Nonhealing Chronic Leg Ulcers Research Articles

Evaluation of autologous platelet rich fibrin in chronic non-healing leg ulcers

Context: Chronic non healing leg ulcers cause psychological, social, and financial burden to the patient. Platelet rich fibrin (PRF), a biological membrane with plethora of growth factors acts as a cheaper and simpler option for the management of non-healing leg ulcers. Aims: To evaluate the effectiveness of PRF in the treatment of chronic nonhealing leg ulcers of varying etiologies. Material and Methods: It was a prospective study conducted in 30 patients in a tertiary care center. PRF dressing was done weekly for the chronic non healings ulcers of various etiologies for 6 weeks. Response to therapy was assessed by calculation of wound area and volume and digital photographs before each treatment session. Statistical analysis was done using Chi-square test, paired t-test and ANOVA test to get P values. Results: In our study, the mean age of subjects was 55.9 ± 14.08. 21 (70%) subjects were male and 9 (30%) were female. Majority of the ulcers were trophic ulcers due to hansen’s disease (n = 11, 36.7%), followed by diabetic ulcers (n = 9, 30%), venous ulcers (n = 6, 20%) and traumatic ulcers (n = 4, 13.3%). Percentage decrease of mean ulcer area and volume were 92.3% and 97.6%, respectively. There was significant decrease in the mean area and volume (P < 0.0001) of the ulcer from 2nd week onwards till the end of 6th week. Conclusions: PRF can be used as an adjuvant along with standard treatment in the management of chronic non healing ulcers to reduce the duration of healing.

Medical Management to Treat Chronic Non-healing Ulcers: A Case Series.

Chronic non-healing leg ulcers are skin defects below the knee that resist healing for more than six weeks. They cause physical, emotional, and economic burdens to patients and society. To introduce an innovative medical strategy that targets the chronic inflammation component in non-healing ulcers (NHUs) with rheumatic features and to evaluate its potential effectiveness in achieving complete healing. We employed an empirical medical therapy regimen, which combined medications like deflazacort, colchicine, dapsone, hydroxychloroquine, and azathioprine. We retrospectively selected 25 patients with chronic pedal ulcerswho underwent our therapy. The mean duration of ulcers was 7.84 years, and the time to heal was 5.97 months. Among 25 patients, 19 had atypical ulcers, four had venous ulcers, and two had diabetic neuropathy ulcers. Four patients with venous ulcers additionally underwent endovenous laser ablation. Our medical strategy showed promising results in healing chronic NHUs with rheumatic features without significant steroid-induced adverse effects.

A Case Series Examining the Use of Extracorporeal Shockwave Therapy (ESWT) to Treat Non-healing Venous Leg Ulcers

With their complex pathogenesis, many wounds, such as venous leg ulcers (VLUs) and diabetic foot ulcers (DFUs), place a significant burden on the global healthcare system [1]. 93% of venous leg ulcers (VLUs) are open for more than a year due to a variety of factors such as comorbidities, lifestyle, and work demands. The most common causes are venous disease, arterial disease, and neuropathy. To avoid inappropriate treatment that could worsen the wound, delay healing, or harm the patient, a correct diagnosis is required. Wound chronicity can lead to complications such as infections, amputation, and even death. The purpose of this study is to determine the efficacy of ESWT therapy in patients with chronic non-healing venous leg ulcers who have not shown any signs of healing for more than a year [2].

Role of Autologous Platelet Rich Plasma in the Management of Chronic Non Healing Ulcers

Background: Chronic non-healing leg ulcers are a major health problem worldwide and have great impact on personal, professional and social levels, with high cost in terms of human and material resources. The present study was conducted with an aim to demonstrate the efficacy of autologous platelet rich plasma (PRP) in chronic non-healing leg ulcers in comparison to conventional dressings. Methods: About 50 patients presenting with chronic non healing ulcers to the surgical outpatient department in a tertiary care centre over a period of one year were included in the study, of which 25 patients received autologous PRP dressings other 25 patients received conventional dressings. Ulcer measurements were taken on day 1, 15, 28 and 42 days. Results: The mean duration of healing of the ulcers was 3.9 weeks in PRP group and 6.2 weeks conventional dressing. PRP dressing group showed a reduction in ulcer size of about 45.50 percent as compared to 14.80 percent in conventional dressing group. Conclusion: Chronic non healing ulcers are often difficult to heal because they lack the necessary growth factors to maintain the healing process. Conventional therapies do not provide satisfactory healing, since these treatments are not able to provide the necessary growth factors (PDGF, EGF, VGEF etc.) which are essential for the healing process. PRP is a safe, affordable, biocompatible and simple office based procedure for the treatment of non-healing ulcers.

Study of Efficacy of Autologous Platelet Rich Fibrin in Chronic Non-Healing Ulcers of Leg

Introduction: Platelet-rich fibrin (PRF) is the newer treatment option for treatment of chronic non-healing ulcers of leg and it contains various growth factors which boosts the wound healing. Objectives: To detect the efficacy of autologous PRF dressing in chronic non-healing leg ulcers and to assess the reduction in ulcer area at the end of each week. Materials and Methods: 30 patients (17 females, 13 males) were taken in this prospective study with informed consent. PRF was prepared by drawing 10cc venous blood and directly centrifuging it at 3000rpm (approximately 400g) for 10 minutes without adding anticoagulant. Three fractions were formed consisting of red coloured lower fraction containing RBCs, middle fraction containing PRF and upper fraction consisting of upper straw coloured platelet poor plasma (PPP). PPP fraction was discarded; middle PRF fraction was collected by separating it from the lower RBC fraction with forceps and scissors. PRF was then applied over the healthy bed of chronic non-healing ulcers every week till the wound heals. Reduction in ulcer at the end of each week is assessed by calculating area (Length×Width×0.7854). Results: The mean size of the ulcers was 10.4 cm2 initially; mean duration of ulcer was 4.7months. Complete healing required minimum 3 and the maximum 8 sittings (mean 4) no adverse events seen. Conclusion: We conclude that PRF dressing can be used as it is effective, safe, outpatient procedure in chronic non-healing leg ulcers.

Autologous platelet-rich fibrin membrane as a wound dressing in the treatment of chronic nonhealing leg ulcers: A prospective study

Background: Chronic nonhealing ulcers of the lower extremity are a cause of morbidity and mortality. The various treatment options available are limited and unsatisfactory. Promoting wound healing with an autologous platelet membrane could be a safe, easy, and inexpensive modality. Purpose: To assess an autologous platelet-rich fibrin (PRF) membrane as a wound dressing in the treatment of chronic nonhealing leg ulcers. Methods: A prospective study enrolled 30 patients with chronic nonhealing leg ulcers. Autologous PRF was applied weekly for 6 weeks. At each visit, the ulcer healing was assessed with wound measurements and photographs. The treatment outcome was defined as a percentage in a change of area and volume of the ulcer at the end of the study period. Results: Thirty patients with chronic nonhealing leg ulcers were treated for 6 weeks. 100% improvement in area of the ulcer was seen in 43% ulcers. The mean percentage of improvement in area of the ulcer was 72%. The mean percentage of improvement in volume of the ulcer was 77%. The mean duration of healing was 5 weeks. Conclusion: This study was limited by the lack of a control group. Autologous PRF may be useful for the treatment of chronic nonhealing leg ulcers which can be done on an outpatient basis with minimum adverse effects.

<em>Hypericum perforatum</em> and <em>Azadirachta indica</em> (Neem) oil in the management of chronic leg ulcers: An uncontrolled retrospective observational case review

Chronic nonhealing leg ulcers are debilitating with high morbidity in a vulnerable patient population and pose a frequent clinical and socioeconomic problem. Numerous local treatment options exist, but clinical trials are rare and wound management still represents a big challenge. Recently a wound dressing based on the natural remedies Hypericum perforatum and Neem oil has been proposed for chronic wound management, but trials on nonhealing leg ulcers are missing. Uncontrolled retrospective observational case review on all patients under our supervision with chronic leg ulcers who underwent treatment with a plant-derived wound dressing based on Hypericum perforatum and Azadirachta indica (Neem) oil. It could be retrieved in a total 16 cases (11 female) with a median age of 71 years. All ulcers (7 ulcers on the leg and 9 ulcers on the feed) showed a complete healing after a median healing time of 82 days (Mean 85, range 14-180 days). No side effects occurred, medication was painless or even reduced pain. Wound dressings based on Hypericum perforatum and Neem oil are well tolerated and could be a potential additional simple treatment option in the management of non-healing leg ulcers. Prospective controlled trials are needed to confirm these observations.

Efficacy and Safety of Intralesional Platelet Rich Plasma (PRP) Therapy in the Management of Chronic Non-healing Leg Ulcers in our Population

Background: Autologous Platelets Rich Plasma (PRP) therapy not only hastens chronic wounds and ulcers healing but also diminishes the rate of amputations of lower leg caused by non-healing recalcitrant ulcers. In this study we have demonstrated the magical results of intralesional autologous PRP in the healing of resistant to heal chronic leg ulcers. Methods: In this metacentric study 26 patients having 30 chronic leg ulcers of more than 6 weeks duration and various etiologies, were treated with intralesional autologous PRP application on weekly basis for a duration of 8 weeks and the final results were calculated by percentage improvement in the volume and area of the ulcer/wound. Results: In our study 26 patient with 30 chronic recalcitrant leg ulcers/wounds were treated with intralesional autologous PRP therapy on weekly basis. Mean age of the included patients was 34.5 years. 19 were male patients and 7 were female. The mean time period of the healing of chronic ulcers was 5.3 weeks. The final mean percentage improvement outcome in the volume and area of the ulcers was calculated as 86% and 88% respectively. Conclusions: PRP therapy is safe, cost effective office based simple procedure in treating recalcitrant chronic leg ulcer/wounds. Keywords: Non-healing, intralesional, autologous platelet rich plasma, chronic ulcers

Use of Porcine-Derived Dermal Substitutes for Treatment of Nonhealing Vascular Leg Ulcers: A Case Series.

Nonhealing leg ulcers are a major health problem worldwide with a high economic burden since they require human and material resources. Moreover, nonhealing ulcers are a major nontraumatic cause of lower limb amputations. Dermal substitutes have emerged as an effective therapeutic option for treatment of skin lesions, but data on leg ulcers are scarce. We evaluated safety and efficacy of a porcine-derived dermal substitute in the treatment of chronic vascular leg ulcers. Records of patients with nonhealing ulcers seen at our unit from 2018 to 2019 were retrospectively reviewed. Wound etiology, wound area, and complications were evaluated. Each patient received one application of porcine-derived dermal substitute and was followed-up. Six patients (5 females and 1 male) with a mean age of 61.3 (52-81) years presented with nonhealing leg ulcers. After surgical debridement and wound bed preparation, porcine-derived dermal substitute was applied onto the ulcer. Granulation was satisfactory within 10 days. All wounds healed after an average time of 14 weeks. Graft take was good, and no graft loss, rejection, or associated infection were observed. In conclusion, the data presented indicate that dermal substitutes are safe and effective for treatment of chronic nonhealing vascular leg ulcers.

A comparative study between platelet rich plasma and conventional dressing in chronic non healing leg ulcers

Background: Chronic non-healing leg ulcers are a major health problem worldwide and have great impact on personal, professional and social levels, with high cost in terms of human and material resources. The present study was conducted with an aim to demonstrate the efficacy of autologous platelet rich plasma (PRP) in chronic non-healing leg ulcers in comparison to conventional dressings.Methods: A total of 50 patients with leg ulcers were randomized into two groups (A and B) with each group comprising of 25 patients each. Group A were treated with autologous platelet rich plasma (PRP) dressings and group B were treated with conventional dressings using normal saline. Ulcer measurements were taken on day 1, day 7, days 15 and after 30 days. The end point of study was complete wound epithelialization or appearance of granulation tissue, which ultimately lead to spilt skin grafting or secondary healing; whichever is earlier.Results: There was statistically significant difference in the average time taken for complete healing of ulcer in PRP dressings, 3.68 weeks against 6.2 weeks in conventional dressing group (p value <0.0001). PRP dressing group showed a 43.96% reduction in ulcer size as compared to 13.81% in conventional dressing group (p <0.0001). It was observed that PRP dressing group has faster wound healing and contraction of wound.Conclusions: PRP dressing of leg ulcers was better than conventional normal saline dressing as it leads to early reduction of ulcer size and enhances rate of wound healing.

Autologous smashed follicular dermal graft with epidermal cell suspension in chronic nonhealing leg ulcers

Wound healing is a multifaceted process. Restoration of the epithelium may occur either by migration of activated epithelial keratinocytes from the adjoining epithelium or by centrifugal migration of putative stem cells found in the bulge region of the hair follicle. Dermal collagen and glycosaminoglycans also play a key role in laying down the scaffold for vascular in-growth and population of the matrix with host fibroblasts. Despite the availability of a wide range of treatment modalities, chronic nonhealing leg ulcers remain a therapeutic challenge and cause significant patient morbidity. Hence, there is a further need to develop novel techniques which would be effective, safe, easily available, and affordable for the patient.

Jodhpur Technique for Chronic Non-Healing Leg Ulcer

Jodhpur Technique for Chronic Non-Healing Leg Ulcer

Multidrug-resistant primary cutaneous tuberculosis: A rare cause of chronic nonhealing leg ulcer in systemic lupus erythematosus

Multidrug-resistant primary cutaneous tuberculosis: A rare cause of chronic nonhealing leg ulcer in systemic lupus erythematosus

Follicular Unit Grafting in Chronic Nonhealing Leg Ulcers: A Clinical Study.

Introduction and Objectives:The restoration of the epithelium after injury takes place by migration of epithelial cells adjoining a wound or by centrifugal migration from hair follicles. To evaluate the feasibility and potential healing capacity of scalp follicular unit grafts transplanted into the wound bed of chronic leg ulcers.Materials and Methods:Patients with chronic nonhealing ulcers of more than 6 weeks duration were selected for the study. Those with infected ulcers and uncontrolled diabetes were excluded from the study. Fifteen patients were included in the study. Follicular unit grafts were harvested under local anesthesia using small-diameter (1 mm) circular punches. A density of 5 follicular grafts/cm2 was implanted into the ulcer bed. The ulcer was dressed with Vaseline gauze and elastic bandage for 24 h. The wound area and volume were calculated by length × width × 0.7854 and length × width × depth × 0.7854, respectively. The treatment outcome was defined as the percentage in change of area and volume of the ulcer, 18 weeks after intervention.Results:A total of 15 patients with 17 ulcers were treated with the above method. Of these 17 ulcers, 11 were venous ulcers, 2 were pyoderma gangrenosum associated with varicose veins, 2 were traumatic ulcers, and 2 were trophic ulcers. The baseline mean area of the ulcer was 6.72 cm2 (SD 5.65) and baseline volume was 2.87 cm3 (SD 2.9). The final area of the ulcer at the end of 18 weeks after the procedure was 3.84 cm2 (SD 5.43) and the final volume was 1.21 cm3 (SD 2.45), which was statistically significant. The mean percentage improvement in the area and volume of the ulcer was 48.8% and 71.98%, respectively. Two patients did not respond to the treatment. There were no adverse events after the procedure.Conclusion:We conclude that follicular unit grafting into wound beds is feasible and represents a promising therapeutic alternative for managing nonhealing chronic leg ulcers.

English

Cutaneous tuberculosis is a rare manifestation of tuberculosis and accounts to less than 2% of cases of tuberculosis. It can have varied manifestation. An accurate diagnosis can be achieved by clinical examination of lesion and relevant investigation including skin biopsy. The cutaneous tuberculosis responds excellently to anti-tubercular drugs. Here we describe a case of young adult female, with chronic non-healing leg ulcer. A diagnosis of cutaneous tuberculosis was established based on skin biopsy findings and her response to treatment with anti-tubercular drugs.

Anhidrosis and nonhealing painless leg ulcer with osteomyelitis in a young boy

The hereditary sensory and autonomic neuropathies (HSAN) are a group of very rare genetic disorders, characterized by prominent sensory as well as autonomic neuropathy without any motor involvement. Five main groups (type-I through type-V) of HSAN do exist. We report here a case of a chronic nonhealing leg ulcer in a young boy associated with anhidrosis, diagnosed as HSAN type-IV with osteomyelitis, for its rarity, and to emphasize the importance of considering this entity in the differential diagnoses of chronic nonhealing ulcers in the pediatric population.

Efficacy of autologous platelet-rich plasma in the treatment of chronic nonhealing leg ulcers

Aim: The aim was to evaluate the efficacy of platelet-rich plasma (PRP) in the treatment of chronic nonhealing ulcers. Methods: A nonrandomized, uncontrolled study was performed on 24 patients with 33 nonhealing ulcers of various etiologies. All patients were treated with PRP at weekly intervals for a maximum of 6 treatments. At the end of the 6-week period, reduction in size of the ulcers (area and volume) was assessed. Results: The mean age of the patients was 42.5 years (standard deviation [SD] 12.48). Of 33 ulcers, there were 19 venous ulcers, 7 traumatic ulcers, 2 ulcers secondary to pyoderma gangrenosum, 2 diabetic ulcers, 2 trophic ulcers, and 1 vasculitic ulcer. The mean duration of healing of the ulcers was 5.6 weeks (SD 3.23). The mean percentage of reduction in area and volume of the ulcers was 91.7% (SD 18.4%) and 95% (SD 14%), respectively. About 100% resolution in the area was seen in 25 (76%) of the ulcers and 100% reduction in volume was seen in 24 (73%) of the ulcers at the end of the 6th treatment. Conclusion: Conventional therapies do not provide satisfactory healing for chronic nonhealing ulcers as they are not able to provide the necessary growth factors (GFs) (platelet-derived GF, epidermal GF, vascular endothelial GF, etc .) which are essential for the healing process. PRP is a safe, affordable, biocompatible, and simple office-based procedure for the treatment of nonhealing ulcers.

A pilot clinical study of hair grafting in chronic leg ulcers

Epidermal sheets spread centrifugally postinjury from the hair follicle infundibulum to reepithelialize the wound bed. Healing progresses faster in skin areas rich in terminal hair follicles. These observations are consistent with the role of the hair follicle as a major reservoir for progenitor cells. To evaluate the feasibility and potential healing capacity of autologous scalp follicular grafts transplanted into the wound bed of chronic leg ulcers, 10 patients with ulcers of an average 36.8 cm(2) size and a 10.5-year duration were included in this pilot study. Within each ulcer we randomly assigned a 2 × 2 cm "experimental" square to receive 20 hair grafts and a nongrafted "control" square of equal size. The procedure seemed to be safe, although major unrelated complications occurred in two patients. At the 18-week end point, we observed a 27.1% ulcer area reduction in the experimental square as compared with 6.5% in the control square (p = 0.046) with a maximum 33.5% vs. 9.7% reduction at week 4 (p = 0.007). Histological analyses showed enhanced epithelialization, neovascularization, and dermal reorganization. We conclude that terminal hair follicle grafting into wound beds is feasible in an outpatient setting and represents a promising therapeutic alternative for nonhealing chronic leg ulcers.

Congenital absence of inferior vena cava and thrombosis: a case report

IntroductionA congenitally absent Inferior Vena Cava (IVC) is a rare anomaly that is recognised to be associated with idiopathic Deep Venous Thrombosis (DVT), particularly in the young. It may not be apparent until later in life. Retrospectively, as discussed in this case, there can be clues indicating the presence of such an anomaly from a young age. However, it is not clear whether early recognition of this condition would affect the prognosis and treatment.Case presentationA 54 year old gentleman was admitted with 3 weeks of abdominal pain and localised swelling over the right flank. Examination revealed palpable 'snake-like' tortuous, tender lumps on the abdominal wall. Past history revealed chronic non-healing venous leg ulcers, and varicose veins necessitating varicose vein ligation at a very young age. The ulcers eventually needed skin grafting.During this, current admission he was investigated and diagnosed with Deep Vein Thrombosis (DVT). CT scan, performed to search for intra-abdominal cancer, revealed absence of the Inferior Vena Cava with extensive thrombosed collaterals of the superficial abdominal and azygous veins and a congenitally atrophic left kidney.ConclusionThis is a case of one of the oldest patient described in the literature to be diagnosed with absence of the IVC. It is thought that IVC anomalies are under-diagnosed, and may be commoner than once believed. However there were vital clues in his previous medical history suspicious for an underlying venous anomaly. Idiopathic DVT in a relatively young person with a past history of chronic leg ulceration or varicose veins should be investigated for congenital anomalies of the IVC. This is best achieved by CT scan of the abdomen.

Modified unna boot and pinch grafting for chronic non-healing venous leg ulcer

Venous ulcers cause considerable morbidity. A 45-year-old man reported with non healing ulcer since 15 years. Patch tests revealed multiple sensitivity. Infection was first controlled with antibiotics and antiseptics. Dressing with modified Unna’s boot made with zinc oxide 40% and glycerine paste 60% resulted in formation of healthy granulation tissue. Pinch grafting was subsequently done to promote epithelization. We recommend the use of Unna’s paste instead of more expensive synthetic and occlusive and semi occlusive dressing to promote granulation tissue and pinch grafting after bed is ready to hasten epithelization.