Mixed Ulcers Research Articles

Characteristics of chronic ulcer patients by gender and ulcer aetiology from a multidisciplinary wound centre.

Chronic ulcer patients form a heterogenous group of patients with various medical backgrounds. Cost-effective targeted treatment necessitates more knowledge about specific features related to different subgroups of ulcer patients. Hence, this study aimed to characterize ulcer patients according to gender and ulcer aetiology. A total of 946 consecutively recorded chronic ulcer patients in the Tampere Wound Registry (TWR) were included and data were gathered from the TWR and patient medical records. Comparisons were made between males and females and patients with venous-, arterial or mixed-, diabetic foot-, pressure- and atypical ulcers. Male patients were found to have diabetes, hypercholesterolemia and obesity significantly more often than females (59.2% vs. 39.6%; p < 0.001, 46.5% vs. 33.3%; p = 0.001, 42.7% vs. 35.9%; p = 0.017 respectively), whereas autoimmune diseases were more common among females (30.6% vs. 15.6%; p < 0.001). Recurrence of ulcers was most common among patients with venous ulcers (p < 0.001) and multimorbidity among those with diabetic foot ulcers (p < 0.001). To conclude, males with chronic ulcers would benefit particularly from lifestyle advice, multidisciplinary treatment should be targeted specifically at those with diabetic and arterial or mixed ulcers and preventive measures at those with venous ulcers.

Development of a localization-based algorithm for the prediction of leg ulcer etiology.

Diagnostic work-up of leg ulcers is time- and cost-intensive. This study aimed at evaluating ulcer location as a diagnostic criterium and providing a diagnostic algorithm to facilitate differential diagnosis. The study consisted of 277 patients with lower leg ulcers. The following five groups were defined: Venous leg ulcer, arterial ulcers, mixed ulcer, arteriolosclerosis, and vasculitis. Using computational surface rendering, predilection sites of different ulcer types were evaluated. The results were integrated in a multinomial logistic regression model to calculate the likelihood of a specific diagnosis depending on location, age, bilateral involvement, and ulcer count. Additionally, neural network image analysis was performed. The majority of venous ulcers extended to the medial malleolar region. Arterial ulcers were most frequently located on the dorsal aspect of the forefoot. Arteriolosclerotic ulcers were distinctly localized at the middle third of the lower leg. Vasculitic ulcers appeared to be randomly distributed and were markedly smaller, multilocular and bilateral. The multinomial logistic regression model showed an overall satisfactory performance with an estimated accuracy of 0.68 on unseen data. The presented algorithm based on ulcer location may serve as a basic tool to narrow down potential diagnoses and guide further diagnostic work-up.

Трофические язвы нижних конечностей у долгожителей: есть ли особенности?

Aim. To compare various clinical and laboratory parameters in centenarians and old patients with trophic ulcers of the lower extremities. Materials and methods. 100 patients were enrolled in the cross-sectional study; 45 centenarians with trophic ulcers – in the main group, 55 patients with trophic ulcers younger than 90 years – in the control group. The age of study patients varied from 61 to 101 years, averaging 82.9±10.5 years. The majority of study patients were women (70%). Results. 40% of ulcers in centenarians were venous ulcers, 24.4% – arterial, 20% – mixed ulcers. Centenarians had a smaller number of ulcers (p=0.03), a shorter duration of ulcers (p=0.01), a smaller area and less infection, compared with patients younger than 90 years. Atrial fibrillation was registered in 46.7% of centenarians, while in patients younger than 90 years this arrhythmia was observed in 31.4% of cases (p=0.02). 22.2% of centenarians and 43.4% of patients under 90 years of age suffered from diabetes mellitus (p=0.001). 11.1% of centenarians and 18.9% of patients of old age suffered stroke in the past (p&lt;0.001). There were no differences in the incidence of myocardial infarction in history (p=0.92) and chronic heart failure (p=0.97) between groups of patients. Among centenarians, 45.2% of patients had normal body weight, 31% were overweight, 23.8% were obese, while in the group of patients younger than 90 years, obesity was registered in 53.7%, and only 22.2 of patients had a normal body mass index (p=0.001). The body mass index in centenarians reached an average of 27.2±6.0 kg/m2, in elderly and senile patients it was 33.7±11.2 (p&lt;0.0001), and the weight was 67.9±16.3 kg and 92.2±33.2 kg, respectively (p&lt;0.0001). The mean count of leukocytes in centenarians was 6.4±2.3×109/l, in patients younger than 90 years – 7.3±2.8×109/l (p=0.07), and platelets – 233±87×109/l and 291±117×109/l, respectively (p=0.006). The mean level of C-reactive protein in centenarians was 12.4±14.7 mg/l, and in patients younger than 90 years it was 26.5±34.0 mg/l (p=0.04). An inverse correlation was observed between the level of C-reactive protein and the age of patients (r=-0.49; p&lt;0.0001). In the group of centenarians a direct correlation was registered between ESR and C-reactive protein level (r=0.49; p=0.02). Conclusions. The study results indicate a number of features of various clinical and laboratory parameters in centenarians with trophic ulcers of the lower extremities, compared with similar old patients.

A RETROSPECTIVE STUDY ON CORNEAL DISEASES AT A TERTIARY EYE HOSPITAL

Aim: To study the patterns of corneal diseases in out-patients department of ophthalmology at tertiary care centre. Materials &amp; Methods: A retrospective study of the patients who presented to the ophthalmology department between 2019 July to 2021 July was done with the help of the data received from the hospital recording system. 176 Patients with only corneal disease were included. Those with corneal disease along with other ocular disease were excluded from the study. A detailed analysis was done for the same. Results: 1. The prevalence of corneal blindness was significantly higher with increasing age(30-50 yrs) 2. The most frequent cause of corneal blindness included keratitis during adulthood (56.7%), with male Preponderance( 65 % ) with mean age (30-50) females (35%) with mean age (20-50), mixed ulcers being the commonest infection( 78%) 3. Trauma (28.6%) 4. Corneal dystrophies and degenerations (10.6%) Conclusion: There is a significant burden of corneal blindness in this population, the majority of which is avoidable. Eye health promotion strategies are warranted to raise awareness about the causes and prevention of corneal blindness.

High-Intensity, Low-Frequency Pulsed Electromagnetic Field as an Odd Treatment in a Patient with Mixed Foot Ulcer: A Case Report

Lower-extremity ulcers are associated with an increasing prevalence and significant economic and social costs. To date, there is no high-quality evidence related to an optimal treatment algorithm. A multimodal approach is needed particularly in patients with comorbidity and polytherapy. Herein, we report the case of a 94-year-old Caucasian female with comorbidity and polytherapy who was admitted to our observation for a history (1 year) of chronic painful malleolar mixed ulcer. After clinical evaluation, she was treated with a twice daily pain relief therapy and with a weekly diamagnetic therapy protocol plus a local treatment. During the clinical examination, we documented a statistically significant improvement in both pain (VAS score from 8 to 2 p &lt; 0.01) and foot ulcer (surface reduction from 6 cm × 4 cm to 2 cm × 2 cm, p &lt; 0.01) at the sixth week of combined treatment. The ulcer completely healed at the ninth week. This is the first study to document the effect of diamagnetic therapy as an add-on therapy in the management of wound healing. In conclusion, even if high-quality evidence is still lacking, diamagnetic therapy might represent an interesting option as an add-on treatment for ulcer.

Health-related quality of life and chronic wound characteristics among patients with chronic wounds treated in primary care: A cross-sectional study in Singapore.

Chronic wounds commonly decrease patients' quality of life. Understanding how chronic wounds impact a patient's health‐related quality of life (HRQoL) is important for healthcare service delivery and treatment management. This study explored HRQoL among patients suffering from chronic wounds and investigated associations with patients' socio‐demographics and wound characteristics. Two hundred and thirty‐three patients across six primary care clinics were assessed and responded to a survey that collected information on socio‐demographic, wound characteristics, and HRQoL using the EQ‐5D‐5L instrument. Data were analysed by descriptive statistics and generalised linear models. The mean age of patients was 61.2 (SD: 14.6) years; 68.2% were males; and 61.8% were of Chinese origin. Arterial ulcers had the greatest negative impact on HRQoL related to mobility, self‐care, pain/discomfort and anxiety/depression, and the lowest VAS mean score 62.31 (SD: 28.3; range: 0‐100) indicating the worst health. HRQoL related to mobility was significantly associated with age (β = 0.008, P < .001), non‐Chinese ethnicity (β = 0.25, P = .001), mixed ulcers (β = −0.41, P = .022), atypical hard‐to‐heal wounds (β = −0.38, P = .021), wounds with low (β = 0.24, P = .044) to moderate (β = 0.29, P = .018) exudate level, and a wound duration ≥6 months (β = 0.19, P = .033). The findings can be used to improve healthcare delivery for patients with chronic wound to optimise their HRQoL.

A service evaluation to examine the use of compression strapping for the management of patients with retromalleolar leg ulcers in a specialist community setting.

Leg ulcers are costly to the NHS, and they have a significant impact on patients' physical, social, and psychological well‐being. Compression therapy is traditionally the “gold‐standard” treatment for the management of venous leg ulcers and can be beneficial for those individuals with mixed ulcer aetiology. Evidence suggests that the application of standard, strong, graduated compression bandaging does not apply therapeutic compression to the retromalleolar fossa. The addition of compression strapping has been found to increase sub‐bandage pressure, promote healing, reduce pain and increase quality of life in patients with retromalleolar leg ulcers. This service evaluation aimed at evaluating the use of compression strapping with patients with retromalleolar leg ulcers. The service evaluation included 24 patients with 41 ulcers treated with compression strapping by a specialist team. Patients treated with CS had multiple comorbidities and shared common characteristics including foot and ankle oedema, previous ulceration, reduced mobility, and failure to heal despite the application of “gold‐standard” compression therapy. Following application of compression strapping, 17 patients (n = 27/41 ulcers) healed, mean pain scores decreased, and mean quality of life scores increased. The compression strapping was tolerated well, and patients reported a positive experience. This service evaluation has contributed towards a growing evidence base that supports the use of CS for the management of patients with retromalleolar leg ulcers.

The importance of Mediterranean diet and hydration habitus in patients with lower limb ulcers: A pilot study

Chronic leg ulcers are a common condition among adults, causing pain and social distress. Population aging has contributed to the amplification of the disease with increased cardiovascular diseases such as myocardial infarction, stroke, limb ischemia, cancers, chronic respiratory diseases, and diabetes. The aim of this study was to evaluate the influence of the Mediterranean Diet (MD) and hydration on the healing rate of the ulcers. A group of 35 patients (M/F 16/19, mean age 78 ± 10 years) with venous, arterial, or mixed ulcers was subjected to a Food Frequency Questionnaire (FFQ) and a Hydration Habits Questionnaire (HHQ). Clinical and anthropometric data were collected. A one-year follow-up was conducted. Complete ulcer healing was observed in 26% of the patients, of whom 67% had a habit of high hydration (more than 1 liter /day), regardless of adherence to the MD. In our study population, about half showed a low adherence to the MD. A moderate-high adherence to the MD showed an increase of arterial ulcer healing compared to subjects with a low adherence to the MD, however, only when associated to a consumption of more than 1 liter of water daily. In conclusion, dietary assessments could help identify patients who are likely to benefit from nutritional interventions for improving overall health and wound healing. The habit of high hydration, namely more than 1 liter daily, can influence the wound healing rate.

Tibial cortex transverse transport facilitating healing in patients with recalcitrant non-diabetic leg ulcers.

SummaryObjectiveThe treatment of recalcitrant not-diabetic leg ulcers remains challenging. Distraction osteogenesis is accompanying by angiogenesis and neovascularization in the surrounding tissues. We previously applied tibial cortex transverse transport (TTT) to patients with recalcitrant diabetic foot ulcers and found neovascularization and increased perfusion in the foot and consequently enhanced healing and limb salvage and reduced recurrence. However, the effects of TTT on recalcitrant non-diabetic leg ulcer remains largely unknown.MethodsConsecutive patients (n ​= ​85) with recalcitrant non-diabetic leg ulcers (University of Texas Grade 2-B to 3-D, ie, wound penetrating to the tendon, capsule, bone, or joint with infection and/or ischemia) were recruited and divided into TTT (n ​= ​42) and control (n ​= ​43) groups based on the treatment they received. There were 36 (85.7%) arterial ulcers, 4 (9.5%) venous ulcers and 2 (4.8%) mixed ulcers in the TTT group and 32 (74.4%) arterial ulcers, 7 (16.7%) venous ulcers and 4 (9.3%) mixed ulcers in the control group (p ​> ​0.05). The two groups were matched on demographic and clinical characteristics. Patients in the TTT group underwent tibial corticotomy followed by 4 weeks of distraction medially then laterally, while those in the control group received conventional surgeries (debridements, revascularization, reconstruction with flaps, or skin grafts or equivalents). Ulcer healing and healing time, limb salvage, recurrence, and patient death were evaluated at a 1-year follow-up. Changes in leg small vessels were assessed in the TTT group using computed tomography angiography (CTA).ResultsTTT group had higher healing rates at 1-year follow-up than the control group (78.6% [33/42] vs. 58.1% [25/43], OR 2.64 [95% CI 1.10 to 6.85], p ​= ​0.04). The healing time of the TTT group was shorter than the control group (4.5 vs. 6.1 months, mean difference −1.60 [95% CI -2.93 to −0.26], p ​= ​0.02). There were no significant differences in rates of major amputation, reulceration, or mortality between the groups (p ​> ​0.05). TTT group displayed more small vessels 4 weeks postoperatively at the wound area, the foot, and the calf of the ipsilateral side in CTA. All patients in the TTT group achieved good union at the osteotomy site and had no skin or soft tissue necrosis or infection around the incision area.ConclusionThe findings showed that TTT facilitated the healing of recalcitrant non-diabetic leg ulcers and reduced the healing time compared with conventional surgeries. They suggest that TTT is an effective procedure to treat recalcitrant non-diabetic foot ulcers compared with standard surgical therapy. The procedure of TTT is relatively simple. Randomized controlled trials are required to confirm these findings.The translational potential of this articleTTT can be used as an effective treatment for recalcitrant non-diabetic leg ulcers in patients. The mechanism may be associated with the neovascularization in the ulcerated foot induced by TTT and consequently increased perfusion. Together with previous findings from recalcitrant diabetic leg ulcers, the findings suggest TTT as an effective procedure to treat recalcitrant chronic leg ulcers.

Thermographic Characterization of Cutaneous Ulcers of Different Etiologies.

The characterization of the temperature of skin ulcers may provide preliminary diagnostic evidence. The aim of this study was to characterize cutaneous ulcers of different etiologies by infrared thermography. 122 cutaneous ulcers of 87 patients (age 60.1 ± 15.7years) were evaluated, allocated into five groups: venous ulcers (VU) n = 26, arterial ulcers (AU) n = 20, mixed ulcers (MU) n = 25, pressure ulcers (PU) n = 29, and neuropathic ulcers (NU) n = 22. The cutaneous temperature was recorded by infrared thermography (FLIR-450™); we also evaluated the ulcer area, the ankle brachial index (ABI), the range of motion (ROM) of the ankle, and pain. For the different variables, the statistical analysis was performed using the Kruskal Wallis test, ANOVA, the chi-squared test, and the Spearman test (SPSS™ software version 20, p < 0.05). A significant difference was found between the temperatures of PU and NU. The ABI was significantly lower in the MU and AU groups, and pain was also higher in these groups. The ROM was decreased in all groups, and the MU and VU groups had the lowest ROM. There was no correlation between temperature and the clinical findings (ABI, ROM, and pain). There was a moderate correlation in the analysis between the temperature and the area of the ulcer in the PU group, as larger ulcers had lower temperatures. It is possible to characterize cutaneous ulcers by infrared thermography, and there are temperature differences among ulcers with different etiologies.

Unna boot therapy impact on wellbeing, hope and spirituality in venous leg ulcer patients: a prospective clinical trial.

To assess the impact of Unna boot therapy on subjective wellbeing, hope and spirituality in patients with venous leg ulcers (VLU). This was a prospective, descriptive, analytical, multicentre clinical trial conducted in a nursing care and education centre, an outpatient wound care clinic and a primary health care unit in Brazil. Adult patients with VLUs took part in the study. Patients with diabetic foot ulcers and mixed ulcers were excluded. A questionnaire assessing sociodemographic and religious characteristics of patients, the Subjective Wellbeing Scale, the Spirituality Self-Rating Scale (SSRS), and the Herth Hope Index (HHI) were administered to all patients. A total of 60 patients (63.3% female; 86.7% aged ≥60 years) participated. Before Unna boot therapy, 65%, 66.7% and 65% of patients reported a score of one on positive affect, negative affect and life satisfaction, respectively, indicating poor subjective wellbeing. After one month of compression therapy, 66.7%, 50.0%, and 80.0% of patients reported a score of three for each element positive affect, negative affect and life satisfaction, respectively, showing a significant improvement in subjective wellbeing (p=0.029). A significant increase in total SSRS scores (p=0.017) was found between baseline (mean: 9.77) and one month of treatment (mean: 25.47), indicating a significant increase in a sense of spirituality. There was also a significant increase in total HHI values (p=0.009) between baseline (mean: 15.68) and one month of compression therapy (mean: 39.38), suggesting a significant increase in hope among patients. Patients with VLUs treated with Unna boot therapy in this study showed significant improvement in subjective wellbeing, spirituality and hope for cure.

Arteriovenous Ulcers: The Mixed Ulcers - Still The Domain Of Arterial Therapy? A Case Report

Arteriovenous Ulcers: The Mixed Ulcers - Still The Domain Of Arterial Therapy? A Case Report

Clinico-Etiological Evaluation of Chronic Leg Ulcer in a Tertiary Care Center of Eastern India.

Background:A chronic leg ulcer (CLU) is a significant public health problem. It has various etiologies. Racial, familial, occupational, and social factors may also have an impact on the prevalence of different causes of leg ulcers. Though there are western data on the epidemiology of leg ulcer, similar data are largely unavailable from our part of the world.Aims:We undertook a study in a tertiary care center in eastern India to determine the clinical and etiological pattern of patients with CLU.Materials and Methods:Hundred consecutive patients presenting with CLU, fulfilling the criteria, were included after informed consent. Patients were subjected to proper history taking, clinical examination, routine blood test, and pus for culture and sensitivity test (where needed) along with Ankle Brachial Index (ABI).Results:Among the 100 patients, venous ulcer (34%) was predominant followed by arterial ulcer (14%), mixed arterial and venous ulcer (11%). History of smoking (56%) and obesity (BMI >25) (32%) were the common risk factors in leg ulcer patients. Fifty nine percent of the total CLU were infected and out of this, 86.4% showed growth of microorganisms. Staphylococcus aureus (39%) was the most commonly isolated organism, followed by Pseudomonas aeruginosa (15%). Eleven (24.44%) clinically diagnosed venous ulcer patients showed significantly lower ABI (<0.9) and were diagnosed as mixed ulcer (a venous ulcer with a peripheral arterial disease).Conclusion:Venous ulcer and mixed ulcer are the most common type of CLU.

Interest of a standardized treadmill test to evaluate pressure drops and stiffness indices under short stretch bandages

Introduction: Under short stretch bandages (SSB), the pressures drop over time. These pressures are documented in non standardized-way and vary from one study to another. Objective: A standardized stress test on a treadmill should help to better understand this evolution and thus to document with more precision the behavior of 3 bandages in use. Materials and Methods: Three bandage kits (Urgo K2, Kit Biflex and a kit consisting of padding + 2 cotton SSB2 were tested in 30 subjects (60 legs) before and after a treadmill test (3 km/h, 6% slope for 30 min or 1.5 km). Results: Before the test, the bandages were applied with nonsignificantly different resting interface pressures (respectively 40.58 ± 2.7 mmHg, 41.05 ± 2.17 mmHg, 38.16 ± 2.98 mmHg). When standing, the pressures were significantly different between Urgo K2, Kit Biflex and SSB2(55.58 ± 6.15 mmHg, 57.3 ± 6.53 mmHg versus 62.3 ± 5.07 mmHg for SSB2). Similarly, the static stiffness indexes (SSI) showed significant differences (15 ± 5.05mmHg and 16.25 ± 6.28 mmHg versus 24.13 ± 4.65 mmHg for SSB2). After the test, resting pressures drop but more significantly under the SSB2 compared to the other 2 multilayer bandages (resting pressures: 31.95 ± 2.66 mmHg and 34.61 ± 2.28 mmHg vs. 25.95 ± 3.15 mmHg for SSB2). However, the SSI is not significantly different from the SSI calculated before the treadmill test (15.41 ± 4.44 mmHg and 15.66 ± 4.85 mmHg vs. 25.06 ± 4.98 mmHg). Conclusions: The treadmill test makes it possible to quantify and to compare the drop in pressure under different bandages in the same conditions. This test could be useful in clinical research before the clinical phases of development, especially in the case of venous leg ulcer. On the other hand, in case of mixed ulcers, the drop in pressure in lying position in multilayer bandages ensure a continuation of the arterial influx in case of mixed ulcers.

CGF treatment of leg ulcers: A randomized controlled trial

BackgroundConcentrated Growth Factors (CGF) is a concentration of second generation autologous growth factors compared to platelet rich plasma (PRP) and represents a multifactorial stimulation system that can be used for the management and treatment of chronic skin ulcers.AimThe aim of this work is to evaluate the additional benefits of the CGF compared to the standard of dressing and its effects on the dynamics of the healing process.MethodsAutologous CGFs were obtained from 100 patients with chronic mixed ulcers (venous ulcers in patients with II stage claudication) of the lower limbs in a multicentric controlled randomized study.ResultsThe results showed a significant advantage in the use of CGF in association with cleansing and selective compression in the healing time and stabilization of mixed ulcers of the lower extremities.ConclusionsThese results support the CGF’s clinical use for improving clinical outcomes in mixed ulcers of the legs.

Healing of wounds in lower extremities employing a non-thermal plasma

Purpose: Venous, neuropathic, and mixed (venous and arterial) ulcers are complex chronic wounds that have a tremendous long-term impact on the mortality, morbidity, and quality of life of patients. In this work it was evaluated the efficacy of the non-thermal helium plasma at atmospheric pressure applied in patients with this suffering.Methods: Using three elements: a RF generator, a needle-type reactor, and helium gas flow, for non-thermal plasma generation were used. The power density on the tissue of patients was of 0.6–0.67 W/cm2. The application time was 30 s/cm2 daily, at 5 to 10 mm of distance from the wound.Results: The thirty-two patients with venous and mixed ulcers indicated that they had a decrease progressively of the pain with the therapy, without the need to continue with analgesics. Besides, the ten patients with chronic wounds showed 100% healing in neuropathic ulcers. For eight patients with venous leg ulcers, the percentage was reduced to 75% healing. While for fourteen patients with mixed leg ulcers, the rate of healing was 59%.Conclusion: The non-thermal plasma generated in a needle reactor with helium gas is a promising candidate for clinical and therapeutic use in the treatment of neuropathic leg ulcers, with time reduction healing, and it can be applied everyday. In the study conducted, it was found that the non-thermal plasma applied to patients with autoimmune diseases clinically was not beneficial.

Wound dressings for leg ulcers in Germany: Distribution, regional variations and health care providers

Abstract Background Although there are standards in guideline-compliant treatment of chronic wounds, little is known about the use of wound dressings in Germany. Objective The objective of the longitudinal study was to analyze the use of wound dressings, to explore regional differences and to characterize prescriptions by different physician specialties in patients with leg ulcers in Germany. Methods Wound dressing rates for incident leg ulcers were analyzed from a German statutory health insurance between 2010 and 2012. Results From 2010 to 2012, out of 7,248,644 insured persons 0.52% [95%-CI 0.51–0.52%] were identified as having an incident ulcer. 76.0% were treated with hydroactive wound dressings. By contrast, in 23.7% only non-hydroactive dressings were used, and more often prescribed in venous (24.0%) than in mixed leg ulcers (20.8%). Most frequently used products were foam dressings (49.7%), followed by gauze compresses (29.5%). Wound specialized physicians had the highest overall proportion of prescriptions (60.2%) and a slightly higher proportion of non-hydroactive wound dressings. Large regional variations were observed. Conclusion In Germany, a high level of use of hydroactive wound dressings in leg ulcers and marked regional variations were found.

Use of Cellutome for the healing of venous or mixed ulcers

Venous or mixed ulcers are common and invalidating. Cutaneous transplants may be necessary if conventional treatment is ineffective. We evaluated the performance of Cellutome in promoting the healing of venous or mixed ulcers 2 months after grafting. This was a retrospective, multi-centric, descriptive study of patients who had a venous or mixed ulcer for at least several months and who received an autologous skin graft using the Cellutome system at least 2 months before. The principle evaluation criterion was the state of the wound after 2 months (completely healed vs not healed). The secondary evaluation criterion was the percentage of wound healing after 2 months. A total of 47 patients were included in the study. The ulcers had evolved over an average of 18 months. The average surface area was 13.37 cm2 . After 2 months, the grafts of 26 of 47 patients (55.3%) were completely healed. The grafts of 21 patients (44.6%) were not completely healed but showed an average rate of healing of 51%. Use of the Cellutome system for epidermal transplants promoted complete or improved healing after 2 months for 55.3% of patients with chronic venous or mixed ulcers. The limited data on the rate of healing of conventional transplants in the literature report rates of approximately 50%. The Cellutome system may therefore be of interest as the healing rate is similar to that of conventional techniques, but using a much simpler, painless procedure on an outpatient basis.

Frailty syndrome and functional disability among older adults with and without diabetes and foot ulcers

To assess frailty and disability among older adults with and without diabetes or foot ulcers. A descriptive, comparative, controlled, multicentre study. Equal numbers of participants were allocated to three groups: (I) no diabetes/no foot ulcers (control), (II) diabetes but no foot ulcers or (III) diabetes and foot ulcers. Individuals with arterial, venous, pressure or mixed ulcers were not included. We collected data using three methods: a sociodemographic questionnaire and the validated Brazilian versions of the Edmonton Frail Scale and Stanford Health Assessment Questionnaire 20-item Disability Scale (HAQ-20). A total of 150 older people took part in the study. The majority of participants were female (n=84, 56%), married (n=86, 57%) and did not exercise (n=94, 63%). Their age ranged from 67.7-71.5 years. In group I, 32 (64%) patients showed no evidence of frailty. In group II, 18 (36%) patients and 12 (24%) patients were 'apparently vulnerable' and 'mildly frail', respectively and in group III 21 (42%) patients and 15 (22%) patients had 'moderate' and 'severe frailty', respectively. The mean total HAQ-20 scores were 0.24, 0.52, and 2.44 for groups I, II, and III, respectively. Patients in group III reported significantly higher scores on all HAQ-20 categories compared with patients in groups I and II. Older patients with DFUs showed frailty and physical disability in activities of daily living.

Self-management by firm, non-elastic adjustable compression wrap device [Translation of Druckmessungen unter Klettverschluss-Kompression - Selbstbehandlung durch feste, unelastische Beinwickelung

&lt;p&gt;Severe forms of chronic venous insufficiency and lymphedema require strong compression-pressure, which exceeds the pressure exerted by medical compression stockings (&amp;gt;40 mmHg). The aim was to investigate if patients are able to apply a Velcro-band compression device (Circaid Juxta Lite™) themselves with sufficient pressure. Thirty-one patients (CEAP C6=23, C5=5, C3=2, mixed ulcer=1) applied Juxta Lite™ on their own legs after a short instruction and were asked to readjust the pressure by their subjective feeling. Sub- bandage pressure was measured after application and 24 h later. In 30 patients without arterial occlusive disease the median sub- bandage pressure values on day 1 and day 2 were 44,5 mmHg (IQR 42-48), and 46 mmHg (IQR 44-48,25) respectively. One patient with an arterialvenous leg ulcer showed pressures of 34 and 36 mmHg. All measured pressure values corresponded to the pursued target range, demonstrating that adequate self application of Velcro bands is feasible and that patents can maintain this pressure by re-adjustment.&lt;/p&gt;&lt;p&gt;&lt;em&gt;Source: this paper is an abridged translation of Mosti G, Partsch H. Druckmessungen unter Klettverschluss-Kompression - Selbstbehandlung durch feste, unelastische Beinwickelung. Vasomed 2017;5:212-6.&lt;/em&gt;&lt;/p&gt;