Non-healing Leg Ulcers Research Articles

Treating Infected Non-Healing Venous Leg Ulcers with Medical-Grade Honey: A Prospective Case Series.

Venous leg ulcers (VLUs) are hard-to-heal wounds and are prone to microbial colonization. Innovative and improved therapies are thus required to resolve local infection and enhance the wound healing process. The objective of this study was to evaluate the effectiveness of medical-grade honey (MGH) for the treatment of clinically infected and non-healing VLUs. This prospective case series included nine patients with an average age of 83.4 years (range: 75-91 years) with a total of eleven VLUs, previously ineffectively treated with various products. Major risk factors for the appearance of VLUs were chronic venous insufficiency, advanced age, multiple comorbidities (particularly cardiovascular diseases), and impaired mobility. All wounds presented with local signs of infection. Upon presentation, treatment was commenced with a range of MGH-based products (L-Mesitran®). Clinical signs of infection were eliminated by MGH after 2.2 weeks on average (range: 1-4 weeks), and wounds were completely healed after 7 weeks on average (range: 3-18 weeks). No further complications or recurrences were observed. MGH has a broad-spectrum antimicrobial activity and promotes rapid healing, thus improving patients' quality of life. Moreover, MGH-based products are safe, easy to use, cost-effective, and can effectively treat VLUs alone or in combination with standard-of-care therapies.

Non-healing leg ulcers in HbE-beta thalassemia.

Non-healing leg ulcers in HbE-beta thalassemia.

Successful use of platelet-rich plasma as a regeneration technique for a non-healing diabetic leg ulcer with chronic osteomyelitis: A case report

Chronic diabetic leg ulcers can be challenging to manage, particularly when osteomyelitis coexists resulting in serious or even life-threatening conditions if not managed appropriately. Such cases require very long periods of treatment with several debridements, antibiotic bead implants, skin grafts or even amputations in many unfortunate cases. Despite that, conventional management appears to be inadequate with poor outcomes and a higher relapse rate. We report a case of a 26-year-old type 1 diabetic female patient presented with a history of non-healing diabetic leg ulcer complicated by chronic osteomyelitis of the left leg. Several wound debridements were performed with the application of vacuum-assisted closure, and culture-guided antibiotics were given. However, only minimal improvements were observed. Eventually, the leg was labeled as an unsalvagable limb due to poor blood supply based on an ankle-brachial index. Platelet-rich plasma (PRP) was tried showing promising results and significant improvement as confirmed by a gallium scan, which showed evidence of osteomyelitis remission. Two months later, the patient improved significantly with the ulcer healed and the osteomyelitis resolved. Autologous PRP promotes wound healing by providing necessary growth factors, reducing inflammation, and showing bactericidal activity. All efforts must be taken to preserve any limb before labeling it non-salvageable. This case report aimed to draw attention to the method that can be implemented to manage non-healing diabetic leg ulcers complicated by chronic osteomyelitis.

The non-healing leg ulcer: A logical approach.

The non-healing leg ulcer: A logical approach.

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 < 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.

Medical Management to Treat Chronic Non-healing Ulcers: A Case Series.

Chronic non-healing leg ulcers are skin defects below the knee that resist healing for more than six weeks. They cause physical, emotional, and economic burdens to patients and society. To introduce an innovative medical strategy that targets the chronic inflammation component in non-healing ulcers (NHUs) with rheumatic features and to evaluate its potential effectiveness in achieving complete healing. We employed an empirical medical therapy regimen, which combined medications like deflazacort, colchicine, dapsone, hydroxychloroquine, and azathioprine. We retrospectively selected 25 patients with chronic pedal ulcerswho underwent our therapy. The mean duration of ulcers was 7.84 years, and the time to heal was 5.97 months. Among 25 patients, 19 had atypical ulcers, four had venous ulcers, and two had diabetic neuropathy ulcers. Four patients with venous ulcers additionally underwent endovenous laser ablation. Our medical strategy showed promising results in healing chronic NHUs with rheumatic features without significant steroid-induced adverse effects.

Effect of Matrix Rhythm Therapy on Non-healing Diabetic Leg Ulcers: A Case Series

Background: Matrix Rhythm Therapy (MaRhyThe) is a recent treatment modality invented by Dr. Ulrich Randoll from Germany which helps in the rhythmic synchronisation of cells. It improves the tissue extensibility and increases the circulation which increases oxygenated blood followed by ATP synthesis and dissolution of the tension. The pathophysiology of non-healing diabetic leg ulcers is complex and leads to poor microcirculation and insufficient supply of oxygen. Hence, this study was undertaken to understand the effect of MaRhyThe in the treatment of non-healing diabetic leg ulcers. Design: Case series Patients: Two cases of non-healing diabetic leg ulcers who had received therapies but failed to heal before the referral were recruited.They were treated with MaRhyThe by trained physiotherapist until the wound healed and its effect was recorded. Outcome measures: Photographic evidence Results: The non-healing period for the diabetic leg ulcer cases was 52 weeks and 90 weeks and the healing period for the wounds was 25 days and 56 days respectively. In both the cases, proliferation was observed and improved with each MaRhyThe session until the wound closed. Conclusion: Matrix Rhythm Therapy (MaRhyThe) is a safe, non-invasive and effective modality in treating non-healing diabetic leg ulcers.

A Case Series Examining the Use of Extracorporeal Shockwave Therapy (ESWT) to Treat Non-healing Venous Leg Ulcers

With their complex pathogenesis, many wounds, such as venous leg ulcers (VLUs) and diabetic foot ulcers (DFUs), place a significant burden on the global healthcare system [1]. 93% of venous leg ulcers (VLUs) are open for more than a year due to a variety of factors such as comorbidities, lifestyle, and work demands. The most common causes are venous disease, arterial disease, and neuropathy. To avoid inappropriate treatment that could worsen the wound, delay healing, or harm the patient, a correct diagnosis is required. Wound chronicity can lead to complications such as infections, amputation, and even death. The purpose of this study is to determine the efficacy of ESWT therapy in patients with chronic non-healing venous leg ulcers who have not shown any signs of healing for more than a year [2].

A Comparative Study on Therapeutic Efficacy of Autologous Platelet-rich Plasma, Autologous Platelet-rich Fibrin Matrix, Recombinant Human Epidermal Growth Factor, and Collagen Particles in Nonhealing Leg Ulcers.

Nonhealing leg ulcers are challenging to manage and cause significant patient morbidity. To promote healing, newer techniques focus on delivering/enhancing dermal matrix components. The aim of this study was to compare the therapeutic efficacy of autologous platelet-rich plasma (PRP), autologous platelet-rich fibrin matrix (PRFM), recombinant human epidermal growth factor (rhEGF), and collagen particles in treating nonhealing leg ulcers. Open, randomized prospective study was conducted in a single tertiary center over 2 years where after fulfilling the criteria, randomization was done into four groups. Group A: Autologous PRP (double spin, manual method, weekly); Group B: Autologous PRFM (weekly); Group C: rhEGF (daily application); and Group D: Collagen particles (weekly) along with cleansing, debris removal, and wound dressing. Treatment endpoints were complete healing/6 months of treatment, whichever was earlier. Follow-up was done two weekly by clinical assessment, photographs, and measurement of the ulcer area. Epi info 7 software was used for statistical analysis. A total of 48 patients completed the study, 12 in each group, with mean age: 42.37 ± 4.56 years and male-to-female ratio 2.6:1. Underlying etiology was varicosities (43.75%), traumatic (25%), diabetes (22.91%), and leprosy (8.34%). At baseline, all groups were comparable in terms of patient and ulcer characteristics. Complete healing was seen in 79.17% at the end of 12 weeks: 91.67% of patients from Groups A and B each, and 66.67% from Groups C and D each. The mean time to complete healing was 6.9 ± 2.5 weeks, the least in Group B (4.73 ± 2.3 weeks). Differences between excellent (≥75%) ulcer healing across all groups were statistically significant at the end of 8 weeks where Group B showed maximum improvement. No major adverse events were seen. PRFM resulted in relatively faster ulcer healing compared with other modalities.

Outcomes of thermal ablation combined with u/s guided foam sclerotherapy in treatment of superficial venous reflux in patients with postphlebitic venous leg ulcer

Background Venous leg ulcers are a considerable health problem because of their high incidence, slow healing, high recurrence rate, and high cost of treatment. Minimally invasive treatments such as endovenous thermal ablation and foam sclerotherapy proved to be safe and effective. However, there is a paucity in studies focusing on the management of postphlebitic venous ulcers using endovenous thermal ablation of the superficial system in combination with foam sclerotherapy. Objectives The aim of our study was to assess the healing time, procedure-related complications and recurrence rate in patients having a postphlebitic venous leg ulcer after being treated with EVLA associated with ultrasound-guided foam sclerotherapy to incompetent perforators with compression therapy. Subjects and methods This is a prospective observational study, conducted at Ain Shams University Hospitals and Nasser institute hospital in Cairo on 30 patients presented with postphlebitic venous leg ulcers. Results After one year, 90% of cases had a totally healed ulcers, 10% with ulcer decrease in size of more than 50%, and recurrence rate 6.7%. The adverse events of this procedure were DVT (6%), hematoma (6%), ecchymosis (43%), thrombophlebitis (6%), and pain (70%). There was significant improvement of the VCSS as regard pain, edema, inflammation, ulcer size, and number. There was highly significant (P < 0.0001) improvement in the mean (SD) VCSS (preoperative 18 [2.808] vs. postoperative 6.367 [2.3449]). Conclusion Patients with totally recanalized deep venous system post deep venous thrombosis, presenting with nonhealing venous leg ulcers, may benefit from thermal ablation of superficial varicose veins combined with ultrasound-guided foam sclerotherapy. This combined approach is a feasible, safe, and effective modality in terms of improved healing rate, low recurrence rate, low complications, and significant improvement in quality of life.

Role of Autologous Platelet Rich Plasma in the Management of Chronic Non Healing Ulcers

Background: Chronic non-healing leg ulcers are a major health problem worldwide and have great impact on personal, professional and social levels, with high cost in terms of human and material resources. The present study was conducted with an aim to demonstrate the efficacy of autologous platelet rich plasma (PRP) in chronic non-healing leg ulcers in comparison to conventional dressings. Methods: About 50 patients presenting with chronic non healing ulcers to the surgical outpatient department in a tertiary care centre over a period of one year were included in the study, of which 25 patients received autologous PRP dressings other 25 patients received conventional dressings. Ulcer measurements were taken on day 1, 15, 28 and 42 days. Results: The mean duration of healing of the ulcers was 3.9 weeks in PRP group and 6.2 weeks conventional dressing. PRP dressing group showed a reduction in ulcer size of about 45.50 percent as compared to 14.80 percent in conventional dressing group. Conclusion: Chronic non healing ulcers are often difficult to heal because they lack the necessary growth factors to maintain the healing process. Conventional therapies do not provide satisfactory healing, since these treatments are not able to provide the necessary growth factors (PDGF, EGF, VGEF etc.) which are essential for the healing process. PRP is a safe, affordable, biocompatible and simple office based procedure for the treatment of non-healing ulcers.

Study of Efficacy of Autologous Platelet Rich Fibrin in Chronic Non-Healing Ulcers of Leg

Introduction: Platelet-rich fibrin (PRF) is the newer treatment option for treatment of chronic non-healing ulcers of leg and it contains various growth factors which boosts the wound healing. Objectives: To detect the efficacy of autologous PRF dressing in chronic non-healing leg ulcers and to assess the reduction in ulcer area at the end of each week. Materials and Methods: 30 patients (17 females, 13 males) were taken in this prospective study with informed consent. PRF was prepared by drawing 10cc venous blood and directly centrifuging it at 3000rpm (approximately 400g) for 10 minutes without adding anticoagulant. Three fractions were formed consisting of red coloured lower fraction containing RBCs, middle fraction containing PRF and upper fraction consisting of upper straw coloured platelet poor plasma (PPP). PPP fraction was discarded; middle PRF fraction was collected by separating it from the lower RBC fraction with forceps and scissors. PRF was then applied over the healthy bed of chronic non-healing ulcers every week till the wound heals. Reduction in ulcer at the end of each week is assessed by calculating area (Length×Width×0.7854). Results: The mean size of the ulcers was 10.4 cm2 initially; mean duration of ulcer was 4.7months. Complete healing required minimum 3 and the maximum 8 sittings (mean 4) no adverse events seen. Conclusion: We conclude that PRF dressing can be used as it is effective, safe, outpatient procedure in chronic non-healing leg ulcers.

Metabolic Profiling Reveals Changes in Serum Predictive of Venous Ulcer Healing.

The aim of this study was to identify potential biomarkers predictive of healing or failure to heal in a population with venous leg ulceration. Venous leg ulceration presents important physical, psychological, social and financial burdens. Compression therapy is the main treatment, but it can be painful and time-consuming, with significant recurrence rates. The identification of a reliable biochemical signature with the ability to identify nonhealing ulcers has important translational applications for disease prognostication, personalized health care and the development of novel therapies. Twenty-eight patients were assessed at baseline and at 20 weeks. Untargeted metabolic profiling was performed on urine, serum, and ulcer fluid, using mass spectrometry and nuclear magnetic resonance spectroscopy. A differential metabolic phenotype was identified in healing (n = 15) compared to nonhealing (n = 13) venous leg ulcer patients. Analysis of the assigned metabolites found ceramide and carnitine metabolism to be relevant pathways. In this pilot study, only serum biofluids could differentiate between healing and nonhealing patients. The ratio of carnitine to ceramide was able to differentiate between healing phenotypes with 100% sensitivity, 79% specificity, and 91% accuracy. This study reports a metabolic signature predictive of healing in venous leg ulceration and presents potential translational applications for disease prognostication and development of targeted therapies.

Management of nonhealing venous leg ulcer: A case report

Management of nonhealing venous leg ulcer: A case report

P24 A case of limited cutaneous systemic sclerosis evolving into an overlap syndrome with systemic lupus erythematosus and pyoderma gangrenosum

P24 A case of limited cutaneous systemic sclerosis evolving into an overlap syndrome with systemic lupus erythematosus and pyoderma gangrenosum

Autologous platelet-rich fibrin membrane as a wound dressing in the treatment of chronic nonhealing leg ulcers: A prospective study

Background: Chronic nonhealing ulcers of the lower extremity are a cause of morbidity and mortality. The various treatment options available are limited and unsatisfactory. Promoting wound healing with an autologous platelet membrane could be a safe, easy, and inexpensive modality. Purpose: To assess an autologous platelet-rich fibrin (PRF) membrane as a wound dressing in the treatment of chronic nonhealing leg ulcers. Methods: A prospective study enrolled 30 patients with chronic nonhealing leg ulcers. Autologous PRF was applied weekly for 6 weeks. At each visit, the ulcer healing was assessed with wound measurements and photographs. The treatment outcome was defined as a percentage in a change of area and volume of the ulcer at the end of the study period. Results: Thirty patients with chronic nonhealing leg ulcers were treated for 6 weeks. 100% improvement in area of the ulcer was seen in 43% ulcers. The mean percentage of improvement in area of the ulcer was 72%. The mean percentage of improvement in volume of the ulcer was 77%. The mean duration of healing was 5 weeks. Conclusion: This study was limited by the lack of a control group. Autologous PRF may be useful for the treatment of chronic nonhealing leg ulcers which can be done on an outpatient basis with minimum adverse effects.

<em>Hypericum perforatum</em> and <em>Azadirachta indica</em> (Neem) oil in the management of chronic leg ulcers: An uncontrolled retrospective observational case review

Chronic nonhealing leg ulcers are debilitating with high morbidity in a vulnerable patient population and pose a frequent clinical and socioeconomic problem. Numerous local treatment options exist, but clinical trials are rare and wound management still represents a big challenge. Recently a wound dressing based on the natural remedies Hypericum perforatum and Neem oil has been proposed for chronic wound management, but trials on nonhealing leg ulcers are missing. Uncontrolled retrospective observational case review on all patients under our supervision with chronic leg ulcers who underwent treatment with a plant-derived wound dressing based on Hypericum perforatum and Azadirachta indica (Neem) oil. It could be retrieved in a total 16 cases (11 female) with a median age of 71 years. All ulcers (7 ulcers on the leg and 9 ulcers on the feed) showed a complete healing after a median healing time of 82 days (Mean 85, range 14-180 days). No side effects occurred, medication was painless or even reduced pain. Wound dressings based on Hypericum perforatum and Neem oil are well tolerated and could be a potential additional simple treatment option in the management of non-healing leg ulcers. Prospective controlled trials are needed to confirm these observations.

Efficacy and Safety of Intralesional Platelet Rich Plasma (PRP) Therapy in the Management of Chronic Non-healing Leg Ulcers in our Population

Background: Autologous Platelets Rich Plasma (PRP) therapy not only hastens chronic wounds and ulcers healing but also diminishes the rate of amputations of lower leg caused by non-healing recalcitrant ulcers. In this study we have demonstrated the magical results of intralesional autologous PRP in the healing of resistant to heal chronic leg ulcers. Methods: In this metacentric study 26 patients having 30 chronic leg ulcers of more than 6 weeks duration and various etiologies, were treated with intralesional autologous PRP application on weekly basis for a duration of 8 weeks and the final results were calculated by percentage improvement in the volume and area of the ulcer/wound. Results: In our study 26 patient with 30 chronic recalcitrant leg ulcers/wounds were treated with intralesional autologous PRP therapy on weekly basis. Mean age of the included patients was 34.5 years. 19 were male patients and 7 were female. The mean time period of the healing of chronic ulcers was 5.3 weeks. The final mean percentage improvement outcome in the volume and area of the ulcers was calculated as 86% and 88% respectively. Conclusions: PRP therapy is safe, cost effective office based simple procedure in treating recalcitrant chronic leg ulcer/wounds. Keywords: Non-healing, intralesional, autologous platelet rich plasma, chronic ulcers

Tissue Debridement Effect of Apamarga Kshara Taila and Adjuvant Medications in the Management of Nonhealing Venous Ulcer

Stasis ulcers of the gaiter zone are difficult to heal due to deoxygenated blood congestion in peripheral areas and lack of oxygenated blood supply. Venous ulcers occur due to insufficiency of distal peripheral veins in legs. This manuscript refers to three cases of nonhealing venous leg ulcers treated with local application of Apamarga Kshara Taila along with some oral drugs. Three patients of nonhealing venous ulcer of the gaiter zone were treated with ayurvedic treatment protocol. In all patients after Panchavalkala Kwatha wound wash, Apamarga Kshara Taila was applied locally on wound once daily up to complete wound healing. In this series, wound healing was achieved in 96 days, 27 days, and 38 days, with a unit healing time of 4.311, 7.287, and 3.677 days/cm3, respectively. For the past 8 months, all three patients are living symptom-free life without any reoccurrence. On the basis of these cases, it can be said that Ayurveda principles of ulcer management have shown a promising role in wound healing and resuming improved quality of life without any untoward effects.

Topical cannabis-based medicines - A novel adjuvant treatment for venous leg ulcers: An open-label trial.

Venous leg ulcers are highly prevalent lower limb integumentary wounds that remain challenging to heal despite the use of evidence-based compression therapies. A multitude of adjuvant treatments has been studied but none have demonstrated enough efficacy to gain adoption into treatment guidelines. Global attention on Cannabis-Based Therapies is increasing and has been driven by quantum scientific advancements in the understanding of the endocannabinoid signalling system. Topical Cannabis-Based Medicines represent a novel treatment paradigm for venous leg ulcers in terms of promoting wound closure. Fourteen complex patients with sixteen recalcitrant leg ulcers were treated with Topical Cannabis-Based Medicines in conjunction with compression bandaging, every second day, to both wound bed and peri-wound tissues. The cohort had a mean age of 75.8years and was medically complex as reflected by a mean M3 multimorbidity index score of 2.94 and a mean Palliative Performance Scale score of 67.1%. Complete wound closure, defined as being fully epithelialized, was achieved among 11 patients (79%) and 13 wounds (81%) within a median of 34days. All three remaining patients demonstrated progressive healing trends but were lost to follow-up. The treatments were well tolerated, and no significant adverse reactions were experienced. The rapid wound closure of previously non-healing venous leg ulcers among elderly and highly complex patients suggests that Topical Cannabis-Based Medicines may become effective adjuvants in conjunction with compression therapy. This may also indicate that they may have an even broader role within integumentary and wound management. Therefore, this treatment paradigm warrants being subjected to controlled trials.