Venous leg ulcer healing time is increased with each subsequent bacterial strain identified in the ulcer. A retrospective study

2020 ◽  
pp. 026835552096194
Author(s):  
Karolina Kruszewska ◽  
Katarzyna Wesolowska-Gorniak ◽  
Bozena Czarkowska-Paczek
Keyword(s):  
Antibiotic Therapy ◽  
Ulcer Healing ◽  
Bacterial Strain ◽  
Bacterial Flora ◽  
Healing Time ◽  
Leg Ulcer ◽  
Leg Ulcers ◽  
Venous Leg Ulcer ◽  
Venous Leg Ulcers ◽  
Systemic Antibiotic Therapy

Objective The aim of the study was to analyze bacterial flora in venous leg ulcers, empiric and targeted antibiotic therapy, and factors influencing healing time. Materials and methods Data from 30 patients with venous leg ulcers were retrospectively analyzed. Collected data included: sociodemographic data, wounds information, number of comorbidities, results of the microbiological examination, and empiric and targeted antibiotic therapy. To compare the empiric and targeted treatment in terms of their compatibility, the group of patients was divided into the four subgroups: NEA (no empiric antibiotics), NA (no antibiotics), ETA+ (compatibility of empiric and targeted antibiotic), ETA− (no compatibility of empiric and targeted antibiotic). Results The average ulcer healing time was 163.4 ± 97.1 (range 51.0 to 426.0) days and increased by 28 days with each additional bacterial strain in the ulcer (p = 0.041). Healing time did not differ between the four groups. Staphylococcus aureus and Pseudomonas aeruginosa were the most frequent bacteria. Amoxicillinium/acidum clavulanicum was the most common empirical antibiotic and amoxicillinium/acidum clavulanicum, and levofloxacinum was the most common targeted antibiotic. Conclusions Venous leg ulcer healing time was prolonged with each subsequent bacterial strain in the ulcer, and it was independent from systemic antibiotic therapy.

scholarly journals VenUS IV (Venous leg Ulcer Study IV) – compression hosiery compared with compression bandaging in the treatment of venous leg ulcers: a randomised controlled trial, mixed-treatment comparison and decision-analytic model

2014 ◽  
Vol 18 (57) ◽  
pp. 1-294 ◽  
Author(s):  
Rebecca L Ashby ◽  
Rhian Gabe ◽  
Shehzad Ali ◽  
Pedro Saramago ◽  
Ling-Hsiang Chuang ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Ulcer Healing ◽  
Cost Effective ◽  
Leg Ulcer ◽  
Leg Ulcers ◽  
Venous Leg Ulcer ◽  
Venous Leg Ulcers ◽  
Treatment Comparison ◽  
High Compression ◽  
Cost Effective Treatment

BackgroundCompression is an effective and recommended treatment for venous leg ulcers. Although the four-layer bandage (4LB) is regarded as the gold standard compression system, it is recognised that the amount of compression delivered might be compromised by poor application technique. Also the bulky nature of the bandages might reduce ankle or leg mobility and make the wearing of shoes difficult. Two-layer compression hosiery systems are now available for the treatment of venous leg ulcers. Two-layer hosiery (HH) may be advantageous, as it has reduced bulk, which might enhance ankle or leg mobility and patient adherence. Some patients can also remove and reapply two-layer hosiery, which may encourage self-management and could reduce costs. However, little robust evidence exists about the effectiveness of two-layer hosiery for ulcer healing and no previous trials have compared two-layer hosiery delivering ‘high’ compression with the 4LB.ObjectivesPart I To compare the clinical effectiveness and cost-effectiveness of HH and 4LB in terms of time to complete healing of venous leg ulcers.Part II To synthesise the relative effectiveness evidence (for ulcer healing) of high-compression treatments for venous leg ulcers using a mixed-treatment comparison (MTC).Part III To construct a decision-analytic model to assess the cost-effectiveness of high-compression treatments for venous leg ulcers.DesignPart I A multicentred, pragmatic, two-arm, parallel, open randomised controlled trial (RCT) with an economic evaluation.Part II MTC using all relevant RCT data – including Venous leg Ulcer Study IV (VenUS IV).Part III A decision-analytic Markov model.SettingsPart I Community nurse teams or services, general practitioner practices, leg ulcer clinics, tissue viability clinics or services and wound clinics within England and Northern Ireland.ParticipantsPart I Patients aged ≥ 18 years with a venous leg ulcer, who were willing and able to tolerate high compression.InterventionsPart I Participants in the intervention group received HH. The control group received the 4LB, which was applied according to standard practice. Both treatments are designed to deliver 40 mmHg of compression at the ankle.Part II and III All relevant high-compression treatments including HH, the 4LB and the two-layer bandage (2LB).Main outcome measuresPart I The primary outcome measure was time to healing of the reference ulcer (blinded assessment).Part II Time to ulcer healing.Part III Quality-adjusted life-years (QALYs) and costs.ResultsPart I A total of 457 participants were recruited. There was no evidence of a difference in time to healing of the reference ulcer between groups in an adjusted analysis [hazard ratio (HR) 0.99, 95% confidence interval (CI) 0.79 to 1.25;p = 0.96]. Time to ulcer recurrence was significantly shorter in the 4LB group (HR = 0.56, 95% CI 0.33 to 0.94;p = 0.026). In terms of cost-effectiveness, using QALYs as the measure of benefit, HH had a > 95% probability of being the most cost-effective treatment based on the within-trial analysis.Part II The MTC suggests that the 2LB has the highest probability of ulcer healing compared with other high-compression treatments. However, this evidence is categorised as low to very low quality.Part III Results suggested that the 2LB had the highest probability of being the most cost-effective high-compression treatment for venous leg ulcers.ConclusionsTrial data from VenUS IV found no evidence of a difference in venous ulcer healing between HH and the 4LB. HH may reduce ulcer recurrence rates compared with the 4LB and be a cost-effective treatment. When all available high-compression treatments were considered, the 2LB had the highest probability of being clinically effective and cost-effective. However, the underpinning evidence was sparse and more research is needed. Further research should thus focus on establishing, in a high-quality trial, the effectiveness of this compression system in particular.Trial registrationCurrent Controlled Trials ISRCTN49373072.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 18, No. 57. See the NIHR Journals Library website for further project information.

Controlling compression bandaging pressure in leg ulcer research trials: A summary of the literature

2019 ◽  
Vol 34 (8) ◽  
pp. 501-514 ◽  
Author(s):  
Sharon L Boxall ◽  
Keryln Carville ◽  
Gavin D Leslie ◽  
Shirley J Jansen
Keyword(s):  
Ulcer Healing ◽  
Gold Standard ◽  
Reliability And Validity ◽  
Leg Ulcer ◽  
Evidence Based ◽  
Leg Ulcers ◽  
Venous Leg Ulcer ◽  
Practice Recommendations ◽  
Compression Bandaging ◽  
Literature Searches

Compression bandaging remains the ‘gold standard’ intervention for the treatment of venous leg ulcers. Numerous studies have investigated the effect of a large variety of compression bandaging techniques and materials on venous leg ulcer healing. However, the majority of these studies failed to monitor both actual bandage application pressures and the bandaging competency of participating clinicians. A series of literature searches to explore the methods, practices, recommendations and results of monitoring compression bandaging pressures in leg ulcer research trials were undertaken. This included investigating the reliability and validity of sub-bandage pressure monitors and the degree to which compression bandaging achieves the recommended sub-bandage pressure. The literature revealed inconsistencies regarding the monitoring of sub-bandage pressure and in sub-bandage pressures produced by clinicians. This creates difficulties when comparing study outcomes and attempting to develop evidence-based practice recommendations.

Venous Leg Ulcer Healing: A Randomized Prospective Study of Long-Stretch versus Short-Stretch Compression Bandages

1998 ◽  
Vol 13 (2) ◽  
pp. 59-63 ◽  
Author(s):  
L. Danielsen ◽  
S. M. Madsen ◽  
L. Henriksen
Keyword(s):  
Ulcer Healing ◽  
Venous Ulcer ◽  
Positive Influence ◽  
Compression Bandage ◽  
Leg Ulcers ◽  
Venous Leg Ulcer ◽  
Venous Leg Ulcers ◽  
Area Reduction ◽  
Compression Bandages ◽  
Table Analysis

Objective: To compare the efficacy of a long-stretch bandage with that of a short-stretch compression bandage. Design: Prospective evaluation of healing of venous leg ulcers in blindly randomized groups of patients. Setting: Bispebjerg Hospital, Copenhagen, Denmark. Patients: Forty-three patients with venous leg ulcers were included. Forty legs in 40 patients were evaluated at 1 month (34 patients), 6 months (32 patients) or 12 months (27 patients). Interventions: Both types of bandage were used at a width of 10 cm and applied using the same spiral bandaging technique. Main outcome measures: Ulcer healing and ulcer area reduction. Results: Healed ulcers after 1 month were observed in 27% of the long-stretch group and in 5% of the short-stretch group ( p = 0.15); after 6 months the corresponding figures were 50% and 36% ( p = 0.49) and after 12 months 71% and 30% ( p = 0.06). Using life-table analysis the predicted healing rate in the long-stretch group after 12 months was 81% and for the short-stretch group 31% ( p = 0.03). The mean of relative ulcer areas at 1 month was 0.45 for the long-stretch group and 0.72 for the short-stretch group ( p = 0.07), at 6 months the corresponding figures were 0.81 and 0.60 ( p = 0.25) and at 12 months 0.25 and 0.95 ( p = 0.01). Conclusions: The present study appears to indicate a Positive influence of the elasticity of a compression bandage on venous ulcer healing.

Frequency of Isolated Superficial Venous Incompetence in Patients with Venous Ulcers as Measured by Ambulatory Strain-Gauge Plethysmography

1995 ◽  
Vol 10 (2) ◽  
pp. 65-68 ◽  
Author(s):  
C. Hansson ◽  
J. Holm
Keyword(s):  
Strain Gauge ◽  
Screening Method ◽  
Leg Ulcer ◽  
Leg Ulcers ◽  
Pressure Measurements ◽  
Venous Leg Ulcer ◽  
Venous Ulceration ◽  
Venous Leg Ulcers ◽  
Strain Gauge Plethysmography ◽  
Venous Ulcers

Objective: Identification of isolated superficial venous incompetence (SVI) in patients with clinically diagnosed venous leg ulcers using a computerized strain-gauge plethysmograph. Design: Ambulatory leg ulcer patients were assessed as to the clinical diagnosis. Diagnoses other than venous ulceration were excluded. Setting: Department of Dermatology, Sahlgrenska Hospital, Göteborg, Sweden. Patients: One hundred and fourteen patients (133 legs) with venous leg ulcers were investigated. Main outcome measures: All patients were also investigated by measuring systolic ankle and arm pressure measurements. The ankle/arm (AI) was below 0.9 in 22 of the 133 ulcerated legs. Results: Of the 111 ulcerated legs with an AI>0.9, 10% had an isolated SVI. Conclusions: Isolated SVI is an important cause of venous leg ulcer development. Strain-gauge plethysmography is an inexpensive screening method, and is easy to use. Further examination with the more exact, but also more expensive and time-consuming, colour duplex should be performed in selected cases.

scholarly journals Health service costs of treating venous leg ulcers in the UK: evidence from a cross-sectional survey based in the north west of England

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e056790
Author(s):  
Sean Urwin ◽  
Jo C Dumville ◽  
Matt Sutton ◽  
Nicky Cullum
Keyword(s):  
Resource Use ◽  
Wound Care ◽  
Leg Ulcer ◽  
Leg Ulcers ◽  
Venous Leg Ulcer ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Venous Leg Ulcers ◽  
Annual Prevalence ◽  
The Uk

ObjectivesTo estimate and examine the direct healthcare costs of treating people with open venous leg ulcers in the UK.DesignCost-of-illness study.SettingA cross-sectional survey of nine National Health Service community locales over 2-week periods in 2015/2016.MethodsWe examined the resource use and prevalence of venous leg ulcer treatment in the community. Examination of variation in these obtained costs was performed by ordinary least squares regression. We used additional resource use information from a randomised control trial and extrapolated costs to the UK for an annual period.ResultsThe average 2-week per person cost of treating patients where a venous leg ulceration was the primary (most severe) wound was estimated at £166.39 (95% CI £157.78 to £175.00) with community staff time making up over half of this amount. Costs were higher where antimicrobial dressings were used and where wound care was delivered in the home. Among those with any recorded venous leg ulcer (primary and non-primary), we derived a point prevalence of 3.2 per 10 000 population and estimated that the annual prevalence could be no greater than 82.4 per 10 000 population. We estimated that the national cost of treating a venous leg ulcer was £102 million with a per person annual cost at £4787.70.ConclusionOur point prevalence figures are in line with the literature. However, our annual prevalence estimations and costs are far lower than those reported in recent literature which suggests that the costs of treating venous leg ulcers are lower than previously thought. Movement towards routinely collected and useable community care activity would help provide a transparent and deeper understanding of the scale and cost of wound care in the UK.

scholarly journals Translation and cross-cultural adaptation of the Venous Leg Ulcer Self Efficacy Tool for use in a Swiss-French setting

2020 ◽  
Vol 21 (Issue 1 Volume 21, 2020) ◽  
pp. 7-10
Author(s):  
Mathieu Turcotte ◽  
Monika Buehrer Skinner ◽  
Sebastian Probst
Keyword(s):  
Cultural Adaptation ◽  
Chronic Venous Insufficiency ◽  
Self Efficacy ◽  
Venous Insufficiency ◽  
Cross Cultural ◽  
Leg Ulcer ◽  
Leg Ulcers ◽  
Venous Leg Ulcer ◽  
Cross Cultural Adaptation ◽  
Venous Leg Ulcers

Venous leg ulcers are lesions between the ankle joint and the knee caused by chronic venous insufficiency. The Venous Leg Ulcer Self Efficacy Tool (VeLUSET) was developed to measure self-care and self-efficacy in Englishspeaking persons with venous leg ulcers. This study describes the translation and cross-cultural adaptation of the original version of the VeLUSET from English into Swiss French.

scholarly journals A multi-centre, prospective, randomised controlled feasibility study of plantar resistance exercise therapy for venous leg ulcers – Results of the PREVUE study

2019 ◽  
Vol 35 (4) ◽  
pp. 237-246
Author(s):  
Leon Jonker ◽  
Jane Todhunter ◽  
Jose Schutter ◽  
Charlotte Halliday ◽  
Stacey Fisher
Keyword(s):  
Resistance Exercise ◽  
Exercise Programme ◽  
Complete Healing ◽  
Leg Ulcer ◽  
P Value ◽  
Daily Routine ◽  
Leg Ulcers ◽  
Venous Leg Ulcer ◽  
Potential Health ◽  
Venous Leg Ulcers

Objectives To evaluate the feasibility of an interventional study involving a seated plantar resistance exercise programme, using a StepIt pedal, aimed at promotion of venous leg ulcer healing. Methods Thirty-two venous leg ulcer patients, recruited from community, GP and hospital settings, were randomised to either a standard care or adjuvant StepIt exercise programme arm for up to 12 weeks. The exercise involved a twice daily routine of 10 times 1 min of exercise, i.e. 2 s push and 2 s lift repetitions (equating to 300 daily ‘steps’). Results Complete healing of the venous leg ulcers was observed in 10 out of 15 (67%; StepIt cohort) and 7 out of 17 (41%; control cohort), respectively (p-value 0.18, Fisher’s exact test). Baseline differences between the two cohorts were longer wound chronicity, less venous leg ulcer-related pain and better venous leg ulcer-related quality of life in the StepIt cohort. One adverse event, involving increased wound exudate and slough production, was observed in a participant using StepIt, and no study withdrawals were recorded in either arm. StepIt users whose wound had completely healed by week 12 were more likely to be compliant with the exercise programme (self-reported) and more positive about the trial experience; however, all would recommend the device to others. Conclusions Seated plantar resistance exercise shows promise and may accelerate venous leg ulcer wound healing. The StepIt pedal is well-received by patients, and its efficacy may depend on the degree of patient compliance with the exercise programme. Further larger scale studies are indicated to allow more concrete inferences to be made on the clinical and potential health economics impact that this device may have.

Lothian and Forth Valley Leg Ulcer Healing Trial, Part 2: Knitted Viscose Dressing versus a Hydrocellular Dressing in the Treatment of Chronic Leg Ulceration

1992 ◽  
Vol 7 (4) ◽  
pp. 142-145 ◽  
Author(s):  
M. J. Callam ◽  
D. R. Harper ◽  
J. J. Dale ◽  
D. Brown ◽  
B. Gibson ◽  
...  
Keyword(s):  
Pain Relief ◽  
Ulcer Healing ◽  
Outcome Measure ◽  
Leg Ulcer ◽  
Leg Ulcers ◽  
Multilayer Systems ◽  
Venous Leg Ulcers ◽  
Patients With Diabetes ◽  
Interaction Testing ◽  
Standard Techniques

Objective: To compare a new ‘advanced’ hydrocellular Polyurethane dressing (HPD) (Allevyn) with a traditional simple non-adherent knitted viscose dressing (KDV) (Tricotex) in the treatment of chronic venous leg ulcers. Design: A randomized trial of factorial design, with interaction testing, to allow the evaluation of two different therapeutic components (dressing and bandages) within a single trial. The treatment period was 12 weeks or until healing, whichever occurred sooner. Setting: The Leg Ulcer Clinics of Edinburgh and Falkirk and District Royal Infirmaries, Scotland. Patients: 132 patients with chronic venous leg ulcers were randomized, 66 to HPD and 66 to KVD. Principal exclusions were patients with diabetes, rheumatoid disease or Doppler ankle/brachial pressure indices of less than 0.8. There were 28 withdrawals (15 KVD, 13 HPD). These were considered as treatment failures. Interventions: Dressings and bandaging were applied by specialist leg ulcer nurses using standard techniques throughout, the bandaging being randomized to either elastic or non-elastic multilayer systems. Main outcome measure: The principal end-point was ulcer healing. Also monitored were healing rates, pain and the frequency of dressing changes. Results: Pain relief was significantly better in the HPD group ( p=0.01). Thirty-one (47%) of the HPD patients healed within 12 weeks compared with only 23 (35%) of the those treated with KVD (95% confidence limits for difference, −5% to +29%). The higest healing rates (61% for all ulcers and 74% for those less than 10 cm2) were observed in the subgroup in which HPD was used in combination with an elastic bandaging system. Conclusion: Patients treated with HPD did significantly better in terms of pain relief, although the higher healing rates observed in this group failed to reach significance at the 5% level.

scholarly journals Patient Explanation of Adherence and Non-Adherence to Venous Leg Ulcer Treatment: A Qualitative Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Carolina D. Weller ◽  
Catelyn Richards ◽  
Louise Turnour ◽  
Victoria Team
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Treatment Adherence ◽  
Theoretical Domains Framework ◽  
Environmental Context ◽  
Leg Ulcer ◽  
Leg Ulcers ◽  
Venous Leg Ulcer ◽  
Venous Leg Ulcers ◽  
Ulcer Treatment

The aim of this study was to understand which factors influence patients’ adherence to venous leg ulcer treatment recommendations in primary care. We adopted a qualitative study design, conducting phone interviews with 31 people with venous leg ulcers in Melbourne, Australia. We conducted 31 semi-structured phone interviews between October and December 2019 with patients with clinically diagnosed venous leg ulcers. Participants recruited to the Aspirin in Venous Leg Ulcer Randomized Control Trial and Cohort study were invited to participate in a qualitative study, which was nested under this trial. We applied the Theoretical Domains Framework to guide the data analysis. The following factors influenced patients’ adherence to venous leg ulcer treatment: understanding the management plan and rationale behind treatment (Knowledge Domain); compression-related body image issues (Social Influences); understanding consequences of not wearing compression (Beliefs about Consequences); feeling overwhelmed because it’s not getting better (Emotions); hot weather and discomfort when wearing compression (Environmental Context and Resources); cost of compression (Environmental Context and Resources); ability to wear compression (Beliefs about Capabilities); patience and persistence (Behavioral Regulation); and remembering self-care instructions (Memory, Attention and Decision Making). The Theoretical Domains Framework was useful for identifying factors that influence patients’ adherence to treatment recommendations for venous leg ulcers management. These factors may inform development of novel interventions to optimize shared decision making and self-care to improve healing outcomes. The findings from this article will be relevant to clinicians involved in management of patients with venous leg ulcers, as their support is crucial to patients’ treatment adherence. Consultation with patients about VLU treatment adherence is an opportunity for clinical practice to be targeted and collaborative. This process may inform guideline development.

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