Treatment Of Venous Ulcers Research Articles

Treatment of Venous Ulcer Related to Acquired Arteriovenous Fistula

Treatment of Venous Ulcer Related to Acquired Arteriovenous Fistula

Cost and effectiveness of Platelet Rich Plasma in the healing of varicose ulcer: Meta-analysis.

to analyze the evidence on the cost and effectiveness of Plaque Rich Plasma in the treatment of venous ulcers compared to other topical therapies. systematic review, with search in the databases: COCHRANE, EMBASE, MEDLINE via PubMed, LILACS, CINAHL, SCOPUS, without temporal cut and in the English, Portuguese and Spanish languages. fifteen articles were included, a cost-minimization analysis showed that the cost of Plaque Rich Plasma is € 163.00 ± 65.90, slightly higher than the cost of standard dressing. Regarding effectiveness, the results of the studies associated with the meta-analysis suggest a tendency that Plaque Rich Plasma is effective in the healing of venous ulcers. it is concluded that there are few studies about the cost of Platelet Rich Plasma and this product tends to be effective in the healing of venous ulcers. However, more controlled and randomized clinical studies are necessary in order to establish a stronger recommendation.

Using compression therapy in a primary care setting to treat complications of chronic venous insufficiency.

Patients with chronic venous insufficiency (CVI) are prone to developing complications such as slow-healing venous leg ulcers. Nurse practitioners can assess patients for complications of CVI during routine examinations. If found, they can implement compression therapy and possibly prevent the development of slow-healing venous leg ulcers. A retrospective chart review of patient occurrences with complications due to CVI between 2011 and 2018 was conducted to evaluate patient outcomes when treated with compression therapy by their primary care providers (PCPs). Patients were identified by the Unna boot's Current Procedural Technology code, the compression therapy used by the providers. Patients included in the review had the diagnosis of or symptoms of CVI. Patient outcomes were identified as improved, unchanged, or deteriorated. The use of compression therapy for patients with documented complication of CVI. The Unna boot was the compression device used at this practice. There were 60 occurrences distributed among 40 patients who met the inclusion criteria. Of the 60 occurrences, 54 or 90% of patient occurrences had an improvement of symptoms. According to the Wound Healing Society Guidelines, high compression therapy, such as the Unna boot, is classified as most supportive, for treatment of venous ulcers. The results of this study demonstrate the positive impact PCPs, including nurse practitioners, may have when initiating compression therapy for patients with complications of CVI.

A Randomised Controlled Clinical Trial Comparing the Effectiveness of Bandaging Compared to The Juxta Curestm Device in the Management Of People with Venous Ulceration: Feasibility Study

Introduction: Venous ulceration affects 0.6% of the adult population, increasing in the elderly, and costs the NHS £662 million per annum. Compression therapy is the mainstay of treatment for venous ulceration. This is an expensive, time consuming treatment often lasting several months prior to ulcer healing. Current bandaging significantly impacts quality of life (qol), is time consuming, and loses compression over time. Velcro wrap devices have recently been used to treat patients with venous ulceration offering potential advantages such as removability, washability, and self care.

Foam Sclerotherapy of Incompetent Perforators with Compression Versus Compression alone for Treatment of Chronic Venous Leg Ulcers

Introduction: Venous Leg Ulcers account for 70% of all leg ulcers and estimates 1% of the populatio Objective: To compare the efficacy of compression +duplex guided injection sclerotherapy of incompetent perforators versus compression alone in treatment of chronic venous leg ulcers. Methods: Patients (older than 18 years) attending at outpatient clinic of Vascular Surgery Department, Faculty of Medicine-Zagazig University, were invited to participate in our study.Results: The study was Randomized Control Trial, conducted on 22 patients with chronic lower limb venous ulcer subdivided in two groups by control randomization, each group 11 patients (11ulcers) : Group A: - (compression only) this group was conservatively managed by four-layer compression bandage after ulcer debridement and irrigation by saline solution for 6 sessions with one weak interval between sessions. Group B: - (compression + foam injection) this group was managed by foam sclerotherapy of incompetent perforators then four-layer compression bandage after ulcer debridement and irrigation by saline solution also for 6 sessions with one-week interval between sessions Conclusion: The compression therapy is important line in management of venous ulcers. This synergistic approach can improve quality of life . Duplex-guided sclerotherapy is a simple procedure, compared to surgical intervention, no hospitalization, no anaesthesia, can be done in outpatient clinic and the patient can return home after 45 min and no work off period. The relative freedom from serious complications and its evident success, make this the first line treatment for venous ulcer and superior to compression alone.

Construction and validation of an educational leaflet for treatment of venous ulcer

Objective: To build and validate an educational leaflet for treatment of patients with ulcer of venous etiology. Methods: Methodological study, developed in two stages: construction of the educational leaflet by literature review and content validation of the material by judges specializing in the subject. Results: The instrument obtained a Content Validity Index (CVI) above 0.80; only one item was modified after the judges’ suggestion. Conclusion: The educational leaflet was presented to be understandable and comprehensive for the content.

Intermittent pneumatic compression in patients with ESRD. A systematic review.

Patients with end-stage renal disease (ESRD) experience frequent hemodialysis (HD) complications. Intradialytic hypotension (IDH) is a common complication presenting in approximately between 20 and 50% of HD sessions. Available interventions such as volume replacement or vasoactive medications are associated with significant side effects. Intermittent pneumatic compression (IPC) has been proposed as a feasible intervention for the prevention of IDH, treatment of peripheral arterial disease and venous ulcers. These devices apply intermittent pressure to the legs improving arterial blood flow, mobilization of pooled blood with an increase in venous return increasing the effective circulatory volume. Our goal was to identify the published clinical evidence on whether IPC has a circulatory benefit and is it well-tolerated among patients receiving HD. We conducted a systematic review to identify studies assessing the efficacy and safety of IPC in patients with ESRD. Our primary outcome was IDH. Secondary outcomes such as HD comfort, ultrafiltration volume, and physical activity were collected. No restrictions where used and we included all observational and interventional studies. Two reviewers performed screening and study quality assessment. We included seven studies. Out of the seven studies, five addressed IDH, and the rest were included for secondary outcomes such as physical capacity and HD comfort. In one randomized crossover trial comparing exercise against IPC, 21 patients were randomized to 3 different arms (no intervention, cycling, IPC) a decrease in the rates of IDH with IPC was described (43%, 38%, and 24% respectively P = 0.014). The smaller studies corroborated these results. All studies where at high risk of bias. IPC might offer significant benefits for patients undergoing HD not limited to prevention of IDH but also improvement of hemodialysis comfort and physical capacity. However, our results should be interpreted in the context of its limitations.

Role of Four Layer Compression Dressings in Management of Chronic Venous Ulcers

Abstract Introduction Nonhealing venous ulcers are one of the most common forms of lower extremity ulcers in the present population. It is cumbersome to treat and is associated with high-morbidity and immense treatment expenses. The current treatments include compression therapy. Four-layer compression dressings have proven to be an effective treatment for venous ulcers. Objective This study aimed to evaluate the efficacy of four-layer compression dressings and to study the rate of healing and duration of treatment with four-layer compression dressings. Materials and Methods A prospective randomized study conducted at MS Ramaiah Medical college which included 70 patients who completed the course of weekly dressings depending on the size of ulcer. The regular four-layer dressings were done by a trained podiatrist in vascular outpatient department (OPD) once a week. The area of the ulcer was calculated using the modified Gilmen formula. Results A total of 70 patients who were compliant with the treatment were included in the study. A considerable percentage (74%) of patients were male and all the ulcers were located at the gaiter area. Most belonged to the age group between 41 to 50 years (25%). The healing rate of ulcers at the end of 4, 8 and 12 weeks were 46.87, 28.12, and 25%, respectively. At the end of 12 weeks, all the ulcers healed.

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

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

Evaluating the combined effects of gravity and compression on the fluid handling properties of surgical dressings.

A new test method is described which provides a convenient technique for assessing the combined effects of gravity and compression on the fluid handling characteristics of surgical dressing which can have important implications for their use in the treatment of venous ulcers. Simple ways of improving use of the fluid handling capacity of products currently used clinically are suggested, and the possibility of developing a dressing specifically designed to resist gravitational effects is discussed.

The Role of Fat Grafting in the Treatment of Keloid Scars and Venous Ulcers.

Autologous fat grafting is an increasingly popular practice in the field of plastic surgery. Since the 1980s, it has become one of the most commonly performed procedures by plastic surgeons. Fat grafting has applications in a variety of clinical scenarios, ranging from breast reconstruction to facial volume loss. Recently, the benefit of fat grafting has been employed in wound healing and the treatment of troublesome scars. In this article, we describe the role of fat grafting in the treatment of keloid scars and venous ulcers.

Vasculogenic Chronic Ulcer: Tissue Regeneration with an Innovative Dermal Substitute.

The healing of venous and arterial ulcers is slow, and in some cases, they may not heal at all. This study aims to demonstrate the clinical advantage of Nevelia®, an innovative collagen dermal template substitute (DS) in venous and arterial chronic ulcers treatment. 35 patients affected by chronic vascular ulcers with a mean area of 35.1 ± 31.8 cm2 were treated with DS followed by autologous dermal epidermal graft (DEG). Follow-up was performed at 7-14-21 and 28 days after DS implant and 7-14-21 and 28 days after DEG. At 28 days after DEG, the mean values of Manchester Scar Scale was of 1.8 ± 0.7 for skin color, 1.6 ± 0.7 for skin contour, 1.7 ± 0.7 for distortion, and 1.7 ± 0.7 for skin texture, whereas skin was matte in 27 patients (77%) and shiny in the remaining eight cases (23%). Histological findings correlate with the clinical result showing a regenerated skin with reactive epidermal hyperplasia and dermal granulation tissue after two weeks (T1), and after three weeks (T2) a re-epithelialization and a formed new tissue architecture analogue to normal skin physiology. These data suggest that Nevelia® could be useful to treat chronic venous and arterial ulcers.

Concentrated suspension of platelets and collagen in the treatment of venous trophic ulcers of large size

Concentrated suspension of platelets and collagen in the treatment of venous trophic ulcers of large size

Medical Applications of Collagen and Collagen-Based Materials.

Collagen and collagen-based materials have been successfully used in medicine for over 50 years. The number of scientific articles about the role of collagen in the construction of scaffolds for tissue engineering has risen precipitously in recent years. The review contains materials about historic and modern applications of collagen in medicine such as soluble collagen injections, solid constructs reconstructed from solution, and decellularized collagen matrices. The analysis of published data proves the efficacy of collagen material in the treatment of chronic wounds, burns, venous and diabetic ulcers, in plastic, reconstructive and general surgery, urology, proctology, gynecology, ophthalmology, otolaryngology, neurosurgery, dentistry, cardiovascular and bone and cartilage surgery, as well as in cosmetology. Further development of collagenoplasty requires addressing the problems of allergic complications, improvement of structure and maximizing therapeutic effects against pathological processes.

Review of adjustable velcro wrap devices for venous ulceration

Compression therapy is the mainstay of treatment for patients with venous leg ulcers. Current gold standard is 4 layer bandaging, which has a significant impact on patients comfort, ability to wear their own shoes, and quality of life, as well as taking significant time to apply, and losing compression over time. This systematic review aims to evaluate the use of Velcro wrap devices for the treatment of venous ulceration. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were used to identify articles reporting the use of Velcro wrap devices in patients with venous ulceration. Sixteen articles were identified (14 case series, 1 randomised trial, and 1 audit) reporting on 192 patients. There were reports of improved time to healing, reduced cost by >50%, reduced number and duration of nursing appointments, and improved quality of life in patients in Velcro wrap devices. Although the evidence remains poor, Velcro devices have potential to improve outcomes for patients with venous ulceration and further good quality studies should be undertaken to evaluate these further.

03:36 PM Abstract No. 155 Inframaleolar venous access for endovascular treatment of venous insufficiency ulcers

03:36 PM Abstract No. 155 Inframaleolar venous access for endovascular treatment of venous insufficiency ulcers

Treatment of venous ulcers with growth factors: systematic review and meta-analysis.

To identify evidence about the effects of growth factor application on venous ulcer healing. Systematic review and meta-analysis, including Randomized Clinical Trials. Searches: Ovid MEDLINE, EMBASE, CINAHL, Cochrane CENTRAL, LILACS, Web of Science, Digital Library of Theses and Dissertations; Google Scholar and list of references. 802 participants were recruited from the 10 included studies: 472 in the intervention group (growth factors) and 330 as control. The relative risk for the complete healing outcome was 1.06 [95% CI 0.92-1.22], p = 0.41. Participants who received Platelet-Rich Plasma and Epidermal Growth Factor showed a slight tendency to achieve complete healing, but without statistical relevance (p <0.05). Most of the studies were classified as moderate risk of bias. The effect of the application of growth factors for complete healing in venous ulcers is not clear, and clinical trials with methodological quality are required for more accurate recommendations.

Improvement the quality of life of patients with trophic ulcers of venous etiology in the application of photodynamic therapy

Purpose. To analyze quality of life dynamics of patients with trophic venous ulcers of the lower limbs after the treatment with the use of photodynamic therapy. Materials and methods. Quality of life research was conducted in 57 patients with trophic ulcers of venous etiology. The first group included 30 patients who received standard treatment, the second group — 27 patients, in which standard treatment was combined with a course of photodynamic therapy. To assess the quality of life of the patients in both groups, a questionnaire was conducted using the EuroQol-5D-5L survey system and the visual analogue scale EQ-VAS. The quality of life assessment was carried out at the beginning of treatment, 10 days and 6 weeks after starting treatment. Results. The results indicate a significant improvement in the quality of life in both groups, but the degree of improvement in this indicator in group 2 was 20.7 % higher.An analysis of the dynamics of improvement in quality of life showed an increase in the mean of the indicator 10 days after the beginning of treatment in patients in the first group of 26.7 %, the second group by 43 %, and in 6 weeks, its increase was achieved in patients in the first group by 32.7 %, in the second group — by 53.4 %. Conclusions. The use of photodynamic therapy in the treatment of venous trophic ulcers significantly affects the quality of life, which is manifested in the anti-inflammatory effect and reduction of pain syndrome in the shorter term (by 76.2 %), compared with patients in the first group.

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

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

Experience of adults and older people with adherence to venous ulcer care.

To understand the experience of adults and older people with adherence to venous ulcer care. A qualitative study based on the concepts of Alfred Schütz's social phenomenology was carried out with 12 adults and older people undergoing venous ulcer treatment in a specialized service in the state of Minas Gerais. The interviews were carried out from October to November 2015, analyzed, categorized, and discussed based on the theoretical-philosophical framework adopted and on thematic literature. The following thematic categories emerged from the interviews: "beliefs and personal and social activities hindering adherence to care"; "being protagonists in the care relationship with venous ulcers", and "motivation for adherence to care". The intersubjective relationship established between patients with venous ulcers and healthcare professionals emerged as a driving force for adherence to care. Promoting the reciprocity relationship of perspectives between these social actors may promote greater adherence to venous ulcer care.