Healing venous ulcers with different modalities of leg compression

Phlebologie ◽  
2006 ◽  
Vol 35 (05) ◽  
pp. 349-355 ◽  
Author(s):  
E. O. Brizzio ◽  
G. Rossi ◽  
A. Chirinos ◽  
I. Cantero ◽  
G. Idiazabal ◽  
...  
Keyword(s):  
Wound Care ◽  
Univariate Analysis ◽  
Compression Therapy ◽  
Healing Time ◽  
Clinical Parameters ◽  
Compression Stockings ◽  
Local Pressure ◽  
Ulcer Size ◽  
Venous Ulcers ◽  
Unexpected Findings

Summary Background: Compression therapy (CT) is the stronghold of treatment of venous leg ulcers. We evaluated 5 modalities of CT in a prospective open pilot study using a unique trial design. Patients and methods: A group of experienced phlebologists assigned 31 consecutive patients with 35 venous ulcers (present for 2 to 24 months with no prior CT) to 5 different modalities of leg compression, 7 ulcers to each group. The challenge was to match the modality of CT with the features of the ulcer in order to achieve as many healings as possible. Wound care used standard techniques and specifically tailored foam pads to increase local pressure. CT modalities were either stockings Sigvaris® 15-20, 20-30, 30-40 mmHg, multi-layer bandages, or CircAid® bandaging. Compression was maintained day and night in all groups and changed at weekly visits. Study endpoints were time to healing and the clinical parameters predicting the outcome. Results: The cumulative healing rates were 71%, 77%, and 83% after 3, 6, and 9 months, respectively. Univariate analysis of variables associated with nonhealing were: previous surgery, presence of insufficient perforating and/or deep veins, older age, recurrence, amount of oedema, time of presence of CVI and the actual ulcer, and ulcer size (p <0.05-<0.001). The initial ulcer size was the best predictor of the healing-time (Pearson r=0.55, p=0.002). The modality of CT played an important role also, as 19 of 21 ulcers (90%) healed with stockings but only 8 of 14 with bandages (57%; p=0.021). Regression analysis allowed to calculate a model to predict the healing time. It compensated for the fact that patients treated with low or moderate compression stockings were at lower risk of non-healing. and revealed that healing with stockings was about twice as rapid as healing with bandages. Conclusion: Three fourths of venous ulcers can be brought to healing within 3 to 6 months. Healing time can be predicted using easy to assess clinical parameters. Irrespective of the initial presentation ulcer healing appeared more rapid with the application of stockings than with bandaging. These unexpected findings contradict current believes and require confirmation in randomised trials.

scholarly journals Assessment of Frailty In Elderly Patients Attending A Multidisciplinary Wound Care Center: A Cohort Study.

2021 ◽  
Author(s):  
Mariona Espaulella-Ferrer ◽  
Joan Espaulella-Panicot ◽  
Rosa Noell-Boix ◽  
Marta Casals-Zorita ◽  
Marta Ferrer-Sola ◽  
...  
Keyword(s):  
Wound Healing ◽  
Elderly Patients ◽  
Healing Rate ◽  
Wound Care ◽  
Frailty Index ◽  
Healing Time ◽  
Venous Ulcers ◽  
Healing Wounds ◽  
Wound Healing Time ◽  
The Relationship

Abstract Background: The incidence of frailty and chronic wounds increases with patients’ age. Knowledge of the relationship between frailty and wound healing progress is greatly lacking. Methods: The aim of this study is to characterize the degree of frailty in elderly patients attending a multidisciplinary wound care centers (MWCC). Additionally, we seek to assess the impact of frailty on the wound healing rate and wound healing time. An open cohort study was conducted on 51 consecutive patients aged > 70 years treated for wounds at an MWCC of an intermediate care hospital. The frailty score was determined according to the Frail-VIG index. Data were collected through patient questionnaires at the beginning of the study, and at six months or upon wound healing. Wounds were followed up every two weeks. To analyze the relationship between two variables was used the Chi-square test and Student’s or the ANOVA model. The t-test for paired data was used to analyze the evolution of the frailty index during follow-up.Results: A total of 51 consecutive patients were included (aged 81.1 ± 6.1 years). Frailty prevalence was 74.5% according to the Frail-VIG index (47.1% mildly frail, 19.6% moderately frail, and 7.8% severely frail). Wounds healed in 69.6% of cases at six months. The frailty index (FI) was higher in patients with non-healing wounds in comparison with patients with healing wounds (IF 0.31 ± 0.15 vs IF 0.24 ± 0.11, p=0.043). A strong correlation between FI and wound healing results was observed in patients with non-venous ulcers (FI 0.37 ± 0.13 vs FI 0.27 ± 0.10, p=0.015). However, no correlation was observed in patients with venous ulcers (FI 0.17 ± 0.09 vs FI 0.19 ± 0.09, p=0.637). Wound healing rate is statically significantly higher in non-frail patients (3,26% wound reduction/day, P25-P75 0.8-8.8%/day) in comparison with frail patients (8.9% wound reduction/day, P25-P75 3.34-18.3%/day; p=0.044). Conclusion: Frailty is prevalent in elderly patients treated at an MWCC. Frailty degree is correlated with wound healing results and wound healing time.

Wound care in venous ulcers

2013 ◽  
Vol 28 (1_suppl) ◽  
pp. 79-85 ◽  
Author(s):  
G Mosti
Keyword(s):  
Granulation Tissue ◽  
Wound Care ◽  
Healing Process ◽  
Cochrane Review ◽  
Healing Time ◽  
Polyurethane Foams ◽  
Wound Dressings ◽  
Pressure Treatment ◽  
Venous Ulcers ◽  
Moist Environment

Wound dressings: ulcer dressings should create and maintain a moist environment on the ulcer surface. It has been shown that in an ulcer with a hard crust and desiccated bed, the healing process is significantly slowed and sometimes completely blocked so favouring infection, inflammation and pain. In contrast a moist environment promotes autolytic debridement, angiogenesis and the more rapid formation of granulation tissue, favours keratinocytes migration and accelerates healing of wounds. Apart from these common characteristics, wound dressings are completely different in other aspects and must be used according to the ulcer stage. In necrotic ulcers, autolytic debridement by means of hydrogel and hydrocolloids or with enzymatic paste is preferred. In case of largely exuding wounds alginate or hydrofibre are indicated. When bleeding occurs alginate is indicated due to its haemostatic power. Where ulcers are covered by granulation tissue, polyurethane foams are preferred. When infection coexists antiseptics are necessary: dressing containing silver or iodine with large antibacterial spectrum have proved to be very effective. In the epithelization stage polyurethane films or membranes, thin hydrocolloids or collagen based dressings are very useful to favour advancement of the healing wound edge. Despite these considerations, a Cochrane review failed to find advantages for any dressing type compared with low-adherent dressings applied beneath compression. Surgical debridement and grafting of wounds, negative wound pressure treatment: surgical and hydrosurgical debridement are indicated in large, necrotic and infected wounds as these treatments are able to get rid of necrotic, infected tissue very quickly in a single surgical session, thereby significantly accelerating wound bed preparation and healing time. Negative wound pressure treatment creating a negative pressure on ulcer bed is able to favour granulation tissue and shorten healing time. In case of hard-to-heal leg ulcers such as large, deep, infected and long-lasting venous ulcers, sharp debridement and skin grafting may favour and shorten ulcer healing.

The Post-Thrombotic Syndrome

Hematology ◽  
2010 ◽  
Vol 2010 (1) ◽  
pp. 216-220 ◽  
Author(s):  
Susan R. Kahn
Keyword(s):  
Risk Factors ◽  
Anticoagulation Therapy ◽  
Compression Therapy ◽  
Secondary Prophylaxis ◽  
Compression Stockings ◽  
Elastic Compression ◽  
Vein Thrombosis ◽  
Post Thrombotic Syndrome ◽  
Venous Ulcers ◽  
Risk Determinants

AbstractThe post-thrombotic syndrome (PTS) is an important chronic complication of deep vein thrombosis (DVT). The present review focuses on risk determinants of PTS after DVT and available means to prevent and treat PTS. More than one-third of patients with DVT will develop PTS, and 5% to 10% of patients develop severe PTS, which can manifest as venous ulcers. PTS has an adverse impact on quality of life as well as significant socioeconomic consequences. The main risk factors for PTS are persistent leg symptoms 1 month after acute DVT, anatomically extensive DVT, recurrent ipsilateral DVT, obesity, and older age. Subtherapeutic dosing of initial oral anticoagulation therapy for DVT treatment may also be linked to subsequent PTS. By preventing the initial DVT and DVT recurrence, primary and secondary prophylaxis of DVT will prevent cases of PTS. Daily use of elastic compression stockings for 2 years after proximal DVT appears to reduce the risk of PTS; however, uncertainty remains regarding optimal duration of use, optimal compression strength, and usefulness after distal DVT. The cornerstone of managing PTS is compression therapy, primarily using elastic compression stockings. Venoactive medications such as aescin and rutosides may provide short-term relief of PTS symptoms. Further studies to elucidate the pathophysiology of PTS, to identify clinical and biological risk factors, and to test new preventive and therapeutic approaches to PTS are needed.

Optimal Compression Therapy and Wound Care for Venous Ulcers

2018 ◽  
Vol 98 (2) ◽  
pp. 349-360 ◽  
Author(s):  
Fedor Lurie ◽  
Samir Bittar ◽  
Gregory Kasper
Keyword(s):  
Wound Care ◽  
Compression Therapy ◽  
Venous Ulcers

scholarly journals Assessment of frailty in elderly patients attending a multidisciplinary wound care centre: a cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mariona Espaulella-Ferrer ◽  
Joan Espaulella-Panicot ◽  
Rosa Noell-Boix ◽  
Marta Casals-Zorita ◽  
Marta Ferrer-Sola ◽  
...  
Keyword(s):  
Wound Healing ◽  
Elderly Patients ◽  
Healing Rate ◽  
Wound Care ◽  
Frailty Index ◽  
Healing Time ◽  
Venous Ulcers ◽  
Healing Wounds ◽  
Wound Healing Time ◽  
The Relationship

Abstract Background The incidence of frailty and non-healing wounds increases with patients’ age. Knowledge of the relationship between frailty and wound healing progress is greatly lacking. Methods The aim of this study is to characterize the degree of frailty in elderly patients attending a multidisciplinary wound care centres (MWCC). Additionally, we seek to assess the impact of frailty on the wound healing rate and wound healing time. An open cohort study was conducted on 51 consecutive patients aged > 70 years treated for wounds at an MWCC of an intermediate care hospital. The frailty score was determined according to the Frail-VIG index. Data were collected through patient questionnaires at the beginning of the study, and at 6 months or upon wound healing. Wounds were followed up every 2 weeks. To analyse the relationship between two variables was used the Chi-square test and Student’s or the ANOVA model. The t-test for paired data was used to analyse the evolution of the frailty index during follow-up. Results A total of 51 consecutive patients were included (aged 81.1 ± 6.1 years). Frailty prevalence was 74.5% according to the Frail-VIG index (47.1% mildly frail, 19.6% moderately frail, and 7.8% severely frail). Wounds healed in 69.6% of cases at 6 months. The frailty index (FI) was higher in patients with non-healing wounds in comparison with patients with healing wounds (IF 0.31 ± 0.15 vs IF 0.24 ± 0.11, p = 0.043). A strong correlation between FI and wound healing results was observed in patients with non-venous ulcers (FI 0.37 ± 0.13 vs FI 0.27 ± 0.10, p = 0.015). However, no correlation was observed in patients with venous ulcers (FI 0.17 ± 0.09 vs FI 0.19 ± 0.09, p = 0.637). Wound healing rate is statically significantly higher in non-frail patients (8.9% wound reduction/day, P25-P75 3.34–18.3%/day;AQ6 p = 0.044) in comparison with frail patients (3.26% wound reduction/day, P25-P75 0.8–8.8%/day). Conclusion Frailty is prevalent in elderly patients treated at an MWCC. Frailty degree is correlated with wound healing results and wound healing time.

scholarly journals Mesoglycan: Clinical Evidences for Use in Vascular Diseases

2010 ◽  
Vol 2010 ◽  
pp. 1-8 ◽  
Author(s):  
Antonella Tufano ◽  
Claudia Arturo ◽  
Ernesto Cimino ◽  
Matteo Nicola Dario Di Minno ◽  
Mirko Di Capua ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Dermatan Sulfate ◽  
Vascular Diseases ◽  
Compression Therapy ◽  
Arterial Disease ◽  
Compression Stockings ◽  
Venous Ulcers ◽  
Essential Components ◽  
Slow Moving ◽  
Peripheral Arterial

Vascular glycosaminoglycans (GAG) are essential components of the endothelium and vessel wall and have been shown to be involved in several biologic functions. Mesoglycan, a natural GAG preparation, is a polysaccharide complex rich in sulphur radicals with strong negative electric charge. It is extracted from porcine intestinal mucosa and is composed of heparan sulfate, dermatan sulfate, electrophoretically slow-moving heparin, and variable and minimal quantities of chondroitin sulfate. Data on antithrombotic and profibrinolytic activities of the drug show that mesoglycan, although not indicated in the treatment of acute arterial or venous thrombosis because of the low antithrombotic effect, may be useful in the management of vascular diseases, when combined with antithrombotics in the case of disease of cerebral vasculature, and with antithrombotics and vasodilator drugs in the case of chronic peripheral arterial disease. The protective effect of mesoglycan in patients with venous thrombosis and the absence of side effects, support the use of GAG in patients with chronic venous insufficiency and persistent venous ulcers, in association with compression therapy (zinc bandages, multiple layer bandages, etc.), elastic compression stockings, and local care, and in the prevention of recurrences in patients with previous DVT following the standard course of oral anticoagulation treatment.

Treatment of Chronic Venous Ulcers Using Sequential Gradient Intermittent Pneumatic Compression

1996 ◽  
Vol 11 (3) ◽  
pp. 111-116 ◽  
Author(s):  
J. J. Schuler ◽  
T. Maibenco ◽  
J. Megerman ◽  
M. Ware ◽  
J. Montalvo
Keyword(s):  
Compression Therapy ◽  
Intermittent Pneumatic Compression ◽  
Complete Healing ◽  
Venous Stasis ◽  
Compression Stockings ◽  
Venous Ulcers ◽  
Qualified Personnel ◽  
Table Analysis ◽  
Area And Perimeter ◽  
At Home

Objective: To determine if a limited regimen of sequential gradient intermittent pneumatic compression (‘HomeRx’: HRx) is as effective in promoting the healing of chronic venous stasis ulcers as is the Unna's boot (UB), considered the ‘gold standard’ in compression therapy. Design: Fifty-three patients, aged 31–85 years, with ulcers ranging up to 31.8 cm2 (mean 9.9, SE 1.1) were Prospectively randomized to treatments with UB or HRx and followed weekly for 180 days or until healing was complete, whichever came first. The HRx group wore graduated compression stockings, which were removed only while intermittent pneumatic compression was applied bilaterally at home for 1 h each morning and 2 h each evening. The UB was re-applied at least weekly. The two groups were equivalent in their use of hydrocolloid dressings and periods of leg elevation. Setting: Therapy performed at home, with weekly visits to an outpatient clinic. Main outcome measures: Complete ulcer healing and the rate of healing, based on area and perimeter changes; amounts of wound exudate and pain. Results: Complete healing was achieved in 20 of 28 Patients (71%) in the HRx group, compared with 15 of 25 (60%) treated with UB. Three patients had an adverse reaction to UB, one had cellulitis and five were non-compliant. Correcting for these withdrawn patients by life table analysis, healing rates were 76% and 64%, respectively. Healing rates did not correlate with haemodynamic measurements made prior to treatment. Conclusions: Using HRx for just a few hours daily to supplement graduated elastic compression heals venous ulcers at least as well as does the UB, without its disadvantages (e.g. the need for frequent re-application by qualified personnel, difficulty bathing), affording patients greater convenience during treatment.

Compression Treatment of Chronic Venous Ulceration: A Review

2000 ◽  
Vol 15 (3-4) ◽  
pp. 162-168 ◽  
Author(s):  
G. L. Moneta ◽  
A. D. Nicoloff ◽  
J. M. Porter
Keyword(s):  
Medical Literature ◽  
Compression Therapy ◽  
Clinical Situation ◽  
Ulcer Recurrence ◽  
Compression Stockings ◽  
Venous Ulceration ◽  
Elastic Compression ◽  
Future Goals ◽  
Venous Ulcers ◽  
The Individual

Objective: To review the recent medical literature with regard to the use of compressive therapy in healing and preventing the recurrence of venous ulceration. Methods: Searches of Medline and Embase medical literature databases. Appropriate non-indexed journals and textbooks were also reviewed. Synthesis: Elastic compression therapy is regarded as the ‘gold standard’ treatment for venous ulceration. The benefits of elastic compression therapy in the treatment of venous ulceration may be mediated through favourable alterations in venous haemodynamics, micro-circulatory haemodynamics and/or improvement in subcutaneous Starling forces. Available data indicate compressive therapy is highly effective in healing of the large majority of venous ulcers. Elastic compression stockings, Unna boots, as well as multi-layer elastic wraps, have all been noted to achieve excellent healing rates for venous ulcers. In compliant patients it appears that approximately 75% of venous ulcers can be healed by 6 months, and up to 90% by 1 year. Non-healing of venous ulcers is associated with lack of patient compliance with treatment, large and long-standing venous ulceration and the coexistence of arterial insufficiency. Recurrence of venous ulceration is, however, a significant problem after healing with compressive therapy, even in compliant patients; approximately 20-30% of venous ulcers will recur by 2 years. Conclusions: Compressive therapy is capable of achieving high rates of healing of venous ulceration in compliant patients. Various forms of compression, including elastic, rigid and multi-layer dressings, are available depending on physician preference, the clinical situation and the needs of the individual patient. Compressive therapy, while effective, remains far from ideal. The future goals are to achieve faster healing of venous ulceration, less painful healing and freedom from ulcer recurrence.

Primary varicose veins

Phlebologie ◽  
2010 ◽  
Vol 39 (03) ◽  
pp. 133-137
Author(s):  
H. Partsch
Keyword(s):  
Varicose Veins ◽  
Compression Therapy ◽  
Daily Practice ◽  
Clinical Severity ◽  
Compression Stockings ◽  
Primary Varicose Veins ◽  
The Cost ◽  
Convincing Data ◽  
Long Term Studies

SummaryBackground: Compression stockings are widely used in patients with varicose veins. Methods: Based on published literature three main points are discussed: 1. the rationale of compression therapy in primary varicose veins, 2. the prescription of compression stockings in daily practice, 3. studies required in the future. Results: The main objective of prescribing compression stockings for patients with varicose veins is to improve subjective leg complaints and to prevent swelling after sitting and standing. No convincing data are available concerning prevention of progression or of complications. In daily practice varicose veins are the most common indication to prescribe compression stockings. The compliance depends on the severity of the disorder and is rather poor in less severe stages. Long-term studies are needed to proof the cost-effectiveness of compression stockings concerning subjective symptoms and objective signs of varicose veins adjusted to their clinical severity. Conclusion: Compression stockings in primary varicose veins are able to improve leg complaints and to prevent swelling.

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