy and vascular medicine, hôpital Tenon, hôpitaux universitaires Paris-Est, 75970 Paris cedex 20, France
| | - D Momar
- Department of clinical research and innovation, university hospital of Amiens Picardy, université Picardie Jules-Verne, 80054 Amiens cedex 1, France
| | - C Picard
- Department of clinical research and innovation, university hospital of Amiens Picardy, université Picardie Jules-Verne, 80054 Amiens cedex 1, France
| | - C Joachim
- Department of dermatology, university hospital of Amiens Picardy, université Picardie Jules-Verne, 80054 Amiens cedex 1, France
| | - A Adas
- Department of dermatology, university hospital of Amiens Picardy, université Picardie Jules-Verne, 80054 Amiens cedex 1, France
| | - C Lok
- Department of dermatology, university hospital of Amiens Picardy, université Picardie Jules-Verne, 80054 Amiens cedex 1, France
| | - G Chaby
- Department of dermatology, university hospital of Amiens Picardy, université Picardie Jules-Verne, 80054 Amiens cedex 1, France.
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17
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Moitinho MS, Yamachi CY, González CVS, de Gouveia Santos VLC, Gamba MA. Determinantes sociales y demográficos relacionados con la cicatrización de heridas en un centro de asistencia y educación en enfermería. J Wound Care 2020; 29:44-53. [PMID: 33251959 DOI: 10.12968/jowc.2020.29.latam_sup_3.44] [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 Analyse the social and demographic variables that affect healing in patients with hard-to-heal wounds. METHOD This retrospective study looked at 349 patient records of people with hard-to-heal wounds at an educational and care centre in San Pablo, Brazil, between 1994 and 2015. Healing was measured using the Pressure Ulcer Scale for Healing (PUSH). RESULTS A total of 128 patient records were included. Most had identified themselves as white (62%), with an incomplete education (31%), household income under three minimum wages (86%), diabetes mellitus (61%), and systemic hypertension (58.4%). The PUSH scale varied between 4-7. The healing rate was 60%. Patients with white/yellow skin had 3.43 more chances to achieve healing (p<0,001). CONCLUSION The social determinants observed were similar to Brazil's major inequality indicators. Statistical significance for white/yellow skin colour related to wound healing was observed. Nursing consultations contributed in achieving wound healing.
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Affiliation(s)
| | - Cintia Yurie Yamachi
- Escola Paulista de Enfermagem, Universidade Federal de São Paulo, San Pablo, Brasil
| | - Carol V Serna González
- Programa de Posgrado en Enfermería en la Salud del Adulto (PROESA), Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil
| | - Vera L C de Gouveia Santos
- Programa de Posgrado en Enfermería en la Salud del Adulto (PROESA), Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil.,Departamento de Enfermería Médico-quirúrgica, Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil
| | - Mônica Antar Gamba
- Departamento de Enfermería y salud colectiva, Escola Paulista de Enfermagem, Universidade Federal de São Paulo, San Pablo, Brasil
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18
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Jørgensen LB, Halekoh U, Jemec GB, Sørensen JA, Yderstræde KB. Monitoring Wound Healing of Diabetic Foot Ulcers Using Two-Dimensional and Three-Dimensional Wound Measurement Techniques: A Prospective Cohort Study. Adv Wound Care (New Rochelle) 2020. [DOI: 10.1089/wound.2019.1000] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Line Bisgaard Jørgensen
- Steno Diabetes Center Odense, Odense University Hospital and Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
- CIMT, Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - Ulrich Halekoh
- Department of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense, Denmark
| | - Gregor B.E. Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde and Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens Ahm Sørensen
- Department of Plastic Surgery, Odense University Hospital and Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Knud Bonnet Yderstræde
- Steno Diabetes Center Odense, Odense University Hospital and Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- CIMT, Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
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19
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Gethin G, Vellinga A, Tawfick W, O'Loughlin A, McIntosh C, Mac Gilchrist C, Murphy L, Ejiugwo M, O'Regan M, Cameron A, Ivory JD. The profile of patients with venous leg ulcers: A systematic review and global perspective. J Tissue Viability 2020; 30:78-88. [PMID: 32839066 DOI: 10.1016/j.jtv.2020.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/05/2020] [Accepted: 08/05/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND A holistic profile that includes demographic, medical history and wound characteristics of individuals with venous leg ulceration is lacking. Lack of such a profile negatively impacts the ability to develop interventions to improve patient outcomes. OBJECTIVES To describe the profile of the patient population with venous leg ulceration from published observational (non-interventional) studies and to identify gaps in the knowledge base for future research in this area. METHODS A systematic review of observational studies that included more than 50 patients, from any world region, of any age and in any care setting. RESULTS twenty studies, involving 3395 patients, from all world regions met our criteria. Demographic characteristics were well reported and showed a female to male ratio of 1.2:1, average age of 47-65 years, high levels of co-morbidities including hypertension (53-71%) and diabetes (16-20%), and only one study reporting ethnicity. When reported, approximately 4-30% had high levels of depression. The average wound size was 18.6-43.39 cm2; mean wound duration was 13.8-65.5 months, mean number of recurrences was four. No study reported on demographic factors plus medical history plus wound characteristics together. CONCLUSION a comprehensive, holistic profile of the population with VLU is lacking. There is a critical need for more comprehensive profiling to enable the development of targeted interventions to improve outcomes.
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Affiliation(s)
- G Gethin
- National University of Ireland, Galway, Ireland; Alliance for Research & Innovation in Wounds (ARIW), Ireland.
| | - A Vellinga
- National University of Ireland, Galway, Ireland; Alliance for Research & Innovation in Wounds (ARIW), Ireland
| | - W Tawfick
- National University of Ireland, Galway, Ireland; Alliance for Research & Innovation in Wounds (ARIW), Ireland
| | - A O'Loughlin
- National University of Ireland, Galway, Ireland; Alliance for Research & Innovation in Wounds (ARIW), Ireland
| | - C McIntosh
- National University of Ireland, Galway, Ireland; Alliance for Research & Innovation in Wounds (ARIW), Ireland
| | - C Mac Gilchrist
- National University of Ireland, Galway, Ireland; Alliance for Research & Innovation in Wounds (ARIW), Ireland
| | - L Murphy
- National University of Ireland, Galway, Ireland; Alliance for Research & Innovation in Wounds (ARIW), Ireland
| | - M Ejiugwo
- National University of Ireland, Galway, Ireland; Alliance for Research & Innovation in Wounds (ARIW), Ireland
| | - M O'Regan
- National University of Ireland, Galway, Ireland; Alliance for Research & Innovation in Wounds (ARIW), Ireland
| | - A Cameron
- National University of Ireland, Galway, Ireland; Alliance for Research & Innovation in Wounds (ARIW), Ireland
| | - J D Ivory
- National University of Ireland, Galway, Ireland; Alliance for Research & Innovation in Wounds (ARIW), Ireland
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20
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Rodriguez JEC, Gamboa SG. Psychosocial factors of patients with venous leg ulcers and their association with healing. ESTIMA 2020. [DOI: 10.30886/estima.v18.845_in] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objectives: To identify psychosocial factors present in patients with venous leg ulcers and the association that these factors have in the healing of venous leg ulcers. Methods: An integrative review of the quantitative studies in MEDLINE, Scielo and Cochrane Library databases, between 2008 and 2019, using the keywords, psychosocial factors, venous ulcer, wound healing, anxiety and depression in English, Spanish and Portuguese. Results: sixteen studies were included. The psychosocial factors present in patients with venous ulcers were depression, anxiety, feelings of helplessness, subjective well-being, self-esteem, loneliness and spirituality. Stress, a negative perception of venous ulcer, living alone and severe experience of symptoms such as pain and depression have statistically significant associations with longer periods of healing. Conclusions: Depression is one of the most frequently measured factors and present in this population. The available evidence on the association of psychosocial factors with the healing of venous ulcers is low.
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21
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Rodriguez JEC, Gamboa SG. Factores psicosociales en los pacientes con úlceras venosas y su asociación con la cicatrización. ESTIMA 2020. [DOI: 10.30886/estima.v18.845_esp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objetivo: Identificar los factores psicosociales presentes en pacientes con úlceras venosas y la evidencia disponible sobre la asociación que estos factores tienen con la curación de este tipo de heridas. Métodos: Revisión integradora de la literatura de estudios cuantitativos en las bases de datos MEDLINE, Scielo y Cochrane Library entre los años 2008 y 2019, utilizando las palabras clave, factores psicosociales, úlcera venosa, cicatrización de heridas ansiedad y depresión en idioma inglés, español y portugués. Resultados: Dieciséis estudios fueron incluidos. Los factores psicosociales presentes en los pacientes con úlceras venosas fueron depresión, ansiedad, sentimientos de impotencia, bienestar subjetivo, autoestima, soledad y espiritualidad. El estrés, una percepción negativa de la úlcera venosa, vivir solo y la experiencia severa de síntomas como dolor y depresión tienen asociaciones estadísticamente significativas con periodos más prolongados de curación. Conclusión: La depresión es uno de los factores psicológicos medido y presente con mayor frecuencia en esta población. La evidencia disponible frente a la asociación de los factores psicosociales con la curación de úlceras venosas es escasa.
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22
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Monfort JB, Senet P. Leg Ulcers in Sickle-Cell Disease: Treatment Update. Adv Wound Care (New Rochelle) 2020; 9:348-356. [PMID: 32286203 DOI: 10.1089/wound.2018.0918] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Significance: Sickle-cell leg ulcers (SCLUs) are a severe, chronic, and recurrent complication of sickle-cell disease (SCD). There are no official recommendations for treatment. Recent Advances: Only a few studies with a high level of evidence have been conducted to evaluate treatment of SCLUs. However, several studies have been conducted with a high level of evidence to evaluate the efficacy of treatments in venous leg ulcers, and SCLUs could benefit from these treatments, especially when a venous incompetence or an edema is associated. Pathophysiology of SCLUs includes a vasculopathy related to chronic hemolysis and an endothelial dysfunction, which could be therapeutic approaches to SCLU treatment. Critical Issues: Therapeutic approaches to SCLUs can target SCD on the one hand and skin healing and associated aggravating factors on the other. A review of the literature found only case series and six randomized controlled trials; some offered encouraging results, but most had serious biases. Clinical trials specifically targeting SCLUs are difficult to realize because of the small number of affected patients, in comparison with patients with leg ulcers from other causes. Future Direction: Treating SCLUs remains a challenge. Data in the literature are currently insufficient to offer clear treatment guidelines because of several biases in controlled studies. New studies are under way to assess the efficacy of topical treatments and describe the microbiome of SCLUs. Prevention of SCLU recurrence should be assessed in future clinical trials because the high risk of recurrence is an unsolved critical issue.
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Affiliation(s)
| | - Patricia Senet
- Department of Dermatology, Tenon Hospital, Paris, France
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23
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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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24
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Gethin G, Ivory JD, Connell L, McIntosh C, Weller CD. External validity of randomized controlled trials of interventions in venous leg ulceration: A systematic review. Wound Repair Regen 2019; 27:702-710. [DOI: 10.1111/wrr.12756] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/02/2019] [Accepted: 07/27/2019] [Indexed: 01/01/2023]
Affiliation(s)
- Georgina Gethin
- School of Nursing and Midwifery, NUI Galway Galway Ireland
- Alliance for Research and Innovation in Wounds, NUI Galway Galway Ireland
- School of Nursing and Midwifery, Monash University Australia
| | - John D. Ivory
- School of Nursing and Midwifery, NUI Galway Galway Ireland
- Alliance for Research and Innovation in Wounds, NUI Galway Galway Ireland
| | - Lauren Connell
- Alliance for Research and Innovation in Wounds, NUI Galway Galway Ireland
- Discipline of Podiatric Medicine, School of Health Sciences, NUI Galway Galway Ireland
| | - Caroline McIntosh
- Alliance for Research and Innovation in Wounds, NUI Galway Galway Ireland
- Discipline of Podiatric Medicine, School of Health Sciences, NUI Galway Galway Ireland
| | - Carolina D. Weller
- School of Nursing and Midwifery, NUI Galway Galway Ireland
- Alliance for Research and Innovation in Wounds, NUI Galway Galway Ireland
- School of Nursing and Midwifery, Monash University Australia
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Jenkins DA, Mohamed S, Taylor JK, Peek N, van der Veer SN. Potential prognostic factors for delayed healing of common, non-traumatic skin ulcers: A scoping review. Int Wound J 2019; 16:800-812. [PMID: 30821117 PMCID: PMC6563199 DOI: 10.1111/iwj.13100] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 02/04/2019] [Indexed: 01/08/2023] Open
Abstract
Healing of non-traumatic skin ulcers is often suboptimal. Prognostic tools that identify people at high risk of delayed healing within the context of routine ulcer assessments may improve this, but robust evidence on which factors to include is lacking. Therefore, we scoped the literature to identify which potentially prognostic factors may warrant future systematic reviews and meta-analyses. We conducted electronic searches in MEDLINE and Embase to identify studies in English published between 1997 and 2017 that tested the association between healing of the three most common non-traumatic skin ulcers encountered by health care professionals (venous leg, diabetic foot, and pressure ulcers) and patient characteristics, ulcer characteristics, and results from clinical investigations. We included 42 studies that investigated factors which may be associated with the healing of venous leg ulcers (n = 17), diabetic foot ulcers (n = 15), and pressure ulcers (n = 10). Across ulcer types, ulcer characteristics were most commonly reported as potential prognostic factors for healing (n = 37), including the size of the ulcer area (n = 29) and ulcer duration at first assessment (n = 16). A total of 35 studies investigated the prognostic value of patient characteristics (n = 35), including age (n = 31), gender (n = 30), diabetes (n = 22), smoking status (n = 15), and history of deep vein thrombosis (DVT) (n = 13). Of these studies, 23 reported results from clinical investigations as potential prognostic factors, with the majority regarding vessel quality. Age, gender, diabetes, smoking status, history of DVT, ulcer area, and ulcer duration at time of first assessment warrant a systematic review and meta-analysis to quantify their prognostic value for delayed ulcer healing.
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Affiliation(s)
- David A. Jenkins
- NIHR Greater Manchester Patient Safety Translational Research CentreThe University of ManchesterManchesterUK
- Health e‐Research Centre, Centre for Health Informatics, Division of Informatics, Imaging and Data Science, School of Health Sciences, Manchester Academic Health Science CentreThe University of ManchesterManchesterUK
| | - Sundus Mohamed
- Health e‐Research Centre, Centre for Health Informatics, Division of Informatics, Imaging and Data Science, School of Health Sciences, Manchester Academic Health Science CentreThe University of ManchesterManchesterUK
| | - Joanne K. Taylor
- Health e‐Research Centre, Centre for Health Informatics, Division of Informatics, Imaging and Data Science, School of Health Sciences, Manchester Academic Health Science CentreThe University of ManchesterManchesterUK
- Manchester University NHS Foundation TrustManchesterUK
| | - Niels Peek
- NIHR Greater Manchester Patient Safety Translational Research CentreThe University of ManchesterManchesterUK
- Health e‐Research Centre, Centre for Health Informatics, Division of Informatics, Imaging and Data Science, School of Health Sciences, Manchester Academic Health Science CentreThe University of ManchesterManchesterUK
- NIHR Manchester Biomedical Research Centre, Faculty of Biology Medicine and HealthThe University of ManchesterManchesterUK
| | - Sabine N. van der Veer
- NIHR Greater Manchester Patient Safety Translational Research CentreThe University of ManchesterManchesterUK
- Health e‐Research Centre, Centre for Health Informatics, Division of Informatics, Imaging and Data Science, School of Health Sciences, Manchester Academic Health Science CentreThe University of ManchesterManchesterUK
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Melikian R, O'Donnell TF, Suarez L, Iafrati MD. Risk factors associated with the venous leg ulcer that fails to heal after 1 year of treatment. J Vasc Surg Venous Lymphat Disord 2018; 7:98-105. [PMID: 30558732 DOI: 10.1016/j.jvsv.2018.07.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 07/19/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Despite regular treatment of venous leg ulcers (VLUs), some fail to heal. Although several risk factors have previously been identified to be associated with the failure of VLUs to heal, the majority of studies are limited to <24-week follow-up. METHODS A retrospective cohort study was performed at an academic vascular and wound center. A total of 65 patients with VLUs who were observed for a year or more were identified. These patients underwent a variety of treatments following the Society for Vascular Surgery and American Venous Forum VLU guidelines. Risk factors, which were based on previously defined elements for failure of VLUs to heal after a period of treatment, were examined. Both univariate (unadjusted) and multivariate (adjusted) logistic regression analyses were used to assess the magnitude of effect that a given risk factor had on healing. RESULTS Of 65 patients treated for a minimum of 52 weeks, 19 (29%) remained unhealed. By univariate analysis, deep venous disease (P = .01; odds ratio [OR], 5.82; 95% confidence interval [CI], 1.49-22.72), history of deep venous thrombosis (P < .001; OR, 14.06; 95% CI, 3.77-52.39), and depression (P = .04; OR, 3.89; 95% CI, 1.10-13.80) were all shown to be significant risk factors for nonhealing. The patient's race (ie, being nonwhite; P = .02; OR, 103.45; 95% CI, 1.94-5.53 × 103), deep venous disease (P = .05; OR, 37.0; 95% CI, 1.05-1.31 × 103), and history of deep venous thrombosis (P = .01; OR, 122.4; 95% CI, 3.09-4.84 × 103), however, were all shown to be significant for nonhealing under multivariate analysis. In addition, identification of an incompetent perforator (P = .02; OR, 0.006; 95% CI, 9.27 × 10-5-0.44) was conversely shown to be a good prognostic factor for healing. CONCLUSIONS This study confirmed that risk factors known to be associated with the failure of a VLU to heal-deep venous disease and post-thrombotic etiology-were significant at 52 weeks, whereas depression and race (nonwhite) are novel risk factors. An analysis of markers of access to care showed no difference between white and nonwhite, suggesting other factors as a cause. The predominance of deep venous disease in the unhealed vs healed cohort (84% vs 48%) highlights the need for a viable treatment option for deep venous disease due to reflux. Overall, this study emphasizes the need to consider all risk factors when evaluating a patient for VLU to coordinate an effective treatment plan and to identify gaps in our treatment.
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Affiliation(s)
| | - Thomas F O'Donnell
- Tufts University School of Medicine, Boston, Mass; The CardioVascular Center at Tufts Medical Center, Boston, Mass
| | - Luis Suarez
- Tufts University School of Medicine, Boston, Mass; The CardioVascular Center at Tufts Medical Center, Boston, Mass
| | - Mark D Iafrati
- Tufts University School of Medicine, Boston, Mass; The CardioVascular Center at Tufts Medical Center, Boston, Mass
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Westby MJ, Dumville JC, Stubbs N, Norman G, Wong JKF, Cullum N, Riley RD. Protease activity as a prognostic factor for wound healing in venous leg ulcers. Cochrane Database Syst Rev 2018; 9:CD012841. [PMID: 30171767 PMCID: PMC6513613 DOI: 10.1002/14651858.cd012841.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Venous leg ulcers (VLUs) are a common type of complex wound that have a negative impact on people's lives and incur high costs for health services and society. It has been suggested that prolonged high levels of protease activity in the later stages of the healing of chronic wounds may be associated with delayed healing. Protease modulating treatments have been developed which seek to modulate protease activity and thereby promote healing in chronic wounds. OBJECTIVES To determine whether protease activity is an independent prognostic factor for the healing of venous leg ulcers. SEARCH METHODS In February 2018, we searched the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Ovid Embase and CINAHL. SELECTION CRITERIA We included prospective and retrospective longitudinal studies with any follow-up period that recruited people with VLUs and investigated whether protease activity in wound fluid was associated with future healing of VLUs. We included randomised controlled trials (RCTs) analysed as cohort studies, provided interventions were taken into account in the analysis, and case-control studies if there were no available cohort studies. We also included prediction model studies provided they reported separately associations of individual prognostic factors (protease activity) with healing. Studies of any type of protease or combination of proteases were eligible, including proteases from bacteria, and the prognostic factor could be examined as a continuous or categorical variable; any cut-off point was permitted. The primary outcomes were time to healing (survival analysis) and the proportion of people with ulcers completely healed; the secondary outcome was change in ulcer size/rate of wound closure. We extracted unadjusted (simple) and adjusted (multivariable) associations between the prognostic factor and healing. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion at each stage, and undertook data extraction, assessment of risk of bias and GRADE assessment. We collected association statistics where available. No study reported adjusted analyses: instead we collected unadjusted results or calculated association measures from raw data. We calculated risk ratios when both outcome and prognostic factor were dichotomous variables. When the prognostic factor was reported as continuous data and healing outcomes were dichotomous, we either performed regression analysis or analysed the impact of healing on protease levels, analysing as the standardised mean difference. When both prognostic factor and outcome were continuous data, we reported correlation coefficients or calculated them from individual participant data.We displayed all results on forest plots to give an overall visual representation. We planned to conduct meta-analyses where this was appropriate, otherwise we summarised narratively. MAIN RESULTS We included 19 studies comprising 21 cohorts involving 646 participants. Only 11 studies (13 cohorts, 522 participants) had data available for analysis. Of these, five were prospective cohort studies, four were RCTs and two had a type of case-control design. Follow-up time ranged from four to 36 weeks. Studies covered 10 different matrix metalloproteases (MMPs) and two serine proteases (human neutrophil elastase and urokinase-type plasminogen activators). Two studies recorded complete healing as an outcome; other studies recorded partial healing measures. There was clinical and methodological heterogeneity across studies; for example, in the definition of healing, the type of protease and its measurement, the distribution of active and bound protease species, the types of treatment and the reporting of results. Therefore, meta-analysis was not performed. No study had conducted multivariable analyses and all included evidence was of very low certainty because of the lack of adjustment for confounders, the high risk of bias for all studies except one, imprecision around the measures of association and inconsistency in the direction of association. Collectively the research indicated complete uncertainty as to the association between protease activity and VLU healing. AUTHORS' CONCLUSIONS This review identified very low validity evidence regarding any association between protease activity and VLU healing and there is complete uncertainty regarding the relationship. The review offers information for both future research and systematic review methodology.
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Affiliation(s)
- Maggie J Westby
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Jo C Dumville
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Nikki Stubbs
- St Mary's HospitalLeeds Community Healthcare NHS Trust3 Greenhill RoadLeedsUKLS12 3QE
| | - Gill Norman
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Jason KF Wong
- Manchester University NHS Foundation TrustManchester Centre for Plastic Surgery and Burns, Wythenshawe HospitalSouthmoor Road, WythenshaweManchesterUKM23 9LT
| | - Nicky Cullum
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Richard D Riley
- Keele UniversityResearch Institute for Primary Care and Health SciencesDavid Weatherall Building, Keele University CampusKeeleStaffordshireUKST5 5BG
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García Carretero R, Garrido-Ollero M, Martinez-Alvarez A, Cadenas-Vara A. Methacrylate dressing on refractory venous leg ulcers. BMJ Case Rep 2018; 2018:bcr-2017-223084. [PMID: 29545429 DOI: 10.1136/bcr-2017-223084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Chronic leg ulcers can have a major impact on the quality of life of patients. These wounds can be complex and hard to heal, as several factors may affect the outcome. Underlying conditions, bacterial growth and excess moisture may prevent wounds from healing. We describe the case of a patient with known chronic venous disease, who was admitted to our hospital for several complex, irregular and infected chronic venous ulcers in his lower legs. The management was frustrating for several months, until we began to use methacrylate powder dressing for his hard-to-heal wounds.
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Affiliation(s)
| | | | | | - Ana Cadenas-Vara
- Hospital at Home, Hospital Universitario de Mostoles, Mostoles, Madrid, Spain
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29
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Diener H, Debus E, Herberger SK, Heyer K, Augustin M, Tigges W, Karl T, Storck M. Versorgungssituation gefäßmedizinischer Wunden in Deutschland. GEFASSCHIRURGIE 2017. [DOI: 10.1007/s00772-017-0326-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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30
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Chaby G, Lok C, Thirion JP, Lucien A, Senet P. Three-dimensional digital imaging is as accurate and reliable to measure leg ulcer area as transparent tracing with digital planimetry. J Vasc Surg Venous Lymphat Disord 2017; 5:837-843. [DOI: 10.1016/j.jvsv.2017.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 05/07/2017] [Indexed: 10/18/2022]
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31
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Westby MJ, Dumville JC, Stubbs N, Norman G, Wong JKF, Cullum N, Riley R. Protease activity as a prognostic factor for wound healing in venous leg ulcers. Hippokratia 2017. [DOI: 10.1002/14651858.cd012841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Maggie J Westby
- University of Manchester, Manchester Academic Health Science Centre; Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine & Health; Jean McFarlane Building Oxford Road Manchester UK M13 9PL
| | - Jo C Dumville
- University of Manchester, Manchester Academic Health Science Centre; Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine & Health; Jean McFarlane Building Oxford Road Manchester UK M13 9PL
| | - Nikki Stubbs
- Leeds Community Healthcare NHS Trust, St Mary's Hospital; Wound Prevention and Management Service; 3 Greenhill Road Leeds UK LS12 3QE
| | - Gill Norman
- University of Manchester, Manchester Academic Health Science Centre; Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine & Health; Jean McFarlane Building Oxford Road Manchester UK M13 9PL
| | - Jason KF Wong
- University Hospital South Manchester; Plastic and Reconstructive Surgery; Southmoor Road, Wythenshawe Manchester UK M23 9LT
| | - Nicky Cullum
- University of Manchester, Manchester Academic Health Science Centre; Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine & Health; Jean McFarlane Building Oxford Road Manchester UK M13 9PL
| | - Richard Riley
- Keele University; Research Institute for Primary Care and Health Sciences; David Weatherall Building, Keele University Campus Keele Staffordshire UK ST5 5BG
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Senet P, Blas-Chatelain C, Levy P, Manea E, Peschanski M, Mirault T, Stankovic-Stojanovic K, Debure C, Debbache K, Girot R, Bureau JM, Bachmeyer C, Baldeschi C, Galacteros F, Lionnet F, Gellen-Dautremer J. Factors predictive of leg-ulcer healing in sickle cell disease: a multicentre, prospective cohort study. Br J Dermatol 2017; 177:206-211. [DOI: 10.1111/bjd.15241] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2016] [Indexed: 01/01/2023]
Affiliation(s)
- P. Senet
- Service de Dermatologie; Hôpital Tenon; Assistance Publique-Hôpitaux de Paris (APHP); 4 Rue de la Chine Paris CEDEX 20 75970 France
| | - C. Blas-Chatelain
- Service de Rééducation Vasculaire; Hôpital Corentin-Celton; APHP; 4 Parvis Corentin-Celton, BP 66 Issy-les-Moulineaux CEDEX 92133 France
| | - P. Levy
- Service de Santé Publique; Hôpital Tenon; APHP; Université Pierre et Marie Curie and Institut National de la Santé et de la Recherche Médicale; UMR-S 1136; Paris France
| | - E.M. Manea
- Unité des Maladies Génétiques du Globule Rouge; Service de Médecine Interne; Centre de Référence de la Drépanocytose; Hôpital Henri-Mondor; APHP and Université Paris-Est Créteil; Créteil France
| | - M. Peschanski
- Inserm/UEVE UMR 861, I-Stem, AFM; Génopôle Campus 1 Évry France
| | - T. Mirault
- Service de Rééducation Vasculaire; Hôpital Corentin-Celton; APHP; 4 Parvis Corentin-Celton, BP 66 Issy-les-Moulineaux CEDEX 92133 France
| | - K. Stankovic-Stojanovic
- Service de Médecine Interne; Centre de Référence de la Drépanocytose; Hôpital Tenon; APHP and Université Pierre et Marie Curie; Paris France
| | - C. Debure
- Service de Rééducation Vasculaire; Hôpital Corentin-Celton; APHP; 4 Parvis Corentin-Celton, BP 66 Issy-les-Moulineaux CEDEX 92133 France
| | - K. Debbache
- Unité des Maladies Génétiques du Globule Rouge; Service de Médecine Interne; Centre de Référence de la Drépanocytose; Hôpital Henri-Mondor; APHP and Université Paris-Est Créteil; Créteil France
| | - R. Girot
- Service de Médecine Interne; Centre de Référence de la Drépanocytose; Hôpital Tenon; APHP and Université Pierre et Marie Curie; Paris France
| | - J.-M. Bureau
- Service de Rééducation Vasculaire; Hôpital Corentin-Celton; APHP; 4 Parvis Corentin-Celton, BP 66 Issy-les-Moulineaux CEDEX 92133 France
| | - C. Bachmeyer
- Service de Médecine Interne; Centre de Référence de la Drépanocytose; Hôpital Tenon; APHP and Université Pierre et Marie Curie; Paris France
| | - C. Baldeschi
- Inserm/UEVE UMR 861, I-Stem, AFM; Génopôle Campus 1 Évry France
| | - F. Galacteros
- Unité des Maladies Génétiques du Globule Rouge; Service de Médecine Interne; Centre de Référence de la Drépanocytose; Hôpital Henri-Mondor; APHP and Université Paris-Est Créteil; Créteil France
| | - F. Lionnet
- Service de Médecine Interne; Centre de Référence de la Drépanocytose; Hôpital Tenon; APHP and Université Pierre et Marie Curie; Paris France
| | - J. Gellen-Dautremer
- Service de Médecine Interne et Maladies Infectieuses; Centre Hospitalier Universitaire Poitires; 86021 Poitiers France
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Heyer K, Protz K, Glaeske G, Augustin M. Epidemiology and use of compression treatment in venous leg ulcers: nationwide claims data analysis in Germany. Int Wound J 2017; 14:338-343. [PMID: 27199102 PMCID: PMC7949887 DOI: 10.1111/iwj.12605] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 03/24/2016] [Accepted: 03/29/2016] [Indexed: 11/26/2022] Open
Abstract
Chronic venous diseases are the most common causes of leg ulcers. Compression treatment (CT) is a central component of venous leg ulcer (VLU) therapy along with prevention based on guidelines and clinical evidence. However, large-scale data on the use of CT are rare. In particular, there have not yet been published nationwide data for Germany. We analysed data from a large German statutory health insurance (SHI) on incident VLU between 2010 and 2012. VLUs were identified by ICD-10 diagnoses. The status of active disease was defined by wound-specific treatments. Compression stockings and bandages were identified by SHI medical device codes. The overall estimated incident rate of active VLU of all insured persons was 0·34% from 2010 to 2012. Adapted to the overall German population, n = 229 369 persons nationwide had an incident VLU in 2010-2012. Among all VLU patients, only 40·6% received CT within 1 year, including 83·3% stockings, 31·8% bandages and 3·1% multi-component compression systems. Compression rates showed significant differences by gender and age. Large regional variations were observed. Validity of data is suggested by high concordance with a primary cohort study. Although recommended by guidelines, there is still a marked under-provision of care, with CT in incident VLUs in Germany requiring active measures.
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Affiliation(s)
- Kristina Heyer
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP)University Medical Center Hamburg‐Eppendorf (UKE)HamburgGermany
| | - Kerstin Protz
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP)University Medical Center Hamburg‐Eppendorf (UKE)HamburgGermany
| | - Gerd Glaeske
- Centre for Social Policy ResearchUniversity of BremenBremenGermany
| | - Matthias Augustin
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP)University Medical Center Hamburg‐Eppendorf (UKE)HamburgGermany
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Parker CN, Finlayson KJ, Edwards HE. Ulcer area reduction at 2 weeks predicts failure to heal by 24 weeks in the venous leg ulcers of patients living alone. J Wound Care 2017; 25:626-634. [PMID: 27827277 DOI: 10.12968/jowc.2016.25.11.626] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Chronic wounds are costly and affect approximately 1-2% of the population. Venous disease is responsible for about 60% of all chronic leg ulcers and these ulcers can be debilitating, with evidence of a decreased quality of life. Unfortunately, up to 30% of venous leg ulcers (VLUs) fail to heal, despite best practice treatment. This study aimed to identify risk factors associated with delayed healing in participants with VLUs and in particular, whether psychosocial factors play a part in this process. METHOD A secondary analysis was conducted of a large data set of clinical, wound healing, health, social, economic and psychological data collected in previous prospective studies of participants with VLUs. Generalised linear mixed modelling was used to identify independent predictors of failure to heal after 24 weeks. RESULTS We recruited 247 participants with 318 VLUs from hospital and community settings. Findings revealed that four early predictors were independently significantly associated with failure to heal by 24 weeks. These were: participants who lived alone (OR 2.3, 95%CI [1.13-4.61], p=0.03); had less than 25% reduction in ulcer area within two weeks of treatment (OR 10.07, 95%CI [4.60-22.19], p<0.001); had higher ulcer severity scores (OR 5.1, 95%CI [2.33-11.88], p=0.001); and participants who were not treated with high level compression therapy (i.e.>30 mmHg) at the time of assessment (OR 4.18, 95% CI [1.95-8.97], p=0.002). CONCLUSION Identified risk factors offer an opportunity for clinicians to determine realistic outcomes for their patients and to guide decisions on early referral and implementation of tailored adjunctive interventions. Additionally, findings from this study suggest health professionals need to assess and address not only clinical risk factors but also social risk factors, when planning interventions to promote healing.
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Affiliation(s)
- C N Parker
- Assistant Dean (International and Engagement), School of Nursing, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD, 4059 Australia.,Assistant Dean (International and Engagement), Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue Kelvin Grove, QLD, 4059 Australia.,Assistant Dean (International and Engagement), Faculty of Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD 4059 Australia.,Assistant Dean (International and Engagement), Wound Management Innovation Cooperative Research Centre, Oxley House, Level 2, 25 Donkin Street West End, QLD 4101 Australia
| | - K J Finlayson
- Assistant Dean (International and Engagement), School of Nursing, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD, 4059 Australia.,Assistant Dean (International and Engagement), Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue Kelvin Grove, QLD, 4059 Australia.,Assistant Dean (International and Engagement), Faculty of Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD 4059 Australia.,Assistant Dean (International and Engagement), Wound Management Innovation Cooperative Research Centre, Oxley House, Level 2, 25 Donkin Street West End, QLD 4101 Australia
| | - H E Edwards
- Assistant Dean (International and Engagement), Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue Kelvin Grove, QLD, 4059 Australia.,Assistant Dean (International and Engagement), Faculty of Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD 4059 Australia.,Assistant Dean (International and Engagement), Wound Management Innovation Cooperative Research Centre, Oxley House, Level 2, 25 Donkin Street West End, QLD 4101 Australia
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Dalac S, Sigal L, Addala A, Chahim M, Faivre-Carrere C, Lemdjadi Z, Bohbot S. Clinical evaluation of a dressing with poly absorbent fibres and a silver matrix for managing chronic wounds at risk of infection: a non comparative trial. J Wound Care 2017; 25:531-8. [PMID: 27608514 DOI: 10.12968/jowc.2016.25.9.531] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To assess the efficacy, safety and acceptability of a new silver poly absorbent dressing (UrgoCleanAg) in the local management of exudative chronic wounds at risk of infection, with inflammatory signs suggesting heavy bacterial load. METHOD This prospective, multicentre, non-comparative clinical trial was conducted in French hospital wards (dermatology and vascular medicine) or specialised private-practice physicians. Patients were considered at high-risk of infection when presenting with at least three of five selected inflammatory clinical signs, suggesting a heavy bacterial load (pain between two dressing changes, erythema, oedema, malodorous wound and presence of a heavy exudate). They were treated for a maximum period of four weeks, and followed by the physician on a weekly basis, including a clinical examination, area tracings and photographs. The primary efficacy criterion of the trial was the relative wound surface area reduction at the end of the four weeks of treatment. Acceptability was documented by the nursing staff at each dressing change between the weekly evaluations. RESULTS We recruited 37 patients with chronic wounds. Wound surface area, mostly covered by sloughy tissue, was reduced by 32.5% at the end of the treatment (median value), while the clinical score (maximum value of 5, based on inflammatory clinical signs) decreased from 4.0 to 2.0. Effective debridement properties were documented (62.5% relative reduction of sloughy tissue at week 4; 58.8% of debrided wounds at week 4) and improvement of the periwound skin status was noted (healthy for 28.6% of the patients at week 4 versus 2.7% at baseline). In addition, the tested wound dressing presented a good safety profile associated to a high level of acceptability, noted by both patients and nursing staff. CONCLUSION These clinical data support that the tested dressing is a credible therapeutic alternative for the management of chronic wounds at risk of infection with inflammatory signs suggesting heavy bacterial load.
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Affiliation(s)
- S Dalac
- Dermatology Department. Bocage University Hospital. Dijon. France
| | - L Sigal
- Head of Dermatology Department, Victor Dupouy Hospital. Argenteuil. France
| | - A Addala
- Department of Vascular Medicine. Edouard Herriot Hospital. Lyon. France
| | - M Chahim
- Vascular Physician, Angiologist, Corentin Celton Hospital. Paris. France
| | - C Faivre-Carrere
- Angiologist, Wound Healing Center. General Hospital. Saint Gaudens. France
| | - Z Lemdjadi
- Clinical Research Department. Laboratoires Urgo. Chenôve. France
| | - S Bohbot
- Medical Director, Laboratoires Urgo. Chenôve. France
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Harding K. Challenging passivity in venous leg ulcer care - the ABC model of management. Int Wound J 2016; 13:1378-1384. [PMID: 27146452 PMCID: PMC7949496 DOI: 10.1111/iwj.12608] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/06/2016] [Indexed: 11/30/2022] Open
Abstract
The under-utilisation of compression for venous leg ulcer (VLU) management translates into lost opportunities to heal wounds, improve patients' quality of life and maximise health care system efficiency. Although compression therapy is considered gold standard according to clinical guidelines, lack of clinician knowledge, unclear referral pathways, local unavailability of compression and patient unwillingness to receive compression, amongst other reasons, mean many candidates for compression do not receive appropriate treatment. This article presents a solution in the form of the 'ABC model of VLU management, a simplified approach that challenges passivity in the current approach to VLU treatment and supports wider adoption of appropriate compression therapy systems.
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Affiliation(s)
- Keith Harding
- Dean of Clinical InnovationCardiff UniversityCardiffUK
- Medical DirectorWelsh Wound Innovation CentreCardiffUK
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Bergersen TK, Storheim E, Gundersen S, Kleven L, Johnson M, Sandvik L, Kvaerner KJ, Ørjasæter NO. Improved Clinical Efficacy with Wound Support Network Between Hospital and Home Care Service. Adv Skin Wound Care 2016; 29:511-517. [DOI: 10.1097/01.asw.0000499714.97688.4b] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chapter 5 - Invasive treatment. J Eur Acad Dermatol Venereol 2016. [PMID: 27558990 DOI: 10.1111/jdv.6_13848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Evidence-based (S3) guidelines for diagnostics and treatment of venous leg ulcers. J Eur Acad Dermatol Venereol 2016; 30:1843-1875. [PMID: 27558268 DOI: 10.1111/jdv.13848] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 06/17/2016] [Indexed: 11/29/2022]
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Chapter 2 - Diagnostics. J Eur Acad Dermatol Venereol 2016. [PMID: 27558780 DOI: 10.1111/jdv.3_13848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Mooij MC, Huisman LC. Chronic leg ulcer: does a patient always get a correct diagnosis and adequate treatment? Phlebology 2016; 31:68-73. [DOI: 10.1177/0268355516632436] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Patients with chronic leg ulcers have severely impaired quality of life and account for a high percentage of annual healthcare costs. To establish the cause of a chronic leg ulcer, referral to a center with a multidisciplinary team of professionals is often necessary. Treating the underlying cause diminishes healing time and reduces costs. In venous leg ulcers adequate compression therapy is still a problem. It can be improved by training the professionals with pressure measuring devices. A perfect fitting of elastic stockings is important to prevent venous leg ulcer recurrence. In most cases, custom-made stockings are the best choice for this purpose.
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Affiliation(s)
- Michael C Mooij
- Department of Phlebology, Centrum Oosterwal Alkmaar, The Netherlands
| | - Laurens C Huisman
- Department of Vascular Surgery, Flevoziekenhuis, Almere and Department of Vascular Surgery, Amsterdam Medical Center, Amsterdam, The Netherlands
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Tang XL, Chen HL, Zhao FF. Meta-analytic approaches to determine gender differences for delayed healing in venous leg ulcers. Phlebology 2015; 31:744-752. [PMID: 26590132 DOI: 10.1177/0268355515616702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective The aim of this analysis was to perform a meta-analysis evaluating gender difference of delayed healing risk in patients with venous leg ulcers. Methods We searched the PubMed and Web of Knowledge from their inception to 4 July 2015. The meta-analysis of pooled odds ratio and 95% confidence interval for venous leg ulcers healing risk were calculated. Results Twelve studies with 4453 patients were included in the meta-analysis. The pooled odds ratio for healing rate stratified by gender was 1.055 (95% CI 0.955-1.165; Z = 1.05, p = 0.292) by fix-effects model. The Begg's test (z = 2.67, p = 0.007), the Egger's test (t = 4.00, p = 0.003), and asymmetric funnel plot suggested there was significant publication bias. Subgroup analysis showed the pooled odds ratios were 1.048 (95% CI 0.945-1.162; Z = 0.88, p = 0.376) in prospective studies and 1.439 (95% CI 0.757-2.736; Z = 1.11, p = 0.266) in retrospective studies. Sensitivity analyses by only pooled adjusted odds ratios showed the pooled odds ratio was 1.049 (95% CI 0.946-1.163; Z = 0.91, p = 0.365), which indicated the results of meta-analysis were robust. Meta-regression analysis showed the healing rate odds ratio stratified by gender was not related with healing rate (t = 0.73, p = 0.484). Conclusion Our meta-analysis indicates that no gender difference existed for delayed healing in venous leg ulcers. Our results may be also useful in developing a risk score for failure of venous leg ulcers to heal.
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Affiliation(s)
- Xiao-Lei Tang
- 1 Department of general surgery, Affiliated Hospital of Nantong University, Jiangsu Province, China PR
| | - Hong-Lin Chen
- 2 Nantong University, Nantong City, Jiangsu Province, PR China
| | - Fang-Fang Zhao
- 2 Nantong University, Nantong City, Jiangsu Province, PR China
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Parker CN, Finlayson KJ, Shuter P, Edwards HE. Risk factors for delayed healing in venous leg ulcers: a review of the literature. Int J Clin Pract 2015; 69:967-77. [PMID: 25831965 DOI: 10.1111/ijcp.12635] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Chronic leg ulcers, remaining unhealed after 4-6 weeks, affect 1-3% of the population, with treatment costly and health service resource intensive. Venous disease contributes to approximately 70% of all chronic leg ulcers and these ulcers are often associated with pain, reduced mobility and a decreased quality of life. Despite evidence-based care, 30% of these ulcers are unlikely to heal within a 24-week period and therefore the recognition and identification of risk factors for delayed healing of venous leg ulcers would be beneficial. AIM To review the available evidence on risk factors for delayed healing of venous leg ulcers. METHODS A review of the literature in regard to risk factors for delayed healing in venous leg ulcers was conducted from January 2000 to December 2013. Evidence was sourced through searches of relevant databases and websites for resources addressing risk factors for delayed healing in venous leg ulcers specifically. RESULTS Twenty-seven studies, of mostly low-level evidence (Level III and IV), identified risk factors associated with delayed healing. Risk factors that were consistently identified included: larger ulcer area, longer ulcer duration, a previous history of ulceration, venous abnormalities and lack of high compression. Additional potential predictors with inconsistent or varying evidence to support their influence on delayed healing of venous leg ulcers included: decreased mobility and/or ankle range of movement, poor nutrition and increased age. DISCUSSION Findings from this review indicate that a number of physiological risk factors are associated with delayed healing in venous leg ulcers and that social and/or psychological risk factors should also be considered and examined further. CONCLUSION The findings from this review can assist health professionals to identify prognostic indicators or risk factors significantly associated with delayed healing in venous leg ulcers. This will facilitate realistic outcome planning and inform implementation of appropriate early strategies to promote healing.
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Affiliation(s)
- C N Parker
- School of Nursing, Institute of Health & Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - K J Finlayson
- School of Nursing, Institute of Health & Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - P Shuter
- School of Nursing, Institute of Health & Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - H E Edwards
- Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia
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Éditorial. Ann Dermatol Venereol 2015; 142:467-8. [DOI: 10.1016/j.annder.2015.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 07/10/2015] [Indexed: 11/22/2022]
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Attal R, Mahé E, Bilan P, Sin C, Amy de la Breteque M, Dias C, Sigal ML. [Compression care for venous leg ulcers: Assessment of medical practices in 100 patients]. ACTA ACUST UNITED AC 2015; 40:158-64. [PMID: 25907132 DOI: 10.1016/j.jmv.2015.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 03/06/2015] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The etiologic treatment of venous ulcers is based on compression therapy in compliance with the new guidelines promulgated by the French National Authority for Health (HAS) in 2010. Prescriptions often originate from a request by the nurse delivering care in the patient's home. A recent French study demonstrated the positive impact of compression therapy on venous ulcer healing. The objective of this study was to evaluate medical practices in order to target corrective actions. MATERIALS AND METHODS We conducted a single-center prospective observational study, using a standardized questionnaire from January to May 2014. Patients with venous ulcers who had an indication for compression therapy were included consecutively. The questionnaire collected demographic and clinical data and also recorded the results of complementary tests and the characteristics of the compression therapy. RESULTS One hundred patients were included (61 women and 39 men). The average age was 76 years. Patients were recruited during consultations (n = 69), with a majority of patients living at home (n = 80) and receiving home care delivered by a nurse (n = 81). Thirteen patients were seen for the first time and 87 patients were receiving long-term care. The ulcers evolved for 5.7 years on average. Patients presented peri-lesional edema (n = 58), ankle ankylosis (n = 49), autonomous mobilization (n = 40) and walking problems (n = 60). Physical therapy was prescribed for 39 patients and was effectively carried out for 24. The two main causes were venous varices (n = 66) and post-phlebitis disease (n = 18). Compression therapy was prescribed for 97 patients and the products delivered by the pharmacy were consistent with the prescription for 74 patients. Compliance with compression therapy was faulty for 28 patients because of poor tolerance, misunderstanding, manipulation problems, or inappropriate footwear. At assessment, 66 patients were wearing the bands, but not always correctly (starting at the base of the toes [n = 61], heel included [n = 43], proper stretching [n = 43] up to below the knee [n = 57]). Proper footwear was noted in 70 patients. CONCLUSION Data are scarce on compliance with compression banding. This study shows that further efforts are needed to ensure proper patient education and professional training for physicians and allied profession concerning the installation of compression therapy. Total compliance was observed in only 35% of patients. In addition, the products delivered by the pharmacy were not consistent with the prescription in 26% of cases. Many discrepancies were observed between what was prescribed and what the patients achieved. Patient adherence is a crucial issue for compression therapy.
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Affiliation(s)
- R Attal
- Service de dermatologie-médecine vasculaire, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel Prudhon, 95100 Argenteuil, France.
| | - E Mahé
- Service de dermatologie-médecine vasculaire, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel Prudhon, 95100 Argenteuil, France
| | - P Bilan
- Service de dermatologie-médecine vasculaire, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel Prudhon, 95100 Argenteuil, France
| | - C Sin
- Service de dermatologie-médecine vasculaire, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel Prudhon, 95100 Argenteuil, France
| | - M Amy de la Breteque
- Service de dermatologie-médecine vasculaire, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel Prudhon, 95100 Argenteuil, France
| | - C Dias
- Service de dermatologie-médecine vasculaire, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel Prudhon, 95100 Argenteuil, France
| | - M L Sigal
- Service de dermatologie-médecine vasculaire, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel Prudhon, 95100 Argenteuil, France
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Wille JJ, Burdge JJ, Park JY. Methods for the preparation of an autologous serum-free cultured epidermis and for autografting applications. Methods Mol Biol 2015; 1195:203-18. [PMID: 24500900 DOI: 10.1007/7651_2014_72] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Cell culture techniques for producing a three-dimensional autologous epidermal autograft (cultured epidermal autograft) suitable for tissue grafting and wound healing procedures are described. This chapter commences with surgical biopsy of patient's skin tissue, further reduction of skin tissues to keratinocyte cells by enzymatic treatment, and recovery of viable adult keratinocytes in a new balanced buffered salt media supportive of the growth of clonally enriched isolated basal keratinocytes. Culture techniques required for the formation of a hole-free monolayer of undifferentiated basal keratinocytes without the use of an organotypic matrix substrate are accomplished with a specially designed nutrient basal media (HECK 109) that is a chemically defined and subsequent culture in this serum-free culture media supplemented with hormones and two human recombinant protein growth factors (EGF and IGF-1). Further culture techniques and media manipulations, including brief exposure to β-TGF to induce reversible G1-phase growth arrest, are followed by para-synchronous induction of a multilayered stratification and keratinizing epidermal differentiation, yielding a living three-dimensional epidermis formed entirely in cell culture. Protocols are listed for its enzymatic removal, floatation, and transfer for shipment to the clinic ready for surgical grafting to the self-same patient's debrided chronic leg ulcers. Recent clinical trial results have demonstrated the utility and efficacy of these grafts in forming durably healed chronic wounds.
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Affiliation(s)
- John J Wille
- Department of Cell Biology, Autologenic, Inc., Chesterfield, NJ, USA,
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McInnes W, Ruzehaji N, Wright N, Cowin A, Fitridge R. Venous ulceration contaminated by multi-resistant organisms: larval therapy and debridement. J Wound Care 2013; 22:S27-30. [DOI: 10.12968/jowc.2013.22.sup10.s27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- W. McInnes
- Vascular/Wound Management Nurse Practitioner; Vascular Surgery Unit, The Queen Elizabeth Hospital, Woodville South, Australia
| | - N. Ruzehaji
- Postdoctoral Scientist; Women's and Children's Health Research Institute, Australia; The University of Adelaide, Faculty of Health Sciences, Australia
| | - N. Wright
- Vascular Surgery Consultant; Vascular Surgery Unit, The Queen Elizabeth Hospital, Woodville South, Australia
| | - A.J. Cowin
- Head of Wound Healing Laboratory, Professor; Centre for Regenerative Medicine, Mawson Institute, University of South Australia, Australia
| | - R. Fitridge
- Professor of Vascular Surgery, Head; Vascular Surgery Unit, The Queen Elizabeth Hospital, Woodville South, Australia; The University of Adelaide, Faculty of Health Sciences, Australia
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