Reduction In Ulcer Size Research Articles

Propolis-based niosomes as oromuco-adhesive films: A randomized clinical trial of a therapeutic drug delivery platform for the treatment of oral recurrent aphthous ulcers

Oromuco-adhesive films for buccal delivery of Propolis extract (PPE) entrapped in niosomes, were prepared to treat oral recurrent aphthous ulcer (RAU). PPE was investigated for antimicrobial compounds. Niosomes composed of span60 and cholesterol were evaluated for particles size, polydispersity index (PDI), zeta-potential, entrapment efficiency and in vitro release. The formed oromuco-adhesive films containing niosomal PPE were evaluated for swelling, mucoadhesion and elasticity. 24 patients suffering from RAU were divided equally into medicated and placebo groups and participated in this study to examine the onset of ulcer size reduction, complete healing and pain relief. Ultra-performance liquid chromatography-high resolution mass spectrometry revealed the presence of pinocembrin, pinobanksin, chrysin and galangin as antimicrobial flavonoids with total content of 158.7 ± 0.15 µg quercetin equivalents and phenolic content of 180.8 ± 0.11 µg gallic acid equivalents/mg. Multilamellar niosomes of 176–333 nm displayed entrapment efficiency of 91 ± 0.48%, PDI of 0.676 and zeta potential of −4.99. In vitro release after 8 h from niosomal dispersion and films were 64.05% and 29.09 ± 0.13% respectively. Clinical results revealed duration of film adherence from 2–4 h in the two groups. The onset of ulcer size reduction in medicated group was attained within second and third day, complete healing was achieved within first 10 days of treatment and pain relief lasted for more than 4–5 h, in contrast to the placebo group. This oromuco-adhesive films which offer controlled and targeting drug delivery can be proposed as a new therapeutic strategy in the treatment of oral recurrent aphthous ulcer.

Efficacy of nano silver dressings over conventional dressings in chronic wounds

Background: Chronic wounds give rise to serious health problems, accompanied by a decrease in quality of life. Silver has been an effective agent with documented efficacy against wide spectrum of bacterial, viral, and fungal infections. Recently, many silver-based preparations are available for effective management of wounds. Among them silver nano particles, exhibit significantly novel and distinct physical, chemical, and biological properties. Due to their nano scale size, they have been elicited much interest in wound management. This study aims to compare the efficacy of nano silver dressing in chronic wounds with that of conventional dressings.Methods: This was a prospective study conducted in the Department of General Surgery, Alluri Sita Rama Raju Academy of Medical Sciences from August 2017 to August 2018. A total of 100 patients with chronic wounds were included in the study and were equally divided into-Study group and Control group randomly. Swab cultures were sent in all the patients. The study group received nano silver dressings while the controls received daily dressings with normal saline soaked gauges, betadine and hydrogen peroxide. Data regarding the time required for healing, number of days required for healing and percentage of healing are noted.Results: Nano silver dressings in the treatment of chronic wounds are found to be safe, effective, promoter of wound healing, promotes epithelization, accelerates healing, eliminates anaerobes and breaks microbial synergy more effectively than conventional dressing. Hence Nano silver spray prove to be more effective in the management of chronic wounds. In study group, 50% of patients stay for 3-4 weeks whereas in control group, 70% of patients stay for 5-6 weeks. 91-99% reduction in size of ulcer is seen in 43 out of 50 patients in study group whereas in control group only 8 out of 50 shows 91-99% reduction in size.Conclusions: Nano silver dressings is a cost effective option in ulcer management. It decreases the period of hospitalization and reduces the burden on the health care system.

Terminal Interruption of the Reflux Source (TIRS) as a Therapeutic Modality in Chronic Venous Ulceration: A Systematic Review

Objectives: Terminal interruption of the reflux source (TIRS) is purported to be a viable method of treating chronic venous ulcers through the temporary reduction of venous hypertension. This technique involves the injection of foam sclerotherapy into venous branches in close proximity to the ulcer bed under ultrasound guidance. This systematic review aims to provide an understanding of the body of published evidence on the value of TIRS in the management of chronic venous ulceration. Methods: A search strategy encompassing MEDLINE, Scopus, the Cochrane database and Google Scholar was developed to identify peer-reviewed articles published prior to April 2018. The search terms used were as follows: ‘venous’, ‘ulcer’, ‘sclerotherapy’, ‘terminal interruption reflux source’, and ‘TIRS’. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 guidelines were followed for data selection and extraction. Results: 3 published articles pertaining to TIRS were identified. 2 studies consisted of case series of 6-14 patients who were treated with ultrasound guided foam injection, followed by compression. 1 randomised controlled trial compared compression alone (n=11) with ultrasound guided microphlebectomy and compression (n=9). Healing time ranged from 6-16 weeks in the case series. Ulcer size reduction was significantly lower in the microphlebectomy cohort in the RCT. Conclusion: There exists a paucity of evidence regarding the utility of TIRS in the management of chronic venous ulceration. A randomized clinical trial is required to eludicate the role of this treatment option.

Topical epidermal growth factor spray for the treatment of chronic diabetic foot ulcers: A phase III multicenter, double-blind, randomized, placebo-controlled trial

AimsThis study was conducted to evaluate the efficacy and safety of a novel spray-applied growth factor therapy containing recombinant human epidermal growth factor (rhEGF) for the treatment of chronic diabetic foot ulcers (DFU). MethodsThis study was a phase III double-blind, randomized, placebo-controlled trial. 167 adult patients at six medical centers were randomized to receive routine wound care plus either topical spray treatment with 0.005% rhEGF (n = 82) or an equivalent volume of saline spray (n = 85) twice a day until ulcer healing or for up to 12 weeks. ResultsDemographics, medical status, and wound characteristics were comparable between rhEGF and placebo groups. More patients in the rhEGF group significantly had complete wound healing compared to placebo (73.2% versus 50.6%, respectively; P = .001). Wound healing velocity was faster in the rhEGF group (P = .029) regardless of HbA1c levels. The rhEGF group had a shorter median time to 50% ulcer size reduction (21 versus 35 days; hazard ratio = 3.13, P < .001) and shorter time to complete ulcer healing (56 versus 84 days; hazard ratio = 2.13, P < .001). ConclusionsThis study confirms that application of spray-applied rhEGF in DFU patients results in faster healing velocity and higher complete healing rate regardless of HbA1c levels.

A Randomized, Controlled Clinical Study to Assess the Effect of Anodal and Cathodal Electrical Stimulation on Periwound Skin Blood Flow and Pressure Ulcer Size Reduction in Persons with Neurological Injuries

The use of electrical stimulation (ES) should be considered for treating nonhealing pressure ulcers (PUs), but optimal ES wound treatment protocols have yet to be established. A randomized, controlled, double-blind clinical study was conducted to evaluate the effects of cathodal and anodal high-voltage monophasic pulsed current (HVMPC) on periwound skin blood flow (PSBF) and size reduction of Stage 2 to Stage 4 PUs of at least 4 weeks' duration. Persons >18 years of age, hospitalized with neurological injuries, at high risk for PU development (Norton scale <14 points; Waterlow scale >15 points), and with at least 1 Stage 2 to Stage 4 PU were eligible to participate in the study. Persons with necrotic wounds, osteomyelitis, electronic or metal implants in the PU area, PUs in need of surgical intervention, acute wound inflammation, diabetes (HBA1c >7%), diabetic neuropathy, cancer, and/or allergies to standard wound treatments were excluded. Patients were randomly assigned to 1 of 3 groups: anodal (AG), cathodal (CG), or placebo (PG) ES. All groups received individualized PU prevention and standard wound care. In the PG, sham ES was applied; the AG and CG were treated with anodal and cathodal HVMPC, respectively (154 μs 100 Hz; 360 µC/second; 1.08 C/day), 50 minutes per day, 5 days per week, for a maximum of 8 weeks. PSBF was measured using laser Doppler flowmetry at baseline, week 2, and week 4, and wound surface area measurements were obtained and analyzed using a digitizer connected to a personal computer. Data analysis utilized the maximum-likelihood chi-squared test, the analysis of variance Kruskal-Wallis test, the Kruskal-Wallis post-hoc test, and Spearman's rank order correlation. Nonlinear approximation based on exponential function was used to calculate treatment time needed to reduce the wound area by 50%. In all tests, the level of significance was set at P ≤.05. Of the 61 participating patients, 20 were in the AG (mean age 53.2 ± 13.82 years), 21 in the CG (mean age 55.67 ± 17.83 years), and 20 in the PG (mean age 52.5 ± 13.18 years). PUs (baseline size range 1.01 cm2 to 59.57 cm2; duration 4 to 48 weeks) were most frequently located in the sacral region (73.77%) and classified as Stage 3 (62.29%). PSBF at week 2 was significantly higher in the AG and CG than in the PG (P <.05). Week 4 differences were not statistically significant. Wound percentage area reduction calculated at week 8 for the AG (64.10% ± 29.22%) and CG (74.06% ± 23.23%) were significantly different from PG ulcers (41.42% ± 27.88%; P = .0391 and P = .0024, respectively). In both ES groups, PSBF at week 4 and percent wound surface area reductions between weeks 4 and 8 were positively correlated, but only the AG correlation was statistically significant (P = .049). In this study, both ES modalities improved blood flow and wound area reduction rate. Studies examining optimal ES treatment times for healing to occur, the effect of comorbidities and baseline wound variables on ES outcomes, and the nature of the relationship between blood flow and healing are necessary.

Platelet rich plasma in treatment of chronic non healing ulcers: a study of ten cases

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Platelet rich plasma (PRP) helps tissue re-modulation by its growth factors (GFs)– platelet derived growth factor (PDGF), transforming growth factor (TGF-β), epidermal growth factor (EGF), fibroblast growth factor (FGF-2), insulin-like growth factor (IGF). These GFs aid healing by attracting undifferentiated stem cells into newly formed matrix and triggering cell division; by promoting capillary growth and by attracting macrophages to improve tissue healing and regeneration.&lt;strong&gt; &lt;/strong&gt;The aims and objectives of the study were to assess reduction in wound size of chronic non-healing ulcers by autologous platelet rich plasma and to evaluate the safety of autologous platelet rich plasma in treatment of chronic non healing ulcers.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was an experimental study conducted on ten patients of chronic non-healing ulcers of varied etiology. Autologous PRP was freshly prepared using 10 ml of patient’s own blood by differential centrifugation process and injected at the margins and base of each ulcer. Four such sittings were administered at weekly intervals for four weeks with a post-treatment follow-up period of one month. Total duration of our study was 8 weeks. Objective assessment of ulcer size was done using centimetre scale and documented by digital photographs.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; While 40% of chronic ulcers healed completely, the remaining 60% cases showed signs of healing at the end of 8 weeks. Mean improvement in ulcer size was 69.38% over a period of 8 weeks. No side effect was encountered in any of our cases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Platelet rich plasma hastened the healing process of chronic non-healing ulcers. Being autologous, it has rare chances of hypersensitivity reactions. &lt;/p&gt;

Comparative evaluation of the efficacy of topical amlexanox 5% oral paste and triamcinolone acetonide 0.1% oral paste in the treatment of Recurrent Aphthous Stomatitis (RAS)

Background: A double-blind randomized control trial was conducted to compare the clinical efficacy of topical triamcinolone acetonide 0.1% and amlexanox 5% in recurrent apthous stomatitis (minor). Materials and Methods: Forty adult patients were assessed for erythema, ulcer size, pain scores, and ulcer healing on three evaluation visits within 24 h of ulcer formation, third day, and fifth day. All participants were monitored for compliance with treatment protocols of four times daily application of calibrated quantity of medication. Results and Discussion: Ninety percent of controls when compared with 65% of the participants in the amlexanox group showed complete improvement of peri-ulcer erythema. Pain reduction was marked from the first to the fifth day (F = 15.249, P = 0.000). The control participants showed 90% reduction in pain in comparison to 70% in the amlexanox group. The mean ulcer size was shown to reduce from the first to fifth day in both groups (F = 18.611, P = 0.000). Completely healed ulcers were seen in 70% of the participants in the control group compared with 75% of the participants in the amlexanox group. Conclusion: The data suggest that the clinical efficacy of topical amlexanox 5% is comparable to topical 0.1% triamcinolone acetonide and may be considered a substitute except in pain control, which was marginally less for the treatment for recurrent apthous stomatitis (minor).

Erythema nodosum with oral and genital ulcers: A case of behçet's disease

Behçet's disease (BD) is a chronic, relapsing, multisystemic disorder characterized by mucocutaneous, ocular, vascular, and central nervous system manifestations. The clinical spectrum includes oral and genital ulcerations, uveitis, and vascular, neurological, articular, renal, and gastrointestinal manifestations. The etiopathogenesis of the disease remains unknown although genetic predisposition, environmental factors, and immunological abnormalities have been implicated. It usually affects young adults. The case of a 22-year-old female who presented with fever, recurrent oral ulcers, genital ulcers, arthralgia, and erythema nodosum is presented here. A diagnosis of BD based on clinical criteria was made. The patient was treated with colchicine 1 mg/day which had beneficial effects on the reduction in size and recurrence of mucocutaneous ulcers.

Comparison of efficacy of Natural honey and Triamcinolone acetonide (0.1%) in the healing of oral ulcers- A clinical study

BACKGROUND: To compare the effectiveness of Natural Honey with Triamcinolone acetonide (0.1%) on the healing of Oral ulcers. METHODS: Seventy four oral ulcers (forty nine recurrent aphthous stomatitis, sixteen aphthous like ulcers in Oral submucous fibrosis and nine traumatic ulcers) were evaluated and each half of them were advised to apply honey and triamcinolone acetonide. Pain score (visual analog scale), ulcer size (measured by William’s Periodontal Probe), erythema level was evaluated on first day and after drug application. Statistical Analysis was done and tabulated by SPSS software. RESULTS: Natural honey showed significant reduction in pain score and ulcer size (p

Effect Of 5% Binahong Leaves Extract Gel On Minor Recurrent Aphthous Stomatitis

Introduction: Recurrent aphthous stomatitis (RAS) is recurrent oral ulcers. RAS pain make patient difficult to speak, eat, swallow, and lowered patient's quality of life. Binahong leaves is a traditional medicine that has anti-inflammatory, antibacterial, covering agents and antioxidants effect that can be used to cure RAS. The purpose of this study was to determine the effect of binahong leaves extract gel for minor RAS healing. Materials and Methods: This study was an experimental study with pretest-posttest control group design which involved 20 RAS patients visiting USU Dental Hospital. Data collected by initial examination then controlled every day for the next three days. Pain scale is measured with visual analog scale. Erythematous halo is measured by the presence or absence of erythema. Ulcer size is measured by measuring the largest diameter of ulcer. Patient was asked to apply the extract thinly with cotton bud. Analysis of the data used Friedman Test and Cochran Test to determine the difference before and after treatment. Results: The result showed significant reduction in pain scale p = 0.001 (p&lt;0.05), erythema halo p = 0.001 (p&lt;0.05), and ulcer size p = 0.001 (p&lt;0.05). There is a reduction in pain scale, erythema halo, and ulcer size at the time of initial examination to first, second and third control. Conclusion(s): The use of 5% binahong leaves extract gel was effective to reduce pain, erythema halo, and ulcer size of minor RAS.

Foam dressings for treating pressure ulcers.

Foam dressings for treating pressure ulcers.

The efficacy of phenytoin dressing in healing of diabetic ulcer: a randomized control study

Background: Diabetic foot infection constitutes up to 10 percent of diabetes-related hospital admissions and the prevalence of diabetes is 2.4% in rural and 12-17% in urban settings. The quest for better wound healing agents for diabetic ulcers is perhaps one of the oldest challenges for medical practice. One such agent that has been tried in wound healing is phenytoin. A common side effect of phenytoin (diphenylhydantoin) treatment for epilepsy is gingival hyperplasia. This stimulatory effect of phenytoin on connective tissue suggested a possibility for its use in wound healing.Methods: 60 patients with diabetic foot ulcer admitted in General Surgery at Mahatma Gandhi Medical College and Research Institute, Puducherry, India were randomly assigned into two groups, the study group consisting of 30 patients who were treated with phenytoin dressing and 30 patients into control group who were treated with conventional saline dressing. Both groups underwent initial debridement and were started on parenteral antibiotics according to wound swab culture and sensitivity. Study group were treated with phenytoin dressing and the wound was assessed based on the rate of ulcer size reduction, the rate of granulation tissue, duration of hospital stays and antibacterial property of phenytoin. Patients were assessed weekly up to 21 days.Results: The rate of granulation tissue in phenytoin group was 90.36% which was statistically significant (p = 0.0011) as compared to control group which was 82.03%. Wound swab cultures repeated on day 21 revealed that there was 50% negative culture in phenytoin group when compared to control group of 24% which also was statistically significant. The mean hospital stay for the patient in phenytoin group was 29.2 days and in control group, it was 26.1 days. It was observed that surface area reduction in phenytoin group was 41.25cm2 to 18.38cm2 and in control group was 40.28cm2 to 20.23cm2 by the end of 21 days, but this was not statistically significant.Conclusions: Phenytoin dressing is effective in increasing the rate of granulation tissue by virtue of its action on stimulating fibroblast proliferation and decreasing collagenase activity. It not only hastens granulation tissue but also decreases bacterial load as compared to conventional dressing by virtue of its intrinsic antibacterial activity and indirectly through their effects on anti-inflammatory cells and neovascularization. Phenytoin prepares the foot ulcer for early grafting thereby improving the overall outcome.

Topical propolis improves wound healing in patients with diabetic foot ulcer: a randomized controlled trial

In this randomized controlled trial, diabetic patients with foot ulcers (Wagner grades 1 and 2) were randomly assigned to conventional therapies for diabetic foot ulcer plus topical propolis ointment (5%; twice daily) or conventional therapies alone. The process of ulcer healing was observed during 4 weeks and compared between the two groups regarding the size, erythema, exudates, white blood cell (WBC) count and erythrocyte sedimentation rate (ESR). The process of ulcer size reduction during the four-week period of study was significantly different between the groups. However, this difference was not significant between the third and fourth weeks. There was no significant difference between two groups regarding erythema and exudate reduction as well as WBC count and ESR. Administration of topical propolis ointment in addition to the conventional treatments of diabetic foot ulcer could reduce the size of ulcers with Wagner grades 1 and 2.

Cost-effectiveness analysis of telephone-based support for the management of pressure ulcers in people with spinal cord injury in India and Bangladesh.

To determine from a societal perspective the cost-effectiveness and cost-utility of telephone-based support for management of pressure ulcers. Cost-effectiveness and cost-utility analysis of a randomised clinical trial. Tertiary centre in India and Bangladesh. An economic evaluation was conducted alongside a randomised clinical trial comparing 12 weeks of telephone-based support (intervention group) with usual care (control group). The analyses evaluated costs and health outcomes in terms of cm2 reduction of pressure ulcers size and quality-adjusted life years (QALYs) gained. All costs were in Indian Rupees (INR) and then converted to US dollars (USD). The mean (95% confidence interval) between-group difference for the reduction in size of pressure ulcers was 0.53 (-3.12 to 4.32) cm2, favouring the intervention group. The corresponding QALYs were 0.027 (0.004-0.051), favouring the intervention group. The mean total cost per participant in the intervention group was INR 43 781 (USD 2460) compared to INR 42 561 (USD 2391) for the control group. The per participant cost of delivering the intervention was INR 2110 (USD 119). The incremental cost-effectiveness ratio was INR 2306 (USD 130) per additional cm2 reduction in the size of the pressure ulcer and INR 44 915 (USD 2523) per QALY gained. In terms of QALYs, telephone-based support to help people manage pressure ulcers at home provides good value for money and has an 87% probability of being cost-effective, based on 3 times gross domestic product. Sensitivity analyses were performed using the overall cost data with and without productivity costs, and did not alter this conclusion.

Phototherapy for treating foot ulcers in people with diabetes.

Foot ulcers are a disabling complication of diabetes that affect 15% to 25% of people with diabetes at some time in their lives. Phototherapy is a relatively new, non-invasive, and pain-free treatment method, which promotes the ulcer repair process through multiple mechanisms such as increased cell growth and vascular activity. Phototherapy may be used as an alternative approach for the treatment of foot ulcers in people with diabetes, but the evidence for its effect compared with placebo or other treatments has not yet been established. To assess the effects of phototherapy for the treatment of foot ulcers in people with diabetes. We searched the Cochrane Wounds Specialised Register (11 October 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2016, Issue 10), Ovid MEDLINE (11 October 2016), Ovid MEDLINE (In-Process & Other Non-Indexed Citations) (11 October 2016), Ovid Embase (11 October 2016), EBSCO CINAHL Plus (11 October 2016), and China National Knowledge Infrastructure (24 June 2017). We also searched clinical trials registries for ongoing and unpublished studies on 24 June 2017, and screened reference lists to identify additional studies. We used no restrictions with respect to language, date of publication, or study setting. Randomised controlled trials or cluster randomised controlled trials that 1) compared phototherapy with sham phototherapy, no phototherapy, or other physical therapy modalities, 2) compared different forms of phototherapy, or 3) compared phototherapy of different output power, wavelength, power density, or dose range, in adults with diabetes and an open foot ulcer of any severity, in any setting. Two review authors independently performed study selection, data extraction, and 'Risk of bias' assessment. We combined the study outcomes when appropriate. Eight trials with 316 participants met the inclusion criteria. Most of the included studies were single-centre studies that were carried out in clinics or hospitals with a sample size ranging from 14 to 84. We generally considered the included studies to be at unclear or high risk of bias, as they had one domain at high risk of bias, or three or more domains at unclear risk of bias.We did not identify any studies that reported valid data for time to complete wound healing. Meta-analysis of four studies including 116 participants indicated that participants receiving phototherapy may experience a greater proportion of wounds completely healed during follow-up compared with those receiving no phototherapy/placebo (64.5% for the phototherapy group versus 37.0% for the no phototherapy/placebo group; risk ratio 1.57, 95% confidence interval 1.08 to 2.28; low-quality evidence, downgraded for study limitations and imprecision). Two studies mentioned adverse events in the results; one study with 16 participants suggested that there were no device-related adverse events, and the other study with 14 participants suggested that there was no clear difference between phototherapy and placebo group.Four studies reported change in ulcer size, but primarily due to high heterogeneity, they were not combined. Results from individual trials (including 16 participants to 84 participants) generally suggested that after two to four weeks of treatment phototherapy may result in a greater reduction in ulcer size but the quality of the evidence was low due to unclear risk of bias in the original trial and small sample size. We based the analyses for quality of life and amputations on only one study each (28 participants and 23 participants respectively); both outcomes showed no clear difference between the phototherapy group and the no phototherapy/placebo group. This systematic review of randomised trials suggested that phototherapy, when compared to no phototherapy/placebo, may increase the proportion of wounds completely healed during follow-up and may reduce wound size in people with diabetes, but there was no evidence that phototherapy improves quality of life. Due to the small sample size and methodological flaws in the original trials, the quality of the evidence was low, which reduces our confidence in these results. Large, well-designed randomised controlled trials are needed to confirm whether phototherapy could be an effective option for the treatment of foot ulcers in people with diabetes.

Sulodexide as an Adjunct for the Management of Venous Ulcers: A Meta-analysis

Background: Venous leg ulcer is a common, chronic recurring condition that causes pain and disability. If not treated, it can lead to severe infection and malignant transformation. Sulodexide is a highly purified glycosaminoglycan with anti-thrombotic, anti-fibrinolytic and anti-inflammatory properties that make it a suitable agent for the management of venous leg ulcers. At present, there is insufficient evidence to support the efficacy of the use of sulodexide in the management of venous leg ulcers and ulcer pain. Objective: This meta-analysis aims to determine the efficacy of sulodexide in the treatment of venous leg ulcers in the promotion of complete ulcer healing and the reduction of pain. Methods: We selected studies with the following inclusion criteria: randomized controlled trials comparing sulodexide with placebo in reducing pain and promoting complete ulcer healing among patients with venous leg ulcers. Both MESH and free text were used for searching text with the following terms: “sulodexide”, “venous ulcer”, “ulcer healing” and “ulcer pain”. The databases used were PubMed, MEDLINE and the Cochrane Central Register of Controlled Trials. Studies published in any language were eligible, without restrictions. The search was restricted to studies conducted with human participants. A review of all the included trials in recent meta-analyses that included sulodexide in the management of venous ulcers was also done. Full-text articles of the selected articles were obtained from websites of publications and collections of both local and international libraries. For articles not available online, correspondence with the author was done. Data on incomplete ulcer healing was extracted from each included trial to determine the reduction of incidences of incomplete ulcer healing among patients with venous leg ulcers, with the use of sulodexide for two and three months. Analysis was done using Review Manager software version 5.3, with heterogeneity measured using I2. Results: Four RCTs (n = 482) were included. Sulodexide was associated with significant reduction of incomplete healing of venous leg ulcer. The pooled analysis at one month showed risk ratio of 0.77 (0.63 to 0.96) with p value of 0.06 and I2 = 71%. At two months, the data showed risk ratio of 0.71 (0.53 to 0.94) with p value of 0.15 and I2 = 47%. At three months, the data showed risk ratio of 0.66 (0.53 to 0.83) with p value of 0.04 and I2 = 77%. Conclusion: The results showed that sulodexide is an effective adjunct to wound care and compression therapy in the management of venous ulcer within two months of use. The results also suggest a reduction in ulcer size as early as one month with further improvement in ulcer healing with continued use for three months. Keywords: sulodexide, venous leg ulcers, ulcer healing, pain.

Effectiveness of combined laser-puncture and conventional wound care to accelerate diabetic foot ulcer healing

Background: Impaired wound healing is a common complication of diabetes. It has complex pathophysiologic mechanisms and often necessitates amputation. Our study aimed to evaluate the effectiveness of combined laser-puncture and conventional wound care in the treatment of diabetic foot ulcers.Methods: This was a double-blind controlled randomized clinical trial on 36 patients, conducted at the Metabolic Endocrine Outpatient Clinic, Cipto Mangunkusumo Hospital, Jakarta, between May and August 2015. Stimulation by laser-puncture (the treatment group) or sham stimulation (the control group) were performed on top of the standard wound care. Laser-puncture or sham were done on several acupuncture points i.e. LI4 Hegu, ST36 Zusanli, SP6 Sanyinjiao and KI3 Taixi bilaterally, combined with irradiation on the ulcers itself twice a week for four weeks. The mean reduction in ulcer sizes (week 2–1, week 3–1, week 4–1) were measured every week and compared between the two groups and analyzed by Mann-Whitney test.Results: The initial median ulcer size were 4.75 (0.10–9.94) cm2 and 2.33 (0.90–9.88) cm2 in laser-puncture and sham groups, respectively (p=0.027). The median reduction of ulcer size at week 2–1 was -1.079 (-3.25 to -0.09) vs -0.36 (-0.81 to -1.47) cm2, (p=0.000); at week 3–1 was -1.70 (-3.15 to -0.01) vs -0.36 (-0.80 to -0.28) cm2, (p=0.000); and at week 4–1 was -1.22 (-2.72 to 0.00) vs -0.38 (-0.74 to -0.57) cm2, (p=0.012).Conclusion: Combined laser-puncture and conventional wound care treatment are effective in accelerating the healing of diabetic foot ulcer.

Use of fat transfer to treat a chronic, non-healing, post-radiation ulcer: a case study

Problematic wound healing and ulceration in radiation-damaged tissue is a surgical challenge. Clinical studies have shown that grafting fat tissue in an irradiated area can improve the quality of the skin and has regenerative effects. This case study describes how fat transfer led to the healing of a chronic ulcer resistant to other forms of treatment. A 67-year-old lady with a chronic, non-healing ulcer in her leg had a squamous cell carcinoma excised, followed by radiotherapy. Despite multiple excisions, the ulcer continued to cause symptoms. Following an initial procedure in which fat was infiltrated around and under the ulcer, the patient underwent a wide local excision and split-thickness skin grafting. Histology demonstrated a post-radiation dermatitis ulcer with no evidence of malignancy. After a period of management with dressings showing a reduction in ulcer size, more fat was infiltrated around the lesion. Two months later, the ulcer had fully healed and has not recurred. The use of adipose-derived stem cells to heal wounds in irradiated tissue has been the focus of research for some time. This case highlights the potential of adipose tissue to improve damaged skin. Its use could negate the need for complex surgical procedures.

Efficacy and safety of topical sevoflurane in the treatment of chronic skin ulcers.

Results of efficacy and safety assessments of topical sevoflurane use in patients with long-term treatment-refractory vascular ulcers are reported. Patients were randomly assigned to receive sevoflurane instillations (1 mL per cm2 of ulcer area 1-4 times daily) plus standard wound care (ulcer cleaning, debridement, and dressing changes) or standard care only. Topical sevoflurane was initiated during hospitalization, with self- or nurse-administered instillations continued after discharge. Study participants were evaluated at least once weekly for 1 month and then every 2 weeks for up to 90 days. The primary efficacy measures were debridement-related and overall pain (assessed using a 10-point visual analog scale), daily opioid use, and ulcer size; secondary measures were patient and clinician impressions of improvement and ulcer-related admissions during treatment. The primary safety endpoint was intolerable sevoflurane-related adverse effects. Compared with the group receiving standard care alone (n = 5), the sevoflurane group (n = 10) had significant (p = 0.001) reductions in mean ± S.D. scores for debridement-related pain on day 1 of treatment and at subsequent time points; the sevoflurane group also had significant reductions in overall pain, daily opioid use, and ulcer size. Outcomes in terms of patient- and clinician-rated improvement and emergency admissions also favored the sevoflurane group. Mild localized reddening in the area surrounding ulcers occurred in 4 sevoflurane-treated patients. Direct application of sevoflurane onto vascular ulcers resulted in an intense and long-lasting analgesia and was associated with a progressive reduction of ulcer size.

Anti-Inflammatory Effect of Sage (Salvia Officinalis) Extracts ABSTRACT on Oral Health

The aim of the study is to show the anti-inflammatory effect of sage ( Salvia officinalis ) extract as mouthwash on treating the infect- ed gums (gingivitis) and mouth ulcers (minor aphthous ulceration). Methods and materials : sixty (60) patients (50% female and 50% male) 30 patients had RAU (minor aphthous ulceration) according to clinical presentation and 30 patients had gingivitis according to gingival index of loe and Silness. Sage mouthwash was extracted from the plant Salvia officinalis . The patients of the study group were demonstrated to how they made the mouth wash. Patients with minor aphthous ulceration of study and control group were included in the post-treatment daily observations of the ulcer on [first, third and sixth day] and we looked for pain relief, reduction of intensity of pain, reduction in size of ulcers, and complete healing. Results: Analysis of gingival scores by gingival index of loe and silness of sage mouthwash individually showed a statistically highly significant improvement and healing of gingivitis (decreased mean value) from the first day to the sixth day. Analysis of gingival scores by gingival index of loe and silness of normal saline mouthwash showed a statistically significant results from the first day to the sixth day but there was no complete healing. Minor aphthous signs and symptoms of the study group in comparison with control group showed a statistically significant improvement in daily observations. Conclusions: Sage extract was found to be effective as anti-inflammatory product against gingival inflammation and mouth ulcers and present study confirmed the efficacy of the plant.