1
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Cordova FP, Furhmann AC, do Carmo ACF, Vales EN, Terra DH, da Silva BU, Machado DDO, Lucena ADF, Paskulin LMG. Effect of Unna's boot on venous ulcer healing: a systematic review and meta-analysis. Rev Esc Enferm USP 2024; 58:e20230397. [PMID: 39221989 PMCID: PMC11368076 DOI: 10.1590/1980-220x-reeusp-2023-0397en] [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: 11/22/2023] [Accepted: 06/25/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVE To analyze the effect of Unna's Boot on the healing of venous ulcers compared to other therapies. METHODS Systematic Review carried out in the databases Scopus, Embase, Cochrane Library, Web of Science, PubMed, Cumulative Index of Nursing and Allied Health Literature, Latin American and Caribbean Literature in Health Sciences, and grey literature. Population - adult patients with venous ulcers; Intervention- Unna's Boot (UB); Control - other compression therapies (CT); Outcome- healing; Designs- randomized clinical trial, cohort study, and case control, published from 2001 to 2024. The effect of the intervention, risk of bias, and quality of evidence were evaluated. Registered with PROSPERO (CRD42021290077). RESULTS A total of 39 studies were included, with 5.151 patients. The majority (71.8%) were randomized controlled trials (RCT). UB was used as intervention/control in eight studies. When comparing CTs, only 1 study with UB showed a superior effect (p < .001) in healing, compared with high compression elastic bandage. In the quality of evidence analysis, 27 studies were assessed as having a high risk of bias. CONCLUSION No superiority of UB was found in the healing of venous ulcers when compared to other CTs.
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Affiliation(s)
| | - Ana Claudia Furhmann
- Universidade Federal do Rio Grande do Sul, Escola de Enfermagem, Porto Alegre, RS, Brazil
| | | | - Eduardo Nunes Vales
- Universidade Federal do Rio Grande do Sul, Escola de Enfermagem, Porto Alegre, RS, Brazil
| | - Diego Henrique Terra
- Universidade Federal de Ciências da Saúde, Faculdade de Medicina, Porto Alegre, RS, Brazil
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2
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Zhang YB, Zhong XM, Wang SY, Ma D, Li R. An Evidence Map of Clinical Practice Guideline Recommendations and Quality on Venous Leg Ulcer. Adv Wound Care (New Rochelle) 2024; 13:140-152. [PMID: 37823751 DOI: 10.1089/wound.2023.0079] [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: 10/13/2023] Open
Abstract
Significance: Venous leg ulcers (VLUs) are the most common venous disease, mainly presenting as open skin lesions on the legs or feet and are an important concern in clinical care settings. Recent Advances: Comprehensive tactics were employed to search electronic databases PubMed, Embase, guideline databases, and society websites were searched for Clinical Practice Guidelines (CPGs) on VLU care. The basic information, recommendations for the VLUs, methodological quality, and reporting quality of VLU's CPGs were extracted and captured in Excel. The quality of each CPG was independently assessed by four researchers using AGREE II instrument and the RIGHT checklist. Critical Issues: This study included 19 CPGs with a combined 23 recommendations. The assessment of VLUs was summarized based on the recommendations of VLUs in 11 major items; six on VLU's diagnosis and six on therapeutic strategies of VLUs. The identified CPGs were of mixed quality, and the highest score based on the scope and purpose was 82.85 ± 11.66, whereas the lowest mean score based on the editorial independence by AGREE II was 59.93 ± 21.50. Regarding the RIGHT checklist, field one (basic information) had the highest reporting rate (84.33%), whereas field five (review and quality assurance) had the lowest quality of CPGs (41.11%). Future Directions: This evidence map provided new perspectives in the presentation of evidence. In addition, the evidence map collected and evaluated the characteristics of published CPGs. Thus, the evidence map enhances our knowledge and promotes the development of trustworthy CPGs for VLUs.
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Affiliation(s)
- Ya-Bin Zhang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Xue-Mei Zhong
- Guangdong Women and Children Hospital, Guangzhou, People's Republic of China
| | - Shui-Yu Wang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Dan Ma
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Rui Li
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
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3
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Hofmann AG, Deinsberger J, Oszwald A, Weber B. The Histopathology of Leg Ulcers. Dermatopathology (Basel) 2024; 11:62-78. [PMID: 38390849 PMCID: PMC10885126 DOI: 10.3390/dermatopathology11010007] [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: 12/17/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
Ulcerations of the lower extremities are a frequently encountered problem in clinical practice and are of significant interest in public health due to the high prevalence of underlying pathologies, including chronic venous disease, diabetes and peripheral arterial occlusive disease. However, leg ulcers can also present as signs and symptoms of various rare diseases and even as an adverse reaction to drugs. In such cases, correct diagnosis ultimately relies on histopathological examination. Apart from the macroscopic presentation, patient history and anatomic location, which are sometimes indicative, most ulcers have very distinct histopathological features. These features are found in different layers of the skin or even associated vessels. In this narrative review, we discuss and highlight the histopathological differences of several types of leg ulcers that can contribute to efficient and accurate diagnosis.
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Affiliation(s)
- Amun Georg Hofmann
- Department of Dermatology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Julia Deinsberger
- Department of Dermatology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - André Oszwald
- Department of Pathology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Benedikt Weber
- Department of Dermatology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
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4
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Deinsberger J, Moschitz I, Marquart E, Manz-Varga AK, Gschwandtner ME, Brugger J, Rinner C, Böhler K, Tschandl P, Weber B. Entwicklung eines Lokalisations-basierten Algorithmus zur Vorhersage der Ätiologie von Ulcera cruris. J Dtsch Dermatol Ges 2023; 21:1339-1350. [PMID: 37946636 DOI: 10.1111/ddg.15192_g] [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: 11/27/2022] [Accepted: 06/22/2023] [Indexed: 11/12/2023]
Abstract
ZusammenfassungHintergrundDie diagnostische Abklärung des Ulcus cruris ist zeit‐ und kostenintensiv. Ziel dieser Studie war es, die Ulkuslokalisation als diagnostisches Kriterium zu bewerten und einen diagnostischen Algorithmus zur Unterstützung in der Diagnostik bereitzustellen.Patienten und MethodikDie Studie umfasste 277 Patienten mit Ulcera cruris. Es wurden die folgenden fünf Gruppen definiert: Ulcus cruris venosum, arterielle Ulzera, gemischte Ulzera, Arteriolosklerose und Vaskulitis. Mittels computergestütztem Oberflächenrendering wurden die Prädilektionsstellen der verschiedenen Ulkustypen bewertet. Die Ergebnisse wurden in ein multinomiales logistisches Regressionsmodell integriert, um die Wahrscheinlichkeit einer bestimmten Diagnose in Abhängigkeit von Lokalisation, Alter, bilateraler Beteiligung und Anzahl der Ulzera zu berechnen. Zusätzlich wurde eine neuronale Netzwerk‐Bildanalyse durchgeführt.ErgebnisseDie Mehrheit der venösen Ulzera fand sich in der medialen Malleolarregion. Arterielle Ulzera waren am häufigsten auf der dorsalen Seite des Vorfußes zu finden. Arteriolosklerotische Ulzera waren zumeist im mittleren Drittel des lateralen Unterschenkels lokalisiert. Vaskulitische Ulzera schienen zufällig verteilt zu sein und waren deutlich kleiner, häufiger multilokulär und bilateral. Das multinomiale logistische Regressionsmodell zeigte eine insgesamt zufriedenstellende Leistung mit einer geschätzten Genauigkeit von 0,68 bei ungesehenen Daten.SchlussfolgerungenDer vorgestellte Algorithmus auf Grundlage der Ulkuslokalisation kann als unterstützendes Instrument zur Eingrenzung potenzieller Differenzialdiagnosen und als Hilfestellung für die Einleitung diagnostischer Maßnahmen dienen.
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Affiliation(s)
- Julia Deinsberger
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Irina Moschitz
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Elias Marquart
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | | | - Michael E Gschwandtner
- Klinische Abteilung für Angiologie, Universitätsklinik für Innere Medizin II, Medizinische Universität Wien, Wien, Österreich
| | - Jonas Brugger
- Zentrum für Medical Data Science, Medizinische Universität Wien, Wien, Österreich
| | - Christoph Rinner
- Zentrum für Medical Data Science, Medizinische Universität Wien, Wien, Österreich
| | - Kornelia Böhler
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Philipp Tschandl
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Benedikt Weber
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
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5
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Deinsberger J, Moschitz I, Marquart E, Manz-Varga AK, Gschwandtner ME, Brugger J, Rinner C, Böhler K, Tschandl P, Weber B. Development of a localization-based algorithm for the prediction of leg ulcer etiology. J Dtsch Dermatol Ges 2023; 21:1339-1349. [PMID: 37658661 DOI: 10.1111/ddg.15192] [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: 11/27/2022] [Accepted: 06/22/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Diagnostic work-up of leg ulcers is time- and cost-intensive. This study aimed at evaluating ulcer location as a diagnostic criterium and providing a diagnostic algorithm to facilitate differential diagnosis. PATIENTS AND METHODS The study consisted of 277 patients with lower leg ulcers. The following five groups were defined: Venous leg ulcer, arterial ulcers, mixed ulcer, arteriolosclerosis, and vasculitis. Using computational surface rendering, predilection sites of different ulcer types were evaluated. The results were integrated in a multinomial logistic regression model to calculate the likelihood of a specific diagnosis depending on location, age, bilateral involvement, and ulcer count. Additionally, neural network image analysis was performed. RESULTS The majority of venous ulcers extended to the medial malleolar region. Arterial ulcers were most frequently located on the dorsal aspect of the forefoot. Arteriolosclerotic ulcers were distinctly localized at the middle third of the lower leg. Vasculitic ulcers appeared to be randomly distributed and were markedly smaller, multilocular and bilateral. The multinomial logistic regression model showed an overall satisfactory performance with an estimated accuracy of 0.68 on unseen data. CONCLUSIONS The presented algorithm based on ulcer location may serve as a basic tool to narrow down potential diagnoses and guide further diagnostic work-up.
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Affiliation(s)
- Julia Deinsberger
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Irina Moschitz
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Elias Marquart
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | | | - Michael E Gschwandtner
- Division of Angiology, 2nd Department of Medicine, Medical University of Vienna, Vienna, Austria
| | - Jonas Brugger
- Center for Medical Data Science, Medical University of Vienna, Vienna, Austria
| | - Christoph Rinner
- Center for Medical Data Science, Medical University of Vienna, Vienna, Austria
| | - Kornelia Böhler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Philipp Tschandl
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Benedikt Weber
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
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6
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Qiu Y, Osadnik CR, Team V. Planning exercise interventions as an adjunct treatment in managing venous leg ulcers: A qualitative study of nurses’ perspectives. J Tissue Viability 2023; 32:279-285. [PMID: 37032305 DOI: 10.1016/j.jtv.2023.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 02/16/2023] [Accepted: 03/26/2023] [Indexed: 03/30/2023]
Abstract
OBJECTIVE To explore clinicians' perspectives regarding strategies to support exercise interventions for people with venous leg ulcers. DESIGN 1:1 interview was guided by the Behaviour Change Wheel (BCW) to collect thoughts from clinicians with experiences in managing venous leg ulcers. SETTINGS Clinical nurses in metropolitan/regional Victoria, Australia. PARTICIPANTS A convenience sample of 21 nurses (mean clinical experience 14 years) was recruited. METHODS We conducted semi-structured remote interviews. Transcripts were coded and analysed using a theory-driven thematic analysis, and interventions to support the implementation of exercise interventions were mapped across the BCW. RESULTS Strategies related to capability, opportunity and motivation components from the BCW were identified. The strategies reported to be important included: i) education of patients and family members; ii) the provision of consistent and clear exercise advice; iii) setting realistic and meaningful goals in light of challenges encountered by patients; iv) flexibility in how exercise programmes were organised/structured, particularly to facilitate rapid adoption; and v) clinician education. CONCLUSIONS In-depth qualitative interviews of nurses working with people with venous leg ulcers in Australia revealed multifactorial issues that potentially affect prescription of care regarding physical exercise. In order to improve and standardise future clinical practice, a clear focus of future research should address such issues.
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Affiliation(s)
- Yunjing Qiu
- School of Nursing and Midwifery, Monash University, Level 3, Building 13D, Clayton Campus, 35 Rainforest Walk, Clayton, VIC, 3800, Australia.
| | - Christian R Osadnik
- Department of Physiotherapy, Monash University, Building B, Peninsula Campus, 47-49 Moorooduc Highway, Frankston, VIC, 3199, Australia
| | - Victoria Team
- School of Nursing and Midwifery, Monash University, Level 3, Building 13D, Clayton Campus, 35 Rainforest Walk, Clayton, VIC, 3800, Australia
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7
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A review of leg ulcerations coverage in the United Kingdom print media: A growing problem for the vulnerable adult. JOURNAL OF VASCULAR NURSING 2023. [DOI: 10.1016/j.jvn.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
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8
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Bull RH, Clements D, Collarte AJ, Harding KG. The impact of a new intervention for venous leg ulcers: A within-patient controlled trial. Int Wound J 2023. [PMID: 36785909 DOI: 10.1111/iwj.14107] [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: 12/05/2022] [Revised: 01/20/2023] [Accepted: 01/20/2023] [Indexed: 02/15/2023] Open
Abstract
A major obstacle to the development of new treatments for venous leg ulcers is the difficulty in generating evidence for their effectiveness. Randomised controlled trials using complete healing as the endpoint are seldom powered to be successful, owing to the heterogeneity of cohorts. A novel approach to the evaluation of treatments is presented, using a self-controlled trial model and two metrics of short-term healing rate as alternate endpoints: rate of wound margin advance, and percentage area reduction over 4 weeks. Two different treatment regimens are compared: multi-layer compression alone, versus multi-layer compression combined with activation of the venous leg pump by neuromuscular stimulation. With 60 patients, adding neuromuscular stimulation to multilayer compression resulted in a significant two-fold increase in the rate of wound healing over a 4-week period, both in terms of wound margin advance and in terms of percentage area reduction. The use of these short-term intermediate endpoint metrics together with a self-controlled study design offers potential for distinguishing between the relative efficacies of interventions more rapidly, with greater sensitivity, and with fewer subjects than a conventional RCT cohort model.
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Affiliation(s)
| | - Donna Clements
- CRN Eastern, Norfolk Community Health and Care Trust, Norwich, UK
| | - Agnes Juguilon Collarte
- North West Division (Central London, Hammersmith & Fulham and West London), St Charles Centre for Health & Wellbeing, London, UK
| | - Keith Gordon Harding
- WWII Ltd (Welsh Wound Innovation Initiative), Welsh Wound Innovation Centre, Pontyclun, UK
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Foffa I, Janowska A, Fabbri M, Losi P, Ciabatti E, Gabbriellini S, Faita F, Rosa LD, Dini V, Mazzoni A, Romanelli M, Soldani G. Carboxymethyl Cellulose-Based Hydrogel Film Combined with Umbilical Cord Blood Platelet gel as an Innovative Tool for Chronic Wound Management: A Pilot Clinical Study. INT J LOW EXTR WOUND 2022:15347346221138189. [PMID: 36380524 DOI: 10.1177/15347346221138189] [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: 02/17/2024]
Abstract
Treatment of chronic leg ulcers remains a major challenge and it is a substantial financial burden on individuals, families, caregivers, and health care system. There is increasing evidence on using of autologous Platelet-rich-plasma in wound repair but limited clinical data are available on the efficacy and safety of the use of umbilical cord blood platelet gel (CBPG). In our pilot study, for the first time, we aimed to evaluated the safety and efficacy of the use of umbilical CBPG combined with a hydrogel dressing in 10 patients with chronic venous ulcers (VU). The protocol consisted of application of umbilical cord blood platelet-rich plasma (PRP) combined with a Carboxymethyl cellulose (CMC)-based hydrogel dressing once a week for 4 weeks. The 80% of patients after 4 weeks of treatment had a significantly decrease in wound size. Moreover, we obtained an improvement in terms of mean Wound Bed Score (WBS), numeric rating scale (NRS) value and the EQ-5D index score. This pilot study showed that the topically therapeutic administration of umbilical CBPG associated with a CMC-based hydrogel dressing has the potential to accelerate the healing of chronic lesions without adverse reaction. However, additional studies with larger sample size and longer follow-up periods are required to confirm our findings.
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Affiliation(s)
- Ilenia Foffa
- Institute of Clinical Physiology, National Research Council, Massa, Pisa, Italy
| | - Agata Janowska
- Unit of Dermatology, 9310University of Pisa, Pisa, Italy
| | - Marco Fabbri
- Transfusion Medicine and Transplant Biology, 9257Pisa University Hospital, Pisa, Italy
| | - Paola Losi
- Institute of Clinical Physiology, National Research Council, Massa, Pisa, Italy
| | - Elena Ciabatti
- Transfusion Medicine and Transplant Biology, 9257Pisa University Hospital, Pisa, Italy
| | - Sabrina Gabbriellini
- Transfusion Medicine and Transplant Biology, 9257Pisa University Hospital, Pisa, Italy
| | - Francesco Faita
- Institute of Clinical Physiology, National Research Council, Massa, Pisa, Italy
| | - Laura De Rosa
- Institute of Clinical Physiology, National Research Council, Massa, Pisa, Italy
- Department of Information Engineering and Computer Science, University of Trento, Trento, Italy
| | - Valentina Dini
- Unit of Dermatology, 9310University of Pisa, Pisa, Italy
| | - Alessandro Mazzoni
- Transfusion Medicine and Transplant Biology, 9257Pisa University Hospital, Pisa, Italy
| | | | - Giorgio Soldani
- Institute of Clinical Physiology, National Research Council, Massa, Pisa, Italy
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10
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Senet P, Addala A, Léger P, Chahim M, Malloizel J, Blaise S, Sauvadet A, Tacca O, Stücker M, Dissemond J. A new compression system for treatment of venous leg ulcers: a prospective, single-arm, clinical trial (FREEDOM). J Wound Care 2022; 31:734-747. [PMID: 36113543 DOI: 10.12968/jowc.2022.31.9.734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the efficacy, tolerability and acceptability of a new multicomponent compression system in one bandage for the local treatment of patients with venous leg ulcers (VLUs). METHOD This was an international, prospective, non-comparative, clinical trial, conducted in France and Germany. Eligible participants had a VLU with a wound area of 2-20cm2, lasting for a maximum of 24 months. For a period of 6 weeks, patients were treated with a new multicomponent compression system in one bandage which was worn day and night, providing high working pressure and moderate resting pressure (UrgoK1). Clinical assessments, wound measurement and photographs were planned at weeks 1, 2, 4 and 6. The primary endpoint was the relative wound area reduction (RWAR) after 6 weeks of treatment. Secondary endpoints included wound closure rate, oedema resolution, change in patient's health-related quality of life (HRQoL), acceptability, adherence to the compression therapy, local tolerance, and physician's overall satisfaction with the evaluated compression system. RESULTS A cohort of 52 patients (52% female, mean age 75.4±13.0 years) with VLUs, including oedema in 58% of cases, were recruited from 22 centres. At baseline, 42 patients had already been treated with a different compression system. VLUs had been present for 5.6±4.9 months and had a mean area of 5.7±4.3cm2. After 6 weeks of treatment, a median RWAR of 91% (interquartile range: 39.4; 100.0) was achieved. Wound closure was reported in 35% of patients. A RWAR ≥40% at week 4, predictive of wound healing at 12 weeks, was achieved in 62% of patients. At the final visit, oedema present at baseline was resolved in 57% of patients. Substantial improvements in the HRQoL of the patients were reported with a decrease of the pain/discomfort and anxiety/depression dimensions. Comfort in wearing the evaluated system was reported as 'very good' or 'good' by 79% of patients, resulting in a high patient adherence to compression therapy. Compared to previous compression systems, half of the patients reported more ease in wearing shoes, and greater satisfaction and comfort with this new system. Nine non-serious adverse events related to the device or its procedure occurred in seven patients. At the final visit, the majority of the physicians were 'very satisfied' or 'satisfied' with the new compression system overall. CONCLUSION The new multicomponent compression system in one bandage has been shown to promote rapid healing of VLUs, reduce oedema, improve HRQoL and to be well tolerated and accepted. It appears to be a viable alternative to existing compression systems.
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Affiliation(s)
- Patricia Senet
- Department of Dermatology, Paris Est University Hospitals (AP-HP) - Tenon Hospital, Paris, France
| | - Azeddine Addala
- Department of Vascular Medicine, Edouard Herriot Hospital, Lyon, France
| | - Philippe Léger
- Wound and Wound Healing Centre, Pasteur Clinic, Toulouse, France
| | - Maxime Chahim
- Department of Vascular Medicine, Corentin Celton Hospital, Issy Les Moulineaux, France
| | - Julie Malloizel
- Department of Vascular Medicine, Rangueil University Hospital, Toulouse, France
| | - Sophie Blaise
- Department of Vascular Medicine, Albert Michalon University Hospital, Grenoble, France
| | - Anne Sauvadet
- Clinical Development Department, URGO Research Innovation and Development, Chenove, France
| | - Olivier Tacca
- Clinical Development Department, URGO Research Innovation and Development, Chenove, France
| | - Markus Stücker
- Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - Joachim Dissemond
- Department of Dermatology, Venerology and Allergology, University Hospital Essen, Essen, Germany
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11
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Barriers and enablers to physical activity in people with venous leg ulcers: A systematic review of qualitative studies. Int J Nurs Stud 2022; 135:104329. [DOI: 10.1016/j.ijnurstu.2022.104329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/16/2022] [Accepted: 07/17/2022] [Indexed: 11/15/2022]
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12
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Qiu Y, Osadnik CR, Team V, Weller CD. Effects of physical activity as an adjunct treatment on healing outcomes and recurrence of venous leg ulcers: A scoping review. Wound Repair Regen 2022; 30:172-185. [PMID: 35142412 PMCID: PMC9303258 DOI: 10.1111/wrr.12995] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/19/2021] [Accepted: 01/09/2022] [Indexed: 01/05/2023]
Abstract
Healing time is protracted and ulcer recurrence is common in patients with venous leg ulcers. Although compression is the mainstay treatment, many patients do not heal timely. Physical activity may be a clinically effective adjunct treatment to compression to improve healing outcomes. This scoping review provides a broad overview of the effect of physical activity as an adjunct treatment to compression on wound healing and recurrence. We followed the six-step framework developed by Arksey and O'Malley. We searched electronic databases and trial registration websites for relevant studies and ongoing trials. Two authors independently screened and selected articles. Findings were presented in a descriptive statistical narrative summary. We consulted and presented our findings to the wound consumer group to ensure the relevance of our study. Physical activity interventions in 12 out of the 16 eligible studies consisted of only one component, eight studies were resistance exercises, three studies reported ankle and/or foot range of motion exercises, and one study reported aerobic/walking exercises. The remaining four studies involved multicomponent exercise interventions. Resistance exercise combined with ankle and/or foot range of motion exercise minimised ulcer size on day 12 (intervention group: 4.55 ± 1.14 cm2 vs. control group: 7.43 ± 0.56 cm2 ) and improved calf muscle pump performance on day 8 (ejection fraction: 40%-65%; residual volume fraction: 56%-40%). We identified one study that reported ulcer recurrence rate with no clinical difference in the intervention group versus the control group (i.e., 12% in intervention vs. 5% in control). Our review identified that resistance exercise was the most common type of physical activity intervention trialled in the published literature. Resistance exercise combined with ankle and/or foot range of motion exercise appears to be effective adjunct treatments; however, the overall evidence is still relatively weak as most programmes had a short intervention period which limited clinical outcomes.
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Affiliation(s)
- Yunjing Qiu
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria
| | - Christian R Osadnik
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
| | - Victoria Team
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria
| | - Carolina D Weller
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria
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13
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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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Aleksandrowicz H, Owczarczyk-Saczonek A, Placek W. Venous Leg Ulcers: Advanced Therapies and New Technologies. Biomedicines 2021; 9:1569. [PMID: 34829797 PMCID: PMC8615583 DOI: 10.3390/biomedicines9111569] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/08/2021] [Accepted: 10/23/2021] [Indexed: 12/19/2022] Open
Abstract
The prevalence of venous leg ulcers (VLUs) differs between 1.5% and 3% in the general population. The challenge in treating VLUs is common recurrence. Moreover, VLUs can be resistant to healing, despite appropriate treatment. In these cases, advanced wound therapies should be considered. The number of new technologies, applied in VLUs treatment, has increased in the last years. These therapies include biophysical interventions such as ultrasound therapy, electrical stimulations, electromagnetic therapy, or phototherapy. Furthermore, stem cell therapies, biologic skin equivalents, platelet-rich plasma therapy, oxygen therapies, anti-TNF therapy, or negative pressure wound therapy are advanced venous ulcer therapeutic methods that may support the standard of care. Medical devices, such as a muscle pump activator, or intermittent pneumatic compression device, may be especially useful for specific subgroups of patients suffering from VLUs. Some of the above-mentioned technologies require broader evidence of clinical efficacy and are still considered experimental therapies in dermatology.
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Affiliation(s)
- Hubert Aleksandrowicz
- Department and Clinic of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, University of Warmia and Mazury, Al. Wojska Polskiego 30, 10-959 Olsztyn, Poland; (A.O.-S.); (W.P.)
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15
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Kolluri R, Lugli M, Villalba L, Varcoe R, Maleti O, Gallardo F, Black S, Forgues F, Lichtenberg M, Hinahara J, Ramakrishnan S, Beckman JA. An estimate of the economic burden of venous leg ulcers associated with deep venous obstruction. Vasc Med 2021; 27:63-72. [PMID: 34392750 PMCID: PMC8808361 DOI: 10.1177/1358863x211028298] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: Venous leg ulcers (VLU) embody the most severe stage of the broad spectrum of
chronic venous disease. Approximately 40% of patients with VLU present with
the underlying deep venous disease (DVD). Although the data are scarce,
these deep venous disease-related VLU (DRV) are thought to have higher
recurrence rates and a substantial economic burden. The objective of this
study was to assess the economic burden of DRV across Australia, France,
Germany, Italy, Spain, the UK, and the USA. Methods: A comprehensive literature review was undertaken to identify publications
documenting the incidence and prevalence of VLU and DRV, medical resource
utilization, and associated costs of DRV. Findings from this literature
review were used to estimate the economic burden of illness, including
direct medical costs over a 12-month interval following initial presentation
of a newly formed DRV. Results: Total annual incidence of new or recurrent DRV in Australia, France, Germany,
Italy, Spain, UK, and the US are estimated at 122,000, 263,000, 345,000,
253,000, 85,000, 230,000, and 643,000 events, respectively, in 2019.
Incidence ranges from 0.73 to 3.12 per 1000 persons per year. The estimated
annual direct medical costs for patients managed conservatively in these
geographies total ~ $10.73 billion (USD) or $5527 per person per year. Conclusion: The availability of published data on the costs of VLU care varies widely
across countries considered in this analysis. Although country-specific VLU
practice patterns vary, there is a uniform pattern of high-cost care.
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Affiliation(s)
- Raghu Kolluri
- Department of Internal Medicine, Riverside Methodist Hospital/OhioHealth, Columbus, OH, USA
| | - Marzia Lugli
- Department of Cardiovascular Surgery, Hesperia Hospital, Modena, Emilia-Romagna, Italy
| | - Laurencia Villalba
- Department of Vascular Surgery, Vascular Care Centre, Wollongong, NSW, Australia
| | - Ramon Varcoe
- Department of Surgery, University of New South Wales, Sydney, NSW, Australia
| | - Oscar Maleti
- Department of Cardiovascular Surgery, Hesperia Hospital, Modena, Emilia-Romagna, Italy
| | - Fernando Gallardo
- Department of Vascular Surgery, Hospital Quironsalud, Marbella, Spain
| | - Stephen Black
- Department of Vascular Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Fannie Forgues
- Centre de Phlébologie Interventionnelle, Région de Toulouse, Clinique Pasteur, Toulouse, France
| | | | | | | | - Joshua A Beckman
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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16
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Say M, Tella E, Boccara O, Sauvage M, Bourrat E, Tian Y, Monfort JB, Lok C, Desierier F, Beneton N, Abasq-Thomas C, Kupfer-Bessaguet I, Mallet S, Lacour JP, Plantin P, Sigal ML, Mazereeuw-Hautier J, Mahé E. Leg ulcers in childhood: A multicenter study in France. Ann Dermatol Venereol 2021; 149:51-55. [PMID: 34218940 DOI: 10.1016/j.annder.2021.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/30/2021] [Accepted: 05/19/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Leg ulcers in adults are a major public health concern. Their incidence increases with age and many causes have been identified, predominantly associated with vascular diseases. Leg ulcers in children and teenagers are less frequent. The aim of our study was to identify the causes of leg ulcers in children and teenagers, and to evaluate their management. METHODS This retrospective multicenter study was conducted by members of the Angio-dermatology Group of the French Society of Dermatology and of the French Society of Pediatric Dermatology. Data from children and teenagers (< 18 years), seen between 2008 and 2020 in 12 French hospitals for chronic leg ulcer (disease course>4 weeks), were included. RESULTS We included 27 patients, aged from 2.3 to 17.0 years. The most frequent causes of leg ulcer were: general diseases (n=9: pyoderma gangrenosum, dermatomyositis, interferonopathy, sickle cell disease, prolidase deficiency, scleroderma, Ehlers-Danlos syndrome), vasculopathies (n=8: hemangioma, capillary malformation, arteriovenous malformation), trauma (n=4: bedsores, pressure ulcers under plaster cast), infectious diseases (n=4: pyoderma, tuberculosis, Buruli ulcer) and neuropathies (n=2). Comorbidities (59.3%) and chronic treatments (18.5%) identified as risk factors for delayed healing were frequent. The average time to healing was 9.1 months. DISCUSSION Leg ulcers are less frequent in children and teenagers than in adults and their causes differ from those in adults. Comorbidities associated with delayed healing must be identified and managed. Children and teenagers tend to heal faster than adults, but a multidisciplinary management approach is necessary.
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Affiliation(s)
- M Say
- Service de dermatologie et médecine vasculaire, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel Prud'hon, 95100 Argenteuil, France.
| | - E Tella
- Service de dermatologie et médecine vasculaire, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel Prud'hon, 95100 Argenteuil, France
| | - O Boccara
- Service de dermatologie, centre hospitalier universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - M Sauvage
- Service de dermatologie, centre de référence des Maladies Rares de la Peau, centre hospitalier universitaire Larrey, Université Paul-Sabatier, Toulouse, France
| | - E Bourrat
- Service de pédiatrie générale, centre hospitalier universitaire Robert-Debré, AP-HP, Paris, France
| | - Y Tian
- Service de pédiatrie générale, centre hospitalier universitaire Robert-Debré, AP-HP, Paris, France
| | - J-B Monfort
- Service de dermatologie, centre hospitalier universitaire Tenon, AP-HP, Paris, France
| | - C Lok
- Service de dermatologie, centre hospitalier universitaire Amiens-Picardie, Amiens, France
| | - F Desierier
- Service de dermatologie, centre hospitalier universitaire Amiens-Picardie, Amiens, France
| | - N Beneton
- Service de dermatologie, centre hospitalier du Mans, Le Mans, France
| | - C Abasq-Thomas
- Service de dermatologie, centre hospitalier Régional Universitaire de Brest, Brest, France
| | | | - S Mallet
- Service de dermatologie, centre hospitalier universitaire La Timone, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - J-P Lacour
- Service de dermatologie, centre hospitalier universitaire L'archet, Nice, France
| | - P Plantin
- Service de dermatologie, centre hospitalier de Cornouaille, Quimper, France
| | - M-L Sigal
- Service de dermatologie et médecine vasculaire, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel Prud'hon, 95100 Argenteuil, France
| | - J Mazereeuw-Hautier
- Service de dermatologie, centre de référence des Maladies Rares de la Peau, centre hospitalier universitaire Larrey, Université Paul-Sabatier, Toulouse, France
| | - E Mahé
- Service de dermatologie et médecine vasculaire, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel Prud'hon, 95100 Argenteuil, France
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17
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Zenjari L, Hali F, Chiheb S. Trichloroacetic acid (50%) in the treatment of venous leg ulcers. JOURNAL DE MÉDECINE VASCULAIRE 2021; 46:139-143. [PMID: 33990288 DOI: 10.1016/j.jdmv.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 03/22/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Leg ulcers are a chronic and disabling condition that is difficult, time-consuming and costly to treat. We report a study evaluating the efficacy of trichloroacetic acid in the treatment of venous leg ulcers. PATIENTS AND METHODS We treated 19 patients with leg ulcers with 50% trichloroacetic acid with one application per week for 6 weeks. The primary evaluation criteria was healing, assessed by measuring the surface area of the ulcer before and after treatment. RESULTS We included 13 men and 6 women, with venous leg ulcers, with an average age of 57 years. The mean ulcer duration was 2.9 years. Complete healing was achieved in 2 patients, good healing in 9 patients, moderate healing in 6 patients, and poor healing in 2 patients. DISCUSSION Our study supports the data in the literature from two published series, and suggests that 50% trichloroacetic acid would be a good therapeutic alternative with satisfactory wound healing, low cost, and absence of adverse effects.
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Affiliation(s)
- L Zenjari
- Department of dermatology and venerology, CHU Ibn Rochd, Casablanca, Morocco.
| | - F Hali
- Department of dermatology and venerology, CHU Ibn Rochd, Casablanca, Morocco
| | - S Chiheb
- Department of dermatology and venerology, CHU Ibn Rochd, Casablanca, Morocco
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18
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Veličković VM, Chadwick P, Rippon MG, Ilić I, McGlone ER, Gebreslassie M, Csernus M, Streit I, Bordeanu A, Kaspar D, Linder J, Smola H. Cost-effectiveness of superabsorbent wound dressing versus standard of care in patients with moderate-to-highly exuding leg ulcers. J Wound Care 2021; 29:235-246. [PMID: 32281509 DOI: 10.12968/jowc.2020.29.4.235] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To determine the cost-effectiveness/utility of a superabsorbent wound dressing (Zetuvit Plus Silicone) versus the current standard of care (SoC) dressings, from the NHS perspective in England, in patients with moderate-to-high exudating leg ulcers. METHOD A model-based economic evaluation was conducted to analyse the cost-effectiveness/utility of a new intervention. We used a microsimulation state-transition model with a time horizon of six months and a cycle length of one week. The model uses a combination of incidence base and risk prediction approach to inform transition probabilities. All clinical efficiency, health-related quality of life (HRQoL), cost and resource use inputs were informed by conducting a systematic review of UK specific literature. RESULTS Treatment with the superabsorbent dressing leads to a total expected cost per patient for a six month period of £2887, associated with 15.933 expected quality adjusted life weeks and 10.9% healing rate. When treated with SoC, the total expected cost per patient for a six month period is £3109, 15.852 expected quality adjusted life weeks and 8% healing rate. Therefore, the superabsorbent dressing leads to an increase in quality-adjusted life weeks, an increase in healing rate by 2.9% and a cost-saving of £222 per single average patient over six months. Results of several scenario analyses, one-way deterministic sensitivity analysis, and probabilistic sensitivity analysis confirmed the robustness of base-case results. The probabilistic analysis confirmed that, in any combination of variable values, the superabsorbent dressing leads to cost saving results. CONCLUSION According to the model prediction, the superabsorbent dressing leads to an increase in health benefits and a decrease in associated costs of treatment.
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Affiliation(s)
- Vladica M Veličković
- Hartmann Group, Heidenheim, Germany.,Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT, Hall i.T., Austria
| | | | - Mark G Rippon
- Huddersfield University, Queensgate, Huddersfield, UK
| | - Ivana Ilić
- Faculty of Medicine, University of Niš, Serbia
| | | | - Mihretab Gebreslassie
- Department of Public Health and Caring Sciences, Social Medicine/CHAP, Uppsala University, Sweden
| | - Mariann Csernus
- Nursing Department, Semmelweis University Faculty of Health Sciences, Budapest, Hungary
| | | | | | | | | | - Hans Smola
- Hartmann Group, Heidenheim, Germany.,Department of Dermatology, University of Cologne, Cologne, Germany
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19
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Boersema GC, Smart H, Giaquinto-Cilliers MGC, Mulder M, Weir GR, Bruwer FA, Idensohn PJ, Sander JE, Stavast A, Swart M, Thiart S, Van der Merwe Z. Management of Nonhealable and Maintenance Wounds: A Systematic Integrative Review and Referral Pathway. Adv Skin Wound Care 2021; 34:11-22. [PMID: 33323798 DOI: 10.1097/01.asw.0000722740.93179.9f] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
GENERAL PURPOSE To synthesize the evidence regarding nonhealable and maintenance wound management and propose an interprofessional referral pathway for wound management. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES After participating in this continuing professional development activity, the participant will apply knowledge gained to:1. Identify the ideas from the authors' systematic review that could prove useful in understanding nonhealable and maintenance wound management.2. Select evidence-based management strategies for nonhealable and maintenance wound management. ABSTRACT OBJECTIVEThis systematic integrative review aims to identify, appraise, analyze, and synthesize evidence regarding nonhealable and maintenance wound management to guide clinical practice. An interprofessional referral pathway for wound management is proposed. DATA SOURCES An electronic search of Scopus, Web of Science, PubMed, Academic Search Ultimate, Africa-Wide Information, Cumulative Index of Nursing and Allied Health Literature database with Full Text, Health Source: ConsumerEdition, Health Source: Nursing/Academic Edition, and MEDLINE was conducted for publications from 2011 to 2019. Search terms included (nonhealable/nonhealing, chronic, stalled, recurring, delayed healing, hard-to-heal) and wound types most associated with nonhealable or maintenance wounds. Published studies were hand searched by the authors. STUDY SELECTION Studies were appraised using two quality appraisal tools. Thirteen reviews, six best-practice guidelines, three consensus studies, and six original nonexperimental studies were selected. DATA EXTRACTION Data were extracted using a coding framework including treatment of underlying causes, patient-centered concerns, local wound care, alternative outcomes, health dialogue needs, challenges within resource restricted contexts, and prevention. DATA SYNTHESIS Data were clustered by five wound types and local wound bed factors; further, commonalities were identified and reported as themes and subthemes. CONCLUSIONS Strong evidence on the clinical management of nonhealable wounds is limited. Few studies describe outcomes specific to maintenance care. Patient-centered care, timely intervention by skilled healthcare providers, and involvement of the interprofessional team emerged as the central themes of effective management of maintenance and nonhealable wounds.
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20
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Geisler AN, Taylor N. Venous Stasis Ulcers: an Update on Diagnosis and Management. CURRENT GERIATRICS REPORTS 2020. [DOI: 10.1007/s13670-020-00344-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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21
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Kerstan A, Niebergall-Roth E, Esterlechner J, Schröder HM, Gasser M, Waaga-Gasser AM, Goebeler M, Rak K, Schrüfer P, Endres S, Hagenbusch P, Kraft K, Dieter K, Ballikaya S, Stemler N, Sadeghi S, Tappenbeck N, Murphy GF, Orgill DP, Frank NY, Ganss C, Scharffetter-Kochanek K, Frank MH, Kluth MA. Ex vivo-expanded highly pure ABCB5 + mesenchymal stromal cells as Good Manufacturing Practice-compliant autologous advanced therapy medicinal product for clinical use: process validation and first in-human data. Cytotherapy 2020; 23:165-175. [PMID: 33011075 PMCID: PMC8310651 DOI: 10.1016/j.jcyt.2020.08.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/05/2020] [Accepted: 08/29/2020] [Indexed: 12/13/2022]
Abstract
Background aim: Mesenchymal stromal cells (MSCs) hold promise for the treatment of tissue damage and injury. However, MSCs comprise multiple subpopulations with diverse properties, which could explain inconsistent therapeutic outcomes seen among therapeutic attempts. Recently, the adenosine triphosphate-binding cassette transporter ABCB5 has been shown to identify a novel dermal immunomodulatory MSC subpopulation. Methods: The authors have established a validated Good Manufacturing Practice (GMP)-compliant expansion and manufacturing process by which ABCB5+ MSCs can be isolated from skin tissue and processed to generate a highly functional homogeneous cell population manufactured as an advanced therapy medicinal product (ATMP). This product has been approved by the German competent regulatory authority to be tested in a clinical trial to treat therapy-resistant chronic venous ulcers. Results: As of now, 12 wounds in nine patients have been treated with 5 × 105 autologous ABCB5+ MSCs per cm2 wound area, eliciting a median wound size reduction of 63% (range, 32–100%) at 12 weeks and early relief of pain. Conclusions: The authors describe here their GMP- and European Pharmacopoeia-compliant production and quality control process, report on a pre-clinical dose selection study and present the first in-human results. Together, these data substantiate the idea that ABCB5+ MSCs manufactured as ATMPs could deliver a clinically relevant wound closure strategy for patients with chronic therapy-resistant wounds.
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Affiliation(s)
- Andreas Kerstan
- Department of Dermatology, Venereology, and Allergology, University Hospital Würzburg, Würzburg, Germany
| | | | | | | | - Martin Gasser
- Department of Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Ana M Waaga-Gasser
- Department of Surgery, University Hospital Würzburg, Würzburg, Germany; Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthias Goebeler
- Department of Dermatology, Venereology, and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Katrin Rak
- Department of Dermatology, Venereology, and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Philipp Schrüfer
- Department of Dermatology, Venereology, and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Sabrina Endres
- Department of Dermatology, Venereology, and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Petra Hagenbusch
- 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
| | - Christoph Ganss
- TICEBA GmbH, Heidelberg, Germany; RHEACELL GmbH & Co. KG, Heidelberg, Germany
| | | | - 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
- TICEBA GmbH, Heidelberg, Germany; RHEACELL GmbH & Co. KG, Heidelberg, Germany.
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22
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Fan W, Yang X, Yang B, Fu C, Huang R, Xv F, Liu G. The safety and efficacy of Sclerosing foam on treating venous leg ulcers: Protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e21608. [PMID: 32769918 PMCID: PMC7593037 DOI: 10.1097/md.0000000000021608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/08/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Venous leg ulcers (VLUs) are common throughout the world, which seriously affects the patient's work and life. Relevant researches suggested that sclerosing foam (SF) has potential benefits for VLUs. However, there is no consistent conclusion. The purpose of our study is to assess whether SF is effective and safe for VLUs. METHODS Relevant clinical randomized controlled trials will be obtained from a search of 8 databases (with no language restrictions) from their inception to May 2020: PubMed, the Cochrane Library, EMBASE, Web of Science, China National Knowledge Infrastructure Database, Wanfang Database, China Science and Technology Journal Database, and Chinese Biological Medicine. Data will be analyzed using RevMan 5.3 after literature screening and data extraction according to predefined inclusion and exclusion criteria. Cochrane Collaboration Risk of bias Tool will be applied in evaluating the quality of enrolled articles. The primary outcome is Closure of venous leg ulcers, ulcer healing rate, adverse events related to SF. The secondary outcomes include ulcer healing time, ulcer recurrence rate, pain. Risk ratio will be used for categorical data; mean differences will be used for measurement data. Where possible and appropriate, meta-analysis will be performed for each outcome. RESULTS To clarify whether Sclerosing foam can be safe and efficient on treating venous leg ulcers. CONCLUSION Our review will provide useful information to judge whether Sclerosing Foam is an effective and safe intervention for patients with venous leg ulcers.
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Affiliation(s)
- Weijing Fan
- Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine
- Shanghai University of Traditional Chinese Medicine, Shanghai
| | - Xiao Yang
- Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine
| | - Baozhong Yang
- Dongfang Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Changgeng Fu
- Dongfang Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Renyan Huang
- Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine
- Shanghai University of Traditional Chinese Medicine, Shanghai
| | - Feng Xv
- Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine
- Shanghai University of Traditional Chinese Medicine, Shanghai
| | - Guobin Liu
- Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine
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23
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González-Duque MI, Hernández-Martínez JD, Fontanilla MR, Muñoz-Medina SE. Treatment with type-I collagen scaffolds in patients with venous ulcers. Case report. CASE REPORTS 2020. [DOI: 10.15446/cr.v6n2.83815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: Chronic venous insufficiency affects about 5% of the global adult population. Venous leg ulcers are one of the most frequent complications of this pathology, with a global prevalence of 2%. This disease affects both the quality of life of patients and, due to the high cost of the treatment, the health system. Compressive therapy and moist wound healing have been the gold standard treatment. However, when complications occur, they may not be effective.Case report: This is the case of a 66-year-old female patient with venous ulcers on her lower limbs and symptoms of fever and local pain that did not respond to conventional therapies. The patient was treated with a new dermal substitute made of an acellular type-I collagen membrane, which promotes the closure of the ulcer by stimulating the replacement of injured tissue with tissue similar to the healthy one. The condition of the patient improved at 16 weeks, and after 8 months of treatment there was no recurrence of the lesions.Conclusions: Acellular type-I collagen membrane developed by the Tissue Engineering Working Group of the Department of Pharmacy of the Universidad Nacional de Colombia is effective in treating venous ulcers of the lower limbs. Its low cost facilitates the access of the whole population to therapies based on its application.
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24
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Weller CD, Richards C, Turnour L, Patey AM, Russell G, Team V. Barriers and enablers to the use of venous leg ulcer clinical practice guidelines in Australian primary care: A qualitative study using the theoretical domains framework. Int J Nurs Stud 2019; 103:103503. [PMID: 31931442 DOI: 10.1016/j.ijnurstu.2019.103503] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 12/02/2019] [Accepted: 12/03/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Venous leg ulcers represent the most common chronic wound problem managed in Australian primary care. Despite the prevalence of the condition, there is an evidence-practice gap in both diagnosis and management of venous leg ulcers. OBJECTIVE We used the Theoretical Domains Framework to identify barriers and enablers perceived by primary care practitioners in implementing venous leg ulcer guidelines in clinical practice. DESIGN We collected data to explore the experiences of practice nurses and general practitioners related to their use of clinical practice guidelines in management of venous leg ulcers. SETTING(S) We recruited participants from primary care settings located in metropolitan and rural areas across Victoria, Australia. PARTICIPANTS We recruited general practitioners (15) and practice nurses (20). METHODS We conducted 35 semi-structured face-to-face and telephone interviews. Content analysis of health practitioners' statements was performed and barriers to implementing clinical practice guidelines were mapped across the Theoretical Domains Framework theoretical domains. RESULTS Six main domains from the Theoretical Domains Framework (Environmental context and resources, Knowledge, Skills, Social influences, Social/Professional Role and Identity and Belief about Capabilities) best explained these barriers and enablers. Many participants were not aware of venous leg ulcer clinical practice guidelines. Those that were aware, stated that finding and accessing guidelines was challenging and most participants relied on other sources of information. Venous leg ulcer management was greatly influenced by professional experience and suggestions from colleagues. Other barriers included busy clinical practice, absence of handheld Doppler ultrasonography, insufficient skills and a lack of confidence related to the use of technology to rule out arterial involvement prior to compression application, a particular skill related to venous leg ulcer management that will impact on healing outcomes. CONCLUSIONS We identified a number of barriers and the lack of enablers that influence the uptake of venous leg ulcer clinical practice guidelines in primary care. This paper adds a theoretically sound, systematic approach for understanding and addressing the behaviour change required to improve translation of venous leg ulcer clinical practice guidelines in clinical practice. Tweetable abstract: The need to optimise venous leg ulcer clinical practice guidelines (CPG) has never been greater as the current estimate of health cost is AUD3billion and increasing due to rising epidemics of diabetes and obesity. We found most primary care health practitioners are unaware of CPG and this will impact on health and healing outcomes in Australian primary care.
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Affiliation(s)
- C D Weller
- School of Nursing and Midwifery, Monash University, Level 5 Alfred Centre, 99 Commercial road, Melbourne, VIC, 3004, Australia.
| | - C Richards
- School of Nursing and Midwifery, Monash University, Level 5 Alfred Centre, 99 Commercial road, Melbourne, VIC, 3004, Australia.
| | - L Turnour
- School of Nursing and Midwifery, Monash University, Level 5 Alfred Centre, 99 Commercial road, Melbourne, VIC, 3004, Australia.
| | - A M Patey
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada.
| | - G Russell
- Department of General Practice, Southern Academic Primary Care Research Unit, Monash University, Building 1, 270 Ferntree Gully Rd, Notting Hill, 3168, Melbourne, Australia.
| | - V Team
- School of Nursing and Midwifery, Monash University, Level 5 Alfred Centre, 99 Commercial road, Melbourne, VIC, 3004, Australia.
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25
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Meulendijks AM, Welbie M, Tjin EPM, Schoonhoven L, Neumann HAM. A qualitative study on the patient's narrative in the progression of chronic venous disease into a first venous leg ulcer: a series of events. Br J Dermatol 2019; 183:332-339. [PMID: 31677155 DOI: 10.1111/bjd.18640] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND A venous leg ulcer (VLU) has a significant negative impact on quality of life. Prevention of a VLU is not yet imbedded in clinical practice because risk factors for developing a first VLU are not well known. OBJECTIVES To explore further the progression of chronic venous disease (CVD) into a first VLU from the patient's perspective. METHODS A qualitative study using semistructured interviews was conducted among male and female patients with a VLU. Patients from primary and secondary care, under and over 50 years of age, and with first and recurrent VLUs were included. The interviews were transcribed and analysed using a narrative approach to a thematic analysis. Transcripts were organized in chronological order and an iterative process was used to code the transcripts. RESULTS Four key themes and the connections made between them emerged from the 11 narratives on the progression of CVD towards a first VLU: 'comorbidity', 'mobility', 'work and lifestyle' and 'acknowledgment of CVD'. Comorbidity was linked to reduced mobility and late acknowledgment of CVD. Comorbidity also affected work and lifestyle and vice versa. Work and lifestyle affected mobility and was linked to the acknowledgment of CVD. CONCLUSIONS A reduction in mobility as a result of comorbidity and work and lifestyle occurred before the VLU developed. Patients did not recognize symptoms of CVD and did not acknowledge the chronicity of CVD. Healthcare professionals should be aware of reductions in mobility and the knowledge deficit in patients with CVD. What's already known about this topic? Not all patients with chronic venous disease (CVD) develop a venous leg ulcer (VLU). A patient's quality of life decreases significantly when a VLU develops. Risk factors for the development of a first VLU in patients with CVD are not well known, unlike risk factors for other chronic wounds like diabetic foot ulcer and pressure ulcers. What does this study add? The patient's narrative towards the development of a first VLU, a series of events. Insight into the events (comorbidity, mobility, work and lifestyle) that patients themselves link to the development of a VLU. Insight into the patients' acknowledgment of CVD in the progression of CVD towards a first VLU. What are the clinical implications of this work? More awareness is needed of CVD symptoms among patients and healthcare providers, as well as more awareness for prevention of a VLU in clinical practice. New insights (for further studies) are needed into the concept of mobility and the development of a VLU. Improved patient education and follow-up are needed for patients with CVD.
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Affiliation(s)
- A M Meulendijks
- University of Applied Sciences Utrecht, Research Group Healthy and Sustainable Living, Utrecht, the Netherlands.,Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - M Welbie
- University of Applied Sciences Utrecht, Research Group Healthy and Sustainable Living, Utrecht, the Netherlands
| | - E P M Tjin
- University of Applied Sciences Utrecht, Research Group Healthy and Sustainable Living, Utrecht, the Netherlands
| | - L Schoonhoven
- Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - H A M Neumann
- Department of Dermatology, Erasmus University Medical Centre Rotterdam, Rotterdam, the Netherlands
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26
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Meulendijks AM, Franssen WMA, Schoonhoven L, Neumann HAM. A scoping review on Chronic Venous Disease and the development of a Venous Leg Ulcer: The role of obesity and mobility. J Tissue Viability 2019; 29:190-196. [PMID: 31668667 DOI: 10.1016/j.jtv.2019.10.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 10/02/2019] [Accepted: 10/07/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The risk factors obesity and reduced mobility are not well known in the development of a Venous Leg Ulcer (VLU). The aim of this scoping review is to explore the mechanisms by which obesity and reduced mobility contribute the development of a VLU in patients with Chronic Venous Disease (CVD). METHODS For this scoping review a search was performed in May 2019 in the Cochrane Library and Pubmed to identify studies on the working mechanisms of obesity and mobility in developing a VLU. Hand searches were performed to find additional studies explaining the working mechanisms (indirectly related to the VLU). Two reviewers independently reviewed the abstracts and full-text articles. RESULTS Twenty-eight studies met our eligibility criteria. Disturbed range of ankle motion and gait can lead to a reduced Calf Muscle Pump (CMP) function which leading to a venous outflow disorder. Increased abdominal pressure due to obesity can lead to a venous outflow obstruction and increased adipose tissue mass results in an increase in adipokine secretion. The venous outflow disorder, outflow obstruction and increased adipokine secretion can all lead to chronic systemic inflammation, increased endothelial permeability and hence microcirculatory dysfunction. This alone can result in a VLU. CONCLUSION Obesity and reduced mobility can lead to a reduction of the CMP function, an increase in abdominal pressure and an increase in adipose tissue mass. This can simultaneously lead to haemodynamic changes in the macro- and microcirculation of the lower extremities and eventually in a VLU. In patients with obesity and reduced mobility the microcirculation alone can lead to skin changes and eventually a VLU. Therefore, early recognition of CVD symptoms in patients with obesity and reduced mobility is crucial to diagnose and treat CVD to prevent a VLU.
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Affiliation(s)
- A M Meulendijks
- University of Applied Sciences Utrecht, Research Group Healthy and Sustainable Living, Utrecht, the Netherlands; University Medical Centre Utrecht, Department Julius Centre for Health Sciences and Primary Care, Nursing Studies, Utrecht, the Netherlands.
| | - W M A Franssen
- University of Hasselt, REVAL, Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - L Schoonhoven
- University Medical Centre Utrecht, Department Julius Centre for Health Sciences and Primary Care, Nursing Studies, Utrecht, the Netherlands
| | - H A M Neumann
- Erasmus University Medical Centre Rotterdam, Department of Dermatology, Rotterdam, the Netherlands
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27
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Gianesini S, Obi A, Onida S, Baccellieri D, Bissacco D, Borsuk D, Campisi C, Campisi CC, Cavezzi A, Chi YW, Chunga J, Corda D, Crippa A, Davies A, De Maeseneer M, Diaz J, Ferreira J, Gasparis A, Intriago E, Jawien A, Jindal R, Kabnick L, Latorre A, Lee BB, Liew NC, Lurie F, Meissner M, Menegatti E, Molteni M, Morrison N, Mosti G, Narayanan S, Pannier F, Parsi K, Partsch H, Rabe E, Raffetto J, Raymond-Martimbeau P, Rockson S, Rosukhovski D, Santiago FR, Schul A, Schul M, Shaydakov E, Sibilla MG, Tessari L, Tomaselli F, Urbanek T, van Rijn MJ, Wakefield T, Wittens C, Zamboni P, Bottini O. Global guidelines trends and controversies in lower limb venous and lymphatic disease: Narrative literature revision and experts' opinions following the vWINter international meeting in Phlebology, Lymphology & Aesthetics, 23-25 January 2019. Phlebology 2019; 34:4-66. [PMID: 31495256 DOI: 10.1177/0268355519870690] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Guidelines are fundamental in addressing everyday clinical indications and in reporting the current evidence-based data of related scientific investigations. At the same time, a spatial and temporal issue can limit their value. Indeed, variability in the recommendations can be found both among the same nation different scientific societies and among different nations/continents. On the other side, Garcia already published in 2014 data showing how, after three years in average, one out of five recommendations gets outdated (Martinez Garcia LM, Sanabria AJ, Garcia Alvarez E, et al. The validity of recommendations from clinical guidelines: a survival analysis. CMAJ 2014;186(16):1211–1219). The present document reports a narrative literature revision on the major international recommendations in lower limb venous and lymphatic disease management, focusing on the different countries’ guidelines, trends and controversies from all the continents, while identifying new evidence-based data potentially influencing future guidelines. World renowned experts’ opinions are also provided. The document has been written following the recorded round tables scientific discussions held at the vWINter international meeting (22–26 January 2019; Cortina d’Ampezzo, Italy) and the pre- and post-meeting literature search performed by the leading experts.
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Affiliation(s)
| | - Andrea Obi
- 2 University of Michigan, Ann Arbor, MI, USA
| | | | | | | | - Denis Borsuk
- 6 Clinic of Phlebology and Laser Surgery, 'Vasculab' Ltd, Chelyabinsk, Russia
| | | | | | - Attilio Cavezzi
- 9 Eurocenter Venalinfa, San Benedetto del Tronto (AP), Italy
| | - Yung-Wei Chi
- 10 University of California, Davis Vascular Center, Sacramento, CA, USA
| | | | | | | | | | | | - Josè Diaz
- 15 Vanderbilt University Medical Center, Nashville, TN, USA
| | - Julio Ferreira
- 16 Instituto Brasilerio de Flebologia, Sao Paulo, Brazil
| | | | | | - Arkadiusz Jawien
- 19 Collegium Medicum, University of Nicolaus Copernicus, Bydgoszcz, Poland
| | | | | | | | | | - N C Liew
- 24 Putra University, Serdang, Malaysia
| | - Fedor Lurie
- 25 Jobst Vascular Institute, Toledo, OH, USA
| | | | | | | | | | | | | | | | - Kurosh Parsi
- 32 St. Vincent's Hospital, University of NSW, Sydney, Australia
| | | | | | | | | | - Stanley Rockson
- 37 Stanford University School of Medicine, Stanford, CA, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Cees Wittens
- 44 Maastricht University Medical Center, Maastricht, Netherlands.,45 Uniklinik Aachen, Aachen, Germany
| | | | - Oscar Bottini
- 46 Universidad de Buenos Aires, Buenos Aires, Argentina
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28
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Team V, Chandler PG, Weller CD. Adjuvant therapies in venous leg ulcer management: A scoping review. Wound Repair Regen 2019; 27:562-590. [PMID: 31025794 DOI: 10.1111/wrr.12724] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/17/2019] [Accepted: 04/22/2019] [Indexed: 12/12/2022]
Abstract
Compression therapy is the current evidence-based approach to manage venous leg ulcers (VLU); however, adherence is a major barrier to successful treatment. Combination approaches may relieve the burden of treatment by shortening the time to ulcer healing. This scoping review conducted by Australian researchers aimed to establish the evidence of effectiveness of various adjuvant methods on wound healing and recurrence. Randomized Controlled Trials (RCTs), and Systematic Reviews (SR) and Meta-Analyses (MA) on VLU management approaches published from January 2015 to December 2018 were included in this review. The articles included in the scoping review were grouped according to the management approaches, including (1) pharmaceutical interventions, (2) surgical interventions, (3) topical agents, (4) the use of devices, and (5) other, such as physiotherapy and psychological interventions. Results of this scoping review indicate that there is a limited high-quality evidence of effectiveness in most adjuvant therapies on wound healing and recurrence. Given the low-quality evidence observed in this scoping review for adjuvant treatments, the implication for practice is that current management guidelines be followed. Further rigorous studies have the potential to produce better quality evidence. Quality of evidence can be improved by ensuring large sample sizes of a single etiology wounds, standardizing reporting outcomes, and maintaining detailed and evidence-based protocols in physiological or psychological interventions.
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Affiliation(s)
- Victoria Team
- Monash Nursing and Midwifery, Level 3, 35 Rainforest Walk, Monash University, Wellington Road, Clayton, 3800, Victoria, Australia
| | - Peter G Chandler
- Monash Nursing and Midwifery, Level 3, 35 Rainforest Walk, Monash University, Wellington Road, Clayton, 3800, Victoria, Australia
| | - Carolina D Weller
- Monash Nursing and Midwifery, Level 3, 35 Rainforest Walk, Monash University, Wellington Road, Clayton, 3800, Victoria, Australia
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29
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Say M, Tella E, Sigal ML, Mahé E. [Leg ulcers in children and teenagers: A monocentric study of 10 cases]. JOURNAL DE MÉDECINE VASCULAIRE 2019; 44:199-204. [PMID: 31029274 DOI: 10.1016/j.jdmv.2019.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 01/30/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Leg ulcers in adults are a major public health concern. Incidence is increasing with age and there are many causes, with a predominance of vascular etiology. Leg ulcers in children and teenagers are less known and few studies have been conducted to investigate them. OBJECTIVE The aim of our study was to examine the causes of leg ulcers in children and teenagers. MATERIAL AND METHODS We conducted a retrospective monocentric study in the Victor-Dupouy hospital in Argenteuil, in children and teenagers who consulted in our center, between 2008 and 2018, for a chronic leg ulcer (disease course>4 weeks). RESULTS Ten patients were included, two boys and eight girls, aged from 7 to 15.3 years old. The most frequent etiologies were: supine ulcers (n=2) and infectious (n=2). The others etiologies were: sores under cast (n=1), sickle cell disease (n=1), dermatomyositis (n=1), post trauma (n=1), Pyoderma gangrenosum (n=1), ulcer on hemangioma (n=1). CONCLUSION Infectious causes and supine ulcers were the most frequent etiologies found in our study. These results should be completed by other observations in a multicentric study, currently underway in order to have a better knowledge of the etiologies of leg ulcers in this population and of their clinical course.
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Affiliation(s)
- M Say
- Service de dermatologie et médecine vasculaire, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel Prud'hon, 95100 Argenteuil, France.
| | - E Tella
- Service de dermatologie et médecine vasculaire, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel Prud'hon, 95100 Argenteuil, France
| | - M-L Sigal
- Service de dermatologie et médecine vasculaire, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel Prud'hon, 95100 Argenteuil, France
| | - E Mahé
- Service de dermatologie et médecine vasculaire, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel Prud'hon, 95100 Argenteuil, France
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30
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Weller CD, Team V, Ivory JD, Crawford K, Gethin G. ABPI reporting and compression recommendations in global clinical practice guidelines on venous leg ulcer management: A scoping review. Int Wound J 2019; 16:406-419. [PMID: 30485668 PMCID: PMC7949354 DOI: 10.1111/iwj.13048] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/01/2018] [Accepted: 11/11/2018] [Indexed: 11/28/2022] Open
Abstract
Clinical practice guidelines (CPGs) for venous leg ulcer (VLU) management recommend below-knee compression to improve healing outcomes after calculating the ankle-brachial pressure index (ABPI) to rule out significant arterial disease. This systematic scoping review aimed to complete a qualitative and quantitative content analysis of international CPGs for VLU management to determine if consensus existed in relation to recommendations for compression application based on an ABPI reading and clinical assessment. Our review shows that there is a lack of consensus across 13 VLU CPGs and a lack of clear guidance in relation to the specific ABPI range of compression therapy that can be safely applied. An area of uncertainty and disagreement exists in relation to an ABPI between 0.6 and 0.8, with some guidelines advocating that compression is contraindicated and others that there should be reduced compression. This has implications in clinical practice, including when it is safe to apply compression. In addition, the inconsistency in the levels of evidence and the grades of recommendation makes it difficult to compare across various guidelines.
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Affiliation(s)
| | - Victoria Team
- Monash Nursing and MidwiferyMonash UniversityClaytonVictoriaAustralia
| | - John D. Ivory
- School of Nursing & MidwiferyNational University of IrelandGalwayRepublic of Ireland
| | | | - Georgina Gethin
- School of Nursing & MidwiferyNational University of IrelandGalwayRepublic of Ireland
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31
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Tan MK, Luo R, Onida S, Maccatrozzo S, Davies AH. Venous Leg Ulcer Clinical Practice Guidelines: What is AGREEd? Eur J Vasc Endovasc Surg 2019; 57:121-129. [DOI: 10.1016/j.ejvs.2018.08.043] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 08/23/2018] [Indexed: 01/07/2023]
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32
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Pinheiro RR, Duarte B, Cabete J. Trichloroacetic acid (80%) as a chemical debridement method for chronic venous leg ulcers-A pilot study. Int Wound J 2018; 15:438-440. [PMID: 29334174 DOI: 10.1111/iwj.12884] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 11/23/2017] [Accepted: 12/04/2017] [Indexed: 11/26/2022] Open
Abstract
Debridement is essential for the optimal care of venous leg ulcers. Several debridement methods with different limitations may be deployed. Trichloroacetic acid (TCA) is used for several dermatological purposes. Its application as a chemical debridement method for leg ulcers has never been explored. We designed a prospective study to determine the role of 80% TCA solution as a chemical debridement method for leg ulcers, regarding efficacy and procedure-associated pain. Chronic venous leg ulcers were treated with 3 cycles of 80% TCA solution or curettage over 1 week. Pain and the mean percentage of fibrin and devitalized tissue covering wound bed were evaluated. At the end of the study, a trend towards larger fibrin mean reduction among the TCA treated ulcers was observed, although this difference was not statistically significant (P = .35). The mean pain score after TCA application was significantly reduced compared to pain after curettage alone (P < 0.001). TCA presented several advantages over mechanical debridement: it is a more selective debridement method, has haemostatic properties, and a simpler and faster application. The 80% TCA solution may be a cheap, simple, and considerably less-painful chemical debridement method for venous leg ulcers compared to classical mechanical debridement.
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Affiliation(s)
- Rita R Pinheiro
- Department of Dermatology, Centro Hospitalar Lisboa Central, Hospital Santo António dos Capuchos, Lisbon, Portugal
| | - Bruno Duarte
- Department of Dermatology, Centro Hospitalar Lisboa Central, Hospital Santo António dos Capuchos, Lisbon, Portugal
| | - Joana Cabete
- Department of Dermatology, Centro Hospitalar Lisboa Central, Hospital Santo António dos Capuchos, Lisbon, Portugal
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Andriessen A, Apelqvist J, Mosti G, Partsch H, Gonska C, Abel M. Compression therapy for venous leg ulcers: risk factors for adverse events and complications, contraindications - a review of present guidelines. J Eur Acad Dermatol Venereol 2017; 31:1562-1568. [DOI: 10.1111/jdv.14390] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 05/18/2017] [Indexed: 11/29/2022]
Affiliation(s)
- A. Andriessen
- Radboud UMC; Nijmegen & Andriessen Consultants; Malden The Netherlands
- International Compression Club (ICC); Berndorf Austria
| | - J. Apelqvist
- Department of Endocrinology; University Hospital of Malmö; Malmö Sweden
| | - G. Mosti
- Department of Angiology; Clinica MD Barbantini; Lucca Italy
- International Compression Club (ICC); Berndorf Austria
| | - H. Partsch
- Medical University Vienna; Vienna Austria
- International Compression Club (ICC); Berndorf Austria
| | - C. Gonska
- Medical & Regulatory Affairs; Lohmann & Rauscher GmbH & Co KG; Rengsdorf Germany
| | - M. Abel
- Medical & Regulatory Affairs; Lohmann & Rauscher GmbH & Co KG; Rengsdorf Germany
- Patient Outcome Group (POG); European Wound Management Association (EWMA); Frederiksberg Denmark
- International Compression Club (ICC); Berndorf Austria
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34
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Bertolini F. Leg ulcers caused by genetic disease 'prolidase deficiency'. J Eur Acad Dermatol Venereol 2017; 31:e377-e378. [PMID: 28222229 DOI: 10.1111/jdv.14180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- F Bertolini
- Department of Dermatology, Hospital of Piove di Sacco, Padua, Italy.,Department of Dermatology, Hospital of Rovigo, Rovigo, Italy.,Department of Dermatology, Medical Legal Center - INAIL, Padua, Italy
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35
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Neumann M. Evidence-based (S3) Guidelines for Diagnostics and treatment of venous leg ulcers - Answer to Dr Bertolini. J Eur Acad Dermatol Venereol 2017; 31:e386. [PMID: 28231377 DOI: 10.1111/jdv.14182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M Neumann
- Department of Dermatology, Erasmus University Hospital, Rotterdam, The Netherlands
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