Lower Limb Ulcers Research Articles

Causal Association of Chronic Venous Insufficiency and Cardiovascular Diseases: A Univariable and Multivariable Mendelian Randomization Study.

The causal relationship between chronic venous insufficiency (CVI) and cardiovascular diseases (CVDs) has yet to be elucidated. Herein, we implement Mendelian randomization (MR) analysis to investigate the causal association. A two-sample MR approach using genetic data from FinnGen and genome-wide association studies (GWAS) Catalog was applied to investigate the causal relationship between CVI and CVDs. This study assessed 77 single nucleotide polymorphisms (SNPs) as instrumental variables, employing random-effect inverse-variance-weighted MR, weighted median, Egger regression, Mendelian Randomization Pleiotropy RESidual Sum and Outlier (MR-PRESSO), and Robust Adjusted Profile Score (RAPS) methods. Multivariable MR (MVMR) considered confounding factors. Genetically predicted CVI was associated with reduced heart failure risk (odds ratio (OR) = 0.96, 95% confidence interval (95% CI): 0.93-0.99, p = 0.025) and increased atrial fibrillation risk (OR = 1.06, 95% CI: 1.03-1.09, p = 0.0002). MVMR, adjusting for venous thromboembolism (VTE), lower limb ulceration, obesity, smoking, and alcohol, attenuated these associations. No significant links were found with hypertension, aortic aneurysm, coronary artery disease, myocardial infarction, valvular heart disease, or stroke. This MR study supports an association between CVI and CVDs, which may imply CVI should be monitored during the treatment of heart failure and atrial fibrillation.

Impact of SGLT2 inhibitors on lower limb complications: a mendelian randomization perspective.

While Sodium-glucose cotransporter 2 (SGLT2) inhibitors are effective in managing diabetes and reducing cardiovascular risk, concerns about their association with lower limb complications, including, osteomyelitis, ulcers, and peripheral artery disease (PAD), persist. This study employs Mendelian Randomization (MR) to assess the causal relationship between SGLT2 inhibitors and these lower limb safety outcomes. A two-sample drug-target MR approach was used, complemented by a one-sample MR and genetic association analysis. Six SNPs were selected as instrumental variables to proxy the effect of SGLT2 inhibition. Primary outcomes were major limb safety outcomes, including osteomyelitis, lower limb ulcers, PAD, and cellulitis. The primary analytical method was the generalized inverse variance-weighted (IVW) approach, along with several sensitivity analyses. The MR analysis indicated no significant causal association between genetically proxied SGLT2 inhibition and most of the studied lower limb safety outcomes. However, a significant association with PAD was observed, necessitating careful interpretation due to discrepancies between IVW and MR-Egger results. Sensitivity analyses supported these findings, showing little evidence of heterogeneity or directional pleiotropy. This study suggests that SGLT2 inhibitors may not be significantly associated with an increased risk of most lower limb safety outcomes, including osteomyelitis, lower limb ulcers, and cellulitis, in patients with type 2 diabetes. However, the complex relationship with PAD highlights the need for further research. These findings contribute to the understanding of the safety profile of SGLT2 inhibitors, supporting their continued use in diabetes management while underlining the importance of continuous safety monitoring.

Overview of Leech Therapy as an Alternative Treatment for Varicose Ulcers: Mechanisms and Efficacy

Varicose ulcer, the most severe and debilitating complication of chronic venous insufficiency in the lower limbs, impart substantial obstacles in medical management because of their chronicity and propensity for recurrence. About 80 percent of ulcerations on the lower extremities are triggered by varicose ulcer. Despite advances in diagnosis and treatment, varicose ulceration remains a major healthcare concern due to its potential for life-threatening complications. The morbidity has a detrimental effect on life expectancy. Venous ulceration results from persistent venous pressure brought on by venous insufficiency. Although the diagnosis is primarily clinical, it must be distinguished from other lower limb ulcer causes. Reduction of edema, enhancement of ulcer healing, and avoidance of recurrence are the objectives of treatment. Although conservative care, mechanical treatment, pharmaceutical, and surgical methods are available for the treatment of venous ulcers, but Hirudotherapy, also known as leech therapy, has grown into a prominent complementary treatment option. It has the potential to promote wound healing and alleviate varicose ulcer symptoms. The objective of this review is to accord a thorough overview of the application of leech therapy to the management of varicose ulcers. The present study emphasizes on the mechanisms of action, efficacy and safety profile of leech therapy in the context of managing varicose ulcers by synthesizing a collection of available literature, clinical investigations, and case reports.

Análise da Metodologia de Aceleração Cicatricial MAC® com uso da própolis e azul de toluidina na cicatrização de úlceras de membros inferiores.

Introduction: Photodynamic Therapy has been an important ally in tissue repair, with positive effects in the treatment of wounds and infections. Objective: To analyze the effects of the Healing Acceleration Methodology (MAC®) using propolis and toluidine blue on lower limb ulcers. Methods: Single-center, experimental, randomized and controlled study. Carried out between April 2021 and May 2022 at the outpatient clinic of the school clinic in a Brazilian capital. Patients were randomly assigned in a 1:1 ratio to receive photodynamic therapy (experimental group) or conventional dressing alone (control group). Patients over 18 years of age diagnosed with lower limb ulcers were included. Ten patients comprised the experimental group and 10 the control group. Patients were seen three times a week and monitored for two months. The primary outcome was the assessment of healing progress and the secondary outcome was the microscopic analysis of wound smears for the presence of cells and microorganisms. Results: In the experimental group, two wounds did not heal completely while in the control group, none of the 10 wounds healed completely during the 60-day follow-up. In the experimental group, 90% of patients did not have bacteria and fungi at the end of 30 days versus 40% in the control group. Conclusion: The present study showed that photodynamic therapy is a potential effective treatment in the healing process of lower limb ulcers. This can impact cost reduction and quality of life. Larger, well-designed studies are needed to corroborate the findings of the present study.

Quality of life case series review: wound bed preparation from a UK perspective.

Previous studies have reported that polyhexamethylene biguanide (PHMB) and betaine solution and gels remove biofilm, improve wound healing and reduce infection rates. Quality of life (QoL) outcomes are not commonly reported on when it comes to wound care. This review aims to summarise QoL data from a cohort of case studies previously published on chronic lower limb ulcers using PHMB products (Prontosan® Solution, Prontosan® Wound Gel X and Prontosan® Debridement Pad). Here, we report on and review a total of 38 case studies describing 56 wounds. From these 38 case studies, 36 reported that all the wounds involved had either healed or improved by the end of their respective study period. QoL themes explore malodour, slough, and exudate, pain, mobility, hair growth, antibiotic intake, return to work, social life and mood. This case series demonstrates that treatment with Prontosan® products improves many QoL outcomes for patients with non-healing wounds.

A STUDY OF PREVALENCE, CLINICAL PRESENTATION AND MANAGEMENT OF LOWER LIMB ULCERS AT A TERTIARY HOSPITAL

Background: Lower limb ulcers are debilitating and painful, greatly reducing patients quality of life. These ulcers are often difficult to treat. The most common aetiologies for lower limb ulcers are venous, arterial, mixed venous and arterial, diabetic and pressure ulcers. However, atypical wounds comprise approximately 20% of chronic wounds and should be kept in mind during differential diagnosis.The successful ulcer management depends upon the accurate diagnosis and treatment of the underlying cause, and it often needs a multidisciplinary approach. Methods: This prospective cross-sectional study conductedin Department of General Surgery atBasaveshwara Teaching and General Hospital, Attached to Mahadevappa Rampure Medical College, Kalaburagi. The study was conducted during the period from June 2022 to December 2023 which included 97 patients presenting withlower limb ulcers and admitted in surgical wards of our hospital. Results: Most of the patients were engaged in agriculture (24%) followed by business (23%) and service (14%). 47.5% of the patients had habit of smoking,alcohol consumption and tobacco chewing. Most of the ulcers were diabetic (36.1%) followed by venous (22.6%) (Z=2.17 p=0). Only 4.1% and 3.1% were malignant and trophic ulcers. Peripheral neuropathy (26.8%) was the most common cause of ulcer followed by venous hypertension (24.7%).In most of the cases, debridement with dressing (32.9%) and Debreidment+dressing+skin grafting (19.6%) was done. At the end of study period, 90 ulcers were healed, 4 were disease free, 2 had recurrence and 1 patient died. Conclusion:A comprehensive assessment of patients general status, personal habits, skin, vascular status, limb, ulcer characteristics are required to determine the etiology and to formulate effective treatment plan. Thus, the study of various cases of lower limb ulcers arouses lot of interest and is mind boggling as far as the treatment of these cases are concerned. With the availability of arsenal of investigation, wide range of antibiotics and with ever improving dressing material, there is certainly a great improvement in treatment of lower limb ulcers. Education and training are vital for all those involved in caring of patients with ulcer.

Challenging the angiosome concept: Delineating peripheral arterial disease patterns in diabetic foot ulcers.

The angiosome concept has significantly impacted diabetic foot ulcer management by highlighting the vascular anatomy's role in wound healing. However, its clinical applicability and validity remain debated due to complexities in foot blood supply and ulcer location determination. A cross-sectional study was conducted on 84 individuals with diabetic foot ulcers undergoing lower limb angiography. Demographics, ulcer characteristics, and angiographic data were collected and analyzed using descriptive statistics and relevant tests. Digital subtraction angiography assessed 89 limbs with diabetic foot ulcers; males comprised 54.8%, primarily type 2 diabetes (96.4%), averaging 64.36 ± 10.09 years. Of 129 angiosomes, angiosome 2 (40.3%) had the highest ulcer incidence. Posterior tibial artery (PTA) involvement was predominant (72.9%), while external iliac artery (EIA) and profunda femoris artery (PFA) were least affected (2.4% each). Posterior tibial artery showed 46.5% complete occlusion. Angiosome 2 correlated notably with anterior tibial artery (ATA), peroneal artery (CPA), and PTA, but categorizing angiosomes by supply patterns showed no significant artery correlation (p > .05). The research indicates inconsistent support for below-the-knee artery involvement correlating with foot ulcer locations in angiosomes. While aiding vascular comprehension, the angiosome concept may not fully elucidate lower limb vascular complexities and ulcer genesis. Factors like collateral circulation should be noticed to understanding ulcer localization and severity, extending beyond angiosomal arterial supply.

Temporal changes in toe-brachial index results in haemodialysis patients.

Toe brachial index (TBI), the ratio of toe pressure to systolic blood pressure (SBP), helps predict peripheral arterial disease. In patients with kidney failure this may be performed during haemodialysis for convenience. Until recently there has been little evaluation of the impact of haemodialysis in limb and systemic perfusion on these values. We aimed to determine if the values of TBI would change during and after dialysis compared to pre-dialysis assessments. Using a repeated measures study, TBIs and toe pressures were measured using the Hadeco Smartop Vascular Ultrasound Doppler in 31 patients undergoing haemodialysis. TBI assessments were completed pre-dialysis and compared to values obtained at 1 hour, 2 hours, 3 hours, and post-dialysis to monitor change in TBI results. Comparison of values for each patient were tested for differences using paired t-tests. Linear mixed-effects models were used to test for the effect of patient and clinical factors on change in outcome measures. Mean TBI decreased from pre-dialysis at 1 hour (0.72 to 0.63, p = 0.01) and remained lower at 2 hours and 3 hours, before returning to pre-dialysis levels at post-dialysis. Mean systolic blood pressure also declined during dialysis. Mean TBI results were lower in those with a history of lower limb ulceration and in females. Sixteen patients (51.6%) had a normal TBI at baseline, 14 (45.2%) had a mildly low TBI, and one (3.2%) had a severely low TBI. Between baseline and 1 h, five patient's results moved from normal to mildly abnormal and one from mildly abnormal to severely abnormal. As haemodialysis concluded (post-dialysis) there were 17 (56.7%) 'normal' TBIs, with no severely abnormal TBIs (p = 0.73). 0.30). TBI and toe pressures are impacted significantly by dialysis. TBI and toe pressure assessments should be conducted before haemodialysis begins, or between dialysis sessions to avoid variability.

Strictosamide promotes wound healing through activation of the PI3K/AKT pathway

Nauclea officinalis, as a Chinese medicine in Hainan province, had the effect of treating lower limb ulcers, burn infections. In this paper, we studied the effect of Strictosamide (STR), the main bioactive compound in Nauclea officinals, on wound healing and explored its internal mechanism. Firstly, the wound healing potential of STR was evaluated in a rat model, demonstrating its ability to expedite wound healing, mitigate inflammatory infiltration, and enhance collagen deposition. Additionally, immunofluorescence analysis revealed that STR up-regulated the expression of CD31 and PCNA. Subsequently, target prediction, protein-protein interaction (PPI), gene ontology (GO), and pathway enrichment analyses were used to obtain potential targets, specific biological processes, and molecular mechanisms of STR for the potential treatment of wound healing. Furthermore, molecular docking was conducted to predict the binding affinity between STR and its associated targets. Additionally, in vivo and in vitro experiments confirmed that STR could increase the expression of P-PI3K, P-AKT and P-mTOR by activating the PI3K/AKT signaling pathway. In summary, this study provided a new explanation for the mechanism by which STR promotes wound healing through network pharmacology, suggesting that STR may be a new candidate for treating wound.

Peripheral artery disease mediating the effect of metabolic syndrome related diseases on lower limb ulcers: Mendelian randomization analysis.

Previous observational studies have demonstrated a correlation between metabolic syndrome related diseases and an elevated susceptibility to ulcers of lower limb. It has been suggested that this causal relationship may be influenced by the presence of peripheral artery disease (PAD). Nevertheless, the precise contribution of these factors as determinants of ulcers of lower limb remains largely unexplored. This research incorporated information on hypertension, BMI, hyperuricemia, type 2 diabetes, PAD, and ulcers of lower limb sourced from the GWAS database. Univariate Mendelian randomization (SVMR) and multivariate Mendelian randomization (MVMR) methods were employed to assess the association between metabolic syndrome related diseases, including hypertension, obesity, hyperuricemia, and type 2 diabetes, as well as to investigate whether this association was influenced by PAD. Univariate Mendelian randomization analysis showed that genetically predicted hypertension, BMI, and type 2 diabetes were associated with an increased risk of PAD and ulcers of lower limb, and PAD was associated with an increased risk of ulcers of lower limb, but there is no causal relationship between hyperuricemia and ulcers of lower limb. The results of multivariate Mendelian randomization showed that PAD mediated the causal relationship between hypertension, obesity and ulcers of lower limb, but the relationship between type 2 diabetes and ulcers of lower limb was not mediated by PAD. Hypertension, BMI and type 2 diabetes can increase the risk of ulcers of lower limb, and PAD can be used as a mediator of hypertension and obesity leading to ulcers of lower limb, These findings may inform prevention and intervention strategies directed toward metabolic syndrome and ulcers of lower limb.

Negative Pressure Wound Therapy with Instillation and Dwell Time Using Antiseptic Solution in Chronic Limb-threatening Ischemia.

Chronic limb-threatening ischemia (CLTI) is a severe peripheral artery disease with rest pain and lower limb ulceration. After revascularization, limb ulceration treatment should be completed quickly before restenosis. We aimed to investigate the effect of negative pressure wound therapy with instillation and dwell (NPWTi-d) using an antiseptic solution (AS) versus a saline solution (SS) in CLTI. There is no research limited to CLTI on this topic. All patients underwent revascularization and surgical debridement. NPWTi-d was applied after surgical debridement. We evaluated wound tissue cultivation from pre- and post-NPWTi-d, length of NPWTi-d, and laboratory data pre- and post-NPWTi-d. All data are presented as the median, interquartile range. For univariate analysis, nonnormally distributed data were examined using the Wilcoxon rank sum test between the two groups of NPWTi-d (AS and SS group). A P value of less than 0.05 was considered statistically significant. Forty-eight CLTI patients participated. The SS group included 24 patients (19 men, five women, average age 68.8 years) and the AS group included 24 patients (16 men, eight women, average age 67.4 years). The comorbidities included 23 and 19 patients with diabetes mellitus and hemodialysis in the SS group, and 22 and 16 patients in the AS group, respectively. There were no adverse events in either group. Both groups reduced the number of bacteria. The AS group required shorter NPWTi-d time (P = 0.02). The AS group was able to shorten the treatment duration in CLTI.

O01 Inborn errors of metabolism - Solving the puzzle of prolidase deficiency

Abstract Inborn errors of metabolism (IEM) may present with ­distinctive cutaneous manifestations as part of a multisystem phenotype. Diagnosis is a multidisciplinary affair, made difficult by their rarity and complex genetic architectures. Knowledge of molecular mechanisms provides hope for targeted therapies, but unmet needs remain in the treatment of skin disease. Prolidase deficiency (OMIM #170100) is a rare IEM characterised by impaired collagen recycling, recalcitrant lower limb ulceration and massive imidodipeptiduria. The cases of two siblings born to related parents are reported, presenting initially in childhood with hydroa vacciniforme-like photosensitivity. Following a decade-long journey, the diagnosis of prolidase deficiency was eventually made. Pitfalls including the limitations of conventional diagnostic modalities and whole genome sequencing are examined, as well as the effects of chronic skin changes and associated disability on quality of life in childhood and adolescence. Therapeutic options, possible connections to hydroa vacciniforme, and prospects for translational research are reviewed. A rational approach to the clinical and genetic diagnosis of IEM in the paediatric dermatology clinic is proposed.

Clinimetrics of the Lanarkshire Oximetry Index for patients with leg ulcers: A systematic review and meta-analysis.

Ankle Brachial Pressure Index (ABPI) measurement has long been considered the gold standard of vascular assessment for people with lower limb ulceration. Despite this, only around 15% of patients in the United Kingdom who require an ABPI measurement undergo the assessment. The Lanarkshire Oximetry Index (LOI) is a cheaper and arguably more accessible approach to vascular assessment and was initially proposed as an alternative to the ABPI in 2000. No synthesis of evidence related to the LOI has been performed since its introduction into the literature. Primary studies were sought to determine the clinimetric properties of the LOI and its level of agreement with ABPI assessments. Systematic searches of MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, BNI, ProQuest Health and Medicine, Science Direct, Google Scholar and the British Library (online search) were conducted. Reference lists of identified studies were also reviewed to identify additional studies. Three primary studies met the inclusion criteria, reporting data from 307 patients and 584 limbs assessed using both the LOI and ABPI. All three studies reported fair to moderate kappa values for interrater reliability (κ = 0.290-0.747) and statistically significant positive correlation coefficients (r = 0.37, p < 0.001 in two studies) between the LOI and ABPI. The combined data from the three studies indicated a sensitivity of 52% (41.78-62.1, 95% confidence interval [CI]) and specificity of 96.08% (93.4-97.9, 95% CI) for the LOI using the ABPI as a reference. Additional data are required to indicate the safety of the LOI in practice. Data are also required to determine if the LOI is more acceptable to clinicians compared to the ABPI and whether there are any barriers/enablers to its implementation in practice. Given the relatively low specificity of the LOI, it may be beneficial to combine measurement of the LOI with a subjective clinical risk assessment tool to improve the sensitivity of this alternative approach to vascular assessment.

Analysis of Lower-Limb Ulcers in Participants with Leprosy Sequelae Using Metabolomics and 16S Ribosomal DNA Sequencing

Analysis of Lower-Limb Ulcers in Participants with Leprosy Sequelae Using Metabolomics and 16S Ribosomal DNA Sequencing

Lower limb ulcers in people experiencing homelessness

The homelessness crisis in Poland poses a serious challenge to the state, with the number of homeless individuals exceeding 30,000 in 2019. In this paper we highlight one of the most common surgical issue of people experiencing homelessness – venous leg ulcers – and present current treatment guidelines. Homeless individuals, particularly exposed to inadequate living conditions, poor hygiene, and circulatory disorders, are at high risk of developing them. Venous ulcers are chronic wounds with prolonged and complex healing processes.They arise due to venous hypertension associated with chronic venous insufficiency and thrombosis. Often, specialized treatment is necessary, which is a challenge for homeless individuals due to difficulties in accessing regular care.The treatment of venous leg ulcers involves a multi-stage process. The gold standard for managing venous leg ulcers is compression therapy, which reduces edema and venous reflux. The TIME strategy outlines the approach to chronic wound management, emphasizing the importance of initial wound cleansing (surgically, enzymatically, or larvotherapy), infection prevention, maintaining proper moisture and wound edge preparation. This requires the use of suitable antiseptics, dressings, and wound hygiene.People experiencing homelessness face specific issues that necessitate a holistic approach, which includes health education, nutrition, and rehabilitation.

Enhancing Lower Extremity Defect Coverage: High Viability Ultra-Thin Split-Thickness Skin Grafts Obtained from the Scalp.

Repairing lower extremity defects presents challenges due to the scarcity of available local tissue. Skin grafting is a widely employed technique for addressing non-healing ulcers, improving the quality of life of patients and minimizing discomfort. However, using traditional donor sites, such as the thigh, can hinder mobility and result in noticeable scarring and pigmentation changes. This study aims to assess the effectiveness of a novel approach utilizing autologous ultra-thin split-thickness skin grafts (STSGs) harvested from the scalp using a disposable, commercially available razor blade named DermaBlade. Fifteen patients (median age: 72 years, eight males and seven females) with diverse lower limb lesions, including carcinomas and ulcers of varying etiologies, were prospectively enrolled. Donor sites included the sideburn extending to the hairy temporal skin (nine cases) and hairy occipital skin (six cases). Ultra-thin skin strips (<0.2 mm thick) were obtained from the scalp through the use of the disposable flexible blade DermaBlade. The strips were positioned over the receptor area with no sutures in most cases and secured using dressings. A substantial majority of patients (90%) achieved successful graft take with no complications. Swift re-epithelialization occurred within a median of 12 days for the donor site and 24 days for the receptor site. No hair transfer or alopecic scars were noted. In contrast to traditional grafting methods, DermaBlade-assisted scalp grafting yields highly viable STSGs that adhere to wound beds without the need for sutures. Notable advantages of this technique encompass rapid wound healing, minimal complications, and superior cosmetic outcomes. Furthermore, it avoids scarring and alopecia, making it a promising approach for addressing lower extremity defects.

Is Inframallolar Angioplasty Effective for Wound Healing in Patients with Critical Lower Limb Ischemia and Tibial Only Disease?

Background Prevalence of PAD is approximately 3–10% in the population as a whole, with this increasing to between 15 and 20% when focusing on older patients (&amp;gt; 70 years of age). Critical limb ischemia is a clinical syndrome defined by the presence of peripheral artery disease (PAD) in combination with rest pain, gangrene, or a lower limb ulceration &amp;gt;2 weeks duration. Aim of the Work The aim of the study is to assess the outcome of inframallelar angioplasty in patients with multiple tibial and pedal arch disease by the impact of technical success in the form of Angiogrophically improvement of pedal arch classification and clinical success by wound healing. Patient and Methods In this observational prospective study; 40 patients were selected from the Ain Shams University Hospitals either at OPC or ER. Patients were subjected to Duplex study and Computerized tomography (CT) angiography for investigation. Patients were treated by balloon angioplasty. Post-intervention medical treatment included: Anti-platelet, Acetylecysitene &amp; fluids. Results Incomparison between the Complete Pedal Arch(CPA), Icomplete Pedal Arch(IPA), Absent Pedal Arch (APA) show no significant change demography and different comorbidities as regard age, gender, smoking, and other co-morbitidies as diabetes, hypertention, renal insufficiency, and obesity. Comparison between 3 groups in terms of wound healing show significant differnerence between CPA(91.7%), IPA (88.9%) and APA (50%) while non significant difference between CPA and IPA. In terms of healing duration it shows non significant difference between CPA and IPA, significant difference between IPA and APA and high significance diference between CPA and APA. Conclusion This is a prospective observational cohort study to asses the outcome of inframallelar angioplasty in patients with multiple tibial and pedal arch disease by the impact of technical success in the form of Angiogrophically improvement of pedal arch classification and clinical success by wound healing. Our study proved that inframalleolar angioplasty play effective role in improving the foot wound healing, shortening its duration in the chronic threatening limb ischemia patients, improving limb salvage and quality of life.

Evaluation of the Role of Negative Pressure Wound Therapy (NBWT) in Healing of Diabetic Foot Ulcers (DFU)

Abstract Background Because of the variable time required for healing, foot wounds are a major concern in general surgery. Lower limb ulcers are exacerbated by chronic conditions like diabetes, as well as our ageing population. The application of negative pressure wound therapy (NPWT) has resulted in a paradigm change in the treatment of various wound types around the world. Objective To evaluate the role and the effectiveness of (NBWT) in the healing of diabetic foot ulcers (DFU), and to compare the rate of healing and the final outcome with the conventional dressing. Methods This randomized controlled prospective study was conducted upon thirteen patients who were presenting with DFU. The study was conducted in Ain Shams university hospitals and National Institute of Diabetes and endocrinology within 6 months. Results In terms of demographics and first labs, there was no statistically significant difference between the two groups based on data analysis. Improvement was considerably better in the NPWT group, providing significant confirmation of our findings regarding the efficacy of NPWT on wound outcomes. Conclusion Patients who received NPWT had a significant reduction in maximum wound depth as compared to those who received traditional dressings. NPWT may play a function in wound healing, according to this research.

Factores de riesgo para la celulitis de miembros inferiores: revisión sistemática y metaanálisis

IntroductionCellulitis is a bacterial infection characterized by affecting the deep dermis and subcutaneous cellular tissue, mainly in the lower limbs. Identifying the associated risk factors is a key objective to prevent its appearance. ObjectiveTo determine the risk factors for cellulitis of the lower limbs. MethodologyA systematic review and meta-analysis was completed and included 3 studies in a definitive way. Data from 933 participants were analyzed, 311 of whom had cellulitis. ResultsRisk factors are: history of cellulitis OR 15.37 (95% CI: 3.19; 74.16), saphenectomy OR 13.03 (95% CI: 4.33; 39.16), skin diseases OR 11.8 (95% CI: 4.42; 31.53), lower limb ulcers OR 10.93 (95% CI: 2. 92; 40.96), deep vein thrombosis OR 10.19 (95% CI: 2.88; 36.05), skin barrier disruption OR 7.17 (95% CI: 4.88; 10.55), blunt trauma to lower limbs OR 6.95 (95% CI: 3.04; 15.90), interdigital region intertrigo OR 6. 27 (95% CI: 2.25; 20.03), chronic lower limb edema OR 5.01 (95% CI: 1.37; 18.30), orthopedic surgery on lower limbs OR 3.91 (95% CI: 1.87; 8.18), previous lower limb surgery OR 3.53 (95% CI: 2.42; 5.16), dermatomycosis OR 3. 17 (95% CI: 2.03; 4.94), white race OR 2.95 (95% CI: 1.83; 4.76), toenail dystrophy OR 2.73 (95% CI: 1.46; 5.09), swimming OR 2.61 (95% CI: 1.59; 4.28), obesity OR 2.45 (95% CI: 1.39; 4.32) and xeroderma OR 2.29 (95% CI, 1.21; 4.33). ConclusionsThe risk factors described should be considered and evaluated to mitigate or suspect cases of cellulitis in the lower limbs.

Time to refocus on the principles of lower limb ulceration management

Time to refocus on the principles of lower limb ulceration management