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

2013 ◽  
Vol 28 (3) ◽  
pp. 132-139 ◽  
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.

Effect of foam sclerotherapy on healing and long-term recurrence in chronic venous leg ulcers

2013 ◽  
Vol 28 (3) ◽  
pp. 140-146 ◽  
Author(s):  
S R Kulkarni ◽  
F J A Slim ◽  
L G Emerson ◽  
C Davies ◽  
R A Bulbulia ◽  
...  
Keyword(s):  
Ulcer Healing ◽  
Healing Rate ◽  
Leg Ulcers ◽  
Venous Reflux ◽  
Foam Sclerotherapy ◽  
Recurrence Rates ◽  
Venous Ulceration ◽  
Venous Leg Ulcers ◽  
Venous Surgery

Introduction The ESCHAR trial showed that superficial venous surgery and compression in chronic venous ulceration achieved a 24-week healing rate of 65% and 12-month recurrence rate of 12%. Foam sclerotherapy treatment is an alternative to surgery. The aim of this study is to assess the effect of foam sclerotherapy on ulcer healing and recurrence in chronic venous leg ulcers. Methods Chronic venous leg ulcers (CEAP [clinical, aetiological, anatomical and pathological elements] 5 and CEAP 6) with superficial venous reflux were treated between March 2006 and June 2011 with ultrasound-guided foam sclerotherapy and compression. Venous duplex was performed on all legs before and after treatment. Twenty-four-week ulcer healing and one- and four-year ulcer recurrence rates were calculated using Kaplan–Meier survival analysis. Results Two hundred legs (186 patients) with chronic venous ulcers (CEAP 5: n = 163 and CEAP 6: n = 37) were treated with foam sclerotherapy. Complete occlusion was achieved in 185/200 (92.5%) limbs, short segment occlusion in 14/200 (7%) limbs and one leg segment failed to occlude. One patient suffered an asymptomatic non-occlusive deep vein thrombosis (DVT) diagnosed on duplex scan at one week and one presented with an occlusive DVT three weeks following a normal scan at one week. One patient developed an asymptomatic occlusive DVT at two weeks following a non-occlusive DVT diagnosed on initial one-week scan. Eighteen patients were lost to follow-up (3 moved away and 15 died of unrelated causes). The 24-week healing rate was 71.1% and one- and four-year recurrence rates were 4.7% and 28.1%, respectively. Conclusion Foam sclerotherapy is effective in abolition of superficial venous reflux and may contribute to similar ulcer healing and long-term recurrence rates to superficial venous surgery. Foam sclerotherapy is an attractive alternative to surgery in this group of patients.

scholarly journals Cost-Effective Management of Venous Ulcer

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

scholarly journals Skin grafting in the treatment of hard-to-heal leg ulcers

2018 ◽  
Vol 2 (1) ◽  
Author(s):  
Giovanni Mosti ◽  
Vincenzo Mattaliano ◽  
Pietro Picerni ◽  
Costantino Christou
Keyword(s):  
Ulcer Healing ◽  
Healing Rate ◽  
Skin Grafting ◽  
Leg Ulcers ◽  
Clinical Routine ◽  
Ulcer Size ◽  
Donor Skin ◽  
Post Traumatic ◽  
Chronic Leg Ulcers

Some risk factors or comorbidities may make Chronic Leg Ulcers (CLU) very difficult to heal. These ulcers are usually defined refractory ulcers and may require an in-hospital intensive care to increase the healing rate. Aim of this retrospective study was to assess if our clinical routine in hospitalized patients, made up with surgical debridement followed by donor skin grafting (allografts), may favor the ulcer healing. The records of 120 patients (55 males and 65 females; mean age 73.9±11.3 years) with ulcers greater than 100 cm2 and lasting for more than 1 year were analyzed. The median ulcer size was 165 cm2 (IQR 130-250 cm2; range 100-1000 cm2). The median ulcer duration was 24 months (IQR 16-32 months; range 12-300 months). The ulcer pathophysiology was venous in 74 patients, arterial in 21, mixed in 12, vasculitis in 5 and post-traumatic in 8 patients. After debridement the patients were submitted to allograft procedures (single or multiple) up to the ulcer healing. When allograft was able to create an effective granulation tissue and reduce the ulcer size an autograft was performed to get the ulcer closure. 109 patients healed and 11 were lost at follow-up. 65 patients healed just with one allograft in 16 weeks (IQR 13-21 weeks). 42 patients healed with 2 procedures in 20 weeks (IQR 18-23 weeks). 31 of them received a final autograft while 11 healed with two allografts. 2 patients with an ulcer surface of 200 cm2, both affected by CLI, healed with 3 allografts procedures in 40 and 33 weeks, respectively. Pain and exudate amount were significantly decreased and even disappeared after the first allograft. Allografts alone or followed by an autograft are able to get the ulcer healing also in case of extensive and long lasting ulcers refractory to all previous treatments.

scholarly journals The lateral infratrigeminal transpontine window to deep pontine lesions

2015 ◽  
Vol 123 (3) ◽  
pp. 699-710 ◽  
Author(s):  
Paolo Ferroli ◽  
Marco Schiariti ◽  
Roberto Cordella ◽  
Carlo Boffano ◽  
Simone Nava ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Surgical Intervention ◽  
Neurological Deficits ◽  
Critical Area ◽  
Surgical Indications ◽  
Surgical Strategies ◽  
Csf Leakage ◽  
New Knowledge ◽  
Pontine Lesion

OBJECT Surgery of brainstem lesions is increasingly performed despite the fact that surgical indications and techniques continue to be debated. The deep pons, in particular, continues to be a critical area in which the specific risks related to different surgical strategies continue to be examined. With the intention of bringing new knowledge into this important arena, the authors systematically examined the results of brainstem surgeries that have been performed through the lateral infratrigeminal transpontine window. METHODS Between 1990 and 2013, 29 consecutive patients underwent surgery through this window for either biopsy sampling or for removal of a deep pontine lesion. All of this work was performed at the Department of Neurosurgery of the Istituto Nazionale Neurologico "Carlo Besta", in Milan, Italy. A retrospective analysis of the findings was conducted with the intention of bringing further clarity to this important surgical strategy. RESULTS The lateral infratrigeminal transpontine window was exposed through 4 different approaches: 1) classic retrosigmoid (15 cases), 2) minimally invasive keyhole retrosigmoid (10 cases), 3) translabyrinthine (1 case), and 4) combined petrosal (3 cases). No deaths occurred during the entire clinical study. The surgical complications that were observed included hydrocephalus (2 cases) and CSF leakage (1 case). In 6 (20.7%) of 29 patients the authors encountered new neurological deficits during the immediate postoperative period. All 6 of these patients had undergone lesion removal. In only 2 of these 6 patients were permanent sequelae observed at 3 months follow-up. These findings show that 93% of the patients studied did not report any permanent worsening of their neurological condition after this surgical intervention. CONCLUSIONS This retrospective study supports the idea that the lateral infratrigeminal transpontine window is both a low-risk and safe corridor for either biopsy sampling or for removal of deep pontine lesions.

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.

Simultaneous Superficial Venous Surgery and On-Table Subintimal Angioplasty in the Treatment of Venous Leg Ulcers With Arterial Compromise

2005 ◽  
Vol 12 (6) ◽  
pp. 739-745 ◽  
Author(s):  
Christos D. Karkos ◽  
Charlotte Holbrook ◽  
Sotirios A. Makris ◽  
Guy Fishwick ◽  
Nicholas J. M. London ◽  
...  
Keyword(s):  
Leg Ulcers ◽  
Subintimal Angioplasty ◽  
Venous Leg Ulcers ◽  
Venous Surgery

scholarly journals Endoscopic posterior cordotomy for treatment of dyspnea due to vocal fold immobility

2020 ◽  
Vol 15 ◽  
Author(s):  
Narin Nard Carmel Neiderman ◽  
Max Chason ◽  
Anat Wengier ◽  
Oshri Wasserzug ◽  
Oren Cavel ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Respiratory Distress ◽  
Surgical Procedures ◽  
Medical Records ◽  
Vocal Fold ◽  
Surgical Intervention ◽  
Acute Setting ◽  
Vocal Fold Immobility ◽  
The Mean

Introduction: Several surgical procedures have been described for the treatment of respiratory distress secondary to vocal fold immobility (VFI), but the contribution of posterior cordotomy (PC) to tracheostomy weaning or prevention has not been studied in depth, particularly in the acute setting. The objective of this study was to show the effectiveness of PC to relieve dyspnea, prevent the need for tracheostomy, and enable decannulation in patients with VFI. Methods: We conducted a retrospective study and reviewed the medical records of all patients whose dyspnea warranted surgical intervention from January 2013 to January 2018. Data were retrieved on epidemiology, etiology, and duration of VFI, tracheostomy dependence, success in decannulation from tracheostomy or respiratory relief, number of procedures until decannulation, and complications. Results: Twelve suitable patients were identified of whom eleven had bilateral VFI and one had unilateral VFI. Five were tracheostomy-dependent. Ten patients underwent unilateral PC, and two patients underwent bilateral PC. All the patients experienced respiratory relief, eleven after a single PC and one after two PCs. All tracheostomy-dependent patients were decannulated. The mean follow-up after PC was 24.55 months during which none of the patients required a re-tracheostomy and three patients required revision of the PC. There were no surgical complications. Postoperatively, eight patients (67%) experienced a breathy voice and three patients (25%) had dysphagia for fluids. No patient had aspiration pneumonia. Conclusions: We conclude that PC is an easy, safe, and effective procedure for tracheostomy weaning and respiratory relief in patients with VFI. A revision PC may be indicated in some patients. A breathy voice is to be expected, and a few patients will experience dysphagia to fluids that may be addressed by instructing the patient to use a fluid thickener and take small sips.

scholarly journals A randomized trial of surgery alone versus surgery plus compression in the treatment of venous leg ulcers in patients with primary venous insufficiency

2020 ◽  
Vol 77 (8) ◽  
pp. 811-815
Author(s):  
Dragan Milic ◽  
Sasa Zivic ◽  
Mladjan Golubovic ◽  
Dragan Bogdanovic ◽  
Milan Lazarevic ◽  
...  
Keyword(s):  
Ulcer Healing ◽  
Venous Insufficiency ◽  
Healing Rate ◽  
Surgical Intervention ◽  
Compression Therapy ◽  
Healing Time ◽  
Leg Ulcers ◽  
Compression Device ◽  
Group A ◽  
Group B

Background/Aim.Venous leg ulcers (VLU) are a significant health problem worldwide. It is well known that VLU are difficult to treat and that they have high tendency for recurrence. Compression therapy is the preferred treatment modality but there is growing evidence that correction of underlying venous disorder in early stages of the disease in addition to compression treatment may improve ulcer healing and reduce recurrence rate. Methods. An open, prospective, randomized, single-center study, with a 6-months follow-up was performed to determine the efficacy of two different treatment modalities (surgery alone versus surgery plus compression) in the treatment of VLU in patients with primary venous insufficiency. Patients with secondary venous insufficiency and/or thrombosis were excluded from the study. Overall, 71 patients were randomized (37 men, 34 women; mean age 60 years) into two groups: the group A ? 34 patients who underwent surgical intervention (stripping) and postoperatively were treated with simple wound dressing only, and the group B ? 37 patients who underwent surgical intervention (stripping) and wore a heelless open-toed elastic class III compression device knitted in tubular form ?Tubulcus? (Laboratoires Innothera, Arcueil, France). All patients in group B were instructed to wear compression device continuously during the day and night. The study was performed at the Clinic for Cardiovascular and Transplant Surgery, Clinical Centre Nis (Serbia) with primary endpoint of the study being complete ulcer healing at 180 days. Results. The healing rate was 29.41% (10/34) in the group A, and 56.76% (21/37) in the group B (p < 0.01). Mean healing time in the group A was 141 ?15 days, and in the group B it was 98 ?12 days (Log-rank life table analysis: p < 0.001). Conclusion. This study suggests that for VLU in patients with primary venous insufficiency, surgery plus compression therapy provides higher healing rate and faster healing time compared to surgery only.

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