The Difficult Venous Ulcer: Case Series of 177 Ulcers Referred for Vascular Surgical Opinion following Failure of Conservative Management

Venous leg ulcers are common, chronic, debilitating, and expensive. Evidence supports use of compression bandaging, with superficial venous surgery in selected cases, but these interventions frequently fail to achieve healing. We describe a series of 152 consecutive referrals from a nurse-led specialist dermatology clinic to a vascular surgical service; a group posing particularly challenging problems. This observational study, with median follow-up of 18 months, describes outcomes in a number of important clinically identifiable subgroups. Its findings may assist service planning and discussion of the surgical role within multidisciplinary ulcer management.

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Failure of a trial evaluating the effect of venous surgery on healing and recurrence rates in venous ulcers? The USABLE trial: rationale, design and methodology, and reasons for failure

Phlebology The Journal of Venous Disease ◽

10.1258/0268355041753371 ◽

2004 ◽

Vol 19 (3) ◽

pp. 137-142 ◽

Cited By ~ 8

Author(s):

A H Davies ◽

A J Hawdon ◽

R M Greenhalgh ◽

S Thompson

Keyword(s):

Controlled Trial ◽

Venous Ulcer ◽

Recurrence Rates ◽

Compression Bandaging ◽

Venous Ulcers ◽

Number Of Patients ◽

Venous Surgery ◽

Ulcer Surgery ◽

Set Up

Objective: This Medical Research Council funded trial was set up to investigate whether venous surgery provided any additional benefit in the healing and recurrence rates of venous ulcers over compression bandaging alone. Methods: Ulcer surgery as adjuvant to compression bandaging for leg ulcers (USABLE) was a multicentre, randomized controlled trial, which planned to recruit 1000 venous ulcer patients to receive either compression bandaging alone or compression bandaging plus venous surgery. Follow up recorded ulcer healing, recurrence and patient quality of life. Results: Recruitment was slow, and involved screening a large number of patients (759) with only 75 randomized over an 18-month recruitment period. Conclusions: The results would infer that surgery is unlikely to be a management option for the majority of patients presenting to a hospital with a gaiter area leg ulcer.

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Healing rates following venous surgery for chronic venous leg ulcers in an independent specialist vein unit

Phlebology The Journal of Venous Disease ◽

10.1258/phleb.2012.011097 ◽

2013 ◽

Vol 28 (3) ◽

pp. 132-139 ◽

Cited By ~ 9

Author(s):

C A Thomas ◽

J M Holdstock ◽

C C Harrison ◽

B A Price ◽

M S Whiteley

Keyword(s):

Retrospective Study ◽

Clinical Improvement ◽

Ulcer Healing ◽

Surgical Intervention ◽

Response Rate ◽

Significant Proportion ◽

Leg Ulcers ◽

Venous Leg Ulcers ◽

Venous Surgery

Objectives This is a retrospective study over 12 years reporting the healing rates of leg ulcers at a specialist vein unit. All patients presented with active chronic venous leg ulcers (clinical, aetiological, anatomical and pathological elements [CEAP]: C6) and had previously been advised elsewhere that their ulcers were amenable to conservative measures only. Method Seventy-two patients (84 limbs) were treated between March 1999 and June 2011. Patients were contacted in August 2011 by questionnaire and telephone. Of 72 patients, two were deceased and two had moved location at follow-up, so were not contactable. Fifty patients replied and 18 did not (response rate 74%), representing a mean follow-up time of 3.1 years. Results Ulcer healing occurred in 85% (44 of 52 limbs) of which 52% (27) limbs were no longer confined to compression. Clinical improvement was achieved in 98% of limbs. Conclusions This study shows that a significant proportion of ulcers currently managed conservatively can be healed by surgical intervention.

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Maintaining a safe uro-oncological surgical service in the face of the COVID-19 pandemic

Journal of Clinical Urology ◽

10.1177/2051415820958302 ◽

2020 ◽

pp. 205141582095830

Author(s):

Samuel Shillito ◽

Kieran O’Flynn ◽

Noel Clarke ◽

Satish Maddineni

Keyword(s):

Case Series ◽

Complication Rates ◽

Surgical Service ◽

Patient Case ◽

Related Complication ◽

Level Of Evidence ◽

The Face ◽

Level 3 ◽

Care Ward

Objective: The COVID-19 pandemic has had a profound impact on the provision of surgery across the NHS. Despite the challenges, the uro-oncology surgical provision at our centre in the northwest of England, a COVID-19 hotspot, has continued throughout. Patients and methods: We report a 26-patient case series performed following national lockdown. Patients were initially screened for COVID-19 symptoms and later all patients required a negative swab pre-operatively. Personal protective equipment using aerosol precautions was used for all cases. A post-operative ‘cold’ COVID-19 critical-care ward was created. Patients who developed possible symptoms of COVID-19 were isolated and swabbed. A telephone questionnaire was completed two weeks following discharge. Results: Three out of 26 patients developed post-operative pyrexia, but all tested negative for COVID-19. Non-COVID-19-related complication rates were consistent with our previous results. Telephone follow-up confirmed that none had experienced symptoms suggestive of COVID-19 infection. Overall, patient satisfaction with hospital COVID-19 precautions was high. All patients were satisfied with their decision to undergo surgery during the pandemic. Conclusions: Our results indicate that during the peak of the COVID-19 pandemic, with appropriate precautions, a safe surgical service can be continued. Level of evidence Level 3

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AUTOLOGOUS SUCTION BLISTER EPIDERMAL GRAFTING FOR CHRONIC LEG ULCERS

10.36106/ijsr/4001401 ◽

2021 ◽

pp. 41-42

Author(s):

Nishant Lal ◽

Aiswarya R Pillai ◽

Shafy Ali Khan

Keyword(s):

Donor Site ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Venous Ulcer ◽

Wound Area ◽

Compression Bandaging ◽

Suction Blister ◽

Chronic Leg Ulcers

Non healing ulcers are a burden to the patient as they are difcult to treat. They also affect patient's quality of life. A series of 2 patients – one with chronic venous ulcer and other with diabetic foot ulcer were included. Epidermal grafts were harvested and applied using Cellutome epidermal harvesting system (KCI) with no anesthesia. After transferring the harvest of epidermal blisters, 4 layer compression bandaging was given. Both the patients tolerated the procedure with no complications involving donor as well as recipient sites. Photographs were taken during various phases of healing. 1 week follow up showed 63% reduction in wound area. Donor site was completely healed by this time. Reduction in ulcer size of upto 99% was seen in 8 weeks.

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The comparative impact of conservative treatment versus superficial venous surgery, for the treatment of venous leg ulcers: A systematic review of the impact on patients’ quality of life

Phlebology The Journal of Venous Disease ◽

10.1177/0268355515581278 ◽

2015 ◽

Vol 31 (2) ◽

pp. 82-93 ◽

Cited By ~ 4

Author(s):

Philippa Tollow ◽

Jane Ogden ◽

Mark S Whiteley

Keyword(s):

Quality Of Life ◽

Future Research ◽

Leg Ulcers ◽

Venous Leg Ulcers ◽

Psychological Mechanisms ◽

Compression Bandaging ◽

Venous Surgery ◽

The Impact ◽

Positive Effect

Objectives Leg ulcers are known to have a profound effect on patients’ quality of life; however, the influence of different treatment approaches is unclear. This review aims to evaluate the comparative impact of conservative treatments and superficial venous surgery, for venous leg ulcers, on patients’ Quality of Life. Data sources Three electronic databases (PsycInfo, Medline and CINAHL), and reference lists of relevant articles, were searched. A total of 209 articles were initially identified, and 16 articles were included in the review. Results The results lend cautious support to the suggestion that all treatments have a positive effect on quality of life, regardless of type, whilst wound status also appears to be an important factor. Conclusions Some evidence suggests that surgical treatment methods may lead to greater improvements in patients’ quality of life than compression bandaging alone; however, future research may focus on the psychological mechanisms underlying such changes.

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Cost-Effective Management of Venous Ulcer

Cardiovascular Journal ◽

10.3329/cardio.v2i2.6629 ◽

1970 ◽

Vol 2 (2) ◽

pp. 136-141

Author(s):

SAN Alam ◽

AHM Bashar ◽

KM Alam ◽

MN Sabah ◽

GMM Hossain ◽

...

Keyword(s):

Saphenous Vein ◽

Ulcer Healing ◽

Great Saphenous Vein ◽

Cost Effective ◽

Venous Ulcer ◽

Leg Ulcers ◽

Venous Leg Ulcers ◽

Group I ◽

Venous Surgery ◽

Group Ii

Background: Venous disorders are very common. About 20% of the population suffer from varicose veins, 2% have skin changes which may precede venous ulceration. Venous ulcers represent a common and debilitating condition associated with significant financial loss for the patients as well as the society. Treatment options for these patients are costly and time consuming. In this study we tried to find out cost-effective measures for treating this group of patients.Method: To evaluate the effectiveness and safety of superficial and perforating leg venous surgery along with pharmacotherapy 66 patients with chronic venous leg ulcers are prospectively studied. After proper history taking and clinical examination all patients underwent venous duplex ultrasonography. Patients were divided into two groups. Group I (n=30) includes patients undergoing saphenofemoral ligation and stripping of the great saphenous vein (GSV). In group II (n=36) patients underwent saphenofemoral and incompetent leg perforator ligation along with stripping of the GSV. Conservative measures, local ulcer care and pharmacotherapy were common in both groups.Result: Postoperative complications, total hospital stay and ulcer healing were studied. Ulcer healing was earlier in group II. Remarkable complications were similar in both the groups.Conclusion: For effective and economic care of venous leg ulcers, combination of standard surgical procedures including incompetent perforator and saphenofemoral ligation with great saphenous vein stripping and standard physio-pharmacotherapeutic care is essential. This combined modality of treatment is highly effective in early and complete ulcer healing in patients suffering from venous ulcers.Keywords: Venous ulcer: Saphenofemoral ligation: Perforator ligation. DOI: 10.3329/cardio.v2i2.6629Cardiovasc. j. 2010; 2(2) : 136-141

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Effect of Isolated Medial Patellofemoral Ligament Reconstruction in Patellofemoral Instability Regardless of Predisposing Factors

The Journal of Knee Surgery ◽

10.1055/s-0040-1713898 ◽

2020 ◽

Author(s):

Jae Ik Lee ◽

Mohd Shahrul Azuan Jaffar ◽

Han Gyeol Choi ◽

Tae Woo Kim ◽

Yong Seuk Lee

Keyword(s):

Medial Patellofemoral Ligament ◽

Trochlear Dysplasia ◽

Case Series ◽

Patellofemoral Instability ◽

International Knee Documentation Committee ◽

Predisposing Factors ◽

Mpfl Reconstruction ◽

Patellar Tilt ◽

Case Series Study

AbstractThe purpose of this study was to evaluate the outcomes of isolated medial patellofemoral ligament (MPFL) reconstruction, regardless of the presence of predisposing factors. A total of 21 knees that underwent isolated MPFL reconstruction from March 2014 to August 2017 were included in this retrospective series. Radiographs of the series of the knee at flexion angles of 20, 40, and 60 degrees were acquired. The patellar position was evaluated using the patellar tilt angle, sulcus angle, congruence angle (CA), and Caton-Deschamps and Blackburne-Peel ratios. To evaluate the clinical outcome, the preoperative and postoperative International Knee Documentation Committee (IKDC) and Lysholm knee scoring scales were analyzed. To evaluate the postoperative outcomes based on the predisposing factors, the results were separately analyzed for each group. Regarding radiologic outcomes, 20-degree CA was significantly reduced from 10.37 ± 5.96° preoperatively to −0.94 ± 4.11° postoperatively (p = 0.001). In addition, regardless of the predisposing factors, delta values of pre- and postoperation of 20-degree CA were not significantly different in both groups. The IKDC score improved from 53.71 (range: 18–74) preoperatively to 94.71 (range: 86–100) at the last follow-up (p = 0.004), and the Lysholm score improved from 54.28 (range: 10–81) preoperatively to 94.14 (range: 86–100) at the last follow-up (p = 0.010). Isolated MPFL reconstruction provides a safe and effective treatment for patellofemoral instability, even in the presence of mild predisposing factors, such as trochlear dysplasia, increased patella height, increased TT–TG distance, or valgus alignment. This is a Level 4, case series study.

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