Leg Ulcers Research Articles

Nursing students' skills in applying short-stretch compression bandages using the control of compression bandaging score.

To assess the feasibility using the Control of Compression Bandaging (CCB) score to measure skills development on short-stretch compression therapy during a second-year nursing students' workshop. A quasi-experimental pilot study with one group. All students followed a blended learning unit comprising an e-learning unit on leg ulcers and compression therapy including videos, followed by hands-on workshops where they could exercise how to apply short-stretch compression bandages. Clinical nurse specialists in wound care collected pre- and post-workshop measures. Data collection included feasibility, absolute pressure under compression bandages and the CCB score. Six clinical nurse specialists (CNSs) collected data and 16 students participated in this pilot study. The mean application time was 8.02 minutes (min=2, max=20) pre and 9.25 minutes (min=5, max=17) post workshop. Pressure under compression bandages increased at the forefoot (P=0.01) and the calf muscle base (P=0.03) post workshop. One extreme outlier was observed. In addition, the CCB score increased from 3.57 to 4.47 (P=0.16). Using pressure measuring devices was described as essential by all the CNSs and the CCB score was easy to use. Using the CCB score and pressure measuring devices were feasible during an undergraduate education session. Recruitment procedure and modality of data collection were satisfactory. This score may be a valuable way to assess students' skills in short-stretch compression therapy. If used for formal assessment, a passing score should be defined.

Photogallery. Rare dermatoses. Part II

In continuation of orphan dermatosis, I would also like to say about diseases such as lichen planus ― which is an autoimmune disease in which the expression of an antigen that has not yet been identified by keratinocytes of the basal layer leads to the activation and migration of T-lymphocytes into the skin with the formation of an immune response and an inflammatory reaction.
 BournevillePringle syndrome (tuberous sclerosis complex) is a rare genetic disease that is part of the group of phakomatoses, characterized by a polysystemic lesion involving the skin, central nervous system, organs of vision, etc. in the pathological process.
 Bullous scleroderma is a rare type of localized scleroderma with a predominant skin lesion in the form of foci of induration and sclerosis, subepidermal blisters with serous contents.
 Trichoadenoma is a rare skin tumor belonging to the group of benign follicular tumors. Consists of numerous, relatively large, round or oval funnel-shaped structures separated by an underdeveloped fibrous stroma.
 Pseudolymphoma is a reactive polyclonal T- or B-cell lymphoproliferative process that can manifest as both localized and disseminated skin lesions.
 Giant flaming nevus of the skin of the face is usually a benign disease, but in some cases malignancy is possible.
 T-cell anaplastic lymphoma associated with sarcoidosis is characterized by lymphadenopathy, lesions, circulating abnormal lymphocytes, and hypercalcemia leading to the sarcoidosis-lymphoma syndrome.
 Devergy's disease is caused by a violation of keratinization and the appearance of follicular hyperkeratotic papules, palmoplantar hyperkeratosis and erythematous scaly plaques with an orange tint.
 FavreShay ocher yellow dermatitis occurs in patients with varicose ulcers on the inner surface of the lower third of the legs, which it either precedes or accompanies.
 Sweet's febrile neutrophilic dermatosis manifests itself in three clinical cases: classical (the disease is preceded by an infectious disease), malignant (occurs as a paraneoplastic syndrome), medicinal (most often occurs in patients treated with G-CSF).
 Lipodermatosclerosis is manifested by induration and hyperpigmentation of the skin, affecting one or both legs, in a characteristic "upside down champagne bottle" appearance.

Efficacy of Irsal-i-Alaq (Hirudotheraphy) in the Management of Venous Ulcer: A Case Report

Background: The most frequent and recurring type of leg ulcers seen in general practise is a venous ulcer (stasis ulcer). Its neglect has a considerable negative influence on quality of life, might result in gangrene, and may necessitate amputating the affected limb. The most serious and incapacitating complication of chronic venous insufficiency is venous ulcer. The conventional system of medicine offers limited clinical evidence for its effectiveness and usually needs amputation. Hence, it can be managed well by one of the Unani regimens, i.e., Irsal-e-Alaq (Hirudotherapy). Objective: The purpose of this case report is to provide insight into the effects of Irsal-e-Alaq (Hirudotherapy) in venous ulcer. Intervention: A 53-year-old male who has complaints of ulcer in left lower leg near lateral malleolus with swelling, pain, discharge and darkening of skin of left lower limb. Four leeches were applied once every 15 days for 45 days. Ulcer was assessed on 0th day, 15th day, 30th day and 45th day on the basis of area of the wound in a square centimetre, appearance of healthy granulation tissues, epithelization in percentage and depth of wound in centimetres, pain (VAS scoring), discharge, smell and number of wounds. Results: on the first day wound size was 4 cm long, 3 cm wide, 2 cm deep and the floor filled with dark granulation tissue with 0 % epithelization, discharge, pain and smell. On the 45th day ulcer was completely healed with 100% epithelization. Conclusion: Irsal-e-Alaq has been proven beneficial in treating venous ulcers and enhancing patients' quality of life. To determine the effectiveness of Irsal-e-Alaq in the management of venous ulcer, rigorous, controlled, randomised, blinded, and long-term follow-up studies on high sample sizes are required.
 Keywords: Hirudotherapy, Unani Medicine, Leech Therapy, Varicose Ulcers

Venous Leg Ulcer: A Review

Chronic venous disease (CVD) is prevalent in the aging population and leads to venous leg ulcers (VLUs). These wounds can last and recur for years, significantly impacting quality of life. A large body of literature exists on CVD and VLU diagnosis and treatment. Multiple algorithms, guidelines, and consensus documents have been published on this topic, highlighting the importance of this issue in clinical practice. Compression is still the mainstay of treatment for CVD and VLUs. Compression is needed long term, but it does not suffice by itself to prevent recurrences without interventional correction. Venous intervention should be offered early to prevent or slow disease progression and reduce recurrence.

Physical exercise for the treatment of non-ulcerated chronic venous insufficiency.

Physical exercise for the treatment of non-ulcerated chronic venous insufficiency.

Prevalence and incidence of venous leg ulcers-A systematic review and meta-analysis.

Venous leg ulcers (VLU) represent a major public health challenge. Little is known about the prevalence and incidence of VLU internationally. Published studies are usually reporting different estimates because of disparities in study designs and measurement methods. Therefore, we conducted a systematic literature review and meta-analysis to identify the prevalence and incidence of VLU internationally and to characterise the population as reported in these studies. Studies were identified from searches in Medline (PubMed), CINAHL Complete (EBSCOhost), Embase, Scopus, Web of Science, LiSSa (Littérature Scientifique en Santé), Google Scholar and Cochrane Database of Systematic Reviews up to November 2022. Studies were included if their primary outcomes were reported as a period prevalence or point prevalence or cumulative incidence or incidence VLU rate. Fourteen studies met the inclusion criteria, 10 reporting estimates of prevalence, three reporting both prevalence and incidence estimates and one incidence. All were included in meta-analyses. The results show a pooled prevalence of 0.32% and a pooled incidence of 0.17%. Our results highlighted an extreme heterogeneity across effect sizes for both prevalence and incidence, which prevent a meaningful interpretation of pooled indexes and argue for further studies with specific prevalence-type reported and target population under study.

Ulcus cruris venosum v kontexte kvality života chorých

Ulcus cruris venosum v kontexte kvality života chorých

Evaluation of the Efficacy of an Online Learning Module to Increase Wound Care Theoretical Knowledge Amongst Medical Students

We developed and evaluated an online learning module for teaching wound care basics to junior medical learners, which was assessed for its ability to increase theoretical knowledge of wound care, and medical learners' perceptions on the use of an online module to teach wound care practices. Between February 2022 to November 2022, participants were enrolled into our unblinded, matched-pair single-arm study. Participants completed a pre- and postquiz prior to and after completing the online module, respectively. Scores on the pre- and postquiz were matched by participant and evaluated for improvement. The online module was composed of free text, animated videos with voiceovers, pictorial examples, and tables, as well as unscored knowledge checks, covering the categories of i) normal wound healing physiology, ii) describing wounds/assessment of wounds, iii) choosing dressings for wounds, and iv) addressing and understanding wound aetiologies, including diabetic, arterial, and venous ulcers. Participants were enrolled at the University of Toronto in Toronto, Canada. Participants were recruited from the undergraduate medicine and physician assistant programs at the University of Toronto. Students were provided with information on how to participate in the study through email and in-person recruitment. Thirty-three participants entered the study, and 23 participants completed the study. Across all participants, the prequiz to postquiz score increase averaged 13.29%, representing a statistically significant increase (p = 0.0000013). Ten of the 20 questions and all question categories had a statistically significant increase in the postquiz scores. All respondents found the module very useful (67%) or extremely useful (33%) for learning wound care, and 67% were very satisfied overall with the quality of the module, with the remainder (33%) of respondents somewhat satisfied. Online learning modules are effective at increasing wound care knowledge in junior medical learners, with high satisfaction amongst learners.

Cost-effectiveness of two reduced pressure compression systems in treating newly diagnosed venous leg ulcers.

To assess the clinical outcomes and cost-effectiveness of using two different reduced pressure compression systems in treating newly diagnosed venous leg ulcers (VLUs) in clinical practice, from the perspective of the UK's National Health Service (NHS). This was a modelling study based on a retrospective cohort analysis of the case records of patients with a newly diagnosed VLU, randomly extracted from The Health Improvement Network (THIN) database, who were initially treated with a two-layer cohesive compression bandage (TLCCB Lite; Coban 2 Lite, 3M, US) or a two-layer compression system (TLCS Reduced; Ktwo Reduced, Urgo, France). No significant differences were detected between the groups. Nevertheless, analysis of covariance (ANCOVA) was performed to enable differences in patients' outcomes between the groups to be adjusted for any heterogeneity in baseline covariates. Clinical outcomes and cost-effectiveness of the alternative compression systems were estimated over 12 months after starting treatment. Time from wound onset to starting compression was a mean of two months. The probability of healing at 12 months was 0.59 in the TLCCB Lite group and 0.53 in the TLCS Reduced group. Patients in the TLCCB Lite group experienced a marginally better health-related quality of life (HRQoL) of 0.02 quality-adjusted life years (QALYs) per patient compared to those in the TLCS Reduced group. The 12-month NHS wound management cost was £3883 per patient treated with TLCCB Lite and £4235 per patient treated with TLCS Reduced. When the analysis was repeated without ANCOVA, the findings from the base case analysis remained unchanged (i.e., use of TLCCB Lite improved outcomes at lower cost). Within the study's limitations, treating newly diagnosed VLUs with TLCCB Lite instead of TLCS Reduced potentially affords a cost-effective use of NHS-funded resources in clinical practice, since it is expected to result in an increased healing rate, better HRQoL and a lower NHS wound management cost.

Venous eczema: more than just a rash.

Venous eczema-also known as varicose, gravitational or stasis eczema-is a common form of eczema. In fact, 37-44% of patients with leg ulcers can present with a venous eczema. It is highly unpleasant, and can disrupt an individual's personal and social life. In this article, Drew Payne provides a community nurse's perspective on what venous eczema is, how to manage it in patients, and how to prevent further reoccurences.

A qualitative study of patients' experiences of living with hard-to-heal leg ulcers.

Patients with hard-to-heal leg ulcers are often older and have underlying conditions that contribute to making wound healing more difficult. Hard-to-heal leg ulcers are often treated in primary care and form a large part of the district nurse's work. To describe patients' experiences of living with hard-to-heal leg ulcers. This qualitative study undertook 18 interviews with patients in primary care with hard-to-heal leg ulcers. A total of three categories were identified: 'Living with changes in everyday life', 'Being dependent on care', and 'Experiencing and dealing with suffering'. The patients described limitations in physical activity and changes in social interaction. Suffering was described in different ways and also resulted in coping strategies. Living with hard-to-heal leg ulcers affects the patient's everyday life physically and mentally. Knowledge about the complexity of patients' experiences can contribute to better care and increased quality of life in a difficult situation.

RWD103 Comparative Effectiveness of a Bilayered Living Cellular Construct and a Cryopreserved Cadaveric Skin Allograft for Use in Venous Leg Ulcers

Using real-world data (RWD) we conducted a comparative effectiveness analysis of bilayered living cellular construct (BLCC)(a) versus a cryopreserved cadaveric skin allograft (CCSA)(b) for the treatment of Venous Leg Ulcers (VLUs).

EFEKTIVITAS AIR MINERAL SEBAGAI CAIRAN PENCUCI LUKA UNTUK PENYEMBUHAN LUKA KRONIS

Background: Chronic wounds occur as a result of a failure in the wound healing process and until now have become a health problem that requires proper management. Several types of chronic wounds include venous leg ulcers (VLU), pressure ulcers (PU), diabetic foot ulcers (DFU). The use of wound cleansing fluid is one of the factors that plays an important role in chronic wound healing. Wound cleansing aims to clean the wound from the remains of previous dressings and reduce the number of bacteria. Mineral water is a type of liquid that can be used for cleansing chronic wounds and is easy to gain.Aim: The aim of this study was to determine the effectiveness of using mineral water as a wound washing fluid in the process of chronic wound healing. The research method was a quasi-experimental without a control group for 20 samples using PUSH (pressure ulcer scale for healing)tool assessment, processing data using the SPSS program with the Wilcoxon test. Result: The study result showed that a mean difference before (12.4) and after (1.9) wound care with mineral water as a wound washing fluid with p-value = 0.000. Conclusion: Mineral water has been proven effective as a wound washing fluid to support the healing process of chronic wounds. Keywords: Mineral Water ; Chronic Wound ; Wound Healing

Severity of Chronic Venous Insufficiency on Primary Total Knee Arthroplasty Outcomes

BackgroundMore than 700,000 people in the United States undergo total knee arthroplasty (TKA) each year. Chronic venous insufficiency (CVI) affects 5% to 30% of adults, sometimes resulting in leg ulceration. These CVI cases in TKAs have been associated with worse outcomes; however, we found no study differentiating CVI severity. MethodsThis retrospective study analyzed TKA outcomes at one institution from 2011 to 2021 using patient-specific codes. Analyses included short-term complications (< 90 days postoperative), long-term complications (< 2 years), and CVI status (yes/no; simple/complex/unclassified). Complex CVI consisted of pain, ulceration, inflammation, and/or other complications. Revisions within 2 years and readmissions within 90 days post-TKA were assessed. Composite complications included short-term and long-term complications, revisions, and readmissions. Multivariable logistic regressions predicted complication (any/long/short) as a function of CVI status (yes/no; simple/complex) and potential confounding variables. Of 7,665 patients, 741 (9.7%) had CVI. Among CVI patients, 247 (33.3%) had simple CVI, 233 (31.4%) had complex CVI, and 261 (35.2%) had unclassified CVI. ResultsThere was no difference in CVI versus control in composite complications (P = .722), short-term complications (P = .786), long-term complications (P = .15), revisions (P = .964), or readmissions (P = .438) postadjustment. Composite complication rates were 14.0% without CVI, 16.7% with complex CVI, and 9.3% with simple CVI. Complication rates differed between simple and complex CVI (P = .035). ConclusionOverall, CVI did not affect postoperative complications versus control. Patients who have complex CVI are at higher risk for post-TKA complications compared to those who have simple CVI.

FROM SEIZURES TO WOUNDS: THE POTENTIAL OF PHENYTOIN IN TRAUMATIC WOUND MANAGEMENT

Objective: Phenytoin is a medication primarily used to treat seizures, but it has been discovered to have the potential for wound healing due to its ability to increase collagen production, promote new blood vessel growth, reduce inflammation, fight infections, and encourage new skin growth. These effects are particularly useful for healing chronic wounds like pressure ulcers, diabetic ulcers, traumatic wounds, and venous ulcers. Methods: This is a two-year prospective study conducted between January 2020 and December 2022 at the Government General Hospital in Kurnool. A study was conducted on 60 patients with traumatic wounds, dividing them into two groups. One group received topical phenytoin dressing, while the other received normal saline dressing. The study compared wound surface area, granulation tissue percentage, pain ratings on the visual analog scale, and healing time between the groups on day 14 and day 21. Results: On day 0, cases and controls had similar wound surface areas (62.17±25.74 cm2 and 62.14±21.57 cm2, respectively) and VAS scores (8.81±1.22 and 8.88±1.52). By day 14, cases had significantly smaller wound surface areas (41±32.32 cm2), a higher percentage of granulation tissue (75.56±7.30%), and lower VAS scores (4.57±1.78) compared to controls (53.28±25.33 cm2, 58.45±7.01%, and 6.32±1.02, respectively). By day 21, cases had even smaller wound surface areas (28.3±31.75 cm2), a higher percentage of granulation tissue (93±3.46%), and lower VAS scores (2.78±0.42) compared to controls (40.34±34.23 cm2, 72.56±5.05%, and 4.82±1.27, respectively). The time for wound healing was significantly shorter for cases (22.76±7.28 d) compared to controls (32.64±9.31 d). On day 21, negative cultures were found in 80% of wounds in the study group and 50% of wounds in the control group, with a statistically significant difference (P-value&lt;0.05). Conclusion: Topical phenytoin dressing had positive effects on wound healing by increasing the rate of granulation tissue formation, providing better pain relief, and shortening the healing time. It was found to be a safe, effective, and cost-effective option for wound healing due to its various mechanisms. The study highlights the significance of phenytoin in treating traumatic wounds, particularly in patients with limited access to expensive wound-healing medications.

Combined Management of Wound Ulcers With Focus on Interventional Techniques

This review provides a summary of current practice patterns in managing venous ulcers. The authors will describe the workup for venous ulcers, including differentiation of symptoms, physical examination, and imaging to guide the most effective treatment course for each patient. An overview of conservative management and minimally invasive treatment options for venous ulcers will be provided with a specific focus on periulcer foam sclerotherapy to aid in preventing ulcer recurrence and promoting healing. We will give interventional troubleshooting techniques for challenging patient presentations.

May-Thurner Syndrome

May-Thurner Syndrome is a rarely diagnosed condition in which patients develop ilio-femoral deep venous thrombosis (DVT) due to an anatomical variant in which the right common iliac artery overlies and compresses the left common iliac vein against the lumbar spine. Early recognition and treatment of this condition can prevent debilitating sequelae of chronic venous hypertension. Accurate diagnostic modalities are transabdominal ultrasound, MRI but the widely available noninvasive MDCT accurately depicts left iliac venous compression by the right iliac artery. May-Thurner Syndrome treatment focuses on improving blood flow and reducing your risk of developing DVT. Treatments are angioplasty and stenting; bypass surgery and surgery to move the right iliac artery. May-Thurner Syndrome is a progressive disease with long-term disabling complications. This type of obstruction may cause leg swelling, varicosities, deep venous thrombosis, chronic venous stasis ulcers, or more serious complications, such as pulmonary embolism or phlegmasia cerulea dolens. In conclusion, May-Thurner Syndrome should be taken into consideration if there is persistent edema of the left leg, especially in young women.

Multidisciplinary Approach to Venous Disease: Enhancing Patient Care and Trainee Education Through Collaboration

The full spectrum of venous disease poses a significant burden on individuals and health-care systems globally. Venous disease can lead to a wide range of symptoms based on the level of disease and underlying pathology. In general, underlying pathologies are due to nonthrombotic (reflux/obstructive) and thrombotic causes. Most conditions are a sequela of the long-term effects of chronic venous insufficiency, deep vein thrombosis (DVT), or nonthrombotic deep vein obstruction. The prevalence of venous disease is substantial, impacting the quality of life of a considerable proportion of the adult population. Untreated and progressive lower extremity venous disease can lead to venous ulceration and other complications. Additionally, poorly recognized and poorly understood venous conditions of the abdomen and pelvis leave many patients "orphaned" in health-care systems that lack expertise in complex venous conditions. Addressing the burden and breadth of venous disease requires comprehensive management approaches, early diagnosis, appropriate treatment interventions, and provider and patient education. Multidisciplinary collaborations and further research are essential to enhance our understanding, develop innovative therapies, and improve patient outcomes in the field of venous disease. In this paper, we highlight the importance of multidisciplinary collaboration and our journey to building an institutional venous team, as well as lessons learned.

NURSING DIAGNOSES AND INTERVENTIONS IN PATIENTS WITH CHRONIC WOUND IN PRIMARY AND SECONDARY CARE

Objective: To identify nursing diagnoses and interventions related to patients with chronic wound produced by a specific system in primary and secondary care. Method: Descriptive study conducted between July and October 2022. We used data from the Systematization of Nursing Care in Wounds–anagerial (SAEFg) system. The study was approved by the Ethics and Research Committee, under Opinion no. 4.329.008/2020. Results: There were 314 records of diagnoses and 1,300 of nursing interventions. The main nursing diagnoses were: venous ulcer (17.6%), impaired wound healing and anxiety (7.6%), risk of falling (7.1%), risk of infection (6.7%), and pruritus (6.4%). The interventions were: prescribe/guide leg elevation (9.3%), guide not to scratch or use abrasive products (8.3%), examine skin conditions (7%), and describe/document wound characteristics (5.5%). Conclusion: The main nursingdiagnoses and interventions were about tegumentary, emotional and risk aspects such as fall and infection. The highest occurrence of records was in secondary care.

Antimicrobial Biomaterials for Chronic Wound Care.

Chronic wounds encompass a myriad of lesions, including venous and arterial leg ulcers, diabetic foot ulcers (DFUs), pressure ulcers, non-healing surgical wounds and others. Despite the etiological differences, chronic wounds share several features at a molecular level. The wound bed is a convenient environment for microbial adherence, colonization and infection, with the initiation of a complex host-microbiome interplay. Chronic wound infections with mono- or poly-microbial biofilms are frequent and their management is challenging due to tolerance and resistance to antimicrobial therapy (systemic antibiotic or antifungal therapy or antiseptic topicals) and to the host's immune defense mechanisms. The ideal dressing should maintain moisture, allow water and gas permeability, absorb wound exudates, protect against bacteria and other infectious agents, be biocompatible, be non-allergenic, be non-toxic and biodegradable, be easy to use and remove and, last but not least, it should be cost-efficient. Although many wound dressings possess intrinsic antimicrobial properties acting as a barrier to pathogen invasion, adding anti-infectious targeted agents to the wound dressing may increase their efficiency. Antimicrobial biomaterials may represent a potential substitute for systemic treatment of chronic wound infections. In this review, we aim to describe the available types of antimicrobial biomaterials for chronic wound care and discuss the host response and the spectrum of pathophysiologic changes resulting from the contact between biomaterials and host tissues.