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Borges D, Pires R, Ferreira J, Dias-Neto M. The effect of wound electrical stimulation in venous leg ulcer healing-a systematic review. J Vasc Surg Venous Lymphat Disord 2023; 11:1070-1079.e1. [PMID: 37196922 DOI: 10.1016/j.jvsv.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/25/2023] [Accepted: 05/08/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE The benefit of using electric stimulation therapy (EST) to heal venous leg ulcers (VLUs) is not well established. The main aim of this systematic review was to evaluate the effects of ulcer EST in VLU healing. METHODS A systematic search of the literature was conducted using the databases PubMed, Scopus, and Web of Science and included original studies that reported VLU healing after EST. The inclusion criteria were at least two surface electrodes placed on or near the wound or a planar probe covering the ulcer area to be treated. The Cochrane risk of bias tool for randomized control trials (RCTs) and Joanna Briggs Institute critical appraisal checklist for case series were used to evaluate the risk of bias. RESULTS This review included eight RCTs and three case series involving a total of 724 limbs in 716 patients with VLUs. The mean patient age was 64.2 years (95% confidence interval, 62.3-66.2), and 46.2% (95% confidence interval, 41.2%-50.4%) were men. The active electrode was placed on the wound with the passive electrode placed on healthy skin (n = 6), the two electrodes were placed on either side of the wound edges (n = 4), or a planar probe was used (n = 1). The pulsed current was the most used waveform (n = 9). The change in the ulcer size was the main method used to determine ulcer healing (n = 8), followed by the ulcer healing rate (n = 6), exudate levels (n = 4), and the time to healing (n = 3). Five RCTs detected a statistically significant improvement in at least one VLU healing outcome, after EST compared with the control group. In two of these, EST was better than the control but only for patients who had not undergone surgical treatment of VLU. CONCLUSIONS The findings from the present systematic review support the use of EST to accelerate wound healing of VLUs, especially for patients who are not surgical candidates. However, the significant variation in electric stimulation protocols represents an important limitation to its use and should be addressed in future studies.
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Affiliation(s)
- Daniela Borges
- Faculdade de Medicina da Universidade do Porto, University of Porto, Porto, Portugal.
| | - Raquel Pires
- Escola Superior de Biotecnologia, Universidade Católica do Porto, Porto, Portugal
| | - Joana Ferreira
- Department of Angiology and Vascular Surgery, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Marina Dias-Neto
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
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Pasek J, Szajkowski S, Cieślar G. Therapeutic efficacy of physical combined therapy in the treatment of venous crural ulcers. Phlebology 2021; 36:481-488. [PMID: 33407055 DOI: 10.1177/0268355520982452] [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] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Venous crural ulcer is a serious medical problem indeed, which is connected with patients' suffering and long term treatment generating high cost. The prognosis is unfavourable in many cases, as complete treatment of ulceration, when it is profound or really extensive is difficult to achieve, and sometimes impossible altogether. The aim of the study was to evaluate the therapeutic efficacy of treatment of venous crural ulcers with the use of multifunctional device LASEROBARIA-S, designed for combined physical therapy procedures. METHOD 147 succeeding patients (67 women and 80 men) diagnosed with venous crural ulcer participated in the study, with age varied between 41 and 79 years (average age - 70.2 years). The patients underwent a 60 day cycle of combined physical therapy, with the use of multifunctional device LASEROBARIA-S, during which therapy the lower extremity of the patient was placed in the therapeutic chamber and simultaneously subjected to the action of: local oxygen hyperbaria, low-frequency variable magnetic field and low energy light radiation emitted by semiconductor LED diodes. Prior to the therapeutic cycle and after its completion, planimetric measurements of the area of ulcer and the assessment of pain intensity with use of VAS scale were performed, in relation to selected factors potentially affecting therapeutic effects of applied therapy, as: sex and age of patients, as well as initial size of the ulcer and duration of the ulcer presence. RESULTS After the completion of therapeutic cycle, statistically significant reduction of the area of treated ulcer was found, by 5.4 cm2 on the average (16.3 cm2 vs 10.5 cm2) (p < 0.05). Moreover, as a result of the combined therapy procedures performed, the statistically significant lowering of the intensity of pain sensation experienced by patients, assessed by means of VAS scale, was obtained (2.55 points vs 0.48 points) (p < 0.05). The obtained improvement was not dependent statistically significantly on any of analysed selected factors potentially affecting regenerative and analgesic effect of applied therapy. CONCLUSIONS The application of combined physical therapy with the use of LASEROBARIA-S device results in significant reduction of the area of the venous crural ulcer surface, as well as reduction of the intensity of accompanying pain complaints and this therapeutic effect was not dependent on sex and age of patients, as well as initial size of the ulcer and duration of the ulcer presence.
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Affiliation(s)
- Jarosław Pasek
- Faculty of Health Sciences, Jan Długosz University in Częstochowa, Częstochowa, Poland.,Department of Osteopathic Medicine, Department of Physiotherapy, Masovian Medical College, Warsaw, Poland
| | - Sebastian Szajkowski
- Department of Osteopathic Medicine, Department of Physiotherapy, Masovian Medical College, Warsaw, Poland
| | - Grzegorz Cieślar
- Department of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Bytom, Poland
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Kamhawy AH, Elbarbary AH, Elhenidy MA, Elwagih AMM. Periulcer Foam Sclerotherapy Injection in Chronic Venous Leg Ulcers Using Near-Infrared Laser for Vein Visualization. INT J LOW EXTR WOUND 2019; 19:63-69. [PMID: 31496316 DOI: 10.1177/1534734619870680] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
High recurrence and high costs of treatment are the main problems with venous ulcer management. Therefore, it is of utmost importance to target the exact pathological cause. The role of cutaneous microvalves reflux in the pathogenesis of these ulcers has been confirmed. In this study, 20 chronic venous leg ulcers were prospectively subjected to foam sclerotherapy injection into periulcer veins using direct visualization by AccuVein AV400. Patients having infected ulcers, acute deep vein thrombosis, hypercoagulability, Ankle-Brachial Index <0.9, pregnancy, and/or allergy to the sclerosant were excluded. Endpoints included rates of ulcer size reduction, complete healing, ulcer recurrence, and procedure-related complications. Aethoxysklerol 1% was used in all cases to produce foam employing the double-syringe system. The mean reduction in ulcer surface area, postinjection, was 75% after 8 weeks and 91% after 12 weeks. Nineteen ulcers (95%) healed in a median time of 8 weeks, range 3 to 17 weeks. At 1 year of follow-up, 18 patients (90%) were still ulcer-free, while 1 patient's ulcer (5%) recurred 19 weeks postinjection. No major complications were encountered. Periulcer foam sclerotherapy injection, guided by vein visualization technology, should be one of the main lines of treatment of venous leg ulcers. It offers good results with regard to rapid ulcer healing and low recurrence rate without major risk. Randomized controlled trials are needed to establish these conclusions.
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Lin ZC, Loveland PM, Johnston RV, Bruce M, Weller CD. Subfascial endoscopic perforator surgery (SEPS) for treating venous leg ulcers. Cochrane Database Syst Rev 2019; 3:CD012164. [PMID: 30827037 PMCID: PMC6397791 DOI: 10.1002/14651858.cd012164.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Venous leg ulcers are complex, costly, and their prevalence is expected to increase as populations age. Venous congestion is a possible cause of venous leg ulcers, which subfascial endoscopic perforator surgery (SEPS) attempts to address by removing the connection between deep and superficial veins (perforator veins). The effectiveness of SEPS in the treatment of venous leg ulcers, however, is unclear. OBJECTIVES To assess the benefits and harms of subfascial endoscopic perforator surgery (SEPS) for the treatment of venous leg ulcers. SEARCH METHODS In March 2018 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA We included randomised controlled trials (RCTs) of interventions that examined the use of SEPS independently or in combination with another intervention for the treatment of venous leg ulcers. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies for inclusion, extracted data, assessed risk of bias, and assessed the certainty of evidence using the GRADE approach. MAIN RESULTS We included four RCTs with a total of 322 participants. There were three different comparators: SEPS plus compression therapy versus compression therapy (two trials); SEPS versus the Linton procedure (a type of open surgery) (one trial); and SEPS plus saphenous surgery versus saphenous surgery (one trial). The age range of participants was 30 to 82, with an equal spread of male and female participants. All trials were conducted in hospital settings with varying durations of follow-up, from 18 months to 6 years. One trial included participants who had both healed and active ulcers, with the rest including only participants with active ulcers.There was the potential for reporting bias in all trials and performance bias and detection bias in three trials. Participants in the fourth trial received one of two surgical procedures, and this study was at low risk of performance bias and detection bias.SEPS + compression therapy versus compression therapy (2 studies; 208 participants)There may be an increase in the proportion of healed ulcers at 24 months in people treated with SEPS and compression therapy compared with compression therapy alone (risk ratio (RR) 1.17, 95% confidence interval (CI) 1.03 to 1.33; 1 study; 196 participants); low-certainty evidence (downgraded twice, once for risk of bias and once for imprecision).It is uncertain whether SEPS reduces the risk of ulcer recurrence at 24 months (RR 0.85, 95% CI 0.26 to 2.76; 2 studies; 208 participants); very low-certainty evidence (downgraded three times, twice for very serious imprecision and once for risk of bias).The included trials did not measure or report the following outcomes; time to complete healing, health-related quality of life (HRQOL), adverse events, pain, duration of hospitalisation, and district nursing care requirements.SEPS versus Linton approach (1 study; 39 participants)It is uncertain whether there is a difference in ulcer healing at 24 months between participants treated with SEPS and those treated with the Linton procedure (RR 0.95, 95% CI 0.83 to 1.09; 1 study; 39 participants); very low-certainty evidence (downgraded three times, twice for very serious imprecision and once for risk of bias).It is also uncertain whether there is a difference in risk of recurrence at 60 months: (RR 0.47, 95% CI 0.10 to 2.30; 1 study; 39 participants); very low-certainty evidence (downgraded three times, twice for very serious imprecision and once for risk of bias).The Linton procedure is possibly associated with more adverse events than SEPS (RR 0.04, 95% CI 0.00 to 0.60; 1 study; 39 participants); very low-certainty evidence (downgraded three times, twice for very serious imprecision and once for risk of bias).The outcomes time to complete healing, HRQOL, pain, duration of hospitalisation and district nursing care requirements were either not measured, reported or data were not available for analysis.SEPS + saphenous surgery versus saphenous surgery (1 study; 75 participants)It is uncertain whether there is a difference in ulcer healing at 12 months between participants treated with SEPS and saphenous surgery versus those treated with saphenous surgery alone (RR 0.96, 95% CI 0.64 to 1.43; 1 study; 22 participants); very low certainty evidence (downgraded three times, twice for very serious imprecision and once for high risk of reporting bias).It is also uncertain whether there is a difference in the risk of recurrence at 12 months: (RR 1.03, 95% CI 0.15 to 6.91; 1 study; 75 participants); very low certainty evidence (downgraded three times, twice for very serious imprecision and once for high risk of reporting bias).Finally, we are uncertain whether there is an increase in adverse events in the SEPS group (RR 2.05, 95% CI 0.86 to 4.90; 1 study; 75 participants); very low certainty evidence (downgraded three times, twice for very serious imprecision and once for high risk of reporting bias).The outcomes time to complete healing, HRQOL, serious adverse events, pain, duration of hospitalisation, and district nursing care requirements were either not measured, reported or data were not available for analysis. AUTHORS' CONCLUSIONS The role of SEPS for the treatment of venous leg ulcers remains uncertain. Only low or very low-certainty evidence was available for inclusion. Due to small sample sizes and risk of bias in the included studies, we were unable to determine the potential benefits and harms of SEPS for this purpose. Only four studies met our inclusion criteria, three were very small, and one was poorly reported. Further high-quality studies addressing the use of SEPS in venous leg ulcer management are likely to change the conclusions of this review.
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Affiliation(s)
- Zhiliang Caleb Lin
- The Alfred HospitalSurgical Services55 Commercial RoadMelbourneVictoriaAustralia3004
| | - Paula M Loveland
- Royal Melbourne HospitalDepartment of Medicine300 Grattan StreetParkvilleVictoriaAustralia3050
| | - Renea V Johnston
- Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash UniversityMonash Department of Clinical Epidemiology4 Drysdale StreetMelbourneVictoriaAustralia3144
| | - Michael Bruce
- Monash UniversityDepartment of Surgery, Cabrini HospitalCabrini Hospital177 Wattletree RoadMalvernVictoriaAustralia3144
| | - Carolina D Weller
- Monash UniversitySchool of Nursing and MidwiferyLevel 3, 35 Rainforest Walk, Clayton CampusWellington Road, ClaytonMelbourneVICAustralia3800
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Smith D, Lane R, McGinnes R, O'Brien J, Johnston R, Bugeja L, Team V, Weller C. What is the effect of exercise on wound healing in patients with venous leg ulcers? A systematic review. Int Wound J 2018; 15:441-453. [PMID: 29446252 DOI: 10.1111/iwj.12885] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 11/29/2017] [Accepted: 12/04/2017] [Indexed: 11/30/2022] Open
Abstract
Standard best practice for the treatment of venous leg ulcers (VLUs) is compression bandaging of the lower leg to reduce hydrostatic pressure. There is considerable variation in reported healing rates when using this gold-standard approach; therefore, a systematic and robust evaluation of other interventions is required. Exercise interventions, in addition to standard compression therapy, could improve wound-healing time and prevent their recurrence. We have conducted a systematic review to examine the effects of exercise on wound characteristics, including time to heal, size and recurrence, pain, quality of life, adverse events, and economic outcomes. This review was registered with PROSPERO 2016:CRD42016046407. A systematic search of Ovid Medline, Ovid EMBASE, Ovid CINAHL, The Cochrane Library, PsycINFO, Web of Science, and PEDro was conducted on January 30, 2017, for randomised control trials to examine the effects of exercise on time to heal, size and recurrence, pain, quality of life, adverse events, and economic outcomes. Six studies met the inclusion criteria, but all had design flaws leading to biases, most commonly performance and selective reporting bias. Three studies compared a progressive resistance exercise programme (PREG) plus compression with compression alone for a period of 12 weeks. Low-quality evidence indicates the following: possibly no difference in the proportion of ulcers healed (risk ratio [RR] 1.14, 95% CI 0.71 to 1.84, I2 36%; 3 trials, 116 participants); probably no difference in quality of life (mean difference [MD] 3 points better on 100 point scale with exercise, 95% CI -1.89 to 7.89, 1 trial, 59 participants); possible increase in the risk of adverse events with exercise (OR 1.32, 95% CI 0.95 to 1.85, 1 RCT, 40 participants); and no difference in ankle range of motion and calf muscle pump. Evidence was downgraded due to susceptibility to bias and imprecision. Recurrence, pain, and economic outcomes were not measured in these trials, and time to healing was measured but not fully reported in 1 trial. We are uncertain of the effects of other interventions (community-based exercise and behaviour modification, ten thousand steps, supervised vs unsupervised exercise) due to the availability of low- or very low-quality evidence only from single trials. The review highlights the need for further research, with larger sample sizes, to properly address the significance of the effect of exercise on VLU wound characteristics.
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Affiliation(s)
- Daisy Smith
- Monash Nursing and Midwifery, Monash University, Clayton, Victoria
| | - Rebecca Lane
- Department of Physiotherapy, Monash University, Frankston, Victoria
| | | | - Jane O'Brien
- School of Health Sciences, University of Tasmania, Tasmania, Australia
| | - Renea Johnston
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria
| | - Lyndal Bugeja
- Monash Nursing and Midwifery, Monash University, Clayton, Victoria
| | - Victoria Team
- Monash Nursing and Midwifery, Monash University, Clayton, Victoria
| | - Carolina Weller
- Monash Nursing and Midwifery, Monash University, Clayton, Victoria
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Sallam RAE, El Ghaweet AI, Regal SAH. Value of combined exercise and ultrasound as an adjunct to compression therapy in chronic venous leg ulcers. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2017. [DOI: 10.4103/1110-161x.205660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Vitse J, Bekara F, Byun S, Herlin C, Teot L. A Double-Blind, Placebo-Controlled Randomized Evaluation of the Effect of Low-Level Laser Therapy on Venous Leg Ulcers. INT J LOW EXTR WOUND 2017; 16:29-35. [DOI: 10.1177/1534734617690948] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This study aimed to determine the effect of low-level laser therapy (LLLT) on chronic venous leg ulcers (VLUs). A double-blinded prospective randomized controlled trial was conducted to compare incidence of complete wound closure, ulcer size and pain reduction in patients randomized to 24 treatments of placebo or LLLT (635 nm) over 12 weeks. Patients presented with a 6-week history of VLUs ranging in size from 5 to 20 cm2. Venous origin was confirmed by Doppler ultrasound and an ankle brachial index of 0.8 or greater. Of 24 patients, 23% of the test group (n = 13) and 18% of placebo group (n = 11) achieved complete wound closure. At 12 weeks, patients in test and placebo groups had a mean surface area reduction of 6.26 cm2 ( P < .0001) and 6.72 cm2 ( P < .005), respectively, and a mean pain score decrease of 43.54 points ( P < .0001) and 25.73 points ( P = .002) respectively. Differences between groups was not statistically significant for wound closure ( P = 1.0) or ulcer size ( P = .80). Mean ulcer pain was significantly reduced from initiation of treatment compared with 4 weeks’ follow-up after 12 weeks with LLLT ( P < .01). Within the limitations of the study, LLLT may not have early effects as an adjunctive therapy to wound healing of VLUs, but LLLT may have delayed effects on VLU healing and associated pain, which requires further study.
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Affiliation(s)
- Julian Vitse
- Montpellier University Hospital, Montpellier, France
| | - Farid Bekara
- Division of Plastic and Reconstructive Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Stephanie Byun
- Division of Plastic and Reconstructive Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Luc Teot
- Montpellier University Hospital, Montpellier, France
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Ashrafi M, Alonso-Rasgado T, Baguneid M, Bayat A. The efficacy of electrical stimulation in lower extremity cutaneous wound healing: A systematic review. Exp Dermatol 2017; 26:171-178. [DOI: 10.1111/exd.13179] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Mohammed Ashrafi
- Plastic and Reconstructive Surgery Research; Centre for Dermatological Research; Institute of Inflammation and Repair; University of Manchester; Manchester UK
| | | | - Mohamed Baguneid
- University Hospital South Manchester NHS Foundation Trust; Wythenshawe Hospital; Manchester UK
| | - Ardeshir Bayat
- Plastic and Reconstructive Surgery Research; Centre for Dermatological Research; Institute of Inflammation and Repair; University of Manchester; Manchester UK
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Polak A, Taradaj J, Nawrat-Szoltysik A, Stania M, Dolibog P, Blaszczak E, Zarzeczny R, Juras G, Franek A, Kucio C. Reduction of pressure ulcer size with high-voltage pulsed current and high-frequency ultrasound: a randomised trial. J Wound Care 2016; 25:742-754. [DOI: 10.12968/jowc.2016.25.12.742] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- A. Polak
- Department of Physical Therapy, Academy of Physical Education, Mikolowska 72B, 40-065 Katowice. Poland
- Institute of Medical Science, Katowice School of Economics, Harcerzy Wrzesnia 3, 40-659 Katowice. Poland
| | - J. Taradaj
- Department of Physical Therapy, Academy of Physical Education, Mikolowska 72B, 40-065 Katowice. Poland
- Institute of Physical Therapy, Public High School of Medicine, Katowice 68, 45-060 Opole, Poland
| | - A. Nawrat-Szoltysik
- Department of Physical Therapy, Academy of Physical Education, Mikolowska 72B, 40-065 Katowice. Poland
- Caritas Skilled Nursing Facility, Wolnosci 30, 41-700 Ruda Slaska, Poland
| | - M. Stania
- Department of Physical Therapy, Academy of Physical Education, Mikolowska 72B, 40-065 Katowice. Poland
| | - P. Dolibog
- Department of Medical Biophysics, Medical University of Silesia, Medyków 18 bud. C2, 40-752 Katowice. Poland
| | - E. Blaszczak
- Department of Medical Biophysics, Medical University of Silesia, Medyków 18 bud. C2, 40-752 Katowice. Poland
| | - R. Zarzeczny
- Institute of Physical Education, Jan Długosz Academy, Waszyngtona 4, 42-200 Czestochowa, Poland
| | - G. Juras
- Department of Motor Behaviour, Academy of Physical Education, ul. Mikołowska 72B, 40-065 Katowice. Poland
| | - A. Franek
- Department of Medical Biophysics, Medical University of Silesia, Medyków 18 bud. C2, 40-752 Katowice. Poland
| | - C. Kucio
- Department of Physical Therapy, Academy of Physical Education, Mikolowska 72B, 40-065 Katowice. Poland
- Department of Internal Medicine, Specialist Hospital, Chelmonskiego 28, 43-600 Jaworzno, Poland
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de Carvalho MR, de Andrade IS, de Abreu AM, Leite Ribeiro AP, Peixoto BU, de Oliveira BGRB. All about compression: A literature review. JOURNAL OF VASCULAR NURSING 2016; 34:47-53. [DOI: 10.1016/j.jvn.2015.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 12/23/2015] [Accepted: 12/23/2015] [Indexed: 11/17/2022]
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Physical methods in the treatment of leg ulcers. ADVANCES IN REHABILITATION 2015. [DOI: 10.1515/rehab-2015-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
The most common complication of the chronic venous leg are ulcers and their frequency increases with age. Taking into consideration time and cost of treatment the ulcers are a serious medical and socioeconomic problem. Causal treatment concerns vein surgery, however, the recurrence risk up to 50% is observed. In the case of contraindications the conservative treatment is practiced. Topical treatment of ulcers is one of the methods of the conservative therapy. Methods of conservative treatment include general and local pharmacotherapy and compression therapy. Shall apply surgical skin grafting. Nowadays the standard therapy is more often completed by physical methods. Physical methods are not only the complement of the conventional treatment, but also a relevant factor referring to the effective treatment, especially as far as the minimum of contraindications is concerned. Electrotherapy, magnetic therapy, sonotherapy, etc. belong to this kind of methods.
The purpose of the paper is to present some methods of physical therapy in the treatment of leg ulcers. Based on the presented in the literature regiments, summarizes efficiency of magnetic therapy, high-voltage electrical stimulation and sonotherapy in the treatment of ulcers. The paper is a review of the current knowledge on the effects of therapeutic action of the above-mentioned methods. The results of the review indicate that magnetic therapy, electrostimulation of high-voltage and sonotherapy have the influence on the process of accelerating the healing of leg ulcers. It has been proved that treatment with low-frequency magnetic field indicates analgesic and anti-inflammatory, purifies wounds, accelerates the skin formation and finally leads to a complete epithelialization. After applying high voltage electrostimulation, can be observed a reduction in the amount of purulend secretions. High voltage electrostimulation (HVS) accelerates the skin formation and granulation process. After applying sonotherapy the uclers surface decreased. Therapy accelerated the process of clearing the wound of pus and the formation of granulation tissue.
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Gethin G, Killeen F, Devane D. Heterogeneity of wound outcome measures in RCTs of treatments for VLUs: a systematic review. J Wound Care 2015; 24:211-2, 214, 216 passim. [PMID: 25970758 DOI: 10.12968/jowc.2015.24.5.211] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- G. Gethin
- Senior Lecturer, BNS 4th year Student, Professor of Midwifery, Director, Health Research Board – Trials Methodology Research Network (HRB-TMRN), School of Nursing and Midwifery, National University of Ireland Galway, Ireland
| | - F. Killeen
- Senior Lecturer, BNS 4th year Student, Professor of Midwifery, Director, Health Research Board – Trials Methodology Research Network (HRB-TMRN), School of Nursing and Midwifery, National University of Ireland Galway, Ireland
| | - D. Devane
- Senior Lecturer, BNS 4th year Student, Professor of Midwifery, Director, Health Research Board – Trials Methodology Research Network (HRB-TMRN), School of Nursing and Midwifery, National University of Ireland Galway, Ireland
- Professor of Midwifery, Director, Health Research Board – Trials Methodology Research Network (HRB-TMRN), HSE West North West Hospital groups
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Comparison of Outcomes in Patients With Venous Leg Ulcers Treated With Compression Therapy Alone Versus Combination of Surgery and Compression Therapy. J Wound Ostomy Continence Nurs 2015; 42:42-6; quiz E1-2. [DOI: 10.1097/won.0000000000000079] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wollina U, Heinig B. Novel therapies developed for the treatment of leg ulcers: focus on physical therapies. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/edm.12.49] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Malas MB, Qazi U, Lazarus G, Valle MF, Wilson LM, Haberl EB, Bass EB, Zenilman J. Comparative effectiveness of surgical interventions aimed at treating underlying venous pathology in patients with chronic venous ulcer. J Vasc Surg Venous Lymphat Disord 2013; 2:212-25. [PMID: 26993193 DOI: 10.1016/j.jvsv.2013.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 09/30/2013] [Accepted: 10/10/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Chronic venous ulcers (CVUs) remain the leading causes for nonhealing wounds in the lower extremities. Although multilayer compression dressing remains the treatment gold standard, there are various surgical procedures aimed at healing CVUs with little or no evidence on the efficacy of these treatment methods. We conducted a systematic review of the effects of various surgical treatments for CVUs, in terms of ulcer healing rates, complete time to heal, recurrence rates, mortality, pain, and quality of life. METHODS We searched MEDLINE, EMBASE, the Cochrane Central Register for Controlled Trials, and the Cumulative Index for Nursing and Allied Health Literature databases from January 1980 through July 2012. We included studies that compared a surgical procedure with multilayer compression therapy or another surgical procedure among patients with CVUs. We also included studies without a comparison group if they were of sufficient quality. Two independent reviewers screened titles, abstracts, and articles for eligibility. Two reviewers extracted data on study design, applicability, results, and quality. RESULTS We identified 10,676 citations, of which 22 studies (23 publications) were included. Eight studies (six randomized controlled trials, two cohorts) compared a surgical procedure with compression. Fourteen studies evaluated different surgical interventions. Adding superficial vein ligation and stripping to compression did not improve wound-healing rate. However, the recurrence rate was 50% reduced when surgery corrected the underlying superficial venous pathology (moderate to high strength of evidence [SOE]). Adding subfascial endoscopic perforator surgery with superficial vein surgery to compression does not improve the healing rate of venous ulcers or reduce the recurrence rate except for medial and large ulcers (high SOE). The SOE was insufficient to support a conclusion about the effects of sclerotherapy when added to compression in healing CVUs. There was insufficient evidence on the surgical treatment of CVUs secondary to deep venous reflux and venous obstruction. We are unable to draw conclusions about the effects of surgical procedures on mortality, pain, and quality of life. CONCLUSIONS Our ability to draw conclusions on most surgical techniques is limited due to poorly designed and executed studies, with no uniformity of treatment methods, follow-up or reporting, and lack of randomization. We found some evidence to suggest superficial vein ligation and stripping may reduce the risk of wound recurrence, but these surgical techniques are infrequently performed. The newer minimally invasive techniques lack evidence. Randomized controlled trials for the endovenous procedures used today for treating CVUs are needed.
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Affiliation(s)
- Mahmoud B Malas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Umair Qazi
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Gerald Lazarus
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - M Fran Valle
- School of Nursing, University of Maryland, Baltimore, Md
| | - Lisa M Wilson
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Elisabeth B Haberl
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Eric B Bass
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Jonathan Zenilman
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Md
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The evaluation of bioelectrical activity of pelvic floor muscles depending on probe location: a pilot study. BIOMED RESEARCH INTERNATIONAL 2013; 2013:238312. [PMID: 24392449 PMCID: PMC3874332 DOI: 10.1155/2013/238312] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 11/25/2013] [Indexed: 11/18/2022]
Abstract
Objectives. The main objective was to determine how the depth of probe placement affects functional and resting bioelectrical activity of the PFM and whether the recorded signal might be dependent on the direction in which the probe is rotated. Participants. The study comprised of healthy, nulliparous women between the ages of 21 and 25. Outcome Measures. Bioelectric activity of the PFM was recorded from four locations of the vagina by surface EMG and vaginal probe. Results. There were no statistically significant differences between the results during functional sEMG activity. During resting sEMG activity, the highest bioelectrical activity of the PFM was observed in the L1 and the lowest in the L4 and a statistically significant difference between the highest and the lowest results of resting sEMG activity was observed (P = 0.0043). Conclusion. Different electrodes placement during functional contraction of PFM does not affect the obtained results in sEMG evaluation. In order to diagnose the highest resting activity of PFM the recording plates should be placed toward the anterior vaginal wall and distally from the introitus. However, all of the PFM have similar bioelectrical activity and it seems that these muscles could be treated as a single muscle.
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Salavastru CM, Nedelcu LE, Tiplica GS. Management of leg ulcers in patients with chronic venous insufficiency: the experience of a Dermatology Clinic in Bucharest, Romania. Dermatol Ther 2013; 25:304-13. [PMID: 22950557 DOI: 10.1111/j.1529-8019.2012.01513.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Venous ulcers are the most severe skin manifestation of chronic venous insufficiency. Treatment is complex and it is performed according to the stage of the disease. It includes changes of lifestyle, compressive therapy, phlebotropic medication, topical therapy of the ulcer, antibiotic therapy (topical and systemic), sclerotherapy, and surgical treatment. Patients with venous leg ulcers that attend the Second Dermatology Clinic of Colentina Clinical Hospital, are treated both as inpatients and as outpatients. They benefit from topical treatment and bandaging performed by specialized medical personnel in separate treatment room with strictly monitored conditions of asepsis and antisepsis. A follow-up study of these patients was made from January 1, 2009 to December 31, 2011. The average age of patients was 65.9 years (± 14.2), most of them being in the eight decade of life (31.9%). In almost half of the cases (44.2%), the patients spent more than 1 week in the hospital. Bacteriological investigations from the ulcers were performed in 55.1% of patients and the most frequent infectious agents were found to be Staphylococcus aureus (26.3%) and Enterobacter spp. (17.2%). Treatment of leg ulcer patients proves to be a long and complex one, a systematic and organized approach being needed in order to obtain healing of the wound.
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Affiliation(s)
- C M Salavastru
- 2nd Clinic of Dermatology, Colentina Clinical Hospital, Bucharest, Romania
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Abstract
BACKGROUND Up to one percent of people in industrialised countries will suffer from a leg ulcer at some time. The majority of these leg ulcers are due to problems in the veins, resulting in an accumulation of blood in the legs. Leg ulcers arising from venous problems are called venous (or varicose or stasis) ulcers. The main treatment is the application of a firm compression garment (bandage or stocking) in order to aid venous return. There is a large number of compression garments available and it was unclear whether they are effective in treating venous ulcers and, if so, which method of compression is the most effective. OBJECTIVES To undertake a systematic review of all randomised controlled trials (RCTs) evaluating the effects on venous ulcer healing of compression bandages and stockings.Specific questions addressed by the review are:1. Does the application of compression bandages or stockings aid venous ulcer healing? 2. Which compression bandage or stocking system is the most effective? SEARCH METHODS For this second update we searched: the Cochrane Wounds Group Specialised Register (31 May 2012); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 5, 2012); Ovid MEDLINE (1950 to May Week 4 2012); Ovid MEDLINE (In-Process & Other Non-Indexed Citations 30 May 2012); Ovid EMBASE (1980 to 2012 Week 21); and EBSCO CINAHL (1982 to 30 May 2012). No date or language restrictions were applied. SELECTION CRITERIA RCTs recruiting people with venous leg ulceration that evaluated any type of compression bandage system or compression stockings were eligible for inclusion. Eligible comparators included no compression (e.g. primary dressing alone, non-compressive bandage) or an alternative type of compression. RCTs had to report an objective measure of ulcer healing in order to be included (primary outcome for the review). SECONDARY OUTCOMES of the review included ulcer recurrence, costs, quality of life, pain, adverse events and withdrawals. There was no restriction on date, language or publication status of RCTs. DATA COLLECTION AND ANALYSIS Details of eligible studies were extracted and summarised using a data extraction table. Data extraction was performed by one review author and verified independently by a second review author. MAIN RESULTS Forty-eight RCTs reporting 59 comparisons were included (4321 participants in total). Most RCTs were small, and most were at unclear or high risk of bias. Duration of follow-up varied across RCTs. Risk ratio (RR) and other estimates are shown below where RCTs were pooled; otherwise findings refer to a single RCT.There was evidence from eight RCTs (unpooled) that healing outcomes (including time to healing) are better when patients receive compression compared with no compression.Single-component compression bandage systems are less effective than multi-component compression for complete healing at six months (one large RCT).A two-component system containing an elastic bandage healed more ulcers at one year than one without an elastic component (one small RCT).Three-component systems containing an elastic component healed more ulcers than those without elastic at three to four months (two RCTs pooled), RR 1.83 (95% CI 1.26 to 2.67), but another RCT showed no difference between groups at six months.An individual patient data meta-analysis of five RCTs suggested significantly faster healing with the four-layer bandage (4LB) than the short stretch bandage (SSB): median days to healing estimated at 90 and 99 respectively; hazard ratio 1.31 (95% CI 1.09 to 1.58).High-compression stockings are associated with better healing outcomes than SSB at two to four months: RR 1.62 (95% CI 1.26 to 2.10), estimate from four pooled RCTs.One RCT suggested better healing outcomes at 16 months with the addition of a tubular device plus single elastic bandage to a base system of gauze and crepe bandages when compared with two added elastic bandages. Another RCT had three arms; when one or two elastic bandages were added to a base three-component system that included an outer tubular layer, healing outcomes were better at six months for the two groups receiving elastic bandages.There is currently no evidence of a statistically significant difference for the following comparisons:⋅alternative single-component compression bandages (two RCTs, unpooled);⋅two-component bandages compared with the 4LB at three months (three RCTs pooled);⋅alternative versions of the 4LB for complete healing at times up to and including six months (three RCTs, unpooled);⋅4LB compared with paste bandage for complete healing at three months (two RCTs, pooled), six months or one year (one RCT for each time point);⋅adjustable compression boots compared with paste bandages for the outcome of change in ulcer area at three months (one small RCT);⋅adjustable compression boots compared with the 4LB with respect to complete healing at three months (one small RCT);⋅single-layer compression stocking compared with paste bandages for outcome of complete healing at four months (one small RCT) and 18 months (another small RCT);⋅low compression stocking compared with SSB for complete healing at three and six months (one small RCT);⋅compression stockings compared with a two-component bandage system and the 4LB for the outcome of complete healing at three months (one small, three-armed RCT); and,⋅tubular compression compared with SSB (one small RCT) for complete healing at three months. SECONDARY OUTCOMES 4LB was more cost-effective than SSB. It was not possible to draw firm conclusions regarding other secondary outcomes including recurrence, adverse events and health-related quality of life. AUTHORS' CONCLUSIONS Compression increases ulcer healing rates compared with no compression. Multi-component systems are more effective than single-component systems. Multi-component systems containing an elastic bandage appear to be more effective than those composed mainly of inelastic constituents. Two-component bandage systems appear to perform as well as the 4LB. Patients receiving the 4LB heal faster than those allocated the SSB. More patients heal on high-compression stocking systems than with the SSB. Further data are required before the difference between high-compression stockings and the 4LB can be established.
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Affiliation(s)
- Susan O'Meara
- Department of Health Sciences, University of York, York, UK.
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Santamato A, Panza F, Fortunato F, Portincasa A, Frisardi V, Cassatella G, Valente M, Seripa D, Ranieri M, Fiore P. Effectiveness of the Frequency Rhythmic Electrical Modulation System for the Treatment of Chronic and Painful Venous Leg Ulcers in Older Adults. Rejuvenation Res 2012; 15:281-7. [DOI: 10.1089/rej.2011.1236] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Andrea Santamato
- Department of Physical Medicine and Rehabilitation–“OORR Hospital,” University of Foggia, Foggia, Italy
| | - Francesco Panza
- Geriatric Unit & Gerontology-Geriatrics Research Laboratory, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Francesca Fortunato
- Section of Hygiene, Department of Medical and Occupational Science, University of Foggia, Foggia, Italy
| | - Aurelio Portincasa
- Department of Plastic and Reconstructive Surgery, University of Foggia, Foggia, Italy
| | - Vincenza Frisardi
- Geriatric Unit & Gerontology-Geriatrics Research Laboratory, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Gennaro Cassatella
- Department of Physical Medicine and Rehabilitation–“OORR Hospital,” University of Foggia, Foggia, Italy
| | - Mauro Valente
- Department of Plastic and Reconstructive Surgery, University of Foggia, Foggia, Italy
| | - Davide Seripa
- Geriatric Unit & Gerontology-Geriatrics Research Laboratory, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Maurizio Ranieri
- Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
| | - Pietro Fiore
- Department of Physical Medicine and Rehabilitation–“OORR Hospital,” University of Foggia, Foggia, Italy
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