Chronic Venous Ulcers Research Articles

May-Thurner Syndrome

May-Thurner Syndrome is a rarely diagnosed condition in which patients develop ilio-femoral deep venous thrombosis (DVT) due to an anatomical variant in which the right common iliac artery overlies and compresses the left common iliac vein against the lumbar spine. Early recognition and treatment of this condition can prevent debilitating sequelae of chronic venous hypertension. Accurate diagnostic modalities are transabdominal ultrasound, MRI but the widely available noninvasive MDCT accurately depicts left iliac venous compression by the right iliac artery. May-Thurner Syndrome treatment focuses on improving blood flow and reducing your risk of developing DVT. Treatments are angioplasty and stenting; bypass surgery and surgery to move the right iliac artery. May-Thurner Syndrome is a progressive disease with long-term disabling complications. This type of obstruction may cause leg swelling, varicosities, deep venous thrombosis, chronic venous stasis ulcers, or more serious complications, such as pulmonary embolism or phlegmasia cerulea dolens. In conclusion, May-Thurner Syndrome should be taken into consideration if there is persistent edema of the left leg, especially in young women.

Effect of Hyaluronic Acid Iontophoresis on Healing of Chronic Venous Ulcer

Purpose: The purpose of the study is to evaluate the effect of hyaluronic acid iontophoresis on healing of chronic venous ulcer. Methods: Forty patients of both genders suffering from chronic venous ulcer in area below the knee and above the ankle with area (5-20 cm2) with less than 50% necrotic tissue participated in this study. Their ages ranged from (45 to 60) years. They were selected from Vascular Surgery Department, Al Ahrar Teaching Hospital between June 2022 and January 2023. Patients were divided randomly into 2 equal groups; each one had 20 patients. Group (A) received Hyaluronic acid iontophoresis 1 session per day, 3 sessions per week, for 4 weeks, and follow up 4 weeks after the end of the treatment. In addition to conventional, medical treatment and traditional care. Group (B) received conventional medical treatment and traditional care (ulcer cleansing, debridement, dressing, compression, medication, exercise). Measurements were done by photographic digital camera for wound Surface area (WSA) and wound volume using saline injection into a wound cavity before treatment and after 4 weeks of treatment. Results: The findings of this study indicated significant decrease in WSA and wound volume after treatment in all groups A, B (p<0.001) at day 60 post treatment. There was significant decrease in ulcer surface area and ulcer volume at day 60 post treatment of study group (group A) compared with that of control group (group B) (p = 0.001).Conclusion: Hyaluronic acid iontophoresis for 6 weeks is an effective and safe adjuvant therapy in treatment of unhealed venous ulcers through accelerating wound healing, reducing Wound Surface Area (WSA) and wound volume. Keywords: Hyaluronic Acid, iontophoresis, Chronic Venous leg ulcers, Wound Healing

Circumferential Radical Debridement and Omental Free Flap in the Treatment of Severe Chronic Venous Ulcers.

Chronic venous leg ulcers are a significant health care burden with a difficult and unreliable treatment. Free flaps may be needed for wound coverage in severe cases. Incomplete removal of dermatoliposclerosis (DLS) area and/or not addressing the underlying venous dysfunction may contribute to the reported modest long-term results. A series of 5 patients with severe chronic venous ulcers of the leg, resistant to conservative treatment and superficial venous surgery, were treated with radical, circumferential, subfascial resection of the DLS skin and coverage with omental free flaps. Delayed arteriovenous (AV) loops were used as recipients. All patients had previous superficial venous surgery and multiple skin grafts. Mean follow-up was 8 years (4-15 years). One hundred percent of flaps survived completely. No major complications occurred. One patient developed ulceration of the flap at 2 years and healed with basic wound care. At a mean follow-up of 8 years, all patients were ulcer-free. One patient died 15 years after the surgery for unrelated causes. Radical circumferential resection of DLS area in severe chronic venous leg ulcers and coverage with a free omental flap using staged AV loop provided durable coverage in a series of 5 patients. Complete resection of DLS area, addressing the underlying venous pathology, and draining the flap to a healthy competent vein graft (AV loop) may contribute to these favorable results.

A New Powder Dressing for Management of Chronic Venous Ulcers.

A new powder dressing (TPD) is a methacrylate-based powder formulation that transforms in situ into a shape-retentive matrix upon hydration to create optimum moist wound healing conditions. The following randomized, controlled, clinical study aimed to evaluate the role of TPD in the management of chronic venous ulcers (CVU). The randomized controlled prospective study enrolled 60 CVU patients. After randomization, patients in the treatment group ( n = 30) were treated with TPD, whereas those in the control group ( n = 30) received conventional compression dressing therapy. After treatment, patients in the TPD group had significantly higher rates of complete ulcer healing at 12 weeks (43.3% vs 10.0%, p = .004) and 24 weeks (86.7% vs 40.0%, p = .001) when compared with conventional dressing group. Moreover, patients in the TP dressing group had significantly shorter time to complete ulcer healing [mean (95% CI): 16.7 (14.1-19.3) versus 37.0 (30.8-43.2) weeks, p = .001]. In addition, patients in the TPD group had significantly fewer number of dressings, less severe pain after dressing, and lower need for systemic analgesics. Use of TPD in management of CVUs was associated with significantly higher healing rates, shorter duration to healing, and lower pain.

Clinical and histopathological responses to bee venom phonophoresis in treating venous and diabetic ulcers: a single-blind randomized controlled trial.

Chronic venous and diabetic ulcers are hard to treat that cause patients long time of suffering as well as significant healthcare and financial costs. The conducted study was to evaluate the efficacy of bee venom (BV) phonophoresis on the healing of chronic unhealed venous and/or diabetic foot ulcers Also, to compare the healing rate of diabetic and venous ulcers. The study included 100 patients (71 males and 29 females) with an age range of 40-60 years' old who had chronic unhealed venous leg ulcers of grade I, grade II, or diabetic foot ulcers with type II diabetes mellitus. They randomly assigned into four equal groups of 25: Group A (diabetic foot ulcer study group) and group C (venous ulcer study group) who both received conservative treatment of medical ulcer care and phonophoresis with BV gel, in addition to group B (diabetic foot ulcer control group) and group D (venous ulcer control group) who both received conservative treatment of medical ulcer care and received ultrasound sessions only without BV gel. Wound surface area (WSA) and ulcer volume measurement (UVM) were used to assess the ulcer healing pre-application (P0), post-6 weeks of treatment (P1), and after 12 weeks of treatment (P2). In addition to Ki-67 immunohistochemistry was used to evaluate the cell proliferative in the granulation tissue of ulcers pre-application (P0) and after 12 weeks of treatment (P2) for all groups. This research revealed a statistical significance improvement (p ≤ 0.0) in the WSA, and UVM with no significant difference between study groups after treatment. Regarding Ki-67 immunohistochemistry showed higher post treatment values in the venous ulcer group in comparison to the diabetic foot ulcer group. Bee venom (BV) provided by phonophoresis is effective adjuvant treatment in accelerating venous and diabetic foot ulcer healing with higher proliferative effect on venous ulcer. www.ClinicalTrials.gov, identifier: NCT05285930.

Study on tensile properties of compression SOCKS ankle cut-strips at practical extension

Compression pressure exertion is strongly related to mechanical properties of compression socks deployed with various type of materials and machine adjustments. These socks work on the principle of highest pressure at the ankle and gradually decrease towards the calf portion. Compression socks are used for the prophylaxis and treatment of venous disorders. Venous disorders range from minor asymptomatic incompetence of venous valves to chronic venous ulceration. Current research work contains analysis of the force at practical extension compared to experimental pressure (Ps), the relationship between experimental pressure (Ps), force at practical extension, and tensile indices which include hysteresis (H), tensile resilience (TR), and tensile linearity (TL). Results showed that the force value at practical extension (FL) impart the significant influence on experimental pressure (Ps). It is also portrayed that the tensile indices (W, W′, H, TR, and TL) combined with force at practical and experimental pressure also shown to have contributed significantly to the explanation of experimental pressure (Ps) results. Compression sock tensile characteristics are highly significant and directly related to their productivity, effectiveness, and working life.

Management Pattern of Chronic venous Disease in Bangladesh

Introduction: Chronic venous disease (CVD) is mostly underdiagnosed diseasewhich may progress to chronic venous insufficiency and venous ulcer thus extensive treatment. CVD may affect negatively into patient’sgood well-beingwhich can create burdens on their life and also healthcare resources. Bangladesh has very minimum awareness on CVD. Materials and Methods: This was a cross-sectional study was carried out in department of vascular surgery of National Institute of Cardiovascular disease. we randomly choose 60 patients with chonic venous disease (CVD) and evaluate their characteristics and prevalence of several types along with the management pattern. Data collection started from May 2021 for next 6 months. Results: The patients of this survey were aged between 24 to 70 years and the Mean±SD age was 43.6±12.2. 78.3% of total study population were male, 33.3% were businessman and 10% were housewife. 66.6% patients were having low socio-economic condition. C2 varicose veins were highly prevalent among the study population ( 35%) & lowest prevalence of C4b lipodermatosclerosis or atrophie blanche (11.7%). Male were predominantly more prevalent to having CVD, 78.33% (n47), (p <0.001). Among all the patient 68.3% patient were exposed to smoking. All the patient were managed predominantly by compression therapy mainly are of moderate pressure (66.7%,) 80% of total patients got treated by oral MPFF therapy. Conclusion: : Patients having CVD, invariably presented with the complains of heaviness of leg and unexplained leg swelling and Varicose vein were highly prevalent irrespective of sex. Compression therapy has been remained the mainstay of treatment in tertiary level hospital NICVD along with oral MPFF therapy. Medicine Today 2023 Vol.35(1): 31-33

Comorbidities as prognostic factors in the healing of venous ulcers

Background: The problem of venous ulcers and chronic venous insufficiency is quite common in dermatological clinics. Every day, we face challenges regarding treatment and prognosis. As the patients are more often over fifty years of age, with more comorbidities, and at the very beginning of treatment, we already have an idea of how the entire process of epithelization of the ulcers may take place. Materials and Methods: A total of 105 patients with chronic venous insufficiency and venous ulcers were included in the study. Each was followed for more than twelve weeks. Patients with hypertension, diabetes mellitus, and thrombophlebitis were analyzed separately. Results: Patients with an ulcer closure time of twelve weeks and longer had a high blood pressure more often. Diabetics with venous ulcers on the lower extremities more often had delayed ulcer healing. A statistically significant difference was confirmed in the distribution of the patients with and without thrombophlebitis. Conclusion: The existence of comorbidities, such as hypertension, diabetes mellitus, and thrombosis, may affect the healing process of venous ulcers, yet thrombosis proved to be the most important factor. Key words: Venous Ulcers; Diabetes Mellitus; Thrombosis; Hypertension

Active legs: Impact of physical activity as an adjuvant treatment in the healing of venous ulcers in primary care: a RCT protocol study

BackgroundVenous ulcers usually present a torpid evolution with a negative impact on patients’ quality of life. In primary care, they account for 2.5% of nursing consultations and their treatment represents high costs for national health systems. These patients usually have a low level of physical activity, with muscle pump dysfunction of the lower limbs, which may improve with increased physical activity. The purpose of this study is to analyse the effectiveness of a structured intervention involving physical activity and exercise (Active Legs) as an adjuvant treatment in improving healing of chronic venous ulcers at 3 months follow-up.MethodsA randomized, multicentre clinical trial. A total of 224 individuals receiving primary nursing care with a diagnosis of venous ulcer, with a diameter of 1 cm or greater and an ankle-brachial index between 0.8 and 1.3, able to comply with the study requirements and consenting to participate, will be sequentially included (112 per group).Both groups will receive the standard treatment in primary care, with cleansing, debridement and healing in a moist environment together with multilayer compression therapy. The intervention group will also receive a structured educational intervention involving lower limb physical exercise and daily ambulation guidelines.The primary response variables will be complete healing –understood as complete and sustained epithelialisation for at least 2 weeks– and time to healing. The secondary variables will be degree of healing, ulcer area, quality of life, pain and variables related to the healing process, prognosis, and recurrences. Sociodemographic variables, adherence to treatment and satisfaction variables will also be recorded. Data will be collected at baseline, at 3 months and at 6 months follow-up. Survival analysis (Kaplan-Meier and Cox) will be performed to measure primary effectiveness. Intention-to-treat analysis.DiscussionIf the intervention is effective, a cost-effectiveness analysis could be conducted and implemented as an additional intervention in the usual venous ulcer treatment in primary care.Trial registrationNCT04039789. [https://ClinicalTrials.gov]. 07/11/2019.

First pilot case-control interventional study using autologous extracellular vesicles to treat chronic venous ulcers unresponsive to conventional treatments

Current therapeutic approaches for chronic venous ulcers (CVUs) still require evidence of effectiveness. Diverse sources of extracellular vesicles (EVs) have been proposed for tissue regeneration, however the lack of potency tests, to predict in-vivo effectiveness, and a reliable scalability have delayed their clinical application. This study aimed to investigate whether autologous serum-derived EVs (s-EVs), recovered from patients with CVUs, may be a proper therapeutic approach to improve the healing process. A pilot case-control interventional study (CS2/1095/0090491) has been designed and s-EVs recovered from patients. Patient eligibility included two or more distinct chronic lesions in the same limb with 11 months as median persistence of active ulcer before enrollment. Patients were treated three times a week, for 2 weeks. Qualitative CVU analysis demonstrated that s-EVs-treated lesions displayed a higher percentage of granulation tissue compared to the control group (Sham) (s-EVs 3 out of 5: 75–100 % vs Sham: none), further confirmed at day 30. s-EVs-treated lesions also displayed higher sloughy tissue reduction at the end of treatment even increased at day 30. Additionally, s-EV treatment led to a median surface reduction of 151 mm2 compared to 84 mm2 in the Sham group, difference even more evident at day 30 (s-EVs 385 mm2vs Sham 106 mm2p = 0.004). Consistent with the enrichment of transforming growth factor-β1 in s-EVs, histological analyses showed a regenerative tissue with an increase in microvascular proliferation areas. This study first demonstrates the clinical effectiveness of autologous s-EVs in promoting the healing process of CVUs unresponsive to conventional treatments.

Evidence-Based Homoeopathy: A Case Report of Bilateral Chronic Venous Leg Ulcer Effectively Treated by Individualised Miasmatic Medicines

AbstractVenous ulcers can occur when the veins in the legs do not push blood back to the heart. Blood backs up in the veins , building up pressure and accumulation of fluid prevents the nutrients and oxygen from getting to the tissues, resulting in cell death and formation of ulcer. Venous ulcer does interfere with quality of life and induces great deal of discomfort. Conventional medicine mentions chronic venous ulcer as surgical disease. In homoeopathy, this condition is treatable without surgery through individualised miasmatic approach. A successfully treated case of 57 years old male, suffering from bilateral chronic venous leg ulcer, complicated with two miasms is reported here.

A Case of Chronic Venous Ulcer Managed with Homoeopathy

AbstractA 57-year-old male farmer reported a painful shallow burning ulcer with serosanguinous discharge for 1 year on the lateral malleolus of his right lower limb. In addition, he also had eczema and oedema in the affected limb. On examination, the ulcer was 7 to 8 cm (approximately), with an irregular margin, red and yellow floor; warm, firm, hyperpigmented and non-tender with varicose veins in the surrounding areas. The patient was thermally hot and his main complaints increased at night and subsided with cold application. Based on the complaints presented and the clinical appearance, a diagnosis of a chronic venous ulcer was made. The surgeon had advised surgery. A painful varicose ulcer in the lower extremities that alleviated with cold application and the patient's thermal reaction led to repertorisation of the case and the final selection of Fluoric acid 200 in consultation with the Materia Medica. Medicine was prescribed once a week, thrice a day with the placebo, and this continued for 4 months. Fluoric acid was discontinued after 4 months and the placebo only continued for the next 2 months. After 6 months of regular treatment, the ulcer had healed and the swelling also reduced significantly. The patient was also advised to practice good hygiene, avoid standing for long periods of time, elevate the legs when at rest etc.

Effectiveness of Epidermal Growth Factor Loaded Carboxymethylcellulose (EGF-CMC) Hydrogel in Biofilm Formation in Wounds of Diabetic Patients: A Randomized Clinical Trial

Diabetic patients frequently develop wounds, which can be colonized by bacteria, mainly Staphylococcus aureus and Pseudomonas aeruginosa, with the ability to form biofilms. This study aimed to evaluate the colonization and biofilm formation of Staphylococcus aureus and Pseudomonas aeruginosa in chronic wounds of diabetic patients treated with a bioactive dressing (EGF-CMC), which consisted of a 2% carboxymethylcellulose (CMC) hydrogel loaded with epidermal growth factor (EGF). This randomized clinical trial was conducted with 25 participants: 14 treated with EGF-CMC hydrogel and 11 treated with CMC hydrogel for 12 weeks. Participants with type 2 diabetes mellitus were selected. All had diabetic foot ulcers or chronic venous ulcers. Swab collections were performed on weeks 1, 6, and 12. The laboratory analyses included the identification of strains, microbial quantification, virulence gene investigation, and the evaluation of biofilm formation. In total, 13 S. aureus strains and 15 P. aeruginosa strains were isolated. There were no statistically significant differences regarding bacterial loads and virulence genes. However, EGF-CMC-hydrogel-treated wounds were colonized by strains with lower biofilm formation abilities. The probability of isolating biofilm-producing strains from CMC-hydrogel-treated wounds was 83% greater than the probability of isolating biofilm-producing strains from EGF-CMC-treated wounds.

Effect of Endovenous Laser Ablation Along With Compression Therapy on Chronic Venous Ulcer Healing.

Introduction Chronic venous insufficiency is a major cause of morbidity, and there is a paucity of data regarding its epidemiology due to the lack of a central wound registry. In this study, we aimed to study the time for healing of the ulcer and compliance with compression therapy (CT) following endovenous laser ablation (EVLA) ± ultrasound-guided foam sclerotherapy (UGFS) along with CT in patients with chronic venous ulcers. Methods This prospective observational study was conducted from January 2020 to June 2021 after obtaining institutional ethical committee clearance. Patients with chronic venous ulcers (>six weeks to <six months duration) were included in this study. Demographic details, venous duplex findings, and duration of ulceration were noted. All patients underwent EVLA (Biolitec® 1470 nm) ± UGFS and CT. The patients were followed up weekly till the healing of the ulcer, followed up at one month, three months, and then at six monthly intervals to look for recurrence. Venous clinical severity score (VCSS) at presentation and follow-up, compliance with CT, rate of ulcer healing at six months, and recurrence rates at two years of follow-up were observed prospectively. Results The mean age of the study participants was 45.7±14.2 years, of which 42 (84%) were males. Ulcer size of <2 cm was present in 38%, 2-4 cmin 52%, and >4 cmin 10% of patients. A total of 38% of patients underwent only EVLA, and EVLA+UGFS were done in 62% of participants. The healing rate at six months follow-up was 92%, with the average time taken being 2.55±1.38 months. Those who remained with an unhealed ulcer at six months follow-up had anulcer size of >5 cmand an age of >50 years. Ninety-six percent of the patients were compliant with CT after an endovenous intervention. The recurrence rate at two years post-ablation was 6%. VCSS was 19.66±3.23 at presentation and 5.5±2.82 at six months of follow-up. Conclusion Endovenous ablation of superficial venous reflux along with CT is associated with a shorter healing time of venous ulcerations and reduced chances of recurrence.There is an improvement in VCSS score over the period of six months follow-up.

Basal cell carcinoma presented and mistreated as chronic venous ulcers - report of five cases

Introduction. Basal cell carcinoma (BCC) is the most common non-melanoma skin cancer in Caucasians and one of the most frequent malignancies in general, especially in older adults. Squamous cell carcinoma is the most frequent tumor developing on chronic leg ulceration, while BCC rarely occurs and is often misdiagnosed. In addition, since older adults commonly have coexisting chronic vein insufficiency, the ulcerated BCC is frequently mistaken as being of venous origin. Outlines of cases. We present five cases of BCC presenting as chronic venous ulcers. Conclusion. Long-lasting ulcers with no healing tendency must be considered malignant until proven otherwise. Knowing the characteristics of malignant ulceration may help in early detection and treatment.

Transient Ischemic Attack Following Foam Sclerotherapy for Chronic Venous Ulcer with No Cardiac Defect - A Rare Case Scenario

Abstract Chronic venous insufficiency (CVI) constitutes one of the main causes for lower limb ulceration. Foam sclerotherapy forms an important part of CVI treatment. It is used to treat truncal incompetence, perforating veins, and primary and secondary varicosities as well as reticular and spider veins. It is used either alone or in addition to the endovenous ablative techniques. Although usually done as an office procedure, it can cause serious complications which include allergic reaction, deep-vein thrombus formation, superficial vein thrombosis, and ulceration if extravasated into the subcutaneous plane and rarely can cause various neurological manifestations such as transient visual loss, migraine, transient ischemic attack, speech disturbances, and stroke. Neurological complications amount to only 0.90% among all the complications according to a systematic review by Tharsi Saravananthan et al. The neurological complications are usually transient and generally occur due to patent foramen ovale (PFO). There are very few case reports mentioned in the literature where the neurological symptoms occur without any evidence of cardiac defects. Herein, we report a case where foam sclerotherapy was given for chronic venous ulcer, and the patient developed speech disturbance in the immediate postprocedure period which resolved on its own. His preoperative echocardiography was normal without any structural heart defects. This is one of the few cases to be reported in the literature where sclerotherapy-induced neurological complication has occurred without any evidence of PFO.

Effect of Catalytic Nanomedicine on Amputation-Stage Chronic Venous Ulcers: Four Case Studies

Effect of Catalytic Nanomedicine on Amputation-Stage Chronic Venous Ulcers: Four Case Studies

A CASE REPORT ON CHRONIC VENOUS LEG ULCER

Venous ulcers are the most common type of leg ulcers, especially in the elder population. This chronic debilitating condition develops due to venous insufficiency, and it substantially affects the quality of life. In Ayurveda, chronic venous ulcer can be correlated with Dushtavranam. In Ayurveda classics treatment of Vrana is well described with sixty types of treatment modalities. A 74 year old female patient came to OPD with ulcer on lateral and medial aspect of the right ankle with severe burning sensation, pain, oozing, itching, and generalized edema of right lower limb below knee. As this Vrana presented with pittapradhana sannipatha dosha lakshanas, pittahara, vrana ropana, sophahara medicines were given with external treatment modalities like kshalana, bandage, and jalukavacharana. 43days of medication completely healed this vrana.

Skin-Derived ABCB5+ Mesenchymal Stem Cells for High-Medical-Need Inflammatory Diseases: From Discovery to Entering Clinical Routine.

The ATP-binding cassette superfamily member ABCB5 identifies a subset of skin-resident mesenchymal stem cells (MSCs) that exhibit potent immunomodulatory and wound healing-promoting capacities along with superior homing ability. The ABCB5+ MSCs can be easily accessed from discarded skin samples, expanded, and delivered as a highly homogenous medicinal product with standardized potency. A range of preclinical studies has suggested therapeutic efficacy of ABCB5+ MSCs in a variety of currently uncurable skin and non-skin inflammatory diseases, which has been substantiated thus far by distinct clinical trials in chronic skin wounds or recessive dystrophic epidermolysis bullosa. Therefore, skin-derived ABCB5+ MSCs have the potential to provide a breakthrough at the forefront of MSC-based therapies striving to fulfill current unmet medical needs. The most recent milestones in this regard are the approval of a phase III pivotal trial of ABCB5+ MSCs for treatment of recessive dystrophic and junctional epidermolysis bullosa by the US Food and Drug Administration, and national market access of ABCB5+ MSCs (AMESANAR®) for therapy-refractory chronic venous ulcers under the national hospital exemption pathway in Germany.

Application of Umbilical Cord Tissue Allografts in Reduction Mammoplasty Wound: A Case Study

Nearly 15 million patients undergo cosmetic surgery in the United States each year, with breast augmentations such as implants, lifts, or reductions being some of the most common procedures. The most common complications of these procedures are scarring and infection at the incision site, which often necessitates expensive corrective surgery. After significant weight loss, the patient in this study underwent an elective lower body lift in conjunction with a breast reduction and nipple-areolar transplant. The patient experienced postoperative wound dehiscence, creating a large open wound, warranting rapid wound closure to avoid further pain and infection. The patient was treated for eight weeks with conservative measures. After eight weeks of failed attempts to close her wound, she was referred for specialist care. Upon initial examination, the donor site wound measured 3.5 cm x 3.5 cm x 1.25 cm deep with no sign of epithelialization. The patient received a single dose of Wharton’s jelly flowable perinatal tissue allograft and twelve hyperbaric oxygen therapy treatments over seven weeks. Upon inspection at the final examination, the wound was closed entirely with 100% epithelialization. This case study demonstrates a precedent for the application of Wharton’s jelly flowable allografts in complicated cosmetic post-surgical wounds. Future efforts will be directed at applying Wharton’s jelly allografts on a preventative basis. Preventative applications could be in stage 2 pressure sores, in the region of recurrent chronic venous insufficiency ulcers between stages of tenuous healing, prior to joint replacement in patients with immune compromised states, or prior to surgical intervention in patients with a known history of postoperative infections. The obvious goal is to prevent needless patient suffering and reduce unnecessary healthcare costs.