Chronic Nonhealing Ulcers Research Articles

A comparative analysis of vacuum assisted closure therapy and conventional dressings: outcomes in chronic diabetic foot ulcers among Indian patients

Background: India faces a growing diabetes epidemic, with approximately 77 million individuals affected. Chronic non-healing diabetic foot ulcers (DFUs) are a common complication of diabetes and a major healthcare challenge in Conventional wound care methods often result in prolonged healing times, increasing the risk of infection, hospitalization, and amputations. Vacuum-assisted closure (VAC) therapy, a modern treatment modality, offers a potentially more effective approach to managing these ulcers. Methods: This prospective, observational study was conducted at a tertiary care hospital in India from March 2022 to March 2024. One hundred patients with chronic non-healing DFUs were randomized into VAC therapy or conventional dressing groups. The primary outcomes included wound size reduction and healing time, while secondary outcomes involved patient satisfaction and cost-effectiveness. Results: VAC therapy significantly reduced wound size (65.2% vs. 40.5%) and shortened healing time (6.2 vs. 10.9 weeks) compared to conventional dressings. Additionally, VAC therapy led to higher patient satisfaction and proved more cost-effective due to fewer dressing changes and shorter hospital stays. Conclusions: VAC therapy outperforms conventional dressings in managing DFUs, offering faster healing, better patient satisfaction, and cost-effectiveness. Expanding its use in India could greatly improve diabetic foot care outcomes.

Comparative efficacy of autologous platelet rich plasma and conventional dressing in the management of chronic ulcers

Background: Chronic ulcers pose a major global healthcare challenge. The use of platelet-rich plasma (PRP) for treating these wounds has garnered interest because of its potential healing benefits. Objective were to determine the effect of autologous PRP therapy on the percentage of surface area reduction/healing in chronic ulcers. Methods: This randomized controlled trial was conducted at the department of general surgery of M.M. institute of medical sciences and research (M.M.I.M.S.R.) Mullana, Ambala from May 1, 2023, to April 30, 2024. Patients aged 18-80 years of either gender with chronic ulcers were enrolled. Patients were randomly allocated to the PRP group and control group. PRP group was administered autologous PRP once in two weeks for 6 weeks after debridement, while for the control group conventional saline dressings were done after debridement. Final assessment was done at 8 weeks. Results: Of the 60 patients, the mean age was 53.90±11.23 years. There were 49 (82%) males and 11 (18%) females. At 8 weeks, the PRP group achieved 83.78% (SD=2.99) reduction in surface area of ulcers, whereas the control group had a 57.78% (SD=1.32) reduction in surface area of ulcers, with a p=0.0000 indicating a significant difference. The small sample size and 56-day follow-up period are insufficient to assess long-term treatment effects. Conclusions: A better outcome of PRP was observed compared to conventional dressing in patients with chronic non-healing ulcers.

Preventive and Therapeutic values of Leech Therapy: A Review

There are three therapeutic modalities in the Unani medical system: Ilaj bit Tadbeer (Regimenal Therapy), Ilaj bid Dawa (pharmacotherapy), and Ilaj bil Yad (surgery). Ilaj bit Tadbeer includes several regimenal therapies such as Hijāma (Cupping Therapy), Ta'līq or Irsal-e-'Alaq (Leech Therapy), Fasd (Venesection), Dalk (Massage), Nutūl (Therapeutic Irrigation), Qai (Emesis), Idrār-i-Bawl (Diuresis), Tariq (Diaphoresis), Mundij wa Mu'shil therapy (Concoction and purgation), Bukhoor (Medicated Steam), Kaiyy (Cauterization), Huqna (Enema) etc. Since ancient times, these therapies have been widely used for their preventive, therapeutic, and rehabilitative effects. One of the most significant regimenal therapies, Irsal-e-Alaq (Leech therapy), is still in use. Renowned Unani physicians Razi, Majoosi, Zahrawi, and Ibne Sina have discussed and recommended the use of non-poisonous (or medicinal) leeches in the prevention and treatment of a variety of illnesses, including joint disorders, chronic non-healing ulcers, and numerous skin disorders like eczema, psoriasis etc. This review paper aims to explore the preventive and therapeutic role of leech therapy. Keywords: Unani Medical System, Therapeutic Role, Leech Therapy

Carcinoma Cuniculatum Masquerading as Eumycetoma: An Unacquainted Entity Posing a Diagnostic Dilemma.

Carcinoma cuniculatum (CC) is a rare and distinct clinicopathological variant of well-differentiated squamous cell carcinoma. It is a rare and slow-growing tumor with a peculiar infiltrative growth pattern resembling rabbit burrows (cuniculi). It usually occurs over the plantar aspect of the foot but can also occur at other sites like the oral cavity and genitals. The pathogenesis is unknown, with various hypotheses of trauma as proposed by different authors. It is essential to be aware of this entity as it commonly mimics benign and other low-grade squamous cell carcinoma (SCC). Diagnosis of CC can be challenging and requires repeated histological evaluation and clinical correlation. Herein, we present a case report of CC of the plantar and dorsal aspect of the foot in a 60-year-old male with a history of multiple chronic non-healing ulcers, which was clinically suspected as eumycetoma and remained inconclusive on numerous biopsies.

ANALYSIS OF EFFICACY OF COLLAGEN DRESSING VERSUS CONVENTIONAL DRESSING IN CHRONIC WOUND

A breach in continuity of the covering epithelium either of skin or of mucus membrane is defined as ulcer. Chronic or non-healing ulcers are defined as ulcers that are unresponsive to initial treatment or that persist for more than 3 weeks after appropriate care and management. Chronic nonhealing ulcers not only have a medical challenge but have social, economical and occupational effects on the patient. Ulcers have been treated conventionally by cleansing, debridement and removal of necrotic and infected tissue which was followed by dressing with topical antiseptic like Povidone iodine, antibiotic ointment, silver ointment, etc. Collagen is a group of naturally occurring proteins found in all phases of wound healing. Collagen is a key component of extracellular matrix which plays critical roles in the regulation of the phases of wound healing in its native fibrillar conformation or as a soluble component.Collagen helps wound healing through deposition and organisation of freshly formed fibres and granulation tissue in the wound bed which creates a good environment for wound healing.Collagen sheets when applied to a wound promote angiogenesis and also enhance bodyÂ’s repair mechanisms Our Aim is To compare the efficacy of the conventional dressing and collagen dressing in chronic wound in terms of Average time required for appearance of Granulation tissue, Requirement of Skin Grafting and mean Hospital Stay. Based on the type of dressing used, patients were divided into 2 groups, Group A(49) patients were dressed with conventional dressing, Group B patients (51) were dressed with collagen making a total of 100 patients. Appearance of healthy granulation tissue was observed to be significantly earlier among patients of collagen dressing group as compared to other group .The observed difference between number of days of hospital stay of patients with collagen dressing was statistically significant as compared to other group Thus Collagen based dressing were observed to be superior from conventional dressings in terms of aspects of healing viz. appearance of healthy granulation tissue.

The Efficacy of Local Autologous Platelet-Rich Plasma Prepared by Single and Double Spin Methods in the Treatment of Chronic Ulcer.

Chronic nonhealing ulcers present significant challenges in diabetic, dermatological, and surgical patients. Platelet-rich plasma (PRP), enriched with bioactive factors, offers promise for wound healing enhancement. This study evaluates PRP's efficacy, prepared via single and double spin methods in nonhealing chronic ulcers. Twenty-two patients aged 18-65 years participated and100 mL of blood was drawn into citrate phosphate dextrose adenine (CPDA) bags with all aseptic precautions. PRP was prepared by single and double spin methods. Patient serum and 10% calcium gluconate were added to fibrin gel. PRP was injected around the ulcer and then dressed. Dressings were changed on the fifth, 15th, and 20th days with PRP. Evaluation occurred on day 30 using surface area and volume assessments by both methods. The single spin PRP group and double spin PRP group had 11 patientseach with hemoglobin range of 10.79±1.88 to 12.63±2.22 g/dL. Initial lesions (16.27 cm²) significantly reduced to 14.76 cm² after double spin PRP sessions (p=0.005) andInitial lesions (9.87 cm²) significantly reduced to 7.65 cm² after single spin PRP sessions (p=0.005). Platelet count differences between whole blood and PRP were significant (p<0.05). The single spin PRP method exhibited considerable improvements in healing parameters, showcasing its potential for chronic ulcer management.

Revitalising Hope: Unveiling the Efficacy of Platelet Rich Plasma in Chronic Non-Healing Ulcers

Revitalising Hope: Unveiling the Efficacy of Platelet Rich Plasma in Chronic Non-Healing Ulcers

Plausible mechanisms in malignisation of non-habit related chronic nonhealing traumatic ulcers of oral cavity.

Chronic nonhealing ulcers of the oral mucosa and lateral tongue, in particular, can transform into invasive oral squamous cell carcinoma (OSCC). Sometimes these ulcers do not heal even after the removal of the etiological agent that actually initiated these lesions, something similar to what happens in "neoplasia." Numerous factors have been postulated in the literature; however, the exact mechanism remains unclear. We hereby would suggest few plausible factors that could be considered for future studies to shed light on some untapped territories in the pathogenesis of OSCC arising from chronic nonhealing traumatic ulcers in purview of chromoanagenesis and the concepts of "quantum entanglement and coherence."

Chronic oral non-healing ulcer with a history of tobacco consumption leads to malignancy: A prospective cross-sectional study in Western Maharashtra, India

Chronic oral non-healing ulcer with a history of tobacco consumption leads to malignancy: A prospective cross-sectional study in Western Maharashtra, India

Can acupuncture increase microcirculation in peripheral artery disease and diabetic foot syndrome? - a pilot study.

Globally, diabetes mellitus (DM) and peripheral artery disease (PAD) have an increasing incidence and a high prevalence and are both associated with high morbidity and complication rates, e.g., as chronic non-healing peripheral ulcers. Impaired macro- and microcirculation and peripheral neuropathy lead to an increased risk of foot ulcers and infections. These complications are difficult to treat, have a high risk of becoming chronic and often lead to lower limb amputation. The aim of this planned study was to investigate the potential effects of acupuncture on improving microcirculation in patients with Diabetic Foot Syndrome (DFS) and PAD. In 18 patients with chronic non-healing peripheral ulcers and diagnosed DM or PAD, data on 8 microcirculatory parameters were collected simultaneously on intact skin close to the wound margin. Microcirculation was assessed using an O2C device combining laser Doppler shift and white light spectroscopy (LEA Medizintechnik GmbH, Giessen, Germany). Unilateral and bilateral acupuncture was performed on the connecting line between acupuncture points Stomach 14 and Stomach 15. After unilateral acupuncture (ipsilateral to the wound side), a statistically significant improvement in 7 out of 8 microcirculatory parameters was demonstrated compared to baseline measurements before acupuncture. After bilateral acupuncture, there was an additional improvement and statistical significance in all parameters in both DFS and PAD patients. These results show an improvement in the microcirculation and peripheral blood flow at the edges of the wound. As impaired micro- and macrocirculation is considered to be a critical prognostic factor for the healing of a peripheral lesion, the intervention could have a positive impact on the healing of (chronic) peripheral wounds.

A randomized controlled clinical study to evaluate the efficacy of Haridra Arka in the management of Dushta Vrana vis-à-vis Chronic Non-Healing Ulcer

Introduction: A chronic wound is a wound that does not heal in an orderly set of stages and in a predictable amount of time. Any wound after 7 days is to be considered as Dushta Vrana. The use of Arka preparations in Vrana is mentioned in classics. Objective: To evaluate the efficacy of Haridra Arka in the management of Dushta Vrana and to study the anti-microbial property of Haridra Arka. Methodology: A single blind clinical study with pre-test and post-test design. The 30 patients with diagnostic criteria of Dushta Vrana were selected from Muniyal Institute of Ayurveda Medical Sciences, Manipal. In Group A, the wound is cleaned and dressed with Haridra Arka. In the control group, Betadine was used for dressing. Wound management done once in a day. Duration of the study for 30 days or till the formation of granulation tissue. Follow-up done once in 7 days for 1 month. The data were graded based on the assessment criteria and were analysed statistically. Results: The outcome of the treatment after 30 days showed high statistical significance in parameters like depth, edge and exudates amount, and other parameters like pain, itching, smell, undermining, necrotic tissue type, necrotic tissue amount, exudates type, skin colour surrounding the wound and granulation tissue showed statistical significance. Conclusion: Both these treatments showed reduction in symptoms but Group B in which Betadine was used showed better results. It can be concluded that Haridra in the form of Arka is not very effective in the management of Dushta Vrana when compared to Betadine.

The effect of active patient management on life expectancy in tongue cancer

The result of the treatment of tongue cancer, which includes surgical treatment at the first stage followed by radiation therapy, is presented. Carrying out radical combined treatment of tongue cancer in the future leads to the appearance of a post-radiation ulcer in the area of surgery, followed by the development of a recurrence of tongue cancer in it and metastasis to regional lymph nodes or submandibular salivary glands. All of the above requires oncologists to actively monitor this group of patients. With the development of a post-radiation chronic long-term non-healing ulcer in the area of surgery, surgical rehabilitation should be carried out. Surgical removal of such an ulcer prevents further development of cancer recurrence. Regular examination, neck ultrasound, cytological examination of suspicious areas of the tongue and regional lymph nodes allows timely detection of relapse and metastases and radical surgical treatment. Such an active tactic of managing this pathology affected the patient’s life expectancy — 17 years.

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 &lt; 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.

Оптимизация лечения хронических экссудирующих ран и язв нижних конечностей: экономическое и клиническое обоснование новых подходов

Background: the Global Burden of Disease (GBD) study has shown a significant increase in the prevalence of cutaneous and subcutaneous tissue diseases. Despite the high prevalence of non-healing wounds, there are very few economic estimates of specific treatment methods, which makes this issue very relevant. Aim: to conduct a clinical and economic analysis concerning the Zetuvit Plus Silicone / Zetuvit Plus Silicone Border superabsorbent dressing for the treatment of moderately and severely chronic non-healing wounds and ulcers of the lower extremities versus standard therapy with other dressings. The target group consisted of patients with moderately and severely chronic non-healing wounds and ulcers of the lower extremities. Patients and Methods: the Markov model was applied during the clinical and economic analysis, conducted with regard to the Russian healthcare system. The horizon analysis corresponded to the mean treatment duration of 24 weeks (about 6 months). Results: simulation showed that the dressing cost for one patient in the group who used superabsorbent dressing (100.6 thousand rubles) was 192.2 thousand rubles less than with standard therapy (292.7 thousand rubles). At the same time, the total cost per patient when using superabsorbent dressing (319 thousand rubles) was 195.8 thousand rubles less than with standard therapy (514.8 thousand rubles). In terms of the projected number of patients (307.4 thousand people), the use of superabsorbent dressing instead of standard therapy will lead to a cost reduction of 60.2 billion rubles. Conclusion: based on the data obtained during the study, the use of Zetuvit Plus Silicone / Zetuvit Plus Silicone Border superabsorbent dressing in the treatment of moderately and severely chronic non-healing wounds and ulcers of the lower extremities is associated with lower costs for both dressing and medical care, which leads to budget savings. KEYWORDS: chronic non-healing wounds, venous trophic ulcers, Zetuvit Plus Silicone Border, Zetuvit Plus Silicone superabsorbent dressing, cost analysis, budget impact analysis, Markov model. FOR CITATION: Zhuravleva M.V., Kokushkin K.A., Luchinina E.V., Krysanova V.S., Luchinin E.A., Petrikov A.S., Lesovik V.S. Treatment optimization of chronic non-healing wounds and ulcers of the lower extremities: economic and clinical justification of new techniques. Russian Medical Inquiry. 2024;8(4):195–200 (in Russ.). DOI: 10.32364/2587-6821-2024-8-4-2.

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.

Fetal progenitor cells for treatment of chronic limb ischemia.

This study investigated the therapeutic potential of fetal progenitor cells (FPCs) in the treatment of chronic non-healing wounds and ulcers associated with chronic limb ischemia (CLI). The research aimed to elucidate the mechanism of action of FPCs and evaluate their efficacy and safety in CLI patients. The researchers isolated FPCs from aborted human fetal liver, brain, and skin tissues and thoroughly characterized them. The preclinical phase of the study involved assessing the effects of FPCs in a rat model of CLI. Subsequently, a randomized controlled clinical trial was conducted to compare the efficacy of FPCs with standard treatment and autologous bone marrow mononuclear cells in CLI patients. The clinical trial lasted 12 months, with a follow-up period of 24-36 months. The primary outcomes included wound healing, frequency of major and minor amputations, pain reduction, and the incidence of complications. Secondary outcomes involved changes in local hemodynamics and histological, ultrastructural, and immunohistochemical assessments of angiogenesis. In the animal model, FPC treatment significantly enhanced angiogenesis and accelerated healing of ischemic wounds compared to controls. The clinical trial in CLI patients demonstrated that the FPC therapy achieved substantially higher rates of complete wound closure, prevention of major amputation, pain reduction, and improvement in ankle-brachial index compared to control groups. Notably, the study reported no serious adverse events. FPC therapy exhibited remarkable efficacy in promoting the healing of ischemic wounds, preventing amputation, and improving symptoms and quality of life in patients with CLI. The proangiogenic and provasculogenic effects of FPCs may be attributed to their ability to secrete specific growth factors. These findings provide new insights into the development of cellular therapeutic angiogenesis as a promising approach for the treatment of peripheral arterial diseases.

Marjolins Ulcer: Clinicopathological Profile and Treatment Patterns

Purpose: Marjolins ulcer is a malignant transformation arising from chronic ulcers or previously traumatized scars that occur usually after burns. This article aims to study the clinicopathological profile and treatment patterns of Marjolins ulcer.&#x0D; Materials and Methods: Retrospective analysis of all Marjolins ulcer patients presented to Vydehi Cancer Centre from 2018 to 2021 was done. A total of 27 patients of all age groups were included in the study. All information regarding detailed history, clinical examination, treatment details were retrospectively collected and analysed.&#x0D; Results: Most of the patients were in the 5th decade of life with an overall male preponderance. The most common cause for Marjolins ulcer was Burns scars followed by Trauma. Lower extremities were found to be the most predominant site. The mean latency period for the development of Marjolins ulcer was 11 years. Squamous cell carcinoma was the most common histological subtype, Adjuvant Radiotherapy was given to the patients with high-risk features.&#x0D; Conclusion: Chronic non-healing ulcers that do not respond to treatment should be carefully examined for malignant transformation. Surgery is the mainstay of treatment and Adjuvant Radiotherapy should be considered in high-risk cases to reduce locoregional recurrence.

Comparing thetraditional and emerging therapies for enhancing wound healing in diabetic patients: A pivotal examination.

Chronic non-healing ulcers are common among diabetic patients, posing significant therapeutic challenges. This study compared traditional therapies (TT) and emerging therapies (ET) for enhancing diabetic patients' wound healing. A total of 150 diabetic patients with chronic ulcers, ages 30-65, were randomly assigned to one of two groups: TT (n = 75) or ET (n = 75). ET included growth factors, bioengineered skin substitutes, and hyperbaric oxygen therapy, while TT for wound healing predominantly included debridement, saline-moistened dressings, and off-loading techniques. The primary outcome was the percentage of lesions that healed within 12 weeks, which was assessed at intervals. Secondary outcomes included time to wound recovery, pain using Visual Analogue Scale (VAS), and life quality via Wound-QoL questionnaire. By the 12th week, the ET group had a repair rate of 81.33% compared to 57.33% in TT group (p < 0.05). ET exhibited superior pain reduction (VAS score: 4.7 ± 1.6 for ET vs. 6.2 ± 1.4 for TT, p < 0.05) and improved life quality (Wound-QoL score: 61.8 ± 9.1 for ET vs. 44.3 ± 10.3 for TT, p < 0.05). However, there were slightly more cases of cutaneous irritation and hematomas among ET patients. ET have demonstrated significant efficacy in accelerating wound healing in diabetic patients, surpassing traditional methods, with additional advantages in pain management and life quality. Due to the observed minor complications, however, caution is required.

Clinical Evaluation of Jalaukavacharana (Medicinal Leech Therapy) in Non-Healing Ulcer

Chronic non-healing ulcers are those that do not heal within three months or often remain in the inflammatory stage for too long and may never heal or may take years. Some wounds heal easily by body’s self-healing mechanism and some poses challenge to normal wound healing and does not heal in time and becomes a matter of concern for the physicians. Leech therapy proved to be a better treatment option by benefits of its salivary constituents in wound healing. It is an ancient way of treating such complicated disorders mentioned in different texts. A patient came at Shalya Tantra OPD with ulcer on posterior aspect of right ankle joint above the heel which was not healing since 6 months even on daily antiseptic dressings. Patient gave h/o immobilization for 2 months following ORIF of same joint 7 months back. During immobilization, after 1month of ORIF, patient developed ulcer at posterior aspect of Rt. Ankle above heel. Leech was applied at wound site twice weekly initially followed by once weekly then once in 15 days along with antiseptic dressing daily. The ulcer started showing signs of healing within three sittings and completely healed by 4 months. This study was carried out in Department of Shalya Tantra, Rajiv Gandhi govt. Post Graduate Ayurvedic college and Hospital, Paprola.

Local Application of Timolol 0.5% Solution in Treating Chronic Non-Healing Ulcers – A Prospective Study

Chronic non-healing ulcers are a variety of ulcers that occur mainly over the lower limb and are resistant to conventional therapy. There are modern treatments like various types of dressings and topical preparations available in the market. However, they are costly and may not be freely available to the general population. Topical usage of β2-AR antagonists like timolol may promote wound healing by enabling keratinocyte migration into the wound to initiate the re-epithelisation. The objective of this study is to assess the effectiveness of topical timolol 0.5% in accelerating the wound healing process by observing the signs of healing. It is a prospective observational study conducted in Government General Hospital, Rangaya Medical Medical College, Kakinada, after getting Institutional Ethical Committee approval from March 2021 to March 2023. One hundred patients with Chronic non-healing foot ulcers were taken for this study. Mean age was 47.64.60% of the study population was in the 20-55 years age group. Reduction in mean ulcer area was on day 15 and day 30 with topical application of timolol.