Potential mechanism underlying HXSJ decoction in the treatment of venous leg ulcers: based on the association between venous leg ulcers and ferroptosis.

Chapter 1 - Epidemiology, Aetiology and Symptomatology.

Chapter 2 - Diagnostics.

Chapter 8 - Life style.

Chapter 6 - Oral medication.

Chapter 3 - Compression therapy.

Leg ulcer treatment

The definition of the venous ulcer

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

Chronic Venous Insufficiency

Venous leg ulcers (VLUs) are the most severe manifestation of chronic venous disease (CVD). Due to their chronic nature, high recurrence rate and slow healing time, VLUs account for 80% of all leg ulcers seen in patients with CVD. VLUs impose a heavy burden on patients that reduces their quality of life; VLUs also represent a major socioeconomic impact due to the cost and duration of care. The primary medical approach to treating VLUs is local compression therapy in combination with venoactive drug (VAD) pharmacotherapy to promote the reduction of the inflammatory reaction initiated by venous hypertension. Micronized purified flavonoid fraction (MPFF; Daflon®) is the most widely prescribed VAD. MPFF counteracts the pathophysiologic mechanisms of CVD and ulceration and has proven to be an effective adjunct to compression therapy in patients with large and chronic VLUs. Two other non-VAD drugs, pentoxifylline and sulodexide, have also been shown to improve VLU healing and are also recommended in addition to compression therapy. However, MPFF is the only VAD with the highest strength of recommendations in the 2018 guidelines for the healing of VLUs.

Intermittent pneumatic compression: Physiologic and clinical basis to improve management of venous leg ulcers

Risk factors related to the failure of venous leg ulcers to heal with compression treatment

The real cost of treating venous ulcers in a contemporary vascular practice.

Aim: To review the evidence for the efficacy and safety of pentoxifylline for the treatment of venous leg ulcers. Data sources: The MEDLINE database and the following evidence based medical sites: National Guideline Clearinghouse, Canadian Medical Association Practice Guidelines InfoBase, Guidelines Finder, Database of Abstracts of Reviews of Effectiveness – Centre for Reviews and Dissemination, Bandolier, and The Cochrane Library. Review methods: Clinical guidelines, systematic reviews, meta-analyses, and randomized controlled trials published between January 2003 and July 2015 in English, Portuguese and Spanish were collected using the MeSH terms: pentoxifylline and venous ulcers. The Strength of Recommendation Taxonomy (SORT) scale of the American Academy of Family Physicians was used for assigning levels of evidence and the strength of recommendation. Results: Of the 51 articles found, six fulfilled the inclusion criteria and were selected for review. These included two clinical guidelines, one meta-analysis, one systematic review, and two clinical trials. A 400mg tablet of pentoxifylline taken three times a day increases the chance of healing of venous ulcers with or without compression. This drug is also cost effective in the treatment of chronic venous leg ulcers. The majority of adverse effects were gastrointestinal disturbances. Conclusions: These studies found pentoxifylline to be efficacious and cost effective in the treatment of chronic venous leg ulcers in adults. It can be used with compression bandaging but should also be considered for use in people unable to tolerate compression (Strength of Recommendation A – SOR A). Given the side effects reported, the optimal dose that combines efficacy and tolerability with maximal therapeutic adherence remains to be determined.

Leg and foot ulcers are symptoms of very different diseases. The aim of this paper is to demonstrate the differential diagnosis of leg ulcers. The majority of leg ulcers occur in the lower leg or foot. In non-venous ulcers the localization in the foot area is more frequent. The most frequent underlying disease is chronic venous disease. In 354 leg ulcers, Koerber found 75.25% venous leg ulcers, 3.66% arterial leg ulcers, 14.66% ulcers of mixed venous and arterial origin and 13.5% vasculitic ulcers. In the Swedish population of Skaraborg, Nelzen found a venous origin in 54% of the ulcer patients. Each leg ulcer needs a clinical and anamnestic evaluation. Duplex ultrasound is the basic diagnostic tool to exclude vascular anomalies especially chronic venous and arterial occlusive disease. Skin biopsies help to find a correct diagnosis in unclear or non-healing cases. In conclusion, chronic venous disease is the most frequent cause of leg ulcerations. Because 25% of the population have varicose veins or other chronic venous disease the coincidence of pathological venous findings and ulceration is very frequent even in non-venous ulcerations. Leg ulcers without the symptoms of chronic venous disease should be considered as non-venous.