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.

The influence of socioeconomic factors on intervention and postoperative healing of venous ulcers: a prospective study.

In previous studies, venous ulcers (VUs) have been found to occur more often in patients with lower socioeconomic status. The aim of this study was to explore if socioeconomic factors influence the delay of referral to a vascular service or the time to healing after superficial venous intervention. In this prospective study, patients answered a questionnaire about the duration and recurrence of their VU, comorbidities, body mass index (BMI), smoking, alcohol, social and physical activities, ambulatory status, education, marital status, housing, perceived economic status and dependence on home care. Postoperative complications, VU healing and recurrence were noted one year after superficial venous intervention. A total of 63 patients were included in this study (30 females and 33 males), with a mean age of 71.2 years (range: 37-92 years). Duration of the present VU in patients was: <3 months in 48%; 3-6 months in 27%; 6-12 months in 11%; and >12 months in 14%. Risk factors for delayed referral were recurrent VU (odds ratio (OR): 4.92; p=0.021); walking impairment (OR: 5.43; p=0.009) and dependence on home care (OR: 4.89: p=0.039) in a univariable analysis. The latter was the only significant finding in a multivariable analysis with socioeconomic risk factor (OR: 4.89; p=0.035). In 85% of patients, their VU healed without recurrence during one year follow-up. Healing took longer if the patients: were of older age (p=0.033); had a normal BMI (independent samples t-test, p=0.028); had a recurrent VU (OR: 5.00; p=0.049); or walking impairment (Fishers exact test, OR: 9.14; p=0.008), but no significant socioeconomic risk factors were found. In this study, socioeconomic factors were not important risk factors for delayed referral of VU patients to a vascular service or prolonged healing time after superficial venous intervention. This work was supported by the Scandinavian Research Foundation for Varicose Veins and other Venous Diseases (SFÅV) and by ALF funding from Region Örebro County. The authors have no conflicts of interest to declare.

Patients with venous leg ulcers can be managed safely in the community ----results of an observational comparison study in Singapore

AimTo examine the healing outcomes of patients with venous leg ulcers requiring compression bandaging in community care versus tertiary care. MethodThis was an analytical observational cohort study. Venous leg ulcer (VLU) patients who required compression bandaging were recruited from an outpatient vascular clinic between May 2021 and August 2022. Eligible patients received two—or four-layer compression bandaging and followed up with the community care or tertiary care centre nurses. The primary outcome was the difference in the total surface area of the VLU after 12 weeks, and the secondary outcome was the patient's quality of life, as measured by the Cardiff Wound Impact Schedule (CWIS). ResultsForty-seven VLU patients were recruited; 27 received compression bandaging in the community care and 20 by the tertiary care centre. Mean age 70 years old (SD 11.04). The two most prevalent comorbidities were hypertension (51.06 %) and diabetes mellitus (38.29 %). Among those who completed follow-up (12 weeks), the median difference of the total surface area of the VLU between community-based care (p = 0.02) versus tertiary-based care (0.003) was significant. However, there was no difference in the healing status between community and tertiary-based care (p = 0.68). There was no difference in the quality of life of patients between groups. ConclusionThis first tropical study comparing VLU healing outcomes between community and tertiary care found no significant difference in healing with compression bandaging by nurses in either setting. However, the small sample size and high dropout rate limit the generalizability of the findings, necessitating a larger-scale study with longer follow-up. Despite these limitations, the study is a crucial step toward improving wound care services in Singapore, and highlights the need for further research to guide future community wound care implementation.

Comparison of the effect of combination therapies in the treatment of large varicose ulcers: A real-world cohort study.

The primary treatment for varicose ulcers is to address the underlying cause of venous hypertension, additionally, split-thickness skin transplantation (ST) is an effective option for large ulcers. The aim of this study was to compare the efficacy of venous surgery with or without split-thickness ST in the management of varicose ulcers (diameter ≥6 cm). Patients with varicose ulcers between 2013 and 2023 were included in the real-world retrospective cohort study. The endovenous microwave ablation/endovenous laser ablation-high ligation-foam sclerotherapy-compression therapy + ST group (EMA/EVLA-CT-HL-FS + ST) consisted of 32 patients, while the EMA/EVLA-CT-HL-FS group consisted of 48 patients. A difference in ulcer healing time was found between the two groups (the hazard ratio [HR] was 4.4, 95% CI [2.3-8.2], P < 0.0001). However, the healing rate did not differ between the two groups at 6 and 12 months postoperatively. ST has been shown to expedite ulcer healing and ameliorate the symptoms of VVs in the early stages of treatment, while its intermediate to long-term efficacy for ulcer healing and overall patient quality of life may be limited.

Single-center clinical experience of cyanoacrylate embolization method for incompetent perforating veins in treating CEAP-6 patients

ObjectiveThe most severe form of chronic venous insufficiency includes venous leg ulcers in the CEAP-6 stage. The aim of this study is to evaluate the relationship between incompetent perforator veins occluding with cyanoacrylate and closure of perforator veins and healing of venous leg ulcers in patients at the CEAP-6 stage. MethodsA total of 187 patients who underwent cyanoacrylate application to incompetent perforator veins due to venous leg ulcers from 2018 to 2021 were retrospectively reviewed. Twelve months after the procedure, patients were evaluated for perforator vein closure, ulcer diameter, and Venous Clinical Severity Scale. Receiver operating characteristic analysis was used to estimate the probability of postoperative nonocclusion of the perforating vein based on the preoperative ulcers’ diameters and the perforating veins’ mean diameters. Univariate and multivariate binary logistic regression analyses were conducted to identify the risk factors associated with incomplete closure of the perforating vein. ResultsAt the 12 months, 87.1% of patients experienced incompetent perforator veins closure, leading to complete healing of venous leg ulcers. Preoperative ulcer diameter significantly decreased from 7.20 ± 3.48 cm2 to 0.28 ± 0.77 cm2 after the procedure (P < .001). On average, 3.5 ± 1.01 perforating veins were treated, with a diameter of 4.09 ± 0.41 mm. No postoperative paresthesia or deep vein thrombosis occurred. Preoperative Venous Clinical Severity Scale scores decreased significantly from 17.85 ± 3.06 to 8.03 ± 3.53 postoperatively (P < .001). Patients with nonoccluded perforating veins had larger preoperative ulcer diameters (13.77 ± 1.78 cm2) than those with occluded perforating veins (6.24 ± 2.47 cm2; P < .001). The mean perforating vein diameter was also larger in nonoccluded perforating veins patients (4.45 ± 0.41 mm) than in occluded perforating veins patients (4.04 ± 0.38 mm; P < .001). The sensitivity, specificity, and accuracy of the preoperative ulcer diameter cutoff point of 11.25 cm2 for the possibility of postoperative nonocclusion of perforating veins were 100% each. In contrast, those for the preoperative mean perforating vein diameter cutoff point of 4.15 mm were determined as 66.7%, 79.1%, and 77.5%, respectively. The presence of diabetes mellitus increased the likelihood of incompetent perforator veins, remaining open by 3.4 times (95% confidence interval: 1.11-10.44; P = .032), whereas a 1 mm larger mean perforating vein diameter increased this likelihood by 9.36 times (95% confidence interval: 3.47-25.29; P < .001). ConclusionsThis study demonstrates that occlusion of incompetent perforator veins with cyanoacrylate is effective, safe, and associated with low complication rates in CEAP-6 patients. The findings support that cyanoacrylate occlusion of perforator veins may be a valuable option in the treatment of venous leg ulcers.

Cross-Over Study Evaluating Photobiomodulation in Pain Control in the Lower Limb.

Introduction Photobiomodulation is an emerging treatment modality in dermatology, with increasing use in doctors' offices. Photobiomodulation is the use of various light sources in the red light (620-700 nm) and near-infrared (700-1440 nm) spectrums as a form of light therapy. Objective The objective of the present study was to evaluate the use of photobiomodulation to improve pain in patients who take analgesics daily for chronic non-arterial leg ulcers. Method A cohort trial was performed with 20 patients to evaluate the improvement in pain, patient tolerance to treatment, and evolution of chronic, difficult-to-heal leg ulcers treated with low-frequency laser. Data were entered into a MicrosoftExcel spreadsheet (Microsoft Corporation, Redmond, WA, US). Statistical analysis used the Stats Direct 3 program with significance being set at an alpha error of 5% (p-value <0.05). Results An improvement in pain immediately after the first session was experienced by 18/20 patients; these patients remained pain-free for at least four days. One patient had suffered much pain during the entire day; a biopsy with culture and antibiogram was performed with the pain improving after treating an infection with appropriate antibiotics. However, one other case reported no improvement in the pain. Conclusion Photobiomodulation is an optional adjuvant therapy to improve pain in the treatment of chronic, difficult-to-heal leg ulcers.

Duplex Guided Injection Foam Sclerotherapy for Incompetent Perforators Combined with Skin Grafting in Venous Leg Ulcer.

Duplex Guided Injection Foam Sclerotherapy for Incompetent Perforators Combined with Skin Grafting in Venous Leg Ulcer.

Assessing the Physical and Clinical Characteristics of a New Adjustable Compression Wrap: Insights from a Single-center Pilot Study in India

Introduction: Adjustable wraps are a revolutionary avenue in compression therapy because of their ease of application and removal, as well as their ability to be manipulated and readjusted, particularly in older adult patients with leg ulcers. Methods: We analyzed the physical and clinical features of a new adjustable wrap marketed by Vein Care, India. Hirai leg was used to demonstrate the stiffness of the wrap, followed by validation on five healthy male participants. Next, we conducted a pilot clinical study to assess the effect of wearing the wrap for 4 h on volume reduction in seven patients with open leg venous ulcers. Results: The Vein Care Calf Compression Wrap® functioned similarly to a short stretch bandage, which we demonstrated through the tests performed on Hirai’s leg and on healthy participants. In the pilot clinical study, following 4 h of application, a statistically significant decrease in total leg volume (median 34.5 cc; P = 0.018) was observed. Moreover, a significant decrease in volume at the calf level compared to the lower leg (P = 0.038) was noticed. However, no significant correlations were found in volumetric reduction with age or body mass index. The wrap posed challenges in applying pressure exceeding 40 mmHg due to its unique composition, stretch, and stiffness properties. This characteristic is especially significant for patients with diabetic or mixed arteriovenous ulcers (ankle–brachial index &gt;0.5 and &lt;0.8). Conclusions: The wrap’s clinical utility and effectiveness necessitate additional clinical trials and studies with a greater number of patients from diverse demographics.

Management of varicose ulcer complicated with class II cellulitis through multimodal Ayurvedic interventions: A case report

Abstract This case report describes a 45-year-old female homemaker with a varicose ulcer complicated by class II cellulitis on her right lower limb. The ulcer, which appeared 26 days before presentation to OPD measured 7.5 cm × 3 cm × 0.2 cm and was located midway between the popliteal fossa and the ankle joint. It was associated with pain and serous discharge, and the surrounding skin exhibited erythema (redness), indicative of cellulitis. An emergency Doppler study of the venous system of the right lower limb was done, which ruled out deep venous thrombosis. As no relief was obtained from the external application of povidone-iodine ointment for about 2 weeks as suggested by conventional treatment, the patient came to the outpatient department of Regional Ayurveda Research Institute, Thiruvananthapuram, Kerala, India. A diagnosis of varicose ulcer complicated with class II cellulitis was established based on the clinical examination, relevant laboratory investigations, and detailed patient history. A comprehensive multimodal Ayurvedic treatment was administered, including internal medications like Panchanimbakwatha, Kaisoraguggulu, Triphalaguggulu, Punarnavadi Paneeya, and Madhusnuhi Rasayana for 20 days. Tablets Mahasudarshanam and AYUSH-64 were given for the first 2 weeks to manage cellulitis, which subsided during this period. The grading of venous insufficiency was C6 according to the “Clinical, Etiology, Anatomic, Pathophysiology classification” on day 1, improved to C1 by day 42 following treatment, indicating significant recovery. According to the “National Pressure Injury Advisory Panel Classification,” the ulcer was graded as Stage 3 on the day with significant improvement by day 42, where only mild discoloration of the overlying skin remained. The medications used for treatment had properties, such as Raktashodhaka (blood purifying), Krimighna (antimicrobial), Soolahara (anodyne), Vranashodhaka (wound-cleansing), Vranaropana (wound-healing), Sophahara (anti-inflammatory), and Pittahara (alleviate Pitta Dosha). In Ayurveda, venous ulcers can be considered as Siragranthijanyavran and cellulitis as Sirashotha. This case highlights the importance of timely intervention in the management of varicose ulcers complicated by cellulitis. The Ayurvedic therapeutic regimen demonstrated in this case offers an effective approach to managing complicated cellulitis in varicose ulcers, emphasizing the potential of Ayurveda in treating chronic conditions when addressed promptly.

Prevalence of Chronic Wounds Microbial Contaminations and their Susceptibility Pattern to Current Antibiotics in Mbingo and Nkwen Baptist Hospitals

Abstract BACKGROUND: Antimicrobial resistance among pathogens causing chronic wound infections is a growing concern, particularly in low-income countries. Understanding the microbial profile and antibiotic susceptibility patterns in chronic wounds is crucial for guiding effective treatment strategies. This study aimed to investigate the prevalence of microbial contamination and antibiotic susceptibility patterns in chronic wounds among patients treated at Mbingo Baptist Hospital and Nkwen Baptist Hospital in Northwest Cameroon. METHODS: A cross-sectional, hospital-based study was conducted from March to June 2022. Wound samples were collected from patients with chronic wounds, and microbiological analyses were performed to identify the isolates and assess their antimicrobial susceptibility. RESULTS: A total of 54 chronic wounds were examined, with venous ulcers being the most common type (42.6%). Bacterial and fungal growth was detected in 89% of the wound swabs. Gram-negative bacteria, including Salmonella spp. (14.8%) and Pseudomonas aeruginosa (7.4%), were frequently isolated, along with Gram-positive organisms such as Staphylococcus aureus (18.5%) and Staphylococcus spp. (11.1%). Polymicrobial infections were observed in 11.2% of the cases. The isolates exhibited high-resistance rates to commonly used antibiotics, such as sulfamethoxazole/trimethoprim (83%), amoxicillin (80.9%), ceftriaxone (74.5%), azithromycin (66%), and doxycycline (61.7%). Diphtheria spp. and S. aureus showed resistance to nearly all the tested antibiotics. CONCLUSION: This study highlights the significant burden of antimicrobial-resistant bacteria in chronic wound infections in the studied health-care facilities in Cameroon. These findings underscore the urgent need for improved antimicrobial stewardship and the development of novel treatment strategies to address the growing challenge of drug-resistant pathogens in chronic wound management.

Leukocytoclastic Vasculitis-Induced Lower Leg Ulceration in the Course of Immune Checkpoint Inhibitor Therapy for Advanced Malignant Melanoma: A Case Report

Immune checkpoint inhibitors (ICIs) have expanded therapeutic options for advanced malignancies, offering new hope for conditions once deemed untreatable. However, the advent of ICIs has introduced a spectrum of immune-related adverse events (irAEs), including leukocytoclastic vasculitis (LCV), a rare but significant complication. This case report describes development of LCV after treatment with nivolumab and ipilimumab in a 70-year-old man with malignant melanoma, highlighting the diagnostic and management challenges of such irAEs. Despite extensive investigation, conventional pathology failed to identify the immune complexes typically associated with LCV. The clinical presentation, alongside a detailed medical history and the exclusion of infections, medications, and autoimmune diseases, was crucial in establishing a diagnosis. Ulcer resolution following discontinuation of ICI therapy and initiation of steroids further support the conclusion that LCV was an irAE in this patient. This case underscores the need for vigilant monitoring for irAEs for the variable onset after ICI therapy and the importance of thorough history-taking to guide diagnosis and treatment. With ICIs becoming increasingly prevalent in oncology, the incidence of ICI-induced ulcers like LCV is expected to rise, necessitating heightened awareness and multidisciplinary approaches to patient care.

Diagnosis and treatment of venous leg ulcers: S2k Guideline of the German Society of Phlebology and Lymphology (DGPL) e.V.

This S2k guideline on venous leg ulcers was created on the initiative and under the leadership of the German Society of Phlebology and Lymphology (DGPL). The guideline group also consisted of representatives from the German Society for Phlebology and Lymphology, German Dermatological Society, German Society for General Medicine, German Society for Angiology, German Society for Vascular Surgery and Vascular Medicine, German Society for Surgery, German Society for Dermatosurgery, German Society for Wound Healing and Wound Treatment, Professional Association of Phlebologists and Lymphologists and Initiative Chronische Wunden. The aim of this guideline is to combine the different approaches and levels of knowledge of the respective professional groups on the basis of consensus, so that a basic concept for the best possible treatment of patients with venous leg ulcers can be provided. A total of 70 specific recommendations were formulated and agreed upon, divided into the subject areas of diagnostics, therapy, prevention of recurrences, and everyday challenges. The guideline thus reflects the current state of scientific knowledge and is intended to be widely used as the best available document for the treatment of patients with venous leg ulcers in everyday clinical practice.

Review of Mixed Arterial Venous Leg Ulcers (MAVLU) Disease in Contemporary Practice.

Mixed Arterial and Venous Leg Ulcers (MAVLU) are challenging. Clinical evidence specific to MAVLU management is scarce. We evaluated our recent experience with MAVLU patients and reviewed current data regarding MAVLU epidemiology, aetiology, diagnostic assessment and management options. A prospective leg ulcer database was retrospectively interrogated to determine the prevalence and clinical outcome of MAVLU over 2-year period (2021-2022). The literature was reviewed to determine if optimal treatment strategies. 307 patients attended the ulcer clinic over a 2-year period. Most were venous leg ulcers (71%), 24% were arterial and 5% were MAVLU. The highest healing rate was in MAVLU (93%), followed by (74%) and (41%), in arterial and venous leg ulcer groups, respectively. Evidence-based guidelines for MAVLU remain lacking. Well-developed randomised controlled trials are warranted to guide current clinical practice.

An overview of systematic reviews of clinical studies of platelet-rich plasma for venous ulcers.

To evaluate the clinical evidence of platelet-rich plasma (PRP) in the treatment of venous ulcers (VUs). Electronic searches were conducted through the Cochrane Library, Web of Science, Embase and PubMed. AMSTAR-2 was used to assess the methodological quality. The quality of evidence was assessed using the GRADE system. According to AMSTAR-2, the methodological quality of the included reviews was generally inadequate owing to the limitations of entries 2, 4 and 7. Due to bias risk and imprecision, the evidence quality of the outcome measures was inadequate. In conclusion, PRP may have a therapeutic effect on VUs. However, this conclusion must be treated with caution due to methodological flaws of the included systematic reviews and meta-analyses.

Using Thermography Infrared to Detect Diabetic Foot Ulcers in Asia Pacific Countries: Scoping Review

Introduction: Diabetes Mellitus (DM) is a growing global health concern, particularly in Indonesia, where the prevalence is projected to rise significantly. Diabetic Foot Ulcer (DFU) is a severe complication of DM that escalates the risk of amputations. Early detection of DFUs plays a crucial role in preventing associated complications Objective: This review aimed to assess the efficacy of infrared thermography in detecting DFUs in the Asia-Pacific region. Methods: A scoping review methodology adhering to PRISMA guidelines was employed. Databases were searched from 2011-2021. PICO strategy used keyword Diabetic foot ulcer, Skin ulcer, Leg ulcer, Foot ulcer, Diabetic neuropathic, Thermography, Temperature mapping, and Detection from PubMed, Scopus, Google Scholar, and Science Direct. Quality of article assessed by JBI. Results: Four (4) studies meeting the inclusion criteria were identified, primarily cross-sectional in design. The results indicated promising sensitivity and specificity of infrared thermography in detecting DFUs among DM patients. The technology's ability to capture thermal images revealing temperature variations associated with tissue inflammation, a common DFU indicator, underscores its efficacy. This non-invasive technique allows for early detection and monitoring of DFUs, facilitating timely interventions and improving patient outcomes. Additionally, infrared thermography provides a quantitative and objective assessment of tissue health, complementing traditional visual inspection and palpation methods. Its effectiveness lies in detecting subtle skin temperature changes, aiding in early identification and management of DFUs before they progress to more severe stages. Conclusion: Infrared thermography shows significant potential in detecting DFUs early, which is vital for effective management and prevention of severe complications. Despite the promising results, broader and more rigorous studies are necessary to validate these findings across different populations and healthcare settings. Further research across diverse settings and study designs is essential to reinforce these findings.

Evaluation of a Semi-Automated Wound-Halving Algorithm for Split-Wound Design Studies: A Step towards Enhanced Wound-Healing Assessment.

Background: Chronic leg ulcers present a global challenge in healthcare, necessitating precise wound measurement for effective treatment evaluation. This study is the first to validate the "split-wound design" approach for wound studies using objective measures. We further improved this relatively new approach and combined it with a semi-automated wound measurement algorithm. Method: The algorithm is capable of plotting an objective halving line that is calculated by splitting the bounding box of the wound surface along the longest side. To evaluate this algorithm, we compared the accuracy of the subjective wound halving of manual operators of different backgrounds with the algorithm-generated halving line and the ground truth, in two separate rounds. Results: The median absolute deviation (MAD) from the ground truth of the manual wound halving was 2% and 3% in the first and second round, respectively. On the other hand, the algorithm-generated halving line showed a significantly lower deviation from the ground truth (MAD = 0.3%, p < 0.001). Conclusions: The data suggest that this wound-halving algorithm is suitable and reliable for conducting wound studies. This innovative combination of a semi-automated algorithm paired with a unique study design offers several advantages, including reduced patient recruitment needs, accelerated study planning, and cost savings, thereby expediting evidence generation in the field of wound care. Our findings highlight a promising path forward for improving wound research and clinical practice.

Scaffold-Mediated Drug Delivery for Enhanced Wound Healing: A Review.

Wound healing is a complex physiological process involving coordinated cellular and molecular events aimed at restoring tissue integrity. Acute wounds typically progress through the sequential phases of hemostasis, inflammation, proliferation, and remodeling, while chronic wounds, such as venous leg ulcers and diabetic foot ulcers, often exhibit prolonged inflammation and impaired healing. Traditional wound dressings, while widely used, have limitations such poor moisture retention and biocompatibility. To address these challenges and improve patient outcomes, scaffold-mediated delivery systems have emerged as innovative approaches. They offer advantages in creating a conducive environment for wound healing by facilitating controlled and localized drug delivery. The manuscript explores scaffold-mediated delivery systems for wound healing applications, detailing the use of natural and synthetic polymers in scaffold fabrication. Additionally, various fabrication techniques are discussed for their potential in creating scaffolds with controlled drug release kinetics. Through a synthesis of experimental findings and current literature, this manuscript elucidates the promising potential of scaffold-mediated drug delivery in improving therapeutic outcomes and advancing wound care practices.

Comparison of two ablation procedures combined with high ligation and foam sclerotherapy and compression therapy for patients with venous leg ulcers

ABSTRACT Aim To compare the ablation techniques’ efficacy of endovenous microwave ablation (EMA) combined with high ligation (HL), foam sclerotherapy (FS) and compression therapy (CT) and endovenous laser ablation (EVLA) combined with HL-FS-CT in the treatment of VLUs. Method 301 consecutive patients with VLUs from 2013 to 2022 in a 3200-bed hospital were intervened by EMA combined with HL-FS-CT and EVLA combined with HL-FS-CT were retrospectively compared. Results One hundred thirty-four patients underwent EMA+HL-FS-CT and 167 patients underwent EVLA+HL-FS-CT. The primary outcome of the ulcer healing time was 1.45(0.75–1.5) months and 1.86(0.5–2.5) months, respectively, in the two groups (HR for ulcer healing was 1.26, 95% CI [0.96–1.66], p = 0.097). Secondary outcomes included that no significant difference was found in ulcer recurrence and GSV recanalization and complications between the two groups, and the postoperative VCSS and AVVQ were significantly lower than the baseline values in the respective groups (p = 0.0001). Conclusion EMA+HL-FS-CT and EVLA+HL-FS-CT are both effective at treating VLUs. Both of the two comprehensive treatments were beneficial to the healing of ulcers, but no evidence showed which one was superior in the ulcer healing time.

Controversies in the pathophysiology of leg ulcers in sickle cell disease.

Patients with sickle cell disease (SCD) often experience painful vaso-occlusive crises and chronic haemolytic anaemia, as well as various acute and chronic complications, such as leg ulcers. Leg ulcers are characterized by their unpredictability, debilitating pain and prolonged healing process. The pathophysiology of SCD leg ulcers is not well defined. Known risk factors include male gender, poor social conditions, malnutrition and a lack of compression therapy when oedema occurs. Leg ulcers typically start with spontaneous pain, followed by induration, hyperpigmentation, blister formation and destruction of the epidermis. SCD is characterized by chronic haemolysis, increased oxidative stress and decreased nitric oxide bioavailability, which promote ischaemia and inflammation and consequently impair vascular function in the skin. This cutaneous vasculopathy, coupled with venostasis around the ankle, creates an ideal environment for local vaso-occlusive crises, which can result in the development of leg ulcers that resemble arterial ulcers. Following the development of the ulcer, healing is hindered as a result of factors commonly observed in venous ulceration, including venous insufficiency, oedema and impaired angiogenesis. All of these factors are modulated by genetic factors. However, our current understanding of these genetic factors remains limited and does not yet enable us to accurately predict ulceration susceptibility.

Combination Foam and Liquid Sclerotherapy for Lower Extremity Reticular and Telangiectatic Veins: A Single-Center Retrospective Study.

Lower extremity reticular and telangiectatic veins are of common cosmetic concern. To retrospectively evaluate results of lower extremity sclerotherapy using a combination of foam and liquid sclerosing agents. A retrospective chart review of sclerotherapy patients at a dermatology practice (January 2014 to April 2023) was performed. Eight hundred and nine patients (775 women and 34 men) with a mean age of 49.6 ± 12.2 (18-84) years underwent a mean 1.4 ± 0.7 (1-7) sessions. Multiple different sclerosing agents were used, with 0.2% sodium tetradecyl sulfate foam/liquid predominating, although 72% glycerin liquid and 0.25% to 0.5% polidocanol foam/liquid were also used. Coagula occurred in 61.0% of patients at 2 weeks and 6.4% at 3 months, whereas postsclerotherapy hyperpigmentation was seen in 5.0% and 19.1% of patients at the same time points. Both were more common after first-round treatment, each with a trend toward decreased frequency with increasing session number. Telangiectatic matting was found in 2.3% of 3-month follow-up patients. Edema, superficial venous thrombophlebitis, migraines, and ulceration were rarely seen. Significant clinical improvement was noted in 72.0% of treatments. This retrospective chart review, the largest to date of its kind, confirms the safety and efficacy of cosmetic lower extremity sclerotherapy with a combination of foam and liquid sclerosing agents.