Unna Boot Research Articles

Randomized Double-Blinded Study Comparing Clinical Versus Endovascular Treatment of Iliac Vein Obstruction.

Randomized Double-Blinded Study Comparing Clinical Versus Endovascular Treatment of Iliac Vein Obstruction.

Effects of weekly LED therapy at 625nm on the treatment of chronic lower ulcers.

The aim of this study was to evaluate the effects of LED therapy associated with compression therapy on chronic venous leg ulcers (CVUs). The study included CVU patients (n = 17, eight men) who were eligible for Unna's boot treatment. Ulcers were treated on a weekly basis with either LED therapy (625 nm, 4 J/cm(2)) and an Unna's boot (LED ulcers, n = 14) or a placebo treatment and an Unna's boot (control ulcers, n = 14). The total surface area of the ulcers, the relative ulcer area, and the healing rate were recorded over a period of 30 weeks. Ulcer exudates were collected for determination of local tumor necrosis factor alpha (TNF-α) levels. The total area was not significantly different between the LED and control ulcers (P > 0.05, Mann-Whitney U test) throughout the study. However, the relative area indicated that non-healing treatment resistant ulcers (n = 6) persisted in the control group after 19 weeks (P < 0.05, Mann-Whitney U Test). No differences in median healing rate were observed (hazard ratio 0.89, CI 95%: 0.40-1.98) between LED (15 weeks) and control ulcers (19.5 weeks). No differences in TNF-α levels were detected (P > 0.05, Mann-Whitney U test). The results suggest that LED therapy improved the effectiveness of the Unna's boot since no refractory ulcer was observed in the LED group after 19 weeks. However, LED therapy did not alter the local secretion of TNF-α nor accelerate wound healing.

Impact of compression therapy using Unna's boot on the self-esteem of patients with venous leg ulcers.

To assess self-esteem in patients with venous leg ulcers treated with Unna's boot. • A descriptive, analytic, clinical study was conducted from June 2010 to May 2011 in an outpatient wound care clinic in São Paulo, Brazil. Patients of both sexes, aged ≥18 years, who had had a venous leg ulcer for more than one year and a Doppler ankle brachial index ranging from 0.8-1.0 were consecutively selected for inclusion. Patients were treated with wound dressings and Unna's boot. Self-esteem was assessed using the Brazilian version of the Rosenberg Self-Esteem Scale (RSE) at inclusion (baseline) and after 4, 8, and 12 months of compression therapy using Unna's boot. The scale is reverse-scored; thus lower scores indicate higher levels of self-esteem. • The patients showed a slight but significant improvement in self-esteem after 4 months of treatment (mean RSE score=17.12) compared with baseline (mean RSE score=24.90). However, a marked and significant improvement in self-esteem was observed after 8 months (mean RSE score=7.40) and 12 months (mean RSE score=2.10) of compression therapy using Unna's boot. • Patients with venous leg ulcers treated with Unna's boot for 12 months showed a significant improvement in self-esteem • All authors declare that no competing financial interests exist. There was no external funding for this study.

Compression of venous ulcers: standardizing standard care.

Venous legulcers (VLUs) are common, affectingupwardof 1% of adults and with increasing incidence and prevalence with advancing age. Venous leg ulcers are associatedwith reduced quality of life and significant health care costs in addition to sustained ambulatory venouspressure (venoushypertension),whichmostoftenresults from thrombosis and/or valve disease, affecting the superficial, perforator, or deep veins.As a result, calfmusclepumpdysfunctionensues, leading to ulcer formation. Standard care withmultilayered compression wraps is aimed at reversing these changes, and applicationofwell-deliveredcompressionachieveshealing inup to 75% of patients. Applying compression, however, is a challenge. Often viewedbypatients andpractitioners as cumbersome,uncomfortable, andoppressive, compression interruptspatients’ lives by altering their bathinghabits and the clothes and shoes they wear. In this issueof JAMADermatology,Zarchi and Jemec1 report that even those with moderate confidence in their ability to apply compression vary substantially in compression application, with less than one-third applying optimal compression, suggesting patients may not be getting the treatment prescribed.2 Given that dermatologists often see patients with VLUs, addressing the gap of providing substandard compression is important. The initial barrier toward change is for practitioners to appreciate the importance of compression in healing VLUs.Without optimal compression, substandard care is provided. Practitioners should understand compression systems and recommend the appropriate system. For example, elastic compression (Coban2 [3M] or Profore [Smith and Nephew])providescompressionwhenpatientsareeitherwalking or resting and differs from inelastic compression (Unna Boot),whichapplies compressiononlywhenpatientsarewalking (the latter is more desirable in patients with mild arterial insufficiency). Next, it is critical, given the variability in compression applied, that well-trained and experienced personnel apply compression. This need typically causes patients to visit a physician’s office, seek treatment at awound center, or usehomehealth services once or twiceweekly, depending on the amount of exudate. Application of compression by patients or untrained caregivers, such as family members, risks inappropriate provision of care; however, recent work suggests firm compression stockings (30-40 mm Hg) may result in similar outcomes for selected patients.3 Education and training of practitioners, staff, and patients about the importance and application of compression are key. Related article page 730 Research Original Investigation Compression Therapy for Venous Leg Ulcers

A Comparative Clinical Study on Five Types of Compression Therapy in Patients with Venous Leg Ulcers

The aim of this study was to compare five types of compression therapy in venous leg ulcers (intermittent pneumatic vs. stockings vs. multi layer vs. two layer short stretch bandages vs. Unna boots). Primary study endpoints were analysis of changes of the total ulcer surface area, volume and linear dimensions inside observed groups. The secondary end points were comparisons between all groups the number of completely healed wounds (ulcer healing rates), Gilman index and percentage change of ulcer surface area. In total, 147 patients with unilateral venous leg ulcers were included to this study. Participants were randomly allocated to the groups: A, B, C, D and E. After two months the healing rate was the highest in group A (intermittent pneumatic compression) - 57.14%, 16/28 patients, B (ulcer stocking system) - 56.66%, 17/30 patients and C (multi layer short stretch bandage) - 58.62%, 17/29 patients. Significantly much worse rate found in group D (two layer short stretch bandages) - only 16.66%, 5/30 patients and E (Unna boots) - 20%, 6/30 patients. The analysis of changes of the percentage of Gilman index and wound total surface area confirmed that intermittent pneumatic compression, stockings and multi layer bandages are the most efficient. The two layer short - stretch bandages and Unna boots appeared again much less effective.

The impact of compression therapy with Unna's boot on the functional status of VLU patients

To assess disability in patients with venous leg ulcers treated with compression therapy with Unna's boot. A descriptive analytic case control study was conducted from June 2010 to May 2011 in an outpatient wound care clinic in interior Brazil. Fifty patients of both sexes, aged 18 years or above, who had had a venous leg ulcer for more than 1 year and a Doppler ankle-brachial index of 0.8-1.0 were selected for the study. Patients were treated with wound dressings and Unna's boot. Disability was assessed using the 20-item Stanford Health Assessment Disability Scale (HAQ-20). Statistical analysis was performed using the Student's t-test, the Kruskal-Wallis test and the chi-square test of independence, all at a significance level of 0.05 (p < 0.05). The mean overall HAQ score at inclusion (baseline) was 2.98, indicating impaired functional capacity. After 8 and 12 months of compression treatment with Unna's boot, the mean overall HAQ scores were 1.35 and 1.0, respectively, indicating good functional capacity. Patients with venous leg ulcer reported severe difficulty or serious disability in their daily functioning at baseline; after 8 months of treatment with Unna's boot, these patients were able to perform activities of daily living.

The Impact of Skin Grafting on the Quality of Life and Self‐Esteem of Patients with Venous Leg Ulcers

The assessment of health-related quality of life in patients with venous leg ulcers provides important information for clinical decision making, evaluation of therapeutic benefits, and prediction of survival probabilities. Health-related quality of life and self-esteem were assessed using the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and the Rosenberg self-esteem (RSE) scale, respectively, in patients with venous leg ulcers treated with split-thickness skin grafts. One hundred patients with venous leg ulcers and indication for skin grafting were divided into two groups of 50 patients each: the control group (patients who received conservative treatment) and surgery group (patients who received split-thickness skin grafts). Patients in the surgery group reported significantly higher SF-36 scores (better health status) than controls one month after surgery, as well as 90 and 180 days postoperatively (p < 0.002). The mean total RSE score was significantly lower (indicating higher self-esteem) in the surgery group (mean RSE score, 17.54) than in the control group (mean RSE score, 24.22). Split-thickness skin grafting resulted in better health-related quality of life and self-esteem in patients with venous leg ulcers than did compression therapy with Unna's boot.

Treatment of Venous Stasis Ulcers Presents Challenges

Treatment of Venous Stasis Ulcers Presents Challenges

Unna Boot in Venous Ulcer Treatment: Evaluation of 30 Patients

Unna Boot in Venous Ulcer Treatment: Evaluation of 30 Patients

Use of a Novel Two-layer Bandage in the Treatment of Chronic Venous Hypertension

Since the development of Unna boot therapies, there has been development in newer technologies for venous compression syndromes and chronic venous hypertension. Chronic lower extremity venous insufficiency results in venous stasis, edema and hypercongestion of the lower extremities. Given the breadth of potential uses, the goal of this study was to retrospectively compile and analyze the clinical application and effectiveness of a 2-layer zinc-impregnated foam Unna boot bandage (Andover Healthcare, Salisbury, MA) in patients with lower extremity swelling with or without wounds treated by a single physician and monitored for 12 weeks post-application in the outpatient setting. In patients with complex comorbidities, the use of this new foam-impregnated multi-layer compression Unna boot shows efficacy in reduction of edema and wound size within 12 weeks. This newer therapy shows extensive promise in the ability to keep patients adherent to treatment regimens with higher rates of success.

Reatment of venous ulcers with an unna boot: a case study

Objective: To assess the healing process of a patient wit h a venous ulcer in a lower limb subject to treatment with an Unna boot. Method: This case study was conducted in the Outpatient Wound Care service of a public hospital in Niteroi, RJ, Brazil between July and September, 2011. A protocol addressing clinica l data was used to assess the wound's healing process, together with measurement of the lesion area and photographic recording. The study was approved by the hospital's Institutional Review Board (Protocol No. 327\10). Results: the wound healed after 12 weeks of follow-up and the patient reported reduced pain and edema in his legs. Conclusion: The treatment with an Unna boot was effective in healing the venous ulcer when associated with systematized outpatient follow-up.

Topical treatment of nonhealing venous leg ulcer with propolis ointment.

An investigation of effectiveness of topical treatment of nonhealing chronic venous leg ulcers with propolis ointment was conducted. 56 patients were included in the study and randomized into two groups. In group 1, there were 28 patients (ulceration area: 6.9–9.78 cm2) treated by means of topical propolis ointment application and short stretch bandage compression. In group 2, there were 29 patients (ulceration area: 7.2–9.4 cm2) treated by means of Unna boot leg compression without topical propolis treatment. In the study, the efficacy of both treatment methods in patients with resistive venous leg ulcers was compared. The ulceration of patients from group 1 healed completely after 6 weeks of therapy in all cases. In all patients from group 2, the process of healing was longer but successfully completed after 16 weeks of the therapy. We found that an adjunctive propolis ointment treatment increases the efficacy of the short stretch bandage compression stocking, and this combined treatment is more effective than Unna's boot compression alone.

Qualidade de vida em pacientes com úlcera venosa em terapia compressiva por bota de Unna

INTRODUÇÃO: As úlceras vasculares vêm se constituindo um grande problema de saúde pública em todo o mundo, sendo responsáveis por considerável impacto econômico pela elevada incidência dessas lesões crônicas. Além de restringir as atividades da vida diária e o lazer, pode ter como consequência alteração na qualidade de vida e na autoestima, levando o paciente, até mesmo, à depressão. O objetivo deste estudo é avaliar a qualidade de vida em pacientes com úlcera venosa que estão sendo tratados com terapia compressiva por bota de Unna. MÉTODO: Foram selecionados 50 pacientes com úlcera venosa em tratamento no Ambulatório de Feridas do Conjunto Hospitalar de Sorocaba (Sorocaba, SP, Brasil). A coleta de dados foi realizada no momento da inclusão no estudo, sendo repetida aos 4 meses, 8 meses e 12 meses após a primeira coleta de dados, utilizando o questionário Short Form-36 (SF-36). RESULTADOS: Durante a inclusão do paciente no estudo, os escores médios do SF-36 foram baixos (15,10), caracterizando queda da qualidade de vida. Após 12 meses de terapia compressiva por bota de Unna, o escore médio foi de 95,38, caracterizando melhora da qualidade de vida dos pacientes analisados (P = 0,0001). CONCLUSÕES: Os pacientes com úlcera venosa, no início da coleta de dados, apresentaram qualidade de vida baixa, e após 8 meses de tratamento com bota de Unna foi observada melhora da qualidade de vida.

Control of Lymphorrhea and Treatment of Warty Excrescences in Elephantiasis

The aim of this study is to report the control of lymphorrhea in the intensive treatment of elephantiasis, using an Unna boot. The case of a 29-year-old female patient is reported. This young patient evolved with the more serious form of lymphedema, elephantiasis, after surgical treatment of an abdominal neoplasm and radiotherapy. Warty excrescences were present on both legs and genitalia where lymphorrhea was constant. The patient arrived at the Godoy's Clinic for treatment. She was weighed and perimetric evaluations were made at the start of treatment and thereafter every day during an intensive outpatient treatment of eight hours daily for three weeks. Treatment included manual lymph drainage, mechanical lymph drainage using the RA Godoy device, and the continuous use of compression stockings with adjustments made every three hours. An Unna boot was employed as compression at sites of dermal lesions (warty excrescences) with overlapping use of individualized compression stockings that were individually adapted. The Unna boot was renewed every two days during the first week and every 3 days during the second and third weeks. By the end of this course of treatment, most of the warty excrescences had reduced in size or even disappeared and the lymphorrhea was controlled.

Treatment of varicose ulcer of the lower limbs by surgery and Unna boot: savings for the Brazilian healthcare system.

To perform an analysis of the costs of treatment of varicose ulcers by radical surgery of varices and the use of Unna boot. Fifteen outpatients were selected to receive treatment of varicose ulcers with radical surgery and Unna boot. The total cost of treatment was calculated (hospitalization, surgery, dressings, and outpatient's follow-up visits) and compared to the cost of clinical follow-up with daily simple dressing changes. The proposed treatment was on average 55.71% more economical than the management with daily dressings (approximately US$452.32 versus US$1,021.39). Radical varicose vein surgery associated with the use of the Unna boot proved meaningly less expensive for the public health system than clinical follow-up with daily dressings.

Enhanced Healing of Surgical Wounds of the Lower Leg Using Weekly Zinc Oxide Compression Dressings

Management of lower extremity wounds after Mohs micrographic surgery can pose a challenge to the surgeon. Postoperative reactive edema and inflammation can lead to a painful and protracted healing course. Unna boots deliver zinc oxide to the wound bed and surrounding skin while providing compression and occlusion of the wound. To evaluate the utility of weekly Unna boot therapy in decreasing postoperative edema, inflammation, and morbidity; minimizing postoperative wound care; and improving the rate of wound healing in patients with lower leg surgical defects. Ten patients (6 men, 4 women) aged 72 to 91 with postoperative defects on the distal lower extremity were treated with weekly Unna boots until wounds had sufficiently granulated or re-epithelialized. In all 10 patients, weekly Unna boot therapy was well tolerated, with high satisfaction levels relating to minimal postoperative wound care, rapid granulation, minimal pain, and excellent esthetic outcome of postoperative wounds. No infections or other complications were noted during the healing process. LIMITATIONS This was not a randomized, controlled trial. In patients with postoperative wounds of the lower leg, weekly Unna boots significantly improve the healing process, decrease postoperative pain, and minimize wound care.

Treatment of venous ulcers with fibrin sealant derived from snake venom

Venous ulcers of the lower limbs complicated by infection or chronicity represent a serious public health problem. The elevated number of those afflicted burdens the health services, interferes in quality of life and causes absenteeism. Although there are 2,500 items on the market, ranging from the simplest dressing up to the most complex types of dressing, treatment remains a challenge. Among the substances used, fibrin sealant is the one that promotes diminution of bacterial colonization and of edema, controls hemorrhaging, alters the pain threshold by protecting the nerve endings, hydrates the wound bed and forms granulation tissue that favors healing. Its disadvantages include higher cost and utilization of human fibrinogen that can transmit infectious diseases. The Center for the Study of Venoms and Venomous Animals (CEVAP) at São Paulo State University (UNESP) developed a new sealant made up of fibrinogen extracted from large animals and from an enzyme obtained from snake venom. The present study, developed in the Health Education Clinic (CEPS) of Sacred Heart University (USC) aimed to evaluate the effect of the new sealant on the healing process of venous ulcers in 24 adult patients, seven of whom were male and 17 female. Two study groups were formed as follows: Group 1 (G1) - control group of 11 patients treated with essential fatty acid (EFA) and Unna's boot, and Group 2 (G2) - 13 patients treated with essential fatty acid (EFA), fibrin sealant and Unna's boot. The follow-up lasted eight weeks and the sealant was applied at only the first and fourth weeks. The results showed that Group 2 presented worse lesion conditions as to healing, but, when comparing the two groups, it was noteworthy that the the sealant was effective in healing venous ulcers. There is evidence that the new sealant is recommended for leg ulcers with the following advantages: ease of application, preparation of the wound bed, diminution of pain and a higher number of discharges in the eighth week. More important, other positive characteristics are non-transmission of infectious diseases, absence of adverse reactions, and economic advantage of being produced by Brazilian technology. Finally, it is suggested that the weekly application of sealant, for at least eight weeks, could improve the healing process and consequently life quality.

Modified unna boot and pinch grafting for chronic non-healing venous leg ulcer

Venous ulcers cause considerable morbidity. A 45-year-old man reported with non healing ulcer since 15 years. Patch tests revealed multiple sensitivity. Infection was first controlled with antibiotics and antiseptics. Dressing with modified Unna’s boot made with zinc oxide 40% and glycerine paste 60% resulted in formation of healthy granulation tissue. Pinch grafting was subsequently done to promote epithelization. We recommend the use of Unna’s paste instead of more expensive synthetic and occlusive and semi occlusive dressing to promote granulation tissue and pinch grafting after bed is ready to hasten epithelization.

Chronic Venous Insufficiency

Venous insufficiency can be divided into primary venous insufficiency and chronic venous insufficiency. The latter is characterized by advanced skin changes of hyperpigmentation, edema, ulceration, scarring from healed ulcers or open ulcerations. Pretreatment evaluation is done with a standing ultrasound reflux examination. Thorough mapping of extremity reflux is desirable. Physiologic tests of venous function, such as plethysmography, are unnecessary. Treatment is directed at closing refulxing axial veins as well as controlling those perforating veins with outward flow. Varicose veins contribute to axial reflux and must be obliterated. In performing ablation of saphenous vein reflux, techniques include high ligation with strrpping, radiofrequency ablation, endovenous laser therapy, and foam sclerotherapy. Initial treatment of severe chronic venous insufficiency is usually carried out by controlling the edema with elastic bandaging or nonelastic support, such as Unna boot or the CircAid dressing. Incompetent perforation interruption can be accomplished surgically by subfascial endoscopic perforator surgery (SEPS) or controlled sclerotherapy using ultrasound.. Surgical intervention has been successful but the advent of foam sclerotherapy has proven to be an attractive alternative to surgery and has added a new tool for the treatment of severe chronic venous insufficiency.1)

Comparative Study of Unna's Boot and Betamethasone Cream in the Treatment of Sulfur Mustard–Related Pruritus

Pruritus, as a chronic lesion caused by sulfur mustard, is a common problem among chemical weapons veterans. Numerous treatments like antihistamines, local anesthetics, and corticosteroids have been prescribed in order to control pruritus in these patients, while long- term and widespread use of each one of them has its own restrictions. Nowadays different mixtures, including Unna's Boot, are being used. They are effective and have limited adverse effects. So in this study we compared this product with corticosteroids. In this double-blind randomized clinical trial in Baqyiatallah hospital, 90 veterans were included and randomly divided into three groups. Subjects of each group received one of the Betamethasone %1 cream, Unna's Boot cream, or placebo cream for three weeks. They used their medication on an itching area of body, one finger tip unit every night. To evaluate the drugs' efficacy we used pruritus score index and Visual Analysis Score index. From 90 patients, 75 patients completely used the medication and the other 15 subjects were excluded from the study. All three drugs caused significant decrease in both pruritus score and VAS (p < .001). Betamethasone and Unna's Boot were significantly more effective than placebo and despite more efficacy of betamethasone rather than Unna's Boot, they did not have any significant differences (p > .05). Pruritus is a chronic lesion in veterans that needs long-term conservation treatment. Regarding definite side effects of local long-term therapy with corticosteroids and nearly equal efficacy of Unna's Boot and betamethasone, Unna's Boot seems to be a better choice in controlling sulfur mustard–related pruritus compared with betamethason.