Good Ulcer Care Research Articles

Relationship Between Sleep Quality and Quality of Life in Diabetic Ulcer Patients

Background: Diabetes mellitus (DM) is a significant prevalence that occurs making Indonesia ranked sixth in the world. Diabetes mellitus can totally affect the quality of life of diabetic patients with complications, ulcers are complications that affect the quality of life of DM patients. One of the factors that can affect the quality of life of DM patients is sleep quality. Purpose: Knowing the relationship between sleep quality and quality of life in patients with diabetic ulcers. Methods: This type of research is analytic research with a correlational design with a cross-sectional approach. The sampling technique in this study was total sampling with a sample size of 36 respondents. Data analysis using the Chi-square test. Results: It was found that there were 32 respondents (88.9%) experiencing moderate sleep quality and there were 30 respondents (83.3%) who had a negative quality of life. Results: statistical test of the relationship between sleep quality and quality of life showed a statistical test p value = 0.662 or a significance value> a = 0.05, which means that there is no significant relationship between sleep quality and the quality of life of patients with diabetic ulcers. Conclusion: There is no relationship between sleep quality and the quality of life of patients with diabetic ulcers at the Griya puspa wound care clinic, Sleman Regency. Researchers suggest that respondents who have poor sleep quality are expected to improve their quality of life by improving physical health, leisure time, independence, managing emotions and performing good ulcer care.

Multisystemic Sarcoidosis Presenting as Pretibial Leg Ulcers

Sarcoidosis is a multisystemic disease of unknown etiology. Up to 30% of patients develop cutaneous manifestations, either specific or nonspecific. Ulcerating sarcoidosis leading to leg ulcers is a rare observation that may lead to confusions with other, more common types of chronic leg ulcers. We report the case of a 45-year-old female patient with chronic multisystemic sarcoidosis presenting with pretibial leg ulcers. Other etiology could be excluded. Histology revealed nonspecific findings. Therefore, the diagnosis of nonspecific leg ulcers in sarcoidosis was confirmed. Treatment consisted of oral prednisolone and good ulcer care. Complete healing was achieved within 6 months. Sarcoidosis is a rare cause of leg ulcers and usually sarcoid granulomas can be found. Our patient illustrates that even in the absence of sarcoid granulomas, leg ulcers can be due to sarcoidosis.

Novel therapies developed for the treatment of leg ulcers: focus on physical therapies

Chronic venous leg ulcers are common. If good ulcer care alone does not lead to healing, other treatment options are warranted. Physical therapies have gained a wider interest in wound healing in general. In the present review, the authors will focus on recent advancements in various types of physical leg ulcer treatment (except compression therapy). Available evidence suggests that low-frequency therapeutic ultrasound, negative topical pressure therapy and electrical stimulation can contribute to improved wound healing, while other technologies need further research. Major effects include stimulation of granulation, microcirculatory effects, debridement and disinfection, which may result in higher healing rates and more rapid healing. These techniques are not negatively influenced by either bacterial multiresistance. They can also be used when there are limited budgets for drug therapies.

Effects of low-frequency ultrasound on microcirculation in venous leg ulcers

Background:Therapeutic low-frequency ultrasound (US) has been used for many years to improve wound healing in chronic wounds like venous leg ulcers. No human data are available for the possible effects of single US applications on microcirculation and their frequency-dependency.Aims:To investigated the role of therapeutic low-frequency US on microcirculation of venous leg ulcers in vivo.Patients and Methods:This is a pilot study on an inpatient basis. We use a newly developed low-frequency continuous-wave US-equipment composed of a US transducer based on piezo-fiber composites that allow the change of frequency. In this study, we apply US of 34 kHz, 53.5 kHz, and 75 kHz respectively. Twelve patients with chronic venous leg ulcers are analyzed. As an adjunct to good ulcer care, therapeutic US is applied, non-contacting, once a day, in a subaqual position for 10 minutes. Microcirculation is assessed in the ulcers adjacent to skin before US-therapy, immediately after the treatment and 30 minutes later. We use a micro-light guide spectrophotometer (O2C, LEA Medizintechnik GmbH, Gieίen, Germany) for calculation of blood flow velocity, hemoglobin oxygen saturation (SCO2) and relative hemoglobin concentration (rHb) in 2 and 8 mm depth. Contact-free remission spectroscopy (SkinREM3, Color Control Chemnitz GmbH, Chemnitz, Germany) allows contact free measurements in the VIS-NIR range of the spectrum (400 ± 1600 nm).Results:It is seen that therapeutic US is well tolerated. One patient dropped out from a treatment series since he developed erysipelas responding to standard antibiotic. Effects were seen at 34 kHz only. The SO2 values increased after single US application. The values for rHb were higher in the superficial layer of the wound bed (depth 2 mm) compared to deeper parts (8 mm depth). US treatment did not result in significant changes of rHb and blood cell velocity. The data obtained by remission spectroscopy disclose an increase of oxygenized hemoglobin.Conclusions:The major findings are that continuous-wave low-frequency US of 34 kHz, but not, 53.5 kHz or 75 kHz, has a temporary stimulatory effect on microcirculation mainly due to an improved oxygenation. Further studies with treatment series are necessary.

Dystrophic Calcification in Chronic Leg Ulcers—A Clinicopathologic Study

Dystrophic calcification (DC) is a risk factor for conservative treatment failure in chronic leg ulcers of various pathologies. We performed a retrospective noncontrolled trial of 212 patients with 362 chronic leg ulcers who underwent ulcer shave excision with subsequent skin grafting. The ulcers existed for at least 3 months, and no healing was achieved with good ulcer care. Tissue was subjected to histopathology (hematoxylin-eosin and van Kossa stains). DC was evident in 39 patients (18%). Metaplastic subcutaneous bone formation was observed in 15 patients (7%). Clinical symptoms associated with DC were resistance to good ulcer care, pain, and ineffective effects of compression therapy (in venous ulcers). Ulcers were treated with deep dermatome shaving of the ulcer bed and surgical removal of DC. In the same setting, defects were closed using mesh graft transplantation. The procedure achieved a complete take rate in 80% and a significant decrease of pain in 95% of cases. When comparing the take rates in patients with and without DC, DC had a negative effect on outcome (take rate: 91% without DC vs 80% with DC, p<.05). DC is resistant to conservative treatment. The first-line treatment is deep ulcer dermatome shaving and complete removal of calcifications whenever possible.

Some Effects of a Topical Collagen-Based Matrix on the Microcirculation and Wound Healing in Patients With Chronic Venous Leg Ulcers: Preliminary Observations

The microcirculation of the wound bed is a key parameter for improving granulation tissue formation and, hence, wound healing. The aim of this study was to determine whether a wound dressing comprising collagen/oxidized regenerated cellulose has effects over a short term on wound healing. Wounds were evaluated using a clinical wound score; pain associated with wounds was measured using a visual analogue scale. Wound microcirculation was evaluated using a technique based on noncontact remission spectroscopy. A prospective trial was performed in 40 patients with chronic venous leg ulcers (mean age 74 years; range, 43-93 years; 25 females and 15 males). Patients in group A were treated with PROMOGRAN Matrix (Johnson& Johnson, New Brunswick, NJ) combined with "good" ulcer care for 2 weeks. Control group B consisted of 10 patients who received only good ulcer care. The authors measured a favorable clinical response in 76.9% (group A) versus 66.7% (group B). The mean reduction of ulcer area was statistically significant in group A (P < .05). The wound score improved in group A from 2.28 +/- 1.24 (before treatment) increasing to 3.72 +/- 1.57 (after 1 week; P < .00023) and 4.92 +/- 1.68 (after 2 weeks; P < .000027). In group B, the score improved from 1.44 +/- 1.33 (before treatment) to 3.22 +/- 1.30 (after 1 week; P < .0077). The mean visual analogue pain score before treatment was 8.72 (group A) and 7.88 (group B) (ns, P > .05). After 1 week of treatment, the score dropped to 5.76 (group A) and 6.66 (group B). In the second week, group A patients had a mean pain score of 3.84 compared with the pain score before treatment (P < .05). After 1 week of treatment, in group A there was a decrease in remission spectroscopy, which is considered to reflect an improvement in microcirculation.

Ulcerated Necrobiosis Lipoidica: A Combined Treatment Approach with Dermatosurgery and PUVA

Ulcerated necrobiosis lipoidica is one of the differential diagnoses in leg ulcers. The diagnosis is confirmed by histopathology. The authors report on a 68-year-old female patient with a history of chronic venous insufficiency who developed a chronic leg ulcer that did not respond to good ulcer care and compression bandaging. Skin biopsies revealed necrobiosis lipoidica. The patient was recently discovered to have diabetes mellitus that was treated orally by ascarose. Phlebosurgery and mesh grafting were performed, and the patient was given pentoxyfiline, dapsone, and clofazimine, but none of these treatments was successful. Therefore, topical PUVA therapy was introduced that resulted in partial remission and stabilizing of the residual pathology. Based on these experiences, the use of surgical methods alone is questionable.

Diabetic foot ulcers: a quality of life issue.

Foot ulcers are a serious complication of diabetes mellitus that are associated with adverse sequelae and high costs. In addition, such foot ulcers have a significant impact on quality of life (QoL). For example, the loss of mobility associated with foot ulcers affects patients' ability to perform simple, everyday tasks and to participate in leisure activities. These and other consequences of foot ulcers often lead to depression and poor QoL. Notably, several studies have shown that patients with diabetes mellitus and foot ulcers were more depressed and had poorer QoL than those who had no diabetic complications. Given the detrimental effect foot ulcers have on patients, it is essential that these foot ulcers are prevented or treated more effectively than at present. Evidence suggests that many foot ulcers can be prevented by using intensive interventions and adopting a multidisciplinary approach to treatment. In addition, preventative strategies may become more effective if new research into how patients with diabetes experience and interpret their health threats (e.g. diagnosis "loss of sensation" or a foot ulcer episode) is taken into account. With regard to treatment, new options should enable ulcers to heal more quickly than with standard therapies. One area of interest is the use of growth factors. For example, recombinant platelet-derived growth factor, in addition to good ulcer care, has been shown to improve the number of ulcers that heal and healing times significantly compared with good ulcer care alone. Other potential new treatments include the use of skin substitutes. In summary, improved preventative measures and wound treatment should reduce the potential for patients with diabetes mellitus to experience impaired QoL caused by foot ulcers.

Clinical efficacy of becaplermin (rhPDGF-BB) gel

The results of four multicenter, randomized, placebo-controlled, parallel group studies of the efficacy of becaplermin gel are reviewed here. The four studies included a total of 922 patients, all of whom received a standardized regimen of good ulcer care. Patients were randomized to receive placebo gel, 30 or 100 μg/g becaplermin gel, or good ulcer care alone. In Studies 1 and 2, the incidence of complete healing was significantly higher in patients receiving becaplermin gel (30 μg/g, Study 1; 100 μg/g, Study 2) compared with that in patients receiving placebo gel. In Study 3, which was not powered for statistical analysis, the incidence of complete healing in patients treated with 100 μg/g becaplermin gel was approximately twice that of patients treated with good ulcer care alone. In Study 4, there was no significant difference in the incidence of complete healing in patients treated with becaplermin gel versus good ulcer care alone.

Clinical safety of becaplermin (rhPDGF-BB) gel

This overview of the safety of becaplermin gel is based on six well-controlled clinical studies that included patients with lower extremity diabetic neuropathic ulcers. Patients receiving becaplermin gel (n = 538), placebo gel (n = 278), or good ulcer care alone (n = 190) had a similar incidence of ulcer-related adverse events, such as infection, cellulitis, or osteomyelitis. Erythematous rash occurred in 2% of patients with suspected wound infections treated with becaplermin gel and 1% of patients treated with placebo gel. No rashes were observed in patients treated with good ulcer care alone. The incidence of cardiovascular, respiratory, musculoskeletal, and central and peripheral nervous system disorders were similar across all treatment groups. Mortality rates were also similar across all treatment groups. Patients treated with becaplermin gel did not develop neutralizing antibodies against becaplermin. Therefore, becaplermin gel appears to be a safe therapy for the treatment of lower extremity diabetic ulcers.

Foundations of good ulcer care

Diabetic foot ulcers are a significant healthcare problem affecting more than 1 million patients at some point in their lifetime. Good ulcer care begins with thorough assessment of the ulcer, which includes determining whether the ulcer is infected and whether neuropathy or peripheral vascular disease is present. The principles of good wound care include use of proper footwear, non–weight-bearing limb support, use of appropriate antibiotics, debridement, aggressive revascularization, control of serum glucose levels, and careful monitoring of the ulcer. For refractory ulcers, new therapies, such as the use of exogenous recombinant growth factors, are being developed that may have a significant benefit in treating these ulcers and lowering the amputation rate.