Treatment of therapy-refractive ulcera cruris of various origins with autologous keratinocytes in fibrin sealant

Background: Evaluation of the effects of cultivated, subconfluent, autologous keratinocytes in fibrin sealant (BioSeed®-S) on the healing of therapy-refractive chronic wounds. Patients and methods: Open observational study in 60 patients with chronic leg ulcers and impaired wound healing of various origins. After whole-skin excision and cultivation of the autologous keratinocytes, the suspended cells were applied to the preconditioned wound in fibrin sealant. Wound epithelization and wound size were recorded at defined times. Results: Fifty-two of the 60 participating patients could be evaluated. After 6 weeks, 29 ulcers (55.8%) were healed. The mean epithelization increased between the 8th and 42nd postoperative day from 23% to 62.5%. In 50.0% of the patients, global assessment of the wound showed a high degree of epithelization or healing after 42 days. In 32.6 % of treated patients, improvement was observed, while no healing tendency was to be found in 17.4%. Conclusion: The present observational study indicates that the transplantation of autologous keratinocytes suspended in fibrin sealant could be of advantage in the treatment of refractive leg ulcers.

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Efficacy of platelet rich plasma in chronic leg ulcers: a prospective randomized controlled study

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20205600 ◽

2020 ◽

Vol 7 (1) ◽

pp. 78

Author(s):

Naphisabet Wanniang ◽

Pankaj Shukla ◽

Varadraj V. Pai

Keyword(s):

Chronic Wounds ◽

Platelet Rich Plasma ◽

The United States ◽

Complete Healing ◽

Controlled Study ◽

Control Group ◽

Leg Ulcers ◽

The Mean ◽

Chronic Leg Ulcers ◽

Area And Volume

Background: Chronic wounds affect approximately 1-2% of the population in Europe and the United States. Platelet rich plasma (PRP) has emerged as an effective, inexpensive, minimally invasive treatment modality for chronic leg ulcers. Objective of the study was to evaluate the efficacy of PRP, and to compare the effectiveness of PRP to regular antiseptic dressing in the management of chronic leg ulcers.Methods: A hundred patients with chronic leg ulcers of more than 6 weeks duration were randomized into two groups (PRP and conventional dressing group). Patients in the PRP group received weekly intradermal injections of PRP to the wound in addition to conventional daily dressings till complete healing of the ulcers or up to a maximum of 6 weekly PRP sessions. Percentage of improvement in the area and volume of the ulcers were recorded. Patients were followed up at 1 month post PRP treatment.Results: The mean reduction in the area of the ulcers at the end of 6 weeks was 66.39% in the PRP group and 28.6% in the control group. The mean reduction in volume of the ulcers at the end of 6 weeks was 71.80% and 37.88% in the case and control group respectively. At the end of 1 month post treatment follow-up, 74% and 10% of the ulcers treated with PRP and with conventional dressing respectively showed complete healing.Conclusions: Leg ulcers treated with PRP showed a significantly higher reduction in the area and volume of the ulcers compared to ulcers treated with conventional moist dressing.

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Efficacy and Safety of a Hyaluronic Acid-Containing Gauze Pad in the Treatment of Chronic Venous or Mixed-Origin Leg Ulcers: A Prospective, Multicenter, Randomized Controlled Trial

WOUNDS A Compendium of Clinical Research and Practice ◽

10.25270/wnds/040721.02 ◽

2021 ◽

Vol 66 (6) ◽

pp. 147-157

Author(s):

Jacek Mikosinski ◽

Anna Di Landro ◽

Krzysztofa Łuczak-Szymerska ◽

Emilie Soriano ◽

Carol Caverzasio ◽

...

Keyword(s):

Hyaluronic Acid ◽

Chronic Wounds ◽

Treatment Time ◽

Complete Healing ◽

Leg Ulcers ◽

Efficacy And Safety ◽

Significant Difference ◽

Multicenter Randomized Controlled Trial ◽

Mixed Origin ◽

Chronic Leg Ulcers

Introduction. Hyaluronic acid (HA)-containing formulations routinely are utilized along with standard therapy to promote faster healing of chronic wounds; evidence to guide clinical decisions on the use of topical HA in the healing of vascular leg ulcers is limited. Objective. This study compared the efficacy and safety of an HA-impregnated gauze pad with an identical gauze pad without HA in the treatment of chronic leg ulcers of vascular origin. Materials and Methods. A prospective, multicenter, multinational, parallel-group, randomized, double-blind, clinical study was conducted between June 13, 2017, and December 31, 2018. Adults with 1 or more chronic leg ulcers of venous or mixed origin between 2 months and 4 years’ duration were eligible to participate. Participants were randomized to treatment consisting of standard care (ie, ulcer cleansing, debridement/anesthesia as necessary, and optimized compression) and either application of a gauze pad containing 0.05% HA or a neutral comparator once daily for a maximum of 20 weeks. The primary efficacy endpoint was complete ulcer healing (100% reepithelialization of the wound area centrally assessed by 1 independent and experienced assessor blinded with respect to the treatment applied, as shown on digital photographs taken under standardized conditions at or before 20 weeks and confirmed 3 weeks later). Secondary efficacy endpoints included the percentage of completely healed target ulcers, residual area of target ulcer relative to baseline, the condition of the periulcerous skin, the total amount of analgesics used, the incidence of infection at the ulcer site of the target ulcer, patient adherence to treatment, time to achieve complete healing as centrally assessed, and pain intensity as measured by a visual analog scale. Results. Among the 168 participants (82 in the HA gauze pad group and 86 in the neutral gauze pad group), 33 (39.8%) in the HA group experienced complete healing of the target ulcer, which was significantly higher than the neutral comparator group (15, 18.5%; P = .002). Results in the full analysis and per-protocol sets were consistent with the primary results; no significant difference was noted in outcomes when participants’ wounds were stratified according to baseline ulcer size. Conclusions. HA delivered in a gauze pad formulation could be a beneficial treatment for chronic leg ulcers of venous or mixed origin.

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Validation of a Screening Questionnaire for Chronic Leg Ulcers

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734616671227 ◽

2016 ◽

Vol 15 (4) ◽

pp. 320-324

Author(s):

Kian Zarchi ◽

Peter Theut Riis ◽

Christine Graversgaard ◽

Iben M. Miller ◽

Michael Heidenheim ◽

...

Keyword(s):

Positive Predictive Value ◽

Predictive Value ◽

Large Scale ◽

Chronic Wounds ◽

Population Based ◽

University Hospital ◽

Leg Ulcers ◽

Screening Questionnaire ◽

Item Questionnaire ◽

Chronic Leg Ulcers

The use of a validated screening questionnaire to identify individuals with chronic leg ulcers allows large-scale population-based studies to be conducted that measure and monitor the prevalence of the disease. The aim of this study was to design and validate such a screening questionnaire to identify patients with chronic leg ulcers. A simple 3-item questionnaire was developed at the Department of Dermatology, University Hospital of Zealand, Denmark. In total, 90 patients attending the department’s outpatient clinic for dermatological diseases and chronic wounds were included in this study. All included participants completed the questionnaire and were subsequently examined by dermatologists. We found that the constructed 3-item questionnaire in this study had a sensitivity and specificity of 95% and 93% and a positive predictive value and negative predictive value of 78% and 95%, respectively. Moreover, we found that the use of the 3-item questionnaire, as compared with a single question, in which the participants were asked whether they currently have a leg ulcer, resulted in significantly higher positive predictive value (+11.6%, P = .035) and specificity (+5.6%, P = .046) of the diagnostic test. Future studies are merited to investigate the diagnostic accuracy of the questionnaire in other populations and settings.

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Nutrition and Lower Extremity Ulcers: Causality and/or Treatment

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734617737639 ◽

2017 ◽

Vol 16 (4) ◽

pp. 238-243 ◽

Cited By ~ 11

Author(s):

Lauren Haughey ◽

Adrian Barbul

Keyword(s):

Chronic Wounds ◽

Nutritional Therapy ◽

Great Likelihood ◽

Leg Ulcers ◽

Impaired Wound Healing ◽

Adequate Nutrition ◽

Long Time ◽

The Individual ◽

Relationship Of ◽

The Relationship

The association between malnutrition, impaired wound healing, and the presence of chronic wounds has been recognized for a long time. It is widely believed that the lack of adequate nutrition increases the risk of developing wounds which have a great likelihood of progressing to chronicity due to lack of appropriate healing responses. This risk is particularly high in the aging population. For the individual patient, as well as patient populations, the diagnosis of malnutrition has been in dispute; further, there is lack of agreement of when and how to intervene nutritionally in those with wounds or healing deficits. This article examines the relationship of nutritional status with the presence and clinical evolution of leg ulcers in humans, focusing on diabetic and venous leg ulcers; we will further review the effect of nutritional therapy on the outcome of these ulcers.

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Clinical Antimicrobial Photodynamic Therapy: Phase II Studies in Chronic Wounds

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2012.0182 ◽

2012 ◽

Vol 10 (Suppl_2) ◽

pp. S-80-S-83 ◽

Cited By ~ 19

Author(s):

Stan Brown

Keyword(s):

Photodynamic Therapy ◽

Chronic Wounds ◽

In Vivo Studies ◽

Antimicrobial Photodynamic Therapy ◽

Leg Ulcers ◽

Preclinical Research ◽

Accelerate Wound Healing ◽

Phase Ii Studies ◽

Chronic Leg Ulcers

Microbiologically based diseases continue to pose serious global health problems. Effective alternative treatments that are not susceptible to resistance are sorely needed, and the killing of photosensitized bacteria through photodynamic therapy (PDT) may ultimately emerge as such an option. In preclinical research and early in vivo studies, PDT has demonstrated the ability to kill an assortment of microorganisms. Antimicrobial PDT has the potential to accelerate wound healing and prevent clinical infection, particularly in patients with chronic leg ulcers. Larger trials are needed to confirm its early promise and suggest its ultimate role in caring for chronic wounds.

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Efficacy and Safety of Intralesional Platelet Rich Plasma (PRP) Therapy in the Management of Chronic Non-healing Leg Ulcers in our Population

10.53350/pjmhs2115102746 ◽

2021 ◽

Vol 15 (10) ◽

pp. 2746-2748

Author(s):

Muhammad Aslam Javed ◽

Sadaf Amin ◽

Wishal Raza ◽

Imran Yousuf

Keyword(s):

Chronic Wounds ◽

Platelet Rich Plasma ◽

Simple Procedure ◽

Cost Effective ◽

Leg Ulcers ◽

Weekly Basis ◽

Time Period ◽

Percentage Improvement ◽

Chronic Ulcers ◽

Chronic Leg Ulcers

Background: Autologous Platelets Rich Plasma (PRP) therapy not only hastens chronic wounds and ulcers healing but also diminishes the rate of amputations of lower leg caused by non-healing recalcitrant ulcers. In this study we have demonstrated the magical results of intralesional autologous PRP in the healing of resistant to heal chronic leg ulcers. Methods: In this metacentric study 26 patients having 30 chronic leg ulcers of more than 6 weeks duration and various etiologies, were treated with intralesional autologous PRP application on weekly basis for a duration of 8 weeks and the final results were calculated by percentage improvement in the volume and area of the ulcer/wound. Results: In our study 26 patient with 30 chronic recalcitrant leg ulcers/wounds were treated with intralesional autologous PRP therapy on weekly basis. Mean age of the included patients was 34.5 years. 19 were male patients and 7 were female. The mean time period of the healing of chronic ulcers was 5.3 weeks. The final mean percentage improvement outcome in the volume and area of the ulcers was calculated as 86% and 88% respectively. Conclusions: PRP therapy is safe, cost effective office based simple procedure in treating recalcitrant chronic leg ulcer/wounds. Keywords: Non-healing, intralesional, autologous platelet rich plasma, chronic ulcers

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Enhanced Hypercoagulability in Sickle Cell Anaemia Patients with Chronic Leg Ulcers

Advances in Hematology ◽

10.1155/2020/5157031 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

David Sackey ◽

Yvonne Dei-Adomakoh ◽

Edeghonghon Olayemi

Keyword(s):

Sickle Cell ◽

Sickle Cell Anaemia ◽

Antiplatelet Agents ◽

Organ Damage ◽

Leg Ulcers ◽

Chronic Complications ◽

The Mean ◽

Hb Concentration ◽

Chronic Leg Ulcers

Sickle Cell Anaemia (SCA) is associated with a hypercoagulable state resulting in a predisposition to venous thromboembolism. With improvements in the quality of care, more patients with SCA survive into adulthood with an associated increase in the frequency of end-organ damage and chronic complications such as chronic leg ulcers (CLUs). These ulcers rarely occur in the first decade of life and are recurrent, painful, and slow-to-heal. This study tested the hypothesis that coagulation is enhanced in SCA patients with CLU. 145 participants (50 SCA with CLU, 50 SCA without CLU, and 45 with haemoglobin AA) were assessed to determine their coagulation profile using selected tests of coagulation. The SCA with the CLU group had the lowest mean haemoglobin (Hb) concentration. SCA patients with and without CLUs had elevated mean platelet counts, shorter mean aPTT, and marginally prolonged mean PT compared to HbAA patients. SCA with CLUs patients had a significantly shortened aPTT than those without CLUs ( p = 0.035) and HbAA ( p = 0.009). There were significant differences in the mean PT between SCA with CLUs patients and HbAA ( p = 0.017); SCA without CLU and HbAA ( p = 0.014). SCA with and without CLUs patients had higher mean D-dimer levels compared to HbAA. There was a negative correlation between Hb concentration and duration of CLU (r = -0.331, p = 0.021). In conclusion, our study demonstrates a heightened hypercoagulability in SCA patients with CLUs. We did not test for platelet activation, and it is not clear what role, if any, the enhanced hypercoagulability plays in the pathogenesis of CLUs in SCA. It will be useful to ascertain if antiplatelet agents or/and anticoagulants quicken the healing of CLUs in SCA patients.

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Causes and the way of treatment of patients with chronic leg ulcers

Phlebologie ◽

10.1055/s-0037-1622275 ◽

2009 ◽

Vol 38 (05) ◽

pp. 211-218 ◽

Cited By ~ 2

Author(s):

C. Wax ◽

A. Körber ◽

J. Dissemond ◽

J. Klode

Keyword(s):

Treatment Period ◽

General Practitioners ◽

Peripheral Arterial Occlusive Disease ◽

Mean Value ◽

Arterial Occlusive Disease ◽

Leg Ulcer ◽

Leg Ulcers ◽

Patient Will ◽

Peripheral Arterial ◽

Chronic Leg Ulcers

SummaryChronic leg ulcer may have various causes, which are currently not centrally recorded in Germany. It is also unclear who treats patients with chronic leg ulcers in Germany and how the basic implementation of diagnosis and treatment of these patients looks like. Patients, methods: Therefore, we started a survey of 1000 general practitioners and practising specialists in dermatology, surgery and phlebology in five different regions of Germany. We carried out the genesis of a total of 6275 patients from 62 different practising therapists, 33 specialists in dermatology, surgery or phlebology and 29 general practitioners. Results: In 66.1% of all patients we found a venous leg ulcer, in 9.1% a leg ulcer from peripheral arterial occlusive disease, and in 8.5% a mixture of both. Thus there suffered a total of 83.8% of patients on chronic venous insufficiency or peripheral arterial occlusive disease as a major factor in the genesis of the chronic leg ulcer. However, even the rarely diagnosed entities such as exogenous factors, vasculitis, pyoderma gangrenosum or infectious diseases are occur in summation in 16.2% of all patients and should therefore be known and excluded. In addition, the treatment periods and referral routes of patients with chronic leg ulcer should be identified. The analysis showed that the vast majority (86.8%) of patients with chronic ulcers who were investigated by us is treated by specialists. The treatment duration of general practitioners is 6.3 weeks (mean value) before the patient will be referred to a specialist. This treatment period is significantly shorter compared to the treatment period of the specialists, who treat their patients 14.1 weeks (mean value) before the patient will be referred to another specialist or to a clinic. Conclusion: Our results show the current aspects of aetiology and the way of treatment of patients with chronic leg ulcers in Germany.

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