Guidelines for the treatment of venous ulcers

The definition of the venous ulcer

Leg ulcer treatment

Chapter 1 - Epidemiology, Aetiology and Symptomatology.

Chapter 2 - Diagnostics.

Chapter 8 - Life style.

Chapter 6 - Oral medication.

Chapter 3 - Compression therapy.

Introduction: Complementary medicine has ancient historical roots and its use is constantly changing. It alongside scientific medicine is useful in the treatment of many diseases, including oncological, respiratory, and dermatological. It is used in the treatment of pain and in the local treatment of various ulcers (lesions) skin. In particular, scientific medicine uses several treatments for venous ulcers with not completely effective outcomes. Effective treatment prevents complications and improves the quality of life of patients. There is scientific evidence on the efficacy of complementary medicine in the treatment of venous ulcers of the lower limbs. Methods: It was performed as a literature review on the databases: MEDLINE, EMBASE and COCHRANE with the aim of detecting the evidence of efficacy of complementary medicine interventions in the treatment of venous ulcers and ways to treat it. We used the keywords and thesaurus descriptors for complementary medicine. We included the following drawings of relevant studies to the subject of the research: systematic reviews randomized controlled trials (RCTs), case control studies, observational studies, case reports, studies, and expert opinion in English, conducted on humans. For the purpose of this research, 174 documents were identified, of which only 15 were relevant and were within the inclusion criteria. Results: An analysis of the literature shows that many studies have evaluated the effectiveness of aloe, calendula, standardized extract from the aerial parts of A. pichinchensis, Mimosa tenuiflora, modified linen bandages, products made of honey found on the market, herbal therapies, polarized light therapy combined with herbal and plant biomembranes. However, these findings are insufficient to support or deny that one treatment is more effective than another. These results are not widely generalizable because of the low number of samples studied. Conclusion: Despite the interest in complementary medicine and the treatment of venous ulcers, there is currently no truly effective treatment strategy. The detected evidence is insufficient to make significant changes in the treatment of venous leg ulcers with complementary medicine interventions. The available studies on the treatment of venous leg ulcers with products based on plants have not established the existence of a treatment that may be effective individually. Additional studies would be needed to demonstrate the efficacy of these treatments.

16. Kumins NH, Weinzweig N, Schuler JJ. Free tissue transfer provides durable treatment for large non healing venous ulcers. J Vasc Surg 2000;32:848-54. 17. Steffe TJ, Caffee HH. Long-term results following free tissue transfer for venous stasis ulcers. Ann Plast Surg 1998;41:131-7. 18. Reddy MM, Reddy MD. Role of free tissue transfer in the management of chronic venous ulcer. Indian J Plast Surg 2004;37:28-33. 19. Vacuum-assisted closure versus standard therapy of chronic non-healing wounds. Wounds 2000;12:60-7. 20. Nelson EA, Harper DR, Prescott RJ, Gibson B, Brown D, Rutkey CV. Prevention of occurrence of venous ulcer randomised controlled trial of class 2, class 3 elastic compression. J Vasc Surg 2006;44:803-8. 21. Davies JA, Bull RH, Farrelly IJ, Wakelin MJ. A home based exercise programme improves ankle range of motion in long term venous ulcer patients. Phlebology 2007;22:86-9. 22. Porter JP, Rutherford RB, Clagett GP. Reporting standards in venous disease. J Vasc Surg 1988;8:172-81. 23. Sytchev GG. Classification of chronic venous disorders of lower extremities and pelvis. Int Angiol 1985;4:203-6 24. Barber C, Watt A, Pham C, Humphreys K, Penington A, Mutimer K, et al. Influence of bioengineered skin substitutes on diabetic foot ulcer and venous leg ulcer outcomes. J Wound Care 2008;17:517-27. 25. Falanga VJ. Tissue engineering in wound repair. Adv Skin Wound Care 2000;13:15-9. 26. Hissink RJ, Bruins RM, Erluns R, Castellenos Nuijits ML, van den Berg M. Innovative treatment in chronic venous insufficiency: Endovenous laser ablation of perforating veins: A prospective short-term analysis of 58 cases. Eur J Vasc Endo Vasc Surg 2010;40:403-6. 27. Amsler F, Willenberg T, Blattler W. Insearch of optimal compression therapy for venous leg ulcer: A meta analysis of studies comparing diver’s bandage with specifically designed stockings. J Vasc Surg 2009;50:66. 28. Netzen O, Bergquist D, Lindhagen A. Venous and nonvenous leg ulcers: Clinical history and appearance in a population study. Br J Surg 1994;81:182-3 29. Legendre C, Debure C, Meaume S, Lok C, Cronard JL, Senet P. Prevalence of protein deficiency on venous ulcer healing. J Vasc Surg 2000;48:688-93 30. Schnirring-Judge M, Belpedio D. Malignant Transformation of a chronic venous stasis ulcer to basal cell carcinoma in a diabetic patient: A case study and review of pathophysiology. J Foot Ankle Surg 2010;49:75-9 31. Coleridge Smith PD, Thomas P, Scurr JH, Dormandy JA. Causes of venous ulcerations: A new hypothesis. BMJ 1988;296:1726-7.

Spray-Applied Cell Therapy With Human Allogeneic Fibroblasts and Keratinocytes for the Treatment of Chronic Venous Leg ulcers: A Phase 2, Multicentre, Double-Blind, Randomised, Placebo-Controlled Trial

Chronic venous disease (CVD) is a common problem worldwide and is primarily related to venous insufficiency of the lower extremity veins. The etiology may be primary, due to venous valvular incompetence; or secondary, due to post deep vein thrombosis (DVT) vein wall damage. The clinical presentation includes leg swelling, pain, lipodermatosclerosis, hyperpigmentation, and venous stasis ulcers (VSUs) (found in the most severe cases). This affects 2.5 million patients per year in the United States and is estimated to cost more than $3 billion per year.1,2 The acute ulcers are problematic and require prolonged medical and surgical care; the recurrence rate of VSUs may be as high as 70%.3 Lack of disease understanding, lack of physician interest, and diffusion of patient care across multiple specialties all contribute to lack of CVD progress. In addition to a thorough medical history and physical examination, standard diagnostic testing for those who present with a VSU should include venous duplex ultrasonography. This yields information about luminal obstruction (post DVT), valvular competence, and whether the insufficiency affects the superficial, deep, or both vein systems anatomically. Similarly, an ideal biomarker would prognosticate patients with mild CVD, either primary or secondary, to either high or low risk of VSU and would be useful for guiding therapeutic interventions. Although several biomarkers, such as intercellular adhesion molecule-1, interleukin 6, and C-reactive protein, have shown some correlation with CVD severity, none are robust enough to use routinely at this point. The Sixth Pacific Vascular Symposium was conducted under the auspices of …

65-Year-Old Woman With Painful Leg Ulcers

1. Co-chaired panel 2. University of Utah, Salt Lake City, UT 3. University of Texas, San Antonio, TX 4. Sinai Hospital/Johns Hopkins Medical Institutions, Baltimore, MD 5. GKT School of Medicine, King’s College, London, UK 6. University of Texas Health Science Center at Houston, TX 7. Sequoia Hospital, Redwood City, CA 8. Maricopa Medical Center, Phoenix, AZ 9. Tufts-New England Medical Center, Boston, MA 10. Southampton University Hospitals Trust NHS, Southampton, UK 11. Penrose–St. Francis Health Services, Colorado Springs, CO 12. Beverly Surgical Associates, Beverly, MA 13. Saint Francis Memorial Hospital, San Francisco, CA 14. Northbay Center for Wound Care, Vacaville, CA, and 15. University of California, San Francisco, CA

The debridement of necrotic and infected tissues, which prolong the wound healing process, is important for the preparation of the wound bed. Therefore, wound-bed preparation and debridement are vital components of venous leg ulcer management. We aimed to present a perspective to evaluate the clinical and microbiological efficacy of Maggot Debridement Therapy (MDT) in the treatment of chronic leg ulcers caused by venous insufficiency. Thirty-eight patients with chronic venous leg ulcers who were referred to our unit with an MDT request were included in the study. Lucilia sericata larvae were applied to the wounds two days a week until the necrotic tissue was cleared. Swab samples were regularly taken before and immediately after each larval application for wound culture. Changes in the percentage of wound surface area and growing pathogenic microorganisms were recorded during the follow-up period. The sample consisted of 38 patients with 55 venous leg ulcers. The mean initial ulcer surface area was 99.1 cm2 (range 3 - 500). Complete debridement was achieved in all ulcers in the 2nd week, on average. Twenty-five ulcers (45.5%) were completely debrided with two one-week MDT sessions. Complete wound healing occurred in 42 ulcers (76.4%) after an average of seven MDT sessions. Microorganisms isolated from the wounds significantly decreased immediately after the first MDT session. Although many methods are used in the treatment of venous leg ulcers, they are often not effective. MDT, which is coming into widespread use today, is a simple and effective method in the treatment of these ulcers. Its effects such as biodebridement, disinfection, and growth stimulation can encourage the rapid healing of chronic venous leg ulcers.

Regarding "Healing of venous ulcers in an ambulatory care program: the roles of chronic venous insufficiency and patient compliance".