Mean Ulcer Area Research Articles

Prognostic indicators of corneal ulcer clinical outcomes at a tertiary care center in the Bronx, New York

PurposeCorneal ulcers frequently result in ocular morbidity and may lead to permanent visual impairment if severe or untreated. This study aims to evaluate the association of patient factors and ocular exam findings on clinical outcomes for patients diagnosed with a corneal ulcer at a tertiary care center in the Bronx, New York.MethodsA retrospective chart review was conducted on all ambulatory and admitted patients diagnosed with a corneal ulcer (identified using ICD-10 code H16.0) at Montefiore Medical Center, Bronx, NY between 2016–2022. Patient demographics, presence of known risk factors, characteristics of subsequent clinical course, and microbiological studies were noted. Clinical outcomes following treatment were longitudinally evaluated and categorized based upon the following criteria: 1) ‘No Surgical Intervention’: No severe complications or surgery required after presentation, 2) ‘Surgical Intervention’: Decline in BCVA with surgery required for a severe complication.ResultsThe search criteria identified 205 patients (205 eyes) with the diagnosis of a corneal ulcer. Mean age was 55.3 ± 21.1 years (mean ± SD). Mean ulcer area at presentation was 7 ± 10.5 mm2. Mean LogMAR at presentation was 1.2 ± 1, and following treatment, improved to 1.0 ± 1. ‘Surgical Intervention’ outcome was associated with advanced age (p = 0.005), presence of ocular surface disease (p = 0.008), central location of ulcer (p = 0.014), greater ulcer area at presentation (p = 0.003), worse visual acuity at presentation (p < 0.001), and isolation of fungi (p = 0.004).ConclusionIdentification of risk factors associated with a poor clinical prognosis can guide treatment and inform expectations for patients diagnosed with a corneal ulcer. Our study highlights the importance of timely diagnosis, work-up, and initiation of appropriate management, particularly in vulnerable populations where access to specialty care is logistically challenging.

Treatment with Umbilical Cord Blood Platelet Lysate Gel Improves Healing of Diabetic Foot Ulcer.

This study was conducted to examine the hypothesis that umbilical cord blood platelet lysate (UCB-PL) gel has a significant impact on the healing rate of DFU. Μethods: In this open-labeled, randomized controlled trial, 110 patients were randomized to treatment with UCB-PL gel (UCB-PL group, n = 52) every three days for one month or dressing with normal saline (control group, n = 58). All participants were followed up for 20 weeks post treatment. Ulcer surface area was assessed with the imitoMeasure application at two, four, and six weeks, and two, four and six months. This study's main outcome was the reduction in ulcer size over the six-month study period. The mean ulcer area at baseline was 4.1 cm2 in the UCB-PL group and 1.7 cm2 in the control group. At six months post treatment, patients on the UCB-PL treatment displayed a significant reduction in ulcer size compared to baseline 0.12 (0-8.16) in contrast to a more modest change in the control group 1.05 (0-24.7). The ulcer area was decreased at the end of the study in 40 patients (97.6%) in the UCB-PL group and 27 (73%) in the control group (Fisher's p = 0.002). The application of UCB-PL gel in DFU resulted in a significant reduction in ulcer size compared to regular saline dressing.

Effect of Visible and Infrared Photobiomodulation on Diabetic Foot Ulcers.

Introduction: Diabetes is a highly prevalent disease worldwide. Despite routine treatments, there is no effective treatment approach for patients with diabetic foot ulcers (DFUs). A new approach to reduce complications and control DFU is low-level laser therapy (LLLT). In the present study, we evaluated the therapeutic effects of LLLT on the symptoms of DFU patients. Methods: Sixty diabetic patients with DFU were included in this randomized clinical trial and were randomly allocated into two groups of laser (n=30) and control (n=30) with signed written consent. The LLLT group underwent visible and infra-red laser therapy and conventional medical treatment, while the control group received only conventional medical treatment. The total laser irradiation sessions of the patients were 20 sessions, (three sessions a week) and each session lasted for 30 minutes over the entire surface of the wound. The power density per session for each laser was calculated to be 35.65 mW/cm2 with an energy density of 64.17 J/cm2. Results: The mean area of ulcers in the LLLT group reduced significantly (P<0.001) from 441.7±365.5 mm2 before LLLT to 163.9±213.9 mm2 from the baseline up to the last session of LLLT, indicating a 62.99% reduction in mean ulcer area. In the control group, the mean ulcer area did not change significantly. Wagner's classification of the patients in the LLLT group reduced to lower grades significantly (P<0.01), while the classification moved towards higher grades in the control group (P<0.08). Conclusion: In this study, we showed the effectiveness of LLLT in the reduction of the surface and depth of DFUs. The results documented that patients experienced significant improvements in the healing of their foot ulcers after laser therapy. It is recommended that the LLLT be considered as a non-invasive method for the treatment of DFU patients.

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.

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.

Effectiveness of Secretome from Human Umbilical Cord Mesenchymal Stem Cells in Gel (10% SM-hUCMSC Gel) for Chronic Wounds (Diabetic and Trophic Ulcer) - Phase 2 Clinical Trial.

Chronic wounds carry financial burdens and increase morbidity and mortality, especially in diabetic ulcers and Hansen's Morbus. More than 50% of chronic ulcers are difficult to heal with regular treatment and require new types of therapy such as the use of secretome of human umbilical cord mesenchymal stem cells (SM-hUCMSC). This experimental study was carried out to see the effectiveness of using SM-hUCMSC in diabetic ulcers and Hansen's Morbus in four medical facilities (multicentre). The level of active secretion has been measured by default in 10% SM-hUCMSC gel, used as a treatment intervention. The primary outcome is wound healing in terms of the length, width, and extent of the wound. The secondary is the side effects of treatment 2 weeks after administration. Follow-up visits will be scheduled at 1 and 2 weeks post-treatment. Forty-one chronic ulcers successfully followed the study until the end. In patients with chronic ulcers, the mean ulcer length, width, and area were 1.60 (0,50-13,0), 1.3 (0,5-6,0), and 2.21 (0,25-78) cm square, respectively, before interventions and 1 (0-12), 0,8 (0-6,0), and 1 (0-72) square cm after interventions at the second follow-up. The change between the beginning and end of the intervention was significant (p-value <0.05). The use of 10% SM-hUCMSC gel topically has been proven effective in accelerating the process of wound healing, especially chronic ulcers with side effects that are not present in this study.

Utility of topical timolol in the management of chronic non-healing foot ulcers

Background: Chronic foot ulcers often do not respond to conventional therapy and result in amputations. Treatment is protracted, expensive and affects the quality of life of the patient. The objective of the study is the efficacy of topical timolol in the treatment of chronic non-healing foot ulcers and the feasibility of its use in a rural/semi-urban population. Methods: An observational, cross-sectional study was conducted at a tertiary hospital situated on the outskirts of Bengaluru from January 2021 to July 2022. Sample size was 95. Topical timolol maleate solution was applied on day 1, 3 and 7 and followed up on days 15 and 30. During each visit the wound was assessed and the area of ulcer was measured. Repeated measures ANOVA was applied to compare the area of ulcer on day 1, 15 and 30 and mean percentage of reduction calculated at different time intervals using post-hoc Bonferroni. Results: Demographic data: predominantly male (61.1%), mean age 48.74±14.8 years, from lower socioeconomic background. 45.3% were diabetics. Efficacy of timolol: mean ulcer area on day 1, 15 and 30 was 70.95, 51.8 and 39.95 cm2 respectively (p=0.001). There was a significant reduction in mean percentage of ulcer area on day 15 and day 30 (p=0.001). No adverse effects due to timolol were observed. Conclusions: Topical timolol is safe, inexpensive and effective. Its use in the treatment of chronic non-healing foot ulcers would be beneficial to a country like India which has a large rural population.

Effect of Topical Insulin Versus Normal Saline Dressing in Healing of Diabetic Foot Ulcers

Diabetic foot ulcer is a common cause of admission in the surgical wards and sometimes the first presentation of this debilitating disease. Numerous topical medication and gels are promoted for ulcer care and healing. Relatively few have proved to be more efficacious than normal saline dressing. This study aimed to compare the effect of topical insulin versus normal saline dressing in healing of diabetic foot ulcers at Rajshahi Medical College Hospital, Rajshahi.&#x0D; Aims and objectives: To assess the effect of topical insulin versus normal saline dressing in healing of diabetic foot ulcers.&#x0D; Methods: A total of 60 patients with diabetic foot ulcers were studied in different units of surgical ward of Rajshahi Medical College Hospital from July 2017 to June 2019. Patients were divided into two groups of 30 patients each that is group A (topical insulin) and group B (Normal saline). Ratio, mean, standard deviation, Pearson Chi-Square test were applied appropriately to this study.&#x0D; Results: Among the 60 patients, majority of the patients were males in both the groups (73.33% in group A and 80.00% in group B) with male to female ratio of 2.7:1 in group A and 4:1 in group B. The mean age in group A was 50.00±7.33 years and in group B it was 53.00±7.80 years, where P=1.00. Among patients with group A significant reduction of mean ulcer area was observed (314.30±171.26 mm2 ) with higher mean percentage reduction (15.30±3.28 percent), whereas, in group B the mean percentage reduction was significantly less (6.35±2.03 percent) with less reduction of mean final ulcer area (110.5±56.23mm2), where P&lt;0.001.&#x0D; Conclusions: Topical insulin dressing provided better outcome in patients with diabetic foot ulcers by significant reduction in wound area when compared to normal saline dressing.&#x0D; Central Medical College Journal Vol 5 No 2 Jul 2021 PP 94-101

Complete Venous Ulceration Healing after Perforator Ablation Does Not Depend on Treatment Modality

Venous leg ulceration (VLU) represents the most advanced form of chronic venous insufficiency (CVI). Persistent VLU that fails to respond to noninvasive treatment requires a minimally invasive endovascular treatment, which may include chemical (ultrasound-guided foam sclerotherapy [UGFS]) and thermal ablation (endovenous laser therapy [EVLT] or radiofrequency ablation [RFA]) targeting incompetent veins. Current guidelines suggest ablation of incompetent perforating veins (IPVs) juxtaposed to active or healed VLU; however, the ideal treatment modality is unknown. We hypothesize that similar to incompetent superficial vein treatment options therapies, VLU healing will be equivalent across minimally invasive IPV treatment options. Using the Vascular Low Frequency Disease Consortium, adults with VLU across 11 medical centers were retrospectively reviewed (2013-2017). We included those who underwent IPV therapies. The primary outcome was complete ulcer healing over time compared with cumulative hazard curves, log-rank testing, and multivariable Cox proportional hazard regression. Secondary outcomes included number of subsequent procedures, which were compared using negative binomial regression. Of the 832 adults with VLU, 158 (19%) were exclusively treated conservatively, and 232 (28%) underwent index treatment for IPV and constitute the full and final cohort. The mean age was 60±14years, 57% were men, and the mean ulcer area was 3.0cm2 (interquartile range, 1-6 cm2). Ninety-one (39%) were treated with EVLT, 127 (55%) RFA, and 14 (6%) UGFS. Patients treated with RFA were older (RFA 62±14years; EVLT 59±14 years; UGFS 52±9 years; P=0.01), more likely to be men (RFA 68%, n=86; EVLT 41%, n=37; UGFS 64%, n=9; P<0.001), with a higher frequency of anticoagulation (RFA 36%, n=46; EVLT 18%, n=16; UGFS 14%, n=2; P=0.005). VLU did not significantly differ in size between groups (RFA 6.2±8; EVLT 4.2±5.4; UGFS 6.1±8; P<0.001). There were no differences in 1-year ulcer healing rates between groups (P=0.18). The number of subsequent procedures did not differ by treatment modality (P=0.47). This multi-institutional retrospective study does not demonstrate any association of IPV treatment modality with differing rates of VLU healing or number of subsequent procedures.

Interventions for ulceration and other skin changes caused by nerve damage in leprosy.

Interventions for ulceration and other skin changes caused by nerve damage in leprosy.

Microbial Keratitis in Stevens-Johnson Syndrome: A Prospective Study.

To evaluate the microbiological profile and outcome in cases with infective keratitis in Stevens-Johnson syndrome (SJS). Eighty-three eyes of 68 patients with SJS presenting with microbial keratitis were recruited and managed with standard antimicrobial therapy. Microbial keratitis developed in 34% of patients with SJS (83 eyes, 68 patients) over a period of 5 years. Four eyes (4.8%) had a history of concurrent topical steroid use at the onset of keratitis. Mean baseline best-corrected visual acuity was 1.8 ± 0.9 logMAR units. The site of corneal ulceration was central in 52 eyes (62.6%), paracentral in 17 eyes (20.5%), and peripheral in 14 eyes (16.8%). The mean ulcer area was 3.9 ± 2.7 mm. Approximately 15 of 24 (62.5%) culture-positive eyes had bacterial infection, most of which (80%) were caused by Gram-positive bacteria. Polymicrobial infection was noted in 7 of 24 eyes (29.1%). Although 57 of 83 (68.6%) eyes healed with medical therapy, 26 of 83 (31.3%) eyes had corneal perforation and were managed with cyanoacrylate glue application (30.7%) or therapeutic keratoplasty (69.3%). Systemic infection as an inciting factor of SJS and an early presentation for keratitis were the major risk factors associated with corneal perforation. Large mean ulcer size, paracentral ulcers, and punctal involvement were associated with a good visual outcome. Infective keratitis in SJS is common, and unlike routine cases, surgical intervention is often required. However, the antibiotic sensitivity pattern suggests that resistance is not that high.

Risk factor analysis on the healing time and infection rate of diabetic foot ulcers in a referral wound care clinic.

Objectives. To determine the prevalence and risk factors for diabetic foot infection (DFI), and to identify factors associated with delayed wound healing of diabetic foot ulcer (DFU). The retrospective study was performed in a referral wound care clinic in Hospital Kuala Lumpur. Data was collected from January 2014 to October 2016 on DFU patients who attended this clinic. Of the 340 patients (216 male and 124 female) DFU patients who attended the clinic (mean age: 58.1±10.8 years old), 41.5% presented with infection with a mean cross-sectional ulcer area of 21.5±33.2cm2. Binary logistic regression analysis revealed that patients of Chinese ethnicity (OR: 3.39; 95%CI 1.49 to 7.70), with fasting blood glucose ≥7mmol/l (OR: 3.41; 95%CI 1.57 to 7.39), ulcer size ≥10cm2 (OR: 2.90; 95%CI 1.45 to 5.82) and blood pressure ≥140/90mmHg (OR: 2.52; 95%CI 1.54 to 4.14) were more likely to develop DFI. The median healing time for patients with DFUs was three months. There were six variables identified as significantly associated with prolonged healing time of DFU, namely presence of infection (p<0.001), poor glycaemic control with fasting blood glucose ≥7mmol/l (p<0.001), high blood pressure ≥140/90mmHg (p<0.001), large DFU size ≥2cm2 (p<0.001), history of amputation (p<0.005) and plantar location of the DFU (p<0.05). Large DFU size, poor glycaemic and blood pressure control are common risk factors for both DFU and DFI. Unexpected high prevalence and ethnicity risk factor for DFI urge more comprehensive primary and secondary preventative strategies to reduce its incidence.

Stem cell therapy for treatment of thromboangiitis obliterans (Buerger's disease).

Thromboangiitis obliterans, also known as Buerger's disease, is a non-atherosclerotic, segmental inflammatory pathology that most commonly affects the small- and medium-sized arteries, veins, and nerves in the upper and lower extremities. The etiology is unknown, but involves hereditary susceptibility, tobacco exposure, immune and coagulation responses. In many cases, there is no possibility of revascularization to improve the condition. Stem cell therapy is an option for patients with severe complications, such as ischemic ulcers or rest pain. To assess the effectiveness and safety of stem cell therapy in individuals with thromboangiitis obliterans (Buerger's disease). The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL and AMED databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 17 October 2017. The review authors searched the European grey literature OpenGrey Database, screened reference lists of relevant studies and contacted study authors. Randomized controlled trials (RCTs) or quasi-RCTs of stem cell therapy in thromboangiitis obliterans (Buerger's disease). The review authors (DC, DM, FN) independently assessed the studies, extracted data and performed data analysis. We only included one RCT (18 participants with thromboangiitis obliterans) comparing the implantation of stem cell derived from bone marrow with placebo and standard wound dressing care in this review. We identified no studies that compared stem cell therapy (bone marrow source) versus stem cell therapy (umbilical cord source), stem cell therapy (any source) versus pharmacological treatment and stem cell therapy (any source) versus sympathectomy. Ulcer healing was assessed in the form of ulcer size. The mean ulcer area decreased more in the stem cell implantation group: from 5.04 cm2 (standard deviation (SD) 0.70) to 1.48 cm2 (SD 0.56) compared with the control group: mean ulcer size area decreased from 4.68 cm2 (SD 0.62) to 3.59 cm2 (SD 0.14); mean difference (MD) -2.11 cm2, 95% confidence interval (CI) -2.49 to -1.73; 1 study, 18 participants; very low-quality evidence. Pain-free walking distance showed more of an improvement in the stem cell implantation group: from mean of 38.33 meters (SD 17.68) to 284.44 meters (SD 212.12) compared with the control group: mean walking distance increased from 35.66 meters (SD 19.79) to 78.22 meters (SD 35.35); MD 206.22 meters, 95% CI 65.73 to 346.71; 1 study; 18 participants; very low-quality evidence.Outcomes such as rate of amputation, pain, amputation-free survival and adverse effects were not assessed.The quality of evidence was classified as very low, with only one study, small numbers of participants, high risk of bias in many domains and missing information regarding tobacco exposure status. Very low-quality evidence suggests there may be an effect of the use of bone marrow-derived stem cells in the healing of ulcers and improvement in the pain-free walking distance in patients with Buerger's disease. High-quality trials assessing the effectiveness of stem cell therapy for treatment of patients with thromboangiitis obliterans (Buerger's disease) are needed.

Effect of low level laser therapy on diabetic foot ulcers: a randomized control trial

Background: Nearly 15% of diabetic patients will suffer from DFU in their life span. Conventional treatment is not effective against the non-healing DFUs so in recent days so many adjuvant therapies which have been tried to stimulate healing process are in use. LLLT, is a non-invasive, pain-free method is considered as a possible treatment option for the diabetic foot syndrome. Aim of this study is to study the role of low level laser therapy on diabetic ulcers, i.e. Reduction in size of the ulcer, faster wound healing, control of infection, cost effectiveness and if secondary procedures like split skin grafting can be avoided.Methods: A total of 100 patients with Diabetic foot ulcer fitting the inclusion criteria was included in the study and they were randomly categorized into control and study group. Patients in the study group received treatment with LLLT. Ulcer bed with edge was irradiated locally with red light (660nm), about 4-8J/cm2 for 20 minutes was delivered for 15 days on daily basis. Conventional dressing was preferred for covering after irradiation and controls were treated with conventional therapy alone which includes dressings with betadine or wet with saline, Course of antibiotic treatment and sloughs removed whenever needed. The size, grade and culture status of the ulcer was assessed on Day 1 and day 15. Duration of stay in hospital was noted to assess cost effectiveness.Results: In LLLT group, after completing 15 days treatment complete wound healing was achieved in 66.6% of grade-1 ulcers and 4.4% of grade-2 ulcers and 96.6% of grade-2 ulcers improved to grade-1. In contrary only 3.4% of grade-2 ulcers improved to Grade 1 and a majority of ulcers remained as such. Reduction in Mean area of ulcer at day-15 was statistically significant in LLLT group (13.74±11.88 to 3.97±5.41cm2 and P&lt;0.001) whereas reduction of mean ulcer area among controls was statistically not significant (19.09±15.03cm2 to 18.80±17.70cm2 and P=0.859). Mean total cost of the treatment was less compared to conventional treatment group. (2264.3±140 Vs 3588.4±68 Rs).Conclusions: Laser therapy is painless, cost effective procedure which induces faster granulation, wound contraction and reepithelialisation, thus accelerates complete wound healing hence avoiding secondary procedures like split skin grafting. Control of infection was also better compared to control group.

Efficacy of Homologous, Platelet-rich Plasma Dressing in Chronic Non-healing Ulcers: An Observational Study.

BackgroundChronic non-healing ulcers are a frequent problem in developing countries and represent a heavy burden to the patients because they lack the necessary growth factors (GFs) to maintain the healing process and are frequently complicated by super, added infections. Traditional therapies, such as regular dressings and wound debridement, cannot provide satisfactory results since these treatments are not able to provide the necessary GFs. Platelet-rich plasma (PRP) helps in enhancing the wound healing by releasing various GFs. The aim was to evaluate the efficacy of PRP dressing in the treatment of chronic non-healing ulcers.MethodsPatients attending the outpatient department on a regular basis and those admitted as inpatients for chronic wound management were included in the study. It was an observational study done in a tertiary health center for a period of one year. All patients with eligible criteria were treated with PRP at twice-weekly intervals for a maximum of 10 dressings. At the end of the five weeks period, the reduction in the size of the ulcers (area and volume) was assessed.ResultsA total of 104 cases with chronic non-healing ulcers of various causes were treated with homologous PRP twice weekly for a maximum of 10 dressings. In those 104 patients, non-healing ulcers in 85 patients (81.73%) were healed at the end of the last dressing. Non-healing ulcers in 13 patients (12.5%) were healed with skin grafting. Among those patients, the baseline mean ulcer area was 5.03 cm2. For each visit, there was a reduction in the ulcer area. At the end of the last visit, the mean ulcer area was 1.69 cm2, which was significant in this study.ConclusionDue to the lack of necessary GFs in chronic non-healing ulcers, PRP is safe and enhances the healing rates of chronic wounds, thereby reducing overall hospital stay and morbidity.

Efficacy of cord blood platelet gel application for enhancing diabetic foot ulcer healing after lower limb revascularization

The efficacy of umbilical cord blood platelet gel (CBPG) application on healing foot ulcers was analyzed in 10 diabetic patients treated for critical lower limb ischemia by surgical or endovascular arterial revascularization. During a 9-month period, 20 diabetic patients affected by critical lower limb ischemia with tissue loss were enrolled in this nonblinded, consecutive series, randomized clinical trial. After clinical evaluation, patients underwent endovascular or surgical revascularization of the affected limb, followed by minor amputations or surgical debridement of ischemic lesions. Patients were then randomly divided into two groups: 10 patients in Group A treated with standard wound care and 10 patients in Group B treated with topic application of CBPG. The CBPG protocol consisted of platelet gel application twice a week for 4 weeks and then once a week for an additional 4 weeks. Healing was assessed by direct ulcer dimension tracing onto clear plastic sheet and subsequent computerized planimetry. The mean pretreatment and post-treatment ulcer areas at 30 days for Group A were 15.1 cm2 and 8.1 cm2, respectively, and for Group B were 15.7 cm2 and 3.25 cm2, respectively; resulting in a mean ulcer area reduction of 46% for Group A and 79% for Group B patients (P < .01). These observations suggest CBPG application can promote more rapid wound healing than standard care, and indicate the need for a randomized, multicenter trial to confirm clinical efficacy.

Healing of Neuropathic Diabetic Foot Ulcers of PEDIS Grade 1-2 at Home Care with Topical Antiseptics: An Observational Follow-Up Investigation

Objective: This observational and clinical prospective follow-up study examined the healing of ordinary diabetic foot ulcers at home-care setting with two commercially available topical antiseptics, one in formulation as a solution and the other one as a salve. Method: The study population consisted of 35 consecutive adult outpatients with diabetic foot ulcers that were classified as grades 1-2 by using the PEDIS (Perfusion, Extent, Depth, Infection and Sensation) classification system. The patients were treated by two commercial antiseptics (Abilar® 10% Resin Salve or Octenidine® solution) and followed-up by a specialized clinic with four follow-up visits during a treatment period of 145 days on average. All patients performed the wound care at home after instructions from the clinic. Results: At study entry, the mean ulcer area was 221 mm2 (median 140 mm2, interquartile range: 73-320 mm2) in the salve group and 277 mm2 (median 132 mm2, interquartile range: 50–365 mm2) in the solution group. In intentto- treat (ITT) analysis of the whole study population of 35 patients, the ulcers healed totally in 14 (37%; 95% CI 24-56%), and in 9 of 19 patients (47%; 95% CI: 25%-77%) and in 5 of 16 patients (31%; 95% CI: 9%-54%) in the resin salve and Octenidine solution groups, respectively (P>0.05). The infected ulcer with small median size showed an insignificant trend to heal better than the other ulcers. The number of positive bacterial cultures from ulcers (bacteria of Staphylococcus and Streptococcus species in great majority of cases), taken on clinical grounds if infection was suspected, was lower in follow-up visits than at study entry. No side effects were observed. Conclusion: Treatment of diabetic foot ulcers of PEDIS grade 1-2 at home-care with topical antiseptics is an option that results in complete healing of ulcer in more than one third of cases in a 145-day treatment period.

The use of a collagen matrix in hard-to-heal venous leg ulcers.

The effects of a collagen dressing on hard-to-heal venous leg ulcers (vlUs) were evaluated in this prospective, randomised, controlled study. Patients with hard-to-heal vlU were included and divided into two groups using the block randomisation method. The first group was treated with a collagen and an alginate dressing (group A), and the second group with an alginate dressing alone (group b). both groups also had a short-stretch compression system applied at every dressing change. The dressings were changed twice a week for 12 weeks or until the ulcer was healed. Granulation tissue improvement, wound size, overall dressing performance and dressing comfort were evaluated and recorded. A total of 40 patients completed the study evaluation period. Group A had a 65% increase in granulation tissue compared to 38% in group b. The mean ulcer area was reduced to 45% in group A compared to 20% in group b at 12 weeks. no significant side effects were detected in either group. Patients of both groups were satisfied with their treatment and healing progress. The results of this study showed the effectiveness and safety of a collagen dressing in hard-to-heal vlUs as an adjunctive therapy with compression bandaging. These encouraging results may positively affect the quality of life of patients with chronic wounds.

New strategies for treatment of onychomycosis

Objective: The objective of this study was to study the antimicrobial activity of topical photodynamic therapy (PDT) on chronic skin ulcers infected with Pseudomonas aeruginosa (PA). Methods: Patients with chronic skin ulcers in lower limbs infectedwith PAwere enrolled. The surface areas of the ulcerswere treatedwith either a combination of aminolevulinic acid (ALA) and red light (ALA PDT) or red light alone, both once aweek for 2weeks. Results: At 24h post treatment, although the bacteria levels in two groups were similar (p<0.05), the reduction in ALA PDT group was more significant (p<0.01). At seven days post treatment, the mean ulcer area in the red light group was reduced 45%, that of the PDT group 73% (p<0.01). Conclusion:ALA PDT is a potentialmodality to control PA infection and promote healing of chronic skin ulcers in lower limbs.

A clinical study of photodynamic therapy for chronic skin ulcers in lower limbs infected with Pseudomonas aeruginosa.

The objective of this study is to evaluate the antimicrobial activity and healing-promoting effect of topical photodynamic therapy (ALA-PDT) on chronic skin ulcers infected with Pseudomonas aeruginosa (PA). A total of 26 patients with chronic skin ulcers in lower limbs infected with PA were enrolled. The surface areas of the ulcers were treated with either δ-aminolevulinic acid (ALA)-mediated PDT (20% ALA solution, 1.5 h incubation, 630 nm red light, 80 J/cm(2)) or red light alone, both once a week for two weeks. Before treatment, the wound areas and the bacteria levels in these two groups were comparable (p > 0.05). Results indicated that the bacteria levels in the skin ulcers of the light only group of 24 h post-treatment (3.4 × 10(7) ± 7.1 × 10(7) CFU/cm(2)) and pre-treatment (5.5 × 10(7) ± 1.6 × 10(8) CFU/cm(2)) were not significantly different. In contrast, the bacteria levels on the surfaces of the ulcers in the PDT group of 24 h post-treatment (6.3 × 10(5) ± 1.7 × 10(6) CFU/cm(2)) and pre-treatment (8.9 × 10(7) ± 1.7 × 10(8) CFU/cm(2)) were significantly different (p < 0.01). At seven days post treatment, the mean ulcer area in the red light group was reduced from 11.85 ± 6.83 to 7.8 ± 4.9 cm(2) (p < 0.01), that of PDT group from 12.72 ± 8.58 to 3.4 ± 3.4 cm(2) (p < 0.01). Better healing was seen in PDT group (p < 0.01). In conclusion, ALA-PDT is a potential modality to control PA infection and promote healing of chronic skin ulcers in lower limbs.