Management Of Ulcers Research Articles

The application value of the multidisciplinary team model led by specialist nurses in pressure ulcer management.

The application value of the multidisciplinary team model led by specialist nurses in pressure ulcer management.

Comparative efficacy of autologous platelet rich plasma and conventional dressing in the management of chronic ulcers

Background: Chronic ulcers pose a major global healthcare challenge. The use of platelet-rich plasma (PRP) for treating these wounds has garnered interest because of its potential healing benefits. Objective were to determine the effect of autologous PRP therapy on the percentage of surface area reduction/healing in chronic ulcers. Methods: This randomized controlled trial was conducted at the department of general surgery of M.M. institute of medical sciences and research (M.M.I.M.S.R.) Mullana, Ambala from May 1, 2023, to April 30, 2024. Patients aged 18-80 years of either gender with chronic ulcers were enrolled. Patients were randomly allocated to the PRP group and control group. PRP group was administered autologous PRP once in two weeks for 6 weeks after debridement, while for the control group conventional saline dressings were done after debridement. Final assessment was done at 8 weeks. Results: Of the 60 patients, the mean age was 53.90±11.23 years. There were 49 (82%) males and 11 (18%) females. At 8 weeks, the PRP group achieved 83.78% (SD=2.99) reduction in surface area of ulcers, whereas the control group had a 57.78% (SD=1.32) reduction in surface area of ulcers, with a p=0.0000 indicating a significant difference. The small sample size and 56-day follow-up period are insufficient to assess long-term treatment effects. Conclusions: A better outcome of PRP was observed compared to conventional dressing in patients with chronic non-healing ulcers.

Utility of a self-assembling peptide in the management of refractory hemorrhagic duodenal ulcers.

Utility of a self-assembling peptide in the management of refractory hemorrhagic duodenal ulcers.

Comparison of corneal ulcer size and depth measurement by slit lamp and anterior segment optical coherence tomography

To evaluate the correlation between corneal ulcer size and depth measurements using slit lamp biomicroscopy and anterior segment optical coherence tomography (AS-OCT). A prospective, observational study was conducted on 100 patients with corneal ulcers at the Hind Institute of Medical Sciences after taking clearance from the ethical committee. Corneal ulcer parameters, including width, height, and depth, were measured and compared using both slit lamp biomicroscopy and AS-OCT.The mean age of patients was 45.74±13.61 years ranging from 22 to 78 years. Majority of patients were males (75%). Right eye was involved among more than half of patients (65%) followed by left eye (35%). The length and depth of infiltrate was significantly (p=0.001) lower by SLIT LAMP than ASOCT method observed by both the observers. The breadth of infiltrate was significantly (p<0.05) higher by SLIT LAMP than ASOCT method observed by both the observers. Corneal thickness measured by ASOCT was significantly (p=0.04) lower evaluated by observer 1 (637.76±135.26) than observer 2 (640.66±130.16). Highly significant positive (p=0.0001) correlation was found between SLIT and ASOCT in all the measurements evaluated by both the observers.AS-OCT provides accurate and non-invasive measurements of corneal ulcer depth, which is not possible with slit lamp biomicroscopy. The use of AS-OCT as an adjunctive modality can enhance diagnosis and management of corneal ulcers. This study highlights the utility of AS-OCT in monitoring disease activity and providing valuable imaging guidelines for clinicians.

Amniotic membrane graft (AMG) for persistent epithelial defects following infective corneal ulcers and keratitis - A systematic review.

Management of nonhealing corneal ulcers is challenging as it can lead to complications such as melting, descemetocele, and perforation, which can be prevented by amniotic membrane graft (AMG). The absence of any review (English language) on AMG for corneal ulcers prompted us to conduct this review. We looked for clinical trials (randomized and controlled) on the effect of AMG combined with other treatments, through various search engines utilizing the terms amniotic membrane and corneal ulcer. All patients who received AMG and/or conventional medication were included. Risk of bias tools derived from Cochrane collaboration were used to ascertain the standard and quality of the trials. Visual acuity and epithelial healing time were the main outcome measures studied. Three trials were finally selected for analysis. AMG was noted to be associated with better uncorrected visual acuity and reduction in neovascularization. There was no difference in best corrected visual acuity, epithelial healing time, and corneal opacity. There is evidence that the use of AMG is associated with improved uncorrected visual acuity as well as reduction in neovascularization of the cornea among patients with corneal ulcers, but there was no improvement in epithelial healing time or corneal opacity. Further multicenter randomized controlled trials are needed to elicit the beneficial effects of the intervention and augment the validity of this review.

"Veins first" versus "artery first" approach for management of mixed arterial venous leg ulcers (MAVLU): Systematic review and meta-analysis.

Mixed Arterial and Venous Leg Ulcers (MAVLU) are challenging. The optimal intervention sequence (artery-first vs vein first) is unclear. This review evaluates current evidence on surgical intervention sequencing. MEDLINE, PUBMED, SCOPUS and EMBASE were searched using the term 'mixed arterial venous leg ulcers.' Studies were eligible if they reported ulcer healing outcomes in MAVLU patients. Pooled proportions were calculated by random effects modelling. The search yielded 606 studies, eight of which contained sufficient data to include in the analysis. There were no randomized controlled trials. Initial modified compression (MCT) and rescue revascularisation in MAVLU with ABI 0.5 to 0.85 achieved a pooled healing rate of 75% (95% CI 69% to 80%) compared to 79% (95% CI 61% to 93%) in patients with standard VLUs. The pooled rescue revascularisation rate for MAVLU patients with moderate arterial disease was 25% (95% CI 6% to 51%). Patients with severe arterial disease (ABI <0.5) who underwent arterial intervention first were less likely to heal (pooled proportion 40%; 95% confidence interval 16% to 66%). No studies compared either MCT or venous ablation with arterial revascularisation as first-line in patients with moderate arterial disease (ABI 0.5 to 0.85) alone or severe arterial disease (ABI <0.5) alone. There was marked heterogeneity between studies with respect to ulcer healing outcomes reported, definitions of ulcer healing, duration and size of ulcers at presentation, use of adjunct procedures such as skin grafting, unit of measurement (legs vs patients) and duration of follow up. A 'veins first' approach to MAVLU is plausible but robust data are lacking and should be evaluated in a randomized controlled trial.

Overview of Leech Therapy as an Alternative Treatment for Varicose Ulcers: Mechanisms and Efficacy

Varicose ulcer, the most severe and debilitating complication of chronic venous insufficiency in the lower limbs, impart substantial obstacles in medical management because of their chronicity and propensity for recurrence. About 80 percent of ulcerations on the lower extremities are triggered by varicose ulcer. Despite advances in diagnosis and treatment, varicose ulceration remains a major healthcare concern due to its potential for life-threatening complications. The morbidity has a detrimental effect on life expectancy. Venous ulceration results from persistent venous pressure brought on by venous insufficiency. Although the diagnosis is primarily clinical, it must be distinguished from other lower limb ulcer causes. Reduction of edema, enhancement of ulcer healing, and avoidance of recurrence are the objectives of treatment. Although conservative care, mechanical treatment, pharmaceutical, and surgical methods are available for the treatment of venous ulcers, but Hirudotherapy, also known as leech therapy, has grown into a prominent complementary treatment option. It has the potential to promote wound healing and alleviate varicose ulcer symptoms. The objective of this review is to accord a thorough overview of the application of leech therapy to the management of varicose ulcers. The present study emphasizes on the mechanisms of action, efficacy and safety profile of leech therapy in the context of managing varicose ulcers by synthesizing a collection of available literature, clinical investigations, and case reports.

Management of Non-Healing Varicose Ulcer with Ayurveda-A Case Study

Management of Non-Healing Varicose Ulcer with Ayurveda-A Case Study

Effectiveness and Tolerability of Topical Curcumin for Management of Diabetic Foot Ulcer: A Pilot Clinical Study

Background: Diabetic foot ulcers (DFUs) affect 9.1 to 26.1 million individuals globally each year, with 15-25% of those with diabetes mellitus (DM) experiencing them during their lives. DFUs are a major cause of amputations, accounting for 85% of such cases in diabetic patients. Curcumin, a compound from Curcuma longa, shows potential in wound healing through mechanisms such as inhibiting the NLRP3 inflammasome pathway, promoting autophagy, and regulating microRNA expression. This study evaluated the efficacy and safety of C3-DiagardTM Cream in treating DFUs. Methods: This open-label, prospective clinical study assessed the efficacy and safety of C3-DiagardTM cream, containing 0.05mg of Harida (Curcuma longa) extract, in treating and preventing DFUs. The cream was applied twice daily for 12 weeks. Key outcomes were assessed through wound size reduction, pain (VAS score), and any adverse reactions during the treatment. Results: Fifty DM patients (36 males, 14 females; mean age 57.58±12.67 years) were enrolled. Among the patients, 75% (38 individuals) showed a wound healing response between 70% and 99%. The average wound size decreased significantly from 6.63 cm&amp;lt;sup&amp;gt;2&amp;lt;/sup&amp;gt; at baseline to 1.83 cm&amp;lt;sup&amp;gt;2&amp;lt;/sup&amp;gt; after 12 weeks, with a mean reduction of 4.8 cm&amp;lt;sup&amp;gt;2&amp;lt;/sup&amp;gt; (p &amp;lt; 0.05). Pain levels, measured by VAS score, significantly dropped from an average of 8 to 3 (p &amp;lt; 0.05). No adverse reactions were reported, highlighting the cream’s safety. Conclusion: C3-DiagardTM cream is effective in reducing the size of diabetic foot ulcers and alleviating pain, with a favourable safety profile. This study supports the clinical use of C3-DiagardTM as a well-tolerated treatment option for patients with DFUs.

COMPARAÇÃOENTRECIRURGIAABERTAEMINIMAMENTEINVASIVAPARA ÚLCERAPÉPTICAPERFURADA

This study conducts a systematic review comparing open surgery and laparoscopic repair techniques for perforated peptic ulcer. The research was performed using PubMed and ScienceDirect databases, covering studies published in the last five years. Nine articles directly comparing the two surgical techniques were included, evaluating factors such as hospitalization time, postoperative complications, wound healing time, and infection rates. The results suggest that laparoscopic surgery offers several advantages, including reduced hospital stay and faster recovery, while open surgery remains relevant in specific cases. The analysis highlights the importance of selecting the surgical technique based on the patient's clinical condition and the surgeon's expertise, with laparoscopy emerging as the preferred approach in most cases. This study aims to provide evidence that can guide surgical practice, promoting better outcomes and a more patient-centered approach to the management of perforated peptic ulcers.

Finding proper timing in pressure ulcer management for quality care.

Finding proper timing in pressure ulcer management for quality care.

NSAID-induced Gastric Ulcer Disease: A Deleterious Connection.

Gastric ulcers induced by non-steroidal anti-inflammatory drug (NSAID) usage have become a common public health problem, and several studies have established chronic NSAID usage to be one of the risk factors for the pathogenesis of peptic ulcers in patients. This review includes numerous articles that link NSAID usage with peptic mucosal erosion, especially among patients under anticoagulant therapy or with other risk factors. Risk factors for NSAID-induced peptic ulcers are reviewed, in addition to pathogenesis, clinical signs, symptoms, diagnosis, prevention, and treatments. We also emphasize effective methods for the prevention and management of peptic ulcers among NSAID users. Such methods include the use of selective Cyclo-oxygenase (COX-2) inhibitors as an alternative to aspirin or other Cyclo-oxygenase (COX-1) inhibitors, or using the lowest dosage possible in patients with other comorbidities. We have conducted a thorough review of the literature on diagnostic tests and alternative medication that can be used in the management of NSAID toxicity-induced ulcers.

A mouldable fibreglass backslab device as a novel approach to offload chronic plantar foot ulcers: A retrospective observational audit.

Pressure offloading is a critical component of plantar foot ulcer management, including diabetes-related foot ulcers (DFU). Conventional offloading options such as total contact casting and removable knee-high walkers may be unsuitable or unsuccessful in patients with morbid obesity, intermittent lower limb oedema, high exudative wounds or poor mobility. A mouldable fibreglass backslab device (BSD) may be a practical alternative to be considered in these situations. Data were retrospectively collected on 28 patients (29 foot ulcers) with non-healing ulcers who received a BSD to offload their foot ulcer as an extension to standard offloading care. Baseline data included: patient demographics, type of offloading prior to BSD application, date of ulcer onset, days ulcer present prior to BSD application and ulcer size at BSD initiation. Measures of success included ulcer size reduction 12weeks post-BSD application, time to complete ulcer healing in BSD, time to 50% reduction in ulcer size post-BSD application and total number of days ulcer present. The median (IQR) ulcer area and ulcer duration at baseline for 19 patients (20 ulcers) who used the BSD was 1.65 (0.4-3.8) cm2 and 531 (101-635) days. At 12weeks, the median (IQR) ulcer area was 0.3 (0-0.55) cm2 with a median (IQR) reduction of 97 (80-100) %. Nine (45%) ulcers achieved complete wound healing (100% reduction in wound size) at 12weeks post-BSD application, and the remaining 11 (55%) ulcers achieved at least 50% reduction in wound size. The median (IQR) time to complete wound healing and 50% reduction in wound size was 71 (35-134) days and 24 (15-44) days, respectively. Nine patients ceased use of the BSD and reverted to conventional offloading before their wounds had healed. Of these, four patients achieved a 50% reduction in wound size at the 12-week mark with conventional offloading. Our preliminary data suggests that a mouldable fibreglass BSD may be a practical offloading option in the management of DFUs, especially when conventional offloading methods are unsuccessful, unsuitable or unacceptable to patients. Higher level evidence is required to demonstrate suitability or efficacy of the BSD compared to current evidence-based recommended offloading methods.

Abstract ID: 68 Medical Management of Marginal Ulcers: A Systematic Review

Abstract ID: 68 Medical Management of Marginal Ulcers: A Systematic Review

Role of Helicobacter Pylori Eradication Therapy in the Management of Recurrent Aphthous Stomatitis: A Case Report

Abstract Recurrent aphthous stomatitis (RAS) is one of the most frequently encountered oral mucosal lesions. The RAS is characterized by recurrent painful ulcers, which can be either single or multiple. The prevalence rate of RAS ranges from 5 to 60% among the different ethnic and socio-economic groups. To date, RAS is one of the least understood oral diseases. It causes many problems for the affected individual due to the diverse precipitating factors and recurrent nature. Prompt diagnosis and management of RAS is a challenge factors. Various micro-organisms, including Helicobacter pylori (H. pylori), are believed to be associated with the development of RAS. H. pylori is a microaerophilic, gram-negative bacterium that colonises the gastric mucosa. Very few reports are available in the literature highlighting the association between H. pylori and RAS. Pain relief, fast ulcer healing increased ulcer-free period are the treatment strategies used for RAS. Identifying the causal factors helps the better management of the patients. The present case highlights successful management of the recurrent ulcers followed by H. pylori eradication therapy.

U-T Flap for Distal Symes Toe Amputation. A New Flap Adapted to Diabetic Ulcers of the Pulp of the Lesser Toes

The surgical management of diabetic ulcers of the tip of the toes complicated with osteomyelitis of the distal phalanx usually consists of the excision of the bone and soft tissue using a distal Symes toe amputation. This surgery is usually conducted through 2 coronal flaps. When the ulcer is away from the nail or extends further on the plantar side of the pulp, wound closure could be difficult to achieve resulting in wound dehiscence. In addition, the remaining toe is often too short when compared with the neighboring digits. The objective of this surgical technique is to propose a new flap design that could be simple and easy to learn, mainly when dealing with small-to-moderate–sized wounds. The U-T flap is designed to reduce wound complications and yield better esthetics. We found the U-T flap to be a reproducible technique with better outcomes in terms of surgical wound healing and final toe length, after excision of distal infected toes. Level of Evidence: Diagnostic level 5—expert opinion. See Instructions for Authors for a complete description of levels of evidence.

Pressure ulcer prevention for people with long-term neurological conditions (LTNCs) who self-manage care and live at home

AimTo develop a Theory of Change (ToC) pathway to facilitate the development of a multi-component intervention package supporting pressure Ulcer (PU) risk identification and management, in partnership with people with Long Term Neurological Conditions (LTNC) who self-manage care and live at home, their informal carers and PAs. MethodsA participatory approach, with extensive input from those whose lives are the focus of the research, was used throughout the 4 interlinked work packages (WP):•WP1 – Development of two co-operative Inquiry Groups (CIGs)•WP2 - Semi-structured interviews and/or app participation•WP3– Professional and strategic stakeholder engagement•WP4–Systems mapping and Theory of Change (ToC pathway developmentIterative data analysis was undertaken with emerging findings from each WP informing subsequent stages of the study. FindingsOverall, 74 participants contributed across the 4 WPs, incorporating 31 Service Users (SU), 8 carers, 9 Personal Assistants (PAs) and 26 professional stakeholders. We identified 8 key themes related to PU prevention, incorporating, learning, safe routines, third sector and peer support, navigating complex systems, adapting and reacting to change, perceptions of risk, risk negotiation and supporting roles. The findings indicate systemic and professional barriers which hamper people's ability to self-care and seek help. ConclusionsThe study highlights the complexities and impact of managing PU prevention activities at home for people with LTNC and areas of learning for health professionals and systems. By understanding these complexities we developed a systems map, identified resource requirements and illustrated a Theory of Change (ToC) pathway, to underpin future work to develop and user test an interactive, multi-component intervention.

Management of corneal ulcer in a British bull dog by telemedicine

The delivery of healthcare services, where distance is a critical factor, by all healthcare professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, are still poorly practiced for advancing the health of the animals at distant remote areas. Corneal ulcer continues to be a common ophthalmic condition in dogs that originates mostly due to trauma resulting in break in the continuity of underlying corneal stroma, that become contaminated with bacteria in complicated cases. A British bull dog received telemedicine such as eye drops containing Betensol and Neomycin 3 drops thrice daily for 5 days followed by gatifloxacine eye drop for a week, acyclovir at the dose rate of 100mg twice daily for a week. There was very good improvement and the ulcer got completely healed by 15 from start of the therapy.

Use of Silver Dressing on Diabetic Ulcers During Infection: Case Report

Aims: This study aimed to describe the results of applying silver dressing on diabetic ulcers during infection in patients with infected wounds on digiti one pedis dextra. Methods: This research uses a descriptive design, namely a case study with a nursing approach consisting of assessment, analysis of problem formulation, formulation of nursing diagnosis, intervention, implementation, evaluation, and nursing documentation. The subject of this case study is Mrs. A with diabetic ulcers on Digi 1 pedis extra with infection. Case management was carried out for three days on April 17-19, 2024. Data was collected through anamnesis, wound assessment, supporting examination, and literature study. Wound assessment was performed using the Meggitt-Wagner instrument for assessing wound severity and the SINBAD (Site, Ischemia, Neuropathy, Bacterial infection, Area ulcer, and Depth) system for improving foot ulcer management according to their severity and predicting major adverse foot events. Results: After three days of treatment using silver dressing, the wound condition shows that the infection has been resolved, and the wound has improved significantly from a grade 2 diabetic ulcer with abscess using the Meggitt-Wagner instrument and a SINBAD score of 3 (less severe ulcer) to a grade 2 diabetic ulcer without abscess and a SINBAD score of 2 (less severe ulcer). Conclusion: Wound care using silver dressing significantly accelerates the resolution of infections and supports the overall healing process

Dual-Modal Optical Imaging of Tissue Perfusion in Response to Cooling Stimulation Facilitates Early Detection of Pressure Ulcer.

Pressure ulcers present a significant human and economic challenge, lacking a reliable method for early detection. To address this, we developed a system capable of early detection by using cooling stimulation and dynamic data acquisition techniques to monitor blood perfusion and skin temperature. The system consists of laser speckle perfusion imaging and thermal imaging. And we performed simulations to demonstrate that the system is capable of detect tissue damage across multiple layers, from superficial to deep. Testing on a rabbit ear model demonstrated that this approach, which combines dynamic perfusion and temperature parameters, effectively distinguishes early pressure ulcer areas from normal skin with a significant p value of 0.0015. This distinction was more precise compared to methods relying solely on static parameters or one parameter. Our study thereby offers a promising advancement in the proactive management and prevention of pressure ulcers.