Treatment Of Chronic Venous Ulcers Research Articles

Ultrasound-guided foam sclerotherapy versus four-layer compression only for treatment of chronic venous ulcers

BackgroundChronic venous ulcers are prevalent, its incidence (1%) in the general population. Venous ulcers are quite a challenge for physicians to treat. Among the numerous pathological causes, venous hypertension remains the leading cause. This study aims to compare the safety, efficacy, short-term complications, factors affecting wound healing as well as pathological outcomes of ultrasound-guided foam sclerotherapy (UGFS) in conjunction with the four-layer compression bandage in the management of chronic venous ulcers.MethodsRetrospective analysis of a hundred patients with chronic venous ulcers treated between December 2018 and December 2021. Two groups were studied: the control group, which received conventional compression, and the study group, which underwent injection sclerotherapy and conventional compression. Punch skin biopsies were taken from both groups before and after treatment to compare the histological effects of the two methods.ResultsComplete healing was achieved in 100% of the patients, with a shorter healing time in the study group (34.82 ± 4.7). Additionally, the degree of inflammation was significantly decreased but there was a higher local complication rate in the study group.ConclusionsUGFS in conjunction with the compression bandage showed superior clinical and pathological results but, risk of complication was increased.

EFFICACY OF ULTRASONIC TRANSDERMAL PLATELET RICH PLASMA ON CHRONIC LOWER LIMB VENOUS ULCER HEALING

The present study was carried-out to examine the impact of Ultrasonic Transdermal Delivery of platelet rich plasma (PRP)on chronic lower limb venous ulcer healing. Design: Randomized controlled trial. Patients and methods: The present work was conducted on sixty patients with chronic lower limb venous ulcers who took-part in this study, they aged from 40 to 60 years. The participants were recruited from Mataria teaching hospital and were randomized into two groups; each group consisted of 30 patients. Group A (Ultrasonic PRP group) received Ultrasonic Transdermal Delivery of autologous PRP twice weekly for a month in addition to medical care and group B (Control group) received medical care in form of antimicrobial dressing, wound care and debridement of ulcers. Saline method was used to measure the ulcer volume. Digital photography/imaging and surface area estimation software (Image J) was used to measure ulcer surface area. Results: After treatment, there was significant decline in wound surface area as well as volume of PRP group in comparison with the control group (p < 0.001). Conclusion: Adding Ultrasonic transdermal delivery of platelets rich plasma to medical treatment of chronic venous ulcer can enhance healing process by reducing surface area and ulcer volume and it is considered a safe, simple, inexpensive and cost effective modality.

Efficiency of the vacuum-assisted closure method in the treatment of chronic venous ulcers and the role of the nurse

Objectives: In our study, it was aimed to reveal the effects of using vacuum-assisted closure (VAC) systems in addition to compression therapy on wound healing in patients hospitalized for chronic venous ulcers. Patients and methods: Fifty-five patients (37 males, 18 females; mean age: 43±5 years, range, 38 to 48 years) who were hospitalized in our clinic for chronic venous ulcers between January 2015 - December 2021 were included in this retrospective study. The demographic data, wound widths, healing times of venous ulcers, length of hospital stay, and surgical treatment methods of patients who did (Group 1) and did not (Group 2) receive VAC therapy in addition to the surgical and medical procedures in the treatment of venous ulcers were compared. Results: The hospital stay of all patients was 9±2 days. While the mean ulcer healing time was 14±2 days in Group 1, it was 48±8 days in Group 2 (p=0.03). The mean hospital stay of the patients was 8±2 days in Group 1, whereas it was 15±3 days in Group 2 (p=0.04). Conclusion: As a result of the study, it was revealed that VAC therapy greatly increased the effectiveness of venous surgical methods and compression therapy in the treatment of chronic venous ulcers and shortened the treatment period; therefore, VAC therapy should be added to the treatment protocol for suitable patients with chronic venous ulcers.

The role of peripheral arterial occlusive disease in the healing of venous ulcers

Background: The biggest challenge in patients with chronic venous insufficiency is venous ulcers that occur in stage 6 of the CEAP classification. In general, acute ulcers have a 71–80% chance of healing, while chronic ulcers only have a 22% chance of healing. Our clinical practice has shown that patients diagnosed with peripheral arterial occlusive disease have a much longer duration of the disease and a more difficult treatment of venous ulcers than patients with normal arterial circulation. Materials and Methods: The study included 105 patients with CVI and a developed leg ulcer. Among these, twenty patients were diagnosed with peripheral arterial occlusive disease. All patients were followed for more than twelve weeks. Results: Peripheral arterial occlusive disease was significantly more common in patients with delayed healing than in patients with normal venous ulcer healing: 18 (30%) vs. 2 (4.4%). for twelve weeks or longer, and it was statistically significant for p = 0.00097. Conclusion: Peripheral arterial occlusive disease has been shown to be an important indicator of venous epithelial wound healing. The establishment of good arterial circulation is closely related to the course of treatment of chronic venous ulcers.

Bacterial cellulose an effective material in the treatment of chronic venous ulcers of the lower limbs

Chronic venous ulcers (CVU) of the lower limbs (LL) are common and cause psychological changes and significant social impact, as they make the patient susceptible to pain, absence from work and social bonds. Some materials are suggested as dressings for the treatment of CVU, but they are expensive and are generally not available for use in public health services. To evaluate the efficacy of the treatment for lower limbs (LL) chronic venous ulcer (CVU) using bacterial cellulose (BC), gel and multi-perforated film associated. A randomized controlled clinical-intervention study was performed among participants with LL CVU, divided into two groups: experimental (EG), treated with BC wound dressing and control (CG), treated with a cellulose acetate mesh impregnated with essential fatty acids (Rayon®). The participants were followed for 180 days, evaluated according to the MEASURE methodology. Thirty-nine patients were treated, 20 from the EG and 19 from the CG. In both groups, the wound area decreased significantly (p < 0.001), the healing rate was similar to the CG. The mean number of dressing changes in the SG was 18.33 ± 11.78, while in the CG it was 55.24 ± 25.81, p < 0.001. The healing dressing of bacterial cellulose, gel and associated film, when stimulating the epithelization of the lesions, showed a significant reduction in the initial area, with a percentage of cure similar to the Rayon® coverage. In addition to requiring less direct manipulation of ulcers.

Clinical and Pathogenetic Aspects of Complex Treatment of Decompensated Forms of Chronic Venous Insufficiency of the Lower Extremities

The article presents a clinical assessment of the effectiveness of the author's method of pharmacological correction in the complex treatment of patients with trophic ulcers of venous origin in the lower extremities. Based on the analysis of the data obtained, we found that the use of the proposed method of drug correction in the complex treatment of chronic venous ulcer ensures the effectiveness of treatment, a reduction in the duration of inpatient treatment, and the reliability of rehabilitation in the postoperative period.

Role of topical phenytoin in treatment of chronic venous ulcers

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Venous leg ulcers are a common cause of significant morbidity leading to compromised quality of life and a huge financial burden on patients. Apart from the systemic therapy, many topical agents are available to accelerate healing in these ulcers. Topical phenytoin is one such agent which has been studied for promotion of wound healing. The aim of the study was to study the efficacy of topical phenytoin in healing of chronic venous ulcers.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 56 patients of chronic venous ulcer were randomly divided in two groups of 28 each. First group was given daily dressing of phenytoin in normal saline (group A) and second group was given only normal saline dressing (group B) for a period of 8 weeks. After 8 weeks the reduction in size of ulcer was measured, on the basis of which results were calculated.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean age of the patients was 50.29±13.37 years. The mean duration of ulcer was 10.13±4.66 weeks. Compared to the conventional normal saline dressing, patients given phenytoin and normal saline dressing showed far greater tendency to heal (p=0.02). 35.7% patients in phenytoin group showed excellent response out of which 21.42% achieved complete healing, while in normal saline group only 14.28% patients showed excellent response and none of patient showed complete healing. No significant adverse effects were observed in either of the group.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Topical phenytoin appears to be a safe, easy, effective and inexpensive option to promote wound healing and can be used as an adjuvant for treatment of chronic venous ulcers. Further studies with larger population are merited.&lt;/p&gt;

Efectos del Sevoflurano tópico en úlceras vasculares. A propósito de un caso

El sevoflurano es un líquido volátil no inflamable, derivado halogenado del éter que se utiliza para inducción y mantenimiento de la anestesia general, por vía inhalatoria. Se han descrito sus propiedades analgésicas, antimicrobianas y vasodilatadoras en el tratamiento de las úlceras venosas crónicas. En el presente artículo reportamos un caso clínico de utilización de sevoflurano tópico en nuestra unidad, en una paciente que presentaba úlceras venosas sin mejoría tras cuidados estándar. Se inician instilaciones del fármaco, registrando una mejoría del dolor basal y del estado de las úlceras.

ROLE OF PLATELET RICH PLASMA IN TREATMENT OF CHRONIC NON-HEALING VENOUS ULCER

Introduction: Venous ulcers are wounds that are thought to occur due to improper functioning of venous valves, usually of the lower limbs. Considering that PRP is a source of growth factors, and consequently has mitogenic, angiogenic, and chemotactic properties, it represents an adjunctive treatment for recalcitrant wounds. Moreover, PRP provides the wound with adhesive proteins, such as fibrinogen, which are important in wound healing. PRP contain more amount of platelets, cytokines and growth factors which are dispersed in a very small amount of plasma which can be prepared from a sample of centrifuged autologous blood. Application of PRP has been reported to be effective in both acute as well as chronic non healing venous ulcers. &#x0D; Aim and Objective: To evaluate the efficacy of autologous platelet rich plasma in the management of chronic venous ulcer. Material and Method: A Prospective study conducted on 100 patients of chronic venous ulcers admitted in Sir T. Hospital Bhavnagar from June 2018 to June 2019 after fulfilled our inclusion and exclusion criteria. PRP then injected intalesionally inside and around the periphery of the wound/ulcer. This process was done once/week for 12 weeks. At every week, the area and volume of ulcer was calculated and photographs were taken. &#x0D; Result: All the patients showed healing of the ulcer with reduction in size of ulcer more than 90% was observed in 72 patients, followed by 80–90% reduction in wound size in 18 patients after the 12 weeks follow-up. Overall, significant reduction in size of ulcer was observed in all the treated patients.&#x0D; Conclusion: Autologous platelet rich plasma (PRP) as an autologous method, it is biocompatible, simple, safe, affordable and less expensive procedure in the treatment of chronic venous ulcers. PRP is found to be useful in improving and enhancing the healing process in chronic venous leg ulcers without any side effect.&#x0D; Keywords: Venous ulcer, Platelet rich plasma

Comparison between the efficacy of injection vs topical platelet-rich plasma as an adjuvant treatment of chronic venous ulcers

Background Chronic venous ulcers are the most common type of leg ulcers and have a major influence on the quality of life and work productivity. Chronic nonhealing ulcers lack the needed growth factors and do not heal later. The use of platelet-rich plasma (PRP) is based on the fact that platelets contain many growth factors that have a well-known role in the course of ulcer repair. Aim and objective The aim was to evaluate and compare the efficacy of autologous PRP injection or topical application in the treatment of chronic venous ulcers. Patients and methods This study was conducted from April 2016 to January 2017 on 30 patients with chronic venous ulcer, who were divided into two equal groups: group A was treated by PRP injections in perilesional tissue, and group B was managed by topical application of PRP on the surface of the ulcer. Thereafter, the ulcers of both groups were covered with Vaseline gauze and then covered by thin elastic sheet without compression for six sessions with a 1-week interval between sessions. Results The study showed marked improvement in patients treated with injection and topical application of PRP after six sessions, with no statistically significant difference between the two groups regarding pressure ulcer scale for healing (PUSH) tool. Moreover, there was no statistically significant difference in healing ratio between both the groups. Conclusion PRP shows promise as an effective treatment in chronic venous ulcers by different methods of application. It is a safe, simple, and inexpensive without any adverse events.

Chronic venous ulcers: a review on treatment with fibrin sealant and prognostic advances using proteomic strategies.

Venous ulcers are the main causes of chronic lower-limb ulcers. The healing difficulties encourage the research and development of new products in order to achieve better therapeutic results. Fibrin sealant is one of these alternatives. Besides being a validated scaffold and drug delivery system, it possesses excellent healing properties. This review covered the last 25 years of the literature and showed that the fibrin sealant is used in various clinical situations to promote the healing of different types of ulcers, especially chronic ones. These are mostly venous in origin and usually does not respond to conventional treatment. Commercially, only the homologous fibrin sealants obtained from human blood are available, which are highly efficient but very expensive. The heterologous fibrin sealant is a non-commercial experimental low-cost product and easily produced due to the abundance of raw material. The phase I/II clinical trial is already completed and showed that the product is safe and promisingly efficacious for the treatment of chronic venous ulcers. In addition, clinical proteomic strategies to assess disease prognosis have been increasingly used. By analyzing liquid samples from the wounds through proteomic strategies, it is possible to predict before treatment which ulcers will evolve favorably and which ones will be difficult to heal. This prognosis is only possible by evaluating the expression of isolated proteins in exudates and analysis using label-free strategies for shotgun. Multicentric clinical trials will be required to evaluate the efficacy of fibrin sealant to treat chronic ulcers, as well as to validate the proteomic strategies to assess prognosis.

Duplex-guided foam sclerotherapy versus multiple-layer compression therapy in the treatment of chronic venous ulcers

Duplex-guided foam sclerotherapy versus multiple-layer compression therapy in the treatment of chronic venous ulcers

Dynamic Interface Pressure Monitoring System for the Morphological Pressure Mapping of Intermittent Pneumatic Compression Therapy

Intermittent pneumatic compression (IPC) is a proactive compression therapeutic technique in the prophylaxis of deep vein thrombosis, reduction of limb edema, and treatment of chronic venous ulcers. To appropriately detect and analyze biomechanical pressure profiles delivered by IPC in treatment, a dynamic interface pressure monitoring system was developed to visualize and quantify morphological pressure mapping in the spatial and temporal domains in real time. The system comprises matrix soft sensors, a smart IPC device, a monitoring and analysis software, and a display unit. The developed soft sensor fabricated by an advanced screen printing technology was used to detect intermitted pressure by an IPC device. The pneumatic pressure signals inside the bladders of the IPC were also transiently collected by a data acquisition system and then transmitted to the computer through Bluetooth. The experimental results reveal that the developed pressure monitoring system can perform the real-time detection of dynamic pressures by IPC and display the morphological pressure mapping multi-dimensionally. This new system provides a novel modality to assist in the effective evaluation of proactive compression therapy in practice. The study results contribute to understanding the working mechanisms of IPC and improving its functional design based on intuitive biomechanical characteristics of compression delivery profiles.

Unique heterologous fibrin biopolymer with hemostatic, adhesive, sealant, scaffold and drug delivery properties: a systematic review.

Fibrin biopolymers, previously referred as “fibrin glue” or “fibrin sealants”, are natural biomaterials with diverse applications on health. They have hemostatic, adhesive, sealant, scaffold and drug delivery properties and have become widely used in medical and dental procedures. Historically, these biomaterials are produced from human fibrinogen and human or animal thrombin, and the possibility of transmission of infectious diseases by human blood is not ruled out. In the 1990s, to overcome this problem, a new heterologous biomaterial composed of a thrombin-like enzyme purified from Crotalus durissus terrificus venom and a cryoprecipitate rich in fibrinogen extracted from buffaloes Bubalus bubalis blood has been proposed. Therefore, a systematic review of studies on exclusively heterologous fibrin sealants published between 1989 and 2018 was carried out using the following databases: PubMed, SciELO and Google Scholar. The keyword used was “heterologous fibrin sealant”. The search resulted in 35 scientific papers in PubMed, four in SciELO and 674 in Google Scholar. After applying the inclusion/exclusion criteria and complete reading of the articles, 30 studies were selected, which formed the basis of this systematic review. It has been observed that the only completely heterologous sealant is the one produced by CEVAP/UNESP. This heterologous biopolymer is proven effective by several studies published in refereed scientific journals. In addition, clinical trials phase I/II for the treatment of chronic venous ulcers authorized by the Brazilian Health Regulatory Agency (ANVISA) were completed. Preliminary results have indicated a safe and promising effective product. Phase III clinical trials will be proposed and required to validate these preliminary findings.

Rápida cicatrización de la úlcera venosa con técnica TAPIRS-LF con láser, espuma y vendajes multicapa

IntroductionThe traditional surgical techniques are being replaced by minimally invasive procedures, such as Endovenous Laser (Thermal, Tumescent), and ultrasound foam sclerotherapy (Non-Thermal, Non-Tumescent). The aim of this study was to determine the healing time and rate of venous ulcers (VU) using a Terminal, Axial and Perforator Interruption of the Reflux Source (TAPIRS-LF) protocol. This included Endovascular Laser Treatment and endoluminal venous occlusion with ultrasound-guided foam and a multilayer bandage system until ulcer healing was achieved. Material and methodsA prospective non-controlled trial was conducted on patients with chronic venous leg ulcers (CEAP [clinical, etiological, anatomical and pathological elements] classification C6) during 2015 and 2016. A total of 27 patients aged 18 years and over, presenting with venous insufficiency, VU, and an ankle-brachial index greater than 0.8, were included, with a total of 27 extremities being analysed. All of the patients were subjected to thermal and non-thermal endoluminal occlusion, with endovenous laser treatment in axial venous system, with ultrasound-guided foam in the distal axial superficial venous system and perforator and terminal veins near to the ulcer, using the Tessari method with 3% polidocanol. Follow-up was carried out every week and a Doppler test was performed after 4, 12, and 24 weeks. ResultsThe mean age of the patients was 59.6 years. The active ulcer duration prior to treatment was 11.7 months. The mean VU diameter was 15.06 cm2, and 92.5% VU were seen to be healing at 8 weeks. ConclusionsThe minimally invasive ablation using Terminal, Axial and Perforator Reflux with compression in patients with active VU results in a faster healing during the treatment of chronic venous ulcers.

Multilayered Polysaccharide Nanofilms for Controlled Delivery of Pentoxifylline and Possible Treatment of Chronic Venous Ulceration

Local drug delivery systems made from nontoxic polysaccharide nanofilms have an enormous potential in wound care. A detailed understanding of the structural, surface, physicochemical, and cytotoxic properties of such systems is crucial to design clinically efficacious materials. Herein, we fabricated polysaccharide-based nanofilms onto either a 2D model (SiO2 and Au sensors) or on nonwoven alginate 3D substrates using an alternating assembly of N,N,N-trimethylchitosan (TMC) and alginic acid (ALG) by a spin-assisted layer-by-layer (LbL) technique. These TMC/ALG multilayered nanofilms are used for a uniform encapsulation and controlled release of pentoxifylline (PTX), a potent anti-inflammatory drug for treatment of the chronic venous ulceration. We show a tailorable film growth and mass, morphology, as well as surface properties (charge, hydrophilicity, porosity) of the assembled nanofilms through control of the coating during the spin-assisted assembly. The uniform distribution of the encapsulated PTX in the TMC/ALG nanofilms is preserved even with when the amount of the incorporated PTX increases. The PTX release mechanism from the model and real systems is studied in detail and is very comparable for both systems. Finally, different cell-based assays illustrated the potential of the TMC/ALG multilayer system in wound care (e.g., treatment chronic venous ulceration) applications, including a decrease of TNF-α secretion, a common indicator of inflammation.

Leg Venous Ulcer Size Inversely Related to Number of Notable Perforating Veins: A Word of Caution

Background Perforating vein ligation has been proposed for the treatment of chronic venous ulcers in the leg. Pubmed.org , however, showed a lack of increase in subfascial endoscopic perforator surgery (SEPS) publications, even before the popularization of perforating vein thermal or chemical ablation procedures. We renewed an investigation on perforating vein ligation surgery as part of venous ulcer treatment. The basic question was if ulcer size and number of notable perforating veins were related. Methods Leg perforating veins were detected by ultrasonography (US) and by clinical palpation in 118 legs of 104 subjects, mostly women (79, 76%). This group represented a sample of a mostly rural Brazilian population. Inclusion criterion was any “request for venous US at any stage of ulcer treatment.” Ulcer size in centimeters squared and number of detected perforating veins (NP) were compared using Pearson correlation coefficient p available with Excel. Results Average ulcer size was 13 ± 17 cm2 (1–100) for NP = 0–7, resulting in p = −0.18 for the 118 pairs of data. Subgroup averages were 16, 16, 11, 8, and 8 cm2 for NP = 0, 1, 2, 3, and ≥4 perforating veins detected (n = 32, 30, 29, 16, and 11, respectively), resulting in p = −0.94 for such averages and NP. Conclusion Ulcer size failed to correlate with number of detected perforating veins based on raw data but correlated inversely to such number if subgroup averages were compared. Average ulcer size was larger for subgroups of legs with lesser number of perforating veins. Arbitrary ligation of detectable perforating veins may result in ulcer size augmentation. Detailed research must continue to find criteria to indicate (a) ligation or (b) preservation of specific perforating veins either (a) detrimental or (b) contributory to venous ulcer healing.

Use of customised pressure-guided elastic bandages to improve efficacy of compression bandaging for venous ulcers.

Compression bandaging is a major treatment of chronic venous ulcers. Its efficacy depends on the applied pressure, which is dependent on the skill of the individual applying the bandage. To improve the quality of bandaging by reducing the variability in compression bandage interface pressures, we changed elastic bandages into a customised version by marking them with circular ink stamps, applied when the stretch achieves an interface pressure between 35 and 45 mmHg. Repeated applications by 20 residents of the customised bandage and non-marked bandage to one smaller and one larger leg were evaluated by measuring the sub-bandage pressure. The results demonstrated that the target pressure range is more often attained with the customised bandage compared with the non-marked bandage. The customised bandage improved the efficacy of compression bandaging for venous ulcers, with optimal sub-bandage pressure.

Successful Treatment of Chronic Venous Ulcers With a 1,320-nm Endovenous Laser Combined With Other Minimally Invasive Venous Procedures.

Venous ulcers are very common with few curative treatment options. To report the closure rate and clinical characteristics of active venous ulcers in a vein clinic using endovenous laser ablation (EVLA) with a 1,320-nm laser. A prospective database was kept consisting of patients with an active venous ulcer at the time of consultation in a single-practitioner academic vein clinic from March 2007 to May 2014. A database was maintained and charts were reviewed with attention to the length of time the patient reported having the ulcer, procedures performed, and time to ulcer healing. Thirty-one patients were identified at consultation with venous ulceration. One patient's ulcer was healed with conservative medical management before receiving treatment. The remaining 30 patients were treated with a combination of EVLA of the great and/or short saphenous veins, foam sclerotherapy of insufficient varicose and reticular veins, and phlebectomy as appropriate. Two patients were lost to follow up after partial treatment. Ulcer healing occurred in more than 93% (27/29) of patients with a median healing time of 55 days from the time of first treatment. The median follow-up time after treatment was 448 days. Endovenous laser ablation with a 1,320-nm laser in combination with foam sclerotherapy and phlebectomy as appropriate is effective treatment of chronic venous ulcers and should be considered as a treatment option for patients with C6 venous insufficiency. To the authors' knowledge, this is the largest, prospective series of chronic venous ulcers treated with EVLA. Further randomized controlled studies are needed to confirm these findings.

Venous intervention in chronic venous ulcer treatment and recurrence avoidance

SummaryIn this brief overview I will progress from superficial venous intervention for venous leg ulcers (VLU) to perforator intervention and finally to deep venous intervention. But first there are a number of concepts that must be accepted. We know that 70 % of patients with leg ulcers have a venous component (1), and in at least 40 % of those patients, ulcers will be caused by superficial venous insufficiency alone or in combination with perforator incompetence (2). Such patients will likely benefit from treatment of their superficial venous disease.One of the most important but often overlooked factors in venous ulcers is calf pump failure. Simka has reported that 45 % of patients with venous ulcers have calf pump failure (3).Thorough duplex evaluation of the venous leg ulcer patient is paramount for accurate diagnosis, the differentiation between arterial and venous components (purely arterial, venous, or mixed etiology), and the obstructive and/or incompetent nature and location of venous lesions. In obstructive venous lesions the degree of obstruction as well as how proximal the lesion extends must be known. For venous insufficiency the location (deep and/or superficial venous system) and the extent (segmental or axial) will help determine how much the incompetence contributes to the overall ulcer condition, and what lesions can be safely treated.