Adding topical pale sulfonated shale oil to compression therapy and moist wound care reduced venous leg ulcer size but had no effect on complete wound healing after 20 weeks

The revised guideline of 2013 is an update of the 2005 guideline “venous leg ulcer”. In this special project four separate guidelines (venous leg ulcer, varicose veins, compression therapy and deep venous disorders) were revised and developed simultaneously. A meeting was held including representatives of any organisation involved in venous disease management including patient organizations and health insurance companies. Eighteen clinical questions where defined, and a new strategy was used to accelerate the process. This resulted in two new and two revised guidelines within one year. The guideline committee advises use of the C of the CEAP classification as well as the Venous Clinical Severity Score (VCSS) and a Quality of life (QoL) score in the assessment of clinical signs. These can provide insight into the burden of disease and the effects of treatment as experienced by the patient. A duplex ultrasound should be performed in every patient to establish the underlying aetiology and to evaluate the need for treatment (which is discussed in a separate guideline). The use of the TIME model for describing venous ulcers is recommended. There is no evidence for antiseptic or antibiotic wound care products except for a Cochrane review in which some evidence is presented for cadexomer iodine. Signs of infection are the main reason for the use of oral antibiotics. When the ulcer fails to heal the use of oral aspirin and pentoxifylline can be considered as an adjunct. For the individual patient, the following aspects should be considered: the appearance of the ulcer (amount of exudate) according to the TIME model, the influence of wound care products on moisturising the wound, frequency of changing compression bandages, pain and allergies. The cost of the dressings should also be considered. Education and training of patients t improves compliance with compression therapy but does not influence wound healing rates.

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Healing venous ulcers with different modalities of leg compression

Phlebologie ◽

10.1055/s-0037-1622150 ◽

2006 ◽

Vol 35 (05) ◽

pp. 349-355 ◽

Cited By ~ 9

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.

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Standard Compression Therapy With/Without Application of Skin Allograft (Theraskin) for Venous Leg Ulcer Treatment

Case Medical Research ◽

10.31525/ct1-nct03935386 ◽

2019 ◽

Author(s):

Keyword(s):

Compression Therapy ◽

Leg Ulcer ◽

Venous Leg Ulcer ◽

Skin Allograft ◽

Ulcer Treatment

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The Impact of a Pluridisciplinary Education Program on Venous Leg Ulcer Size Reduction

Case Medical Research ◽

10.31525/ct1-nct04019340 ◽

2019 ◽

Author(s):

Keyword(s):

Education Program ◽

Leg Ulcer ◽

Size Reduction ◽

Venous Leg Ulcer ◽

Ulcer Size ◽

The Impact

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Hyperbaric oxygen treatment for University of Texas grade 3 diabetic foot ulcers: a retrospective cohort study

Journal of Wound Care ◽

10.12968/jowc.2021.30.9.722 ◽

2021 ◽

Vol 30 (9) ◽

pp. 722-728

Author(s):

Rutger C Lalieu ◽

Willem Mulder ◽

René D Bol Raap ◽

Saskia Stolk ◽

Casper Smit ◽

...

Keyword(s):

Wound Healing ◽

Cohort Study ◽

Retrospective Cohort ◽

Wound Care ◽

Complete Healing ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

University Of Texas ◽

Complete Wound Healing ◽

Grade 3

Aim: Hard-to-heal diabetic foot ulcers (DFUs) may increase the risk of amputation. This study reports the positive influence of hyperbaric oxygen therapy (HBOT) on hard-to-heal DFUs involving underlying bone. Method: A single-centre, retrospective cohort study reporting the results of HBOT and wound care on hard-to-heal University of Texas grade 3 DFUs (i.e., involving underlying bone) between 2013 and 2019. Outcome measures were primarily (near-) complete wound healing (i.e., ≥80% ulcer surface area reduction) and amputation rate (minor or major), and secondarily the number of hyperbaric sessions and improvement in quality of life (QoL) and pain score. Results: The study included 206 patients, of whom 74 (36%) achieved complete wound healing, and 75 (36%) near-complete healing. Amputations were performed in 27 patients (13%): 12 (6%) minor and 15 (7%) major. The median number of HBOT sessions was 42. Participants who achieved complete healing received a median of 43 sessions, compared with 10 for those who required major amputation. Patients with at least 30 sessions were less likely to undergo amputation (odds ratio: 0.08; 95% confidence interval (CI): 0.03–0.21). Mean QoL increased by 7.6 points (95%CI: 3.9–11.3; p<0.01) and median pain score fell from 3 to 1 (0–3) (p<0.01). Conclusions: The addition of HBOT to standard wound care may lead to a decreased amputation risk, improved wound healing and increased QoL for people with a University of Texas grade 3 DFU. An adequate number of HBOT sessions is required to achieve optimal clinical results. Objective selection criteria and shared decision-making are suggested to improve dropout rates.

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