Chronic leg oedema, ulceration and heart failure: a potentially deadly and often neglected combination.

1. Co-chaired this panel2. University of South Florida, Tampa, FL3. Healthpoint Ltd., Fort Worth, TX4. University of California, San Francisco, CA5. University of Texas Medical Branch, Galveston, TX6. University of Cardiff, Cardiff, Wales, UK7. University of Pennsylvania, Philadelphia, PA8. Private practice, Warren, PA9. Private practice, Tamarac, FL10. University of Pittsburgh, Pittsburgh, PA11. St. Louis University, St. Louis, MO, and12. Washington University, St. Louis, MO

Chapter 3 - Compression therapy.

Chapter 1 - Epidemiology, Aetiology and Symptomatology.

Chapter 2 - Diagnostics.

Chapter 8 - Life style.

Chapter 6 - Oral medication.

The definition of the venous ulcer

Getting Ready for Wound Certification: Assessing and Managing Lower Extremity Venous Disease.

Chronic venous leg ulcer (CVLU) is a common and refractory complication of chronic venous diseases, and is clinically characterized by chronic leg ulcers and pain. Matrix metalloproteinases (MMPs) are a kind of highly conservative and zinc-dependent endopeptidases, and can be divided into 6 types according to their substrates and structures. Among the 6 types, collagenases, gelatinases and stromelysins play a key role in the occurrence and development of CVLU. Moreover, the up-regulation of MMP-1,-2,-3,-8 and ratio of MMP-2 to tissue inhibitor of metalloproteinase-2 (TIMP-2) is associated with delayed ulcer healing, whereas the up-regulation of MMP-7,-10,-13 and TIMP-1,-2 facilitates ulcer healing. However, roles of MMP-9 and -12 in venous ulcers are still unclear and need further study. According to functional characteristics of some MMPs, intervention of their composition and functions may provide new therapeutic targets for the treatment of CVLU. Key words: Varicose ulcer; Lower extremity; Matrix metalloproteinases; Extracellular matrix; Wound healing

Leg ulcer treatment

Objective - To study the prevalence, aetiology and treatment of chronic leg and foot ulcers, and to estimate the nurse's time in wound management. Design - A structured questionnaire with 19 questions about chronic ulcers and wound management was sent to all district and community nurses in the county during 1 week in March 1998. A similar questionnaire has been administered regularly since 1986. Setting - Primary and community care in the county of Blekinge, Sweden, with a population of 151 610. Patients - 287 patients with chronic leg and foot ulcers were identified during the week studied. Main outcome measures - Prevalence of leg and foot ulcers, ulcer aetiology, treatment of ulcers and wound management time. Results - The estimated prevalence of chronic leg and foot ulcers was 0.19%. Venous ulcers were the most common (38%), of which 87% were treated with some form of compression therapy. Seven percent of the nurse's workload was devoted to ulcer care. During the period 1986 to 1998, ulcers with missing or unknown aetiology decreased from 31% to 6% and ulcers with a duration of more than 2 years from 44% to 27%, while treatment time per ulcer decreased from 2.1 to 1.7 hours/week. Conclusion ? Monitoring standards for ulcer aetiology through repeated questionnaires seems to ensure more accurate diagnoses. Thorough and detailed information about treatment time documents the workload for wound management.

BackgroundRecurrent chronic leg ulcers and its are morbidities associated with sickle cell anaemia (SCA). Compression therapy increases the rate of healing of these ulcers and also decreases the rate of recurrence.ObjectiveThis study evaluated the haematological parameters of patients with SCA and chronic leg ulcers placed on high compression bandaging to provide data for improved ulcer management and prevention.MethodsEighteen patients with SCA and chronic leg ulcers were recruited for treatment by compression therapy in Ibadan, Nigeria, from March to June 2015. Eighteen SCA patients with no history of chronic leg ulcers were age and sex matched and recruited as controls. Blood samples, wound biopsies and swabs were collected at different time points for full blood count, microbiology, culture and antimicrobial susceptibility tests. Haemoglobin variants were quantified by high performance liquid chromatography. Fasting blood sugar was tested for leg ulcer patients to determine diabetic status.ResultsUlcers ranged from 0.5 cm2 to 416 cm2 (median: 38.4 cm2). Post-intervention ulcer size ranged from 0.0 cm2 to 272 cm2 (median: 18.6 cm2, p < 0.001); four ulcers completely healed. Compared to the control group, haematological indices at commencement of treatment were more severe in leg ulcer patients (p = 0.02). No patients with chronic leg ulcer was diabetic. Microorganisms isolated from the leg ulcers include Pseudomonas aeruginosa, Staphylococcus aureus, Proteus sp., Escherichia coli and Klebsiella oxytoca.ConclusionMeasures to improve haematological parameters during leg ulcer treatment in SCA patients should be taken to aid wound healing.

Porcine tri-layer wound matrix for the treatment of stage IV pressure ulcers

Introduction: Venous Leg Ulcers account for 70% of all leg ulcers and estimates 1% of the populatio Objective: To compare the efficacy of compression +duplex guided injection sclerotherapy of incompetent perforators versus compression alone in treatment of chronic venous leg ulcers. Methods: Patients (older than 18 years) attending at outpatient clinic of Vascular Surgery Department, Faculty of Medicine-Zagazig University, were invited to participate in our study.Results: The study was Randomized Control Trial, conducted on 22 patients with chronic lower limb venous ulcer subdivided in two groups by control randomization, each group 11 patients (11ulcers) : Group A: - (compression only) this group was conservatively managed by four-layer compression bandage after ulcer debridement and irrigation by saline solution for 6 sessions with one weak interval between sessions. Group B: - (compression + foam injection) this group was managed by foam sclerotherapy of incompetent perforators then four-layer compression bandage after ulcer debridement and irrigation by saline solution also for 6 sessions with one-week interval between sessions Conclusion: The compression therapy is important line in management of venous ulcers. This synergistic approach can improve quality of life . Duplex-guided sclerotherapy is a simple procedure, compared to surgical intervention, no hospitalization, no anaesthesia, can be done in outpatient clinic and the patient can return home after 45 min and no work off period. The relative freedom from serious complications and its evident success, make this the first line treatment for venous ulcer and superior to compression alone.

In cold plasma medicine, anti-inflammatory, anti-itch, antimicrobic, ultravio - let, and other therapeutic modalities are combined within one treatment. Two types of cold plasma can be discerned: direct (dielectric barrier discharge (DBD)) and indirect plasma. DBD generates a low-temperature plasma under atmospheric pressure. The PlasmaDerm VU-2010 device is a noninvasive active medical intervention that does not come into direct contact with skin. For our medical application, a nonequilibrium, weakly ionized, physical DBD plasma is generated by the application of high voltages across small gaps; the electrode is covered by a dielectric. The skin itself acts as the second electrode. Chronic leg ulcers are a major problem among the elderly. The prevalence corresponds to 2-4% of the population. Eighty percent of chronic leg ulcers are caused by varicosis. In general, 3 phases of wound healing (cleaning of the wound ground, granulation, and epithelialization) can be discerned as disturbed in chronic venous leg ulcers. Wound debridement, modern wound dressings, and compression hosiery comprise methods of standard care. Despite these measures, leg ulcers often persist. Addi- tional plasma treatment may have the potential to facilitate wound healing by disinfection, stimulation of tissue regeneration and microcirculation, and acidification of the wound envi- ronment. We are currently conducting an ongoing clinical trial with the PlasmaDerm VU-2010 device to assess the safety, applicability, and efficacy of plasma treatment for chronic venous leg ulcers. So far, no adverse effects of plasma treatment have been reported, pointing toward a positive outcome of our study.