Leg Ulcers Research Articles

Eficacia del plasma rico en plaquetas sobre las úlceras venosas. Revisión sistemática

Introduction: Venous ulcers are painful open sores that are difficult to heal. Treatment can be challenging, depending on the complexity of the wound, and may require the use of several therapies. Recently, the use of platelet-rich plasma in these patients has been suggested as a novel treatment. The objective of this work is to carry out a review on the effectiveness of platelet-rich plasma in venous ulcers. Method: A review was carried out following the PRISMA regulations. The databases of PubMed, Cinahl, PsycINFO, SPORTDiscus, Academic Search Complete, Lilacs, IBECS, CENTRAL, SciELO, and WOS were consulted. The Cochrane tool was used to assess the risk of bias. Results: Platelet-rich plasma is effective in venous ulcers. The total sample was 311 patients from seven clinical trials. The duration of therapy ranges from 6 to 24 weeks. All studies showed safety, tolerability and no major side effects. Conclusions: Platelet-rich plasma is an effective and safe method to accelerate healing, reduce the area of ulcers and reduce pain in patients. Furthermore, this therapy does not increase bacteriological growth or microbial load in chronic venous ulcers.

Analysis of computed tomography venography for the diagnosis and endovascular treatment of iliac venous compression syndrome with venous leg ulcers: a retrospective study

Iliac vein compression syndrome (IVCS) is a clinical condition defined as obstruction of the iliac vein caused by chronic compression imposed by various causes. Currently, the clinical role of computed tomography venography (CTV) in the diagnosis of IVCS is unclear. Accurately diagnosing IVCS using CTV may enhance the understanding of the pathological anatomy of iliac veins, which may lead to better treatment outcomes, especially for recalcitrant venous leg ulcers (VLU). We aimed to investigate diagnostic criteria, contributing clinical factors, and stenting for IVCS with VLU in this study. CTV, digital subtraction angiography (DSV), and Doppler ultrasound (DUS) data were obtained from the medical and imaging records of 62 patients. Additionally, contributing factors and stenting for IVCS were analysed. Patients (100%) had clinical, aetiological, anatomic, or pathological C6 disease. CTV reduced the procedure time and contrast medium dose and provided more information than DSV. Risk factors for IVCS with VLU included female sex (P = 0.036) and advanced age (P = 0.014). The rate of ulcer healing was lower in the IVCS group without stent implantation (P = 0.020). Significant improvements were noted in venous clinical severity scores (P < 0.001) and chronic venous insufficiency questionnaire-20 scores (P < 0.001) after stenting for IVCS with C6 ulcers. CTV provides a more accurate diagnosis than DUS and DSV and allows detection of possible causes of IVCS. Female sex and advanced age were potential contributing factors for IVCS. Satisfactory outcomes were observed with stenting in the treatment of IVCS with C6 ulcers.

Adherencia al Tratamiento Inmunosupresor en Pacientes Trasplantados Renales en una Institución de Salud de la Ciudad de Corrientes, entre 2018-2023.

Objective: This research aimed to describe adherence to immunosuppressive treatment in kidney transplant patients.Material and methods: Quantitative, descriptive, cross-sectional and observational study. Population: Kidney transplant recipients assisted in a health institution in the city of Corrientes, in the period from March 2018 to March 2023. A questionnaire was used based on 2 measurement scales, ITAS and ITBS. The information collected was analyzed using an Excel computer program. 23 kidney transplant patients were surveyed.Results: 92% adhered to immunosuppressive treatment, the average age was 43 years and 57% were female. With respect to the variable that evaluates uncontrollable barriers to adherence to immunosuppressive treatment in the last three months, it is relevant to highlight that 87% of the participants report a decrease in these barriers, and in relation to the variable on controllable barriers that perceived by patients to adhere to immunosuppressive treatment in the last 3 months, it was observed that 100% of those surveyed have a lower presence of controllable barriers. Finally, adherence to immunosuppressive treatment according to age and sex. Conclusion: High adherence to immunosuppressive treatment in kidney transplantation is highlighted, 92% of participants. Improvement in uncontrollable barriers suggests positive progress in treatment management. Although there are divergences with other studies, the minimal perception of controllable barriers indicates a general commitment of patientsConclusions: Platelet-rich plasma is an effective and safe method to accelerate healing, reduce the area of ulcers and reduce pain in patients. Furthermore, this therapy does not increase bacteriological growth or microbial load in chronic venous ulcers.

Impaired microvascular function in patients with sickle cell anemia and leg ulcers improved with healing.

Leg Ulcer (LU) pathophysiology is still not well understood in sickle cell anaemia (SCA). We hypothesised that SCA patients with LU would be characterised by lower microvascular reactivity. The aim of the present study was to compare the microcirculatory function (transcutaneous oxygen pressure (TcPO2) on the foot and laser Doppler flowmetry on the arm) and several blood biological parameters between nine SCA patients with active LU (LU+) and 56 SCA patients with no positive history of LU (LU-). We also tested the effects of plasma from LU+ and LU- patients on endothelial cell activation. We observed a reduction of the TcPO2 in LU+ compared to LU- patients. In addition, LU+ patients exhibited lower cutaneous microvascular vasodilatory capacity in response to acetylcholine, current and local heating compared to LU- patients. Inflammation and endothelial cell activation in response to plasma did not differ between the two groups. Among the nine patients from the LU+ group, eight were followed and six achieved healing in 4.4 ± 2.5 months. Among thus achieving healing, microvascular vasodilatory capacity in response to acetylcholine, current and local heating and TcPO2 improved after healing. In conclusion, microcirculatory function is impaired in patients with LU, and improves with healing.

Nearly complete hair re-pigmentation in an older patient treated with hydroxyurea for essential thrombocytosis

Introduction Employed in the treatment of malignancies and non-neoplastic conditions, hydroxyurea is associated with integumentary adverse effects, including skin discoloration, xerosis, pruritus, cutaneous atrophy, chronic leg ulcers, oral ulcerations, alopecia, and some nail abnormalities. Case Report A 77-year-old woman was diagnosed with essential thrombocytosis and started on low dose hydroxyurea. After 20 weeks of treatment, she experienced an unexpected change in hair color from gray to dark brown, without using hair dye or supplements. She later developed bilateral dorsal hand melanoderma, melanonychia, and onychodystrophy. Management and outcome It was decided to monitor the patient with no action taken as she was happy with this side effect of hydroxyurea. The platelet count has remained in excellent control. The dark brown hair color persisted over time. Discussion/Conclusion Hair hyperpigmentation likely occurred through melanocyte activation via hydroxyurea. Severe side effects may require dosage adjustments, while milder effects can be monitored closely. The newly observed hair color restoration in this case highlights potential dual (therapeutic and aesthetic) applications of this class of agents.

Current state of education in venous diseases within vascular surgery training programs in Italy: A national web-based survey among residents

Background To analyze the perception of vascular surgery trainees from Italian schools of Vascular Surgery regarding the level of practical and theoretical education in venous diseases. Methods An anonymous electronic survey was sent to Italian vascular surgery residents affiliated with 19 universities, asking about their training and experience in the management of venous diseases. The survey gathered information on the residents’ personal and demographic details, their university’s teaching program, operative experience in phlebology, as well as their confidence levels in performing various venous procedures, with the goal of analyzing the training and learning programs provided by Italian vascular surgery schools. Results The analysis showed that 28% of programs do not include phlebology in the curriculum, and more than 40% of residents are unable to independently perform venous duplex ultrasound or treat venous ulcers. Additionally, most residents (over 70%) have limited weekly exposure to phlebology cases, with only 5% having access to a dedicated phlebology operating room. The vast majority of residents (96%) expressed a strong desire to deepen their knowledge and skills in this field, particularly in areas such as endovascular ablation techniques, venous duplex ultrasound, and management of deep venous disease. Conclusions The survey reveals significant limitations in phlebology education and hands-on experience within the current training programs, highlighting the need to standardize and enhance venous disease management education in order to ensure that future vascular surgeons are adequately equipped to provide high-quality care for patients with a wide range of venous disorders.

Pediatric peri-medullary arteriovenous fistula: Pearls for diagnosis and treatment

Pediatric type IVc perimedullary arteriovenous fistulae (PAVF) comprise a rare subcategory of spinal vascular malformations in which multiple spinal arteries directly connect with draining veins resulting in high-flow arteriovenous shunting and large intradural venous varicosities. Complete disconnection of the fistula is necessary to prevent hemorrhage or spinal compression. A surgical, rather than endovascular, approach proves favorable under specific circumstances. Due to the rarity of these pediatric fistulae, no large studies exist to enumerate these circumstances. This case report fills this void by detailing several considerations which favored surgery for a type IVc PAVF in a 17-year-old female patient.

Satisfactory result of great saphenous vein endovenous laser ablation until below the knee on active venous leg ulcer: a case series

Background Active venous leg ulcer (VLU) is the most severe manifestation of chronic venous disease which not only affects patients’ health, but also decreases the quality of life, and delivers economic burdens. Treatment of superficial venous reflux with early endovenous laser ablation (EVLA) has been associated with reducing ulcer recurrence levels and promoting faster VLU healing. We reported three cases of patients with active VLU undergoing EVLA with different approaches. Case illustration Three patients came with complaint of leg ulcer, diagnosed with C6sEpAsdPr, with venous clinical severity scores (VCSS) of 15, 23, and 22 respectively. Severe great saphenous veins (GSV) reflux was found in all patients by duplex ultrasound examination. The second patient had undergone above-the-knee EVLA. All patients underwent EVLA using 1470-nano meter wavelength laser device and ELVeS radial fiber (Biolitec, Bonn, Germany). The laser energy protocol used was 6 W linear endovenous energy density (LEED) 50 J/cm for proximal until media ATK GSV ablation, 5 W LEED 40 J/cm for media ATK until proximal below-the-knee (BTK) GSV, and 2 W LEED 20 J/cm for proximal until distal BTK GSV. The third patient was also treated with EVLA for small saphenous vein severe reflux. Follow-up until 6 months post-EVLA showed significant healing of the ulcer with 14, 16, and 17 VCSS reduction consecutively without any complication. Conclusion We’ve reported three cases of patients with active VLU undergoing EVLA until BTK with significant results. The EVLA of GSV until BTK where there is still significant reflux is safe and provides satisfactory results in patients with VLU.

Clinical outcomes in patients with chronic limb-threatening ischemia and infected ulcers following endovascular therapy are pathogen dependent: A single-center experience from 2012 to 2021.

Patients with chronic limb-threatening ischemia (CLTI) and infected leg ulcers are at risk of amputation and postinterventional sepsis. This retrospective, single-center study included patients with CLTI and infected leg ulcers who underwent endovascular treatment (EVT) between 2012 and 2021. The study included 712 patients, 286 (40.2%) of whom underwent amputation (minor, n = 212; major, n = 74). Gram-negative bacteria (GNB) were significantly more prevalent in amputees (36.4% vs 30.9%, p < 0.05). Patients with gram-positive bacteria (GPB) had a 4-year freedom from any amputation rate of 72% (95% CI 64-81%) compared to 52% (95% CI 42-66%) in patients with GNB identification (p < 0.05). Cox proportional regression analysis showed that GNB, male sex, mean Wound, Ischemia, and foot Infection (WIfI) score, diabetes mellitus, and end-stage renal disease were independently and positively associated with amputation (p < 0.05). The mean WIfI score and end-stage renal disease were independently and positively associated with death from any cause (p < 0.05). Staphylococcus aureus or GNB, end-stage renal disease, and diabetes mellitus were independent risk factors for sepsis after EVT (p < 0.05). Inpatient-administered antibiotic regimes had significantly higher microbiological activity in cases of GPB identification compared to GNB identification (28% vs 9%, p < 0.05). Although the isolation of both GNB and S. aureus is a risk factor for sepsis following EVT, the isolation of GNB is independently associated with higher rates of amputation, demonstrating the importance of identifying pathogens to recognize patients at high risk.

The association between the “T” vein and ulceration of the lateral aspect of the leg

The “T” vein is a tributary of The Great Saphenous Vein (GSV) located in the upper third of the leg with a perpendicular course to the GSV. It usually crosses the tibial bone and feeds by reflux of varicose veins of the lateral aspect of the leg. It is of surgical interest because it is involved with a significant percentage of varicose networks. The aim of this study is to analyze the prevalence of the T vein pattern in a cohort of patients affected by Chronic Venous Insufficiency (CVI), as well as its possible association with Venous Leg Ulcers (VLU) of the lateral aspect of the leg. One thousand nine hundred and twenty-two consecutive patients (1441 females and 481 males) were evaluated from January 2013 to May 2024 by means of clinical examination and the same Duplex Ultrasound Scanning (DUS) protocol. We assessed the frequency of patients presenting with the T vein pattern and the percentage of patients in which it causes symptomatic reflux. We also evaluated the susceptibility, respectively in the T vein and in the CVI cohort, of venous ulcerations (C5-C6 clinical classes according to the Clinical, Etiological, Anatomical, and Pathophysiological, CEAP, classification) in the medial and/or in the medial and lateral aspect of the leg vs exclusively in the lateral aspect of the leg. A p-value &lt;0.05 has been considered significant. Overall, the presence of the T vein pattern was observed in 64 patients (3.33%). There is no statistically significant difference in the prevalence of T vein configuration in males (4.16%) and in females (3.05%) (p-value=0.24). A bilateral T vein pattern has been detected in just one case. T vein was involved in varicose vein networks, with only 2 patients being asymptomatic and without signs of CVI (3.1%). Noteworthy VLU (C5-C6) affected respectively 10 patients of the T vein cohort and 74 of the control population; in the T vein cohort, 80% of patients presented with VLU in the lateral perimalleolar region, while 72.9% of patients in the control group had VLU in the typical medial perimalleolar area (p-value=0.000852). Sometimes the clinician is doubtful about the venous pathogenesis of ulcerations visible in the lateral area of the leg. Our study suggests in these cases to investigate by DUS an eventual reflux coming from the T vein.

Dysregulated S100A9 Expression Impairs Matrix Deposition in Chronic Wounds.

Chronic non-healing wounds are characterized by persistent inflammation, excessive matrix-degrading proteolytic activity and compromised extracellular matrix (ECM) synthesis. Previous studies showed that S100A8/A9 are strongly dysregulated in delayed wound healing and impair the proper function of immune cells. Here, we demonstrate an unrecognized pathological function of S100A9 overexpression in wounds with impaired healing that directly affects ECM functions in fibroblasts. S100A9 was analyzed in two different mouse models mimicking the features of the two most prominent types of non-healing wounds in humans. Db/db mice were used as a model for diabetes-associated impaired wound healing. Iron-overloaded mice were used to mimic the conditions of impaired wound healing in chronic venous leg ulcers. The skin wounds of both mouse models are characterized by delayed wound closure, high and sustained expression of pro-inflammatory mediators and a substantially decreased ECM deposition, all together the hallmarks of non-healing wounds in humans. The wounds of both mouse models also present a solid and prolonged expression of S100A8 and S100A9 that coincides with a compromised ECM deposition and that was confirmed in chronic wounds in humans. Mechanistically, we reveal that S100A9 directly affects ECM deposition by shifting the balance of expression of ECM proteins and ECM degrading enzymes in fibroblasts via toll-like-receptor 4-dependent signaling. Consequently, blocking S100A9 during delayed wound healing in db/db mice restores fibroblast ECM functions eliciting increased matrix deposition. Our data indicate that the dysregulation of S100A9 directly contributes to a compromised ECM deposition in chronic wounds and further suggests S100A9 as a promising therapeutic target to improve tissue repair in chronic wounds.

Introduction and overview on autogenous Platelet concentrates.

This special issue on autologous platelet concentrates (APCs) provides clinicians with an overview on the current understanding of the use of these biomaterials for soft and hard-tissue regeneration. The included papers summarize scientific evidence and the clinical findings, presented in simple tables that outline potential benefits including Patient Reported Outcome Measures (PROMs). This approach enables clinicians to assess clinical relevance and researchers to identify significant gaps in the literature. The first part provides a comprehensive summary of the basic science surrounding APC, with particular focus on their preparation methods. Clear recommendations are outlined, which are crucial for obtaining high-quality APCs, alongside an exploration of how APCs may influence both soft and hard tissue healing processes. Part 2 delves into the clinical evidence for the potential benefits of APCs across a range of applications: alveolar ridge preservation, sinus floor elevation, periodontal plastic surgery, guided tissue regeneration, guided bone regeneration, the healing of Medication-Related Osteonecrosis of the Jaw (MRONJ), and endodontic surgery. In the part 3, the discussion turns to the effects of APCs on the healing of extra-oral wounds, including diabetic foot ulcers, venous leg ulcers, pressure injuries, burns, and more. For those clinicians persuaded by the evidence, the fourth section offers a detailed, step-by-step flowchart for each treatment modality, providing a clear guide for clinical application.

Punch Grafting Technique for the Treatment of Chronic Venous Leg Ulcers

Punch Grafting Technique for the Treatment of Chronic Venous Leg Ulcers

"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 of the Association of Fibrin Scaffolds, Nanohydroxyapatite, and Photobiomodulation with Simultaneous Low-Level Red and Infrared Lasers in Bone Repair.

Biomaterials and biopharmaceuticals for correcting large bone defects are a potential area of translational science. A new bioproduct, purified from snake venom and fibrinogen from buffalo blood, aroused interest in the repair of venous ulcers. Expanding potential uses, it has also been used to form biocomplexes in combination with bone grafts, associated with physical therapies or used alone. The aim of this preclinical study was to evaluate low-level laser photobiomodulation (PBM) in critical defects in the calvaria of rats filled with nanohydroxyapatite (NH) associated with the heterologous fibrin biopolymer (HFB). Sixty animals were used, divided into six groups (n = 10 each): G1 (NH); G2 (HFB); G3 (NH + HFB); G4 (NH + PBM); G5 (HFB + PBM); G6 (NH + HFB + PBM). PBM simultaneously used red (R) and infrared (IR) light emission, applied intraoperatively and twice a week, until the end of the experiment at 42 days. Microtomography, bone formation can be seen initially at the margins of the defect, more evident in G5. Microscopically, bone formation demonstrated immature and disorganized trabeculation at 14 days, with remnants of grafting materials. At 42 days, the percentage of new bone formed was higher in all groups, especially in G5 (HFB, 45.4 ± 3.82), with collagen fibers at a higher degree of maturation and yellowish-green color in the birefringence analysis with Picrosirius-red. Therefore, it is concluded that the HFB + PBM combination showed greater effectiveness in the repair process and presents potential for future clinical studies.

Impact of primary dressings on healing of venous leg ulcers: a French cohort study from the healthcare insurance database.

Multicomponent bandages (MCBs) are recommended by the French Authority for Health (Haute Autorité de Santé) as first-line treatment for venous leg ulcers (VLUs). A first analysis of the data collected from the French administrative healthcare database (Système National des Données de Santé (SNDS)) on 25,255 patients with a VLU supported superiority of MCBs versus short stretch bandages when considering the healing outcomes and costs associated with closure of these wounds. The aim of this study was to assess how beneficial the primary dressing (technology lipido-colloid nano-oligosaccharide factor (TLC NOSF) or control dressing group (CDG)) could be, when used in combination with MCBs in the treatment of VLUs. Data from the SNDS were collected for patients meeting the following inclusion criteria: treatment for a VLU with MCBs and with the same dressing type (TLC-NOSF or CDG) during the whole treatment period. Healing outcomes were documented on the global cohorts and propensity score-matched cohorts. The mean healthcare cost and the ecological impact were calculated for those patients healed within the study period. In total, 12,507 patients met the criteria for treatment with both MCBs and TLC-NOSF dressings (n=1134) versus MCBs and CDG (n=11,373); with 1134 and 2268 patients per group following propensity score matching. Healing outcomes were favourable for the TLC-NOSF group in the global cohort and were enhanced in the propensity score-matched cohorts. At every point of the analysis, the adjusted healing rates were significantly higher in the TLC-NOSF group than in the CDG group (p<0.001). In the propensity score-matched cohorts (n=3402), the healing rate at three months was 52% in the TLC-NOSF group versus 37% in the CDG group (p<0.001). The median healing time was 87 days versus 125.5 days in the TLC-NOSF and CDG groups, respectively (p<0.0001). TLC-NOSF dressings significantly reduced the average treatment cost per healed ulcer (€2099) by 23.7% compared with dressings without TLC-NOSF (€2751) (p<0.001), as well as the resources used. This SNDS analysis confirms, in the largest real-life study performed in VLU management, the superiority of the TLC-NOSF dressings versus those not impregnated with the NOSF compound. Better clinical outcomes associated with cost savings and a positive ecological impact support the combination of MCBs and TLC-NOSF dressings and should be considered as an optimal standard of care for the global management of VLUs. These outcomes reinforce the current positions of the international guidelines on the use of NOSF impregnated dressings (UrgoStart range; Laboratoires Urgo, France) in this pathology.

Continuous muscle pump activation by neuromuscular electrical stimulation of the common peroneal nerve in the treatment of patients with venous leg ulcers: A position paper.

The standard treatment for patients with confirmed Venous Leg Ulcers (VLUs) is compression therapy to improve the function of the calf muscle pump. There is a significant cohort of patients who are unable to tolerate optimal compression therapy or indeed any level of compression therapy. In addition, there is a cohort of patients who can tolerate compression whose ulcers show little or no evidence of healing. There is a need for ways to further improve calf muscle pump function and to improve venous ulcer healing in these patients. Published data were reviewed on the use of Muscle Pump Activation (MPA) using common peroneal nerve neuromuscular electrical stimulation (NMES) to improve calf muscle pump function. There is physiological evidence that MPA can improve calf muscle pump function and venous return in both control subjects and in patients with venous disease. The use of MPA has also been shown to improve venous flow volume and venous flow velocity on ultrasound scanning in patients with venous disease. MPA has been shown to improve microcirculation in the skin using Laser Doppler and laser Doppler Speckle Contrast Imaging, in both normal subjects as well as in patients with venous disease and VLU. A recent randomized controlled trial of MPA plus compression therapy compared with compression therapy alone, found significantly faster rates of healing with the use of MPA in addition to compression therapy. There are indications for the use of MPA as an adjunctive treatment to enhance calf muscle pump function in patients with VLU: who cannot tolerate compression therapy who can only tolerate suboptimal, low-level compression whose ulcer healing remains slow or stalled with optimal compression.

Cytokine stability in chronic wound fluid and its association to fibroblast proliferation.

Cytokines are commonly deregulated in venous leg ulcers. We have investigated cytokine stability by incubating sterile-filtered wound fluids from chronic venous leg ulcers in vitro. Incubation of wound fluids for 24 h at 37°C decreased IL-1β levels by 88% and TNF-α levels by 64%. IL-1β was degraded by serine proteinases and metalloproteinases while the mechanism for reduced TNF-α remains elusive. The levels of the other peptides did not change significantly (p > 0.05). Normal human dermal fibroblasts exposed to five of the six wound fluids showed increased proliferation with the length of prior incubation using an assay optimised for evaluation of wound fluid bioactivity. Exogenous IL-1β and TNF-α unexpectedly increased (p < 0.001) cell proliferation at concentrations that were measured in the wound fluids. In conclusion, the stability of the eight investigated cytokines in wound fluids differed and presumably the loss of detrimental factors, unlikely IL-1β or TNF-α, resulted in increased fibroblast proliferation.