Use of a flowable wound matrix to treat lower limb vascular ulcers

Objectives: This study is aimed at assessing the safety and effectiveness of an advanced flowable wound matrix (FWM) in the treatment of hard-to-heal vascular leg ulcers that often involve deep structures, are irregular and/or tunnelled or excavated. Methods: Records of patients seen at our Vascular Surgery Unit, at the University of Campania ‘Luigi Vanvitelli’, for hard-to-heal vascular leg ulcers between January 2018 and January 2020 were retrospectively reviewed. For each wound aetiology, area and complications were recorded and evaluated. Every patient received one or more applications of FWM and was followed up. Results: A total of 22 patients (18 female/four male), mean age 63±8.5 years, were treated. The initial wound area ranged from 4–58cm2. After wound bed preparation, FWM was applied. Treatment was well tolerated and effective—rate of complications was low, graft take was very satisfactory, and no graft loss, rejection or superimposed infections were observed. Healing time was short: 85% of ulcers healed after 12 weeks. Most importantly, there was a decrease in the rate and level of amputations as compared with standard wound care. Conclusions: The data presented indicate that FWM is an option for the treatment of hard-to-heal vascular leg ulcers, particularly for those with an irregular cavity. Declaration of interest: The authors have no conflicts of interest.

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Use of Porcine-Derived Dermal Substitutes for Treatment of Nonhealing Vascular Leg Ulcers: A Case Series

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734620945561 ◽

2020 ◽

pp. 153473462094556

Author(s):

Marianna Sallustro ◽

Raffaele Polichetti ◽

Anna Florio

Keyword(s):

Therapeutic Option ◽

Graft Loss ◽

Case Series ◽

Skin Lesions ◽

Dermal Substitute ◽

Leg Ulcers ◽

Major Health Problem ◽

Dermal Substitutes ◽

Effective Therapeutic Option ◽

Wound Bed Preparation

Nonhealing leg ulcers are a major health problem worldwide with a high economic burden since they require human and material resources. Moreover, nonhealing ulcers are a major nontraumatic cause of lower limb amputations. Dermal substitutes have emerged as an effective therapeutic option for treatment of skin lesions, but data on leg ulcers are scarce. We evaluated safety and efficacy of a porcine-derived dermal substitute in the treatment of chronic vascular leg ulcers. Records of patients with nonhealing ulcers seen at our unit from 2018 to 2019 were retrospectively reviewed. Wound etiology, wound area, and complications were evaluated. Each patient received one application of porcine-derived dermal substitute and was followed-up. Six patients (5 females and 1 male) with a mean age of 61.3 (52-81) years presented with nonhealing leg ulcers. After surgical debridement and wound bed preparation, porcine-derived dermal substitute was applied onto the ulcer. Granulation was satisfactory within 10 days. All wounds healed after an average time of 14 weeks. Graft take was good, and no graft loss, rejection, or associated infection were observed. In conclusion, the data presented indicate that dermal substitutes are safe and effective for treatment of chronic nonhealing vascular leg ulcers.

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PENGARUH PENGGUNAAN ASI PADA PERAWATAN LUKA PERINIEM DENGAN LAMA WAKTU PENYEMBUHAN LUKA PERINIUM

Jurnal Kebidanan Mutiara Mahakam ◽

10.36998/jkmm.v7i2.61 ◽

2019 ◽

Vol 7 (2) ◽

pp. 67-73

Author(s):

Annisa Ul Mutmainnah ◽

Siti Noorbaya

Keyword(s):

Wound Healing ◽

Data Analysis ◽

Random Sampling ◽

Wound Care ◽

Healing Time ◽

Natural Process ◽

Control Group ◽

P Value ◽

Research Subjects ◽

Wound Area

Childbirth is a natural process, but sometimes labor can also cause birth canaltrauma, especially in the aluminum region, this trauma can be injuries to the periniumarea, the cause can be intentional biases such as episiotomy or unintentional actions such as spontaneous tears in the process of removing the baby. Injury to the perineum if not treated properly can cause postpartum infection because the wound area will be a medium for developing germs. The purpose of this study was to analyze the effect of the use of breast milk in the treatment of periniem wounds with the duration of perinium wound healing at the Ramlah Parjib Clinic in Samarinda. The method used in this study was Posttest Only Control Group Desigen research subjects were postpartum motherswith a sample of 60 respondents taken by random sampling and grouped based on treatment using ASI. Data analysis using ANOVA test. The results showed that the use of ASI had a significant effect on the treatment of periniem wounds with a healing time seen from the P value of 0,000. Conclusion: Periniuem wound care techniques are factors that influence the duration of perinieum wound healing

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ImageJ: A Free, Easy, and Reliable Method to Measure Leg Ulcers Using Digital Pictures

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734617744951 ◽

2017 ◽

Vol 16 (4) ◽

pp. 269-273 ◽

Cited By ~ 14

Author(s):

Javier Aragón-Sánchez ◽

Yurena Quintana-Marrero ◽

Cristina Aragón-Hernández ◽

María José Hernández-Herero

Keyword(s):

Correlation Coefficient ◽

Wound Care ◽

National Institutes Of Health ◽

Area Measurement ◽

Leg Ulcers ◽

Digital Cameras ◽

Wound Area ◽

Care Nurse ◽

Interclass Correlation Coefficient ◽

Interclass Correlation

Wound measurement to document the healing course of chronic leg ulcers has an important role in the management of these patients. Digital cameras in smartphones are readily available and easy to use, and taking pictures of wounds is becoming a routine in specialized departments. Analyzing digital pictures with appropriate software provides clinicians a quick, clean, and easy-to-use tool for measuring wound area. A set of 25 digital pictures of plain foot and leg ulcers was the basis of this study. Photographs were taken placing a ruler next to the wound in parallel with the healthy skin with the iPhone 6S (Apple Inc, Cupertino, CA), which has a camera of 12 megapixels using the flash. The digital photographs were visualized with ImageJ 1.45s freeware (National Institutes of Health, Rockville, MD; http://imagej.net/ImageJ ). Wound area measurement was carried out by 4 raters: head of the department, wound care nurse, physician, and medical student. We assessed intra- and interrater reliability using the interclass correlation coefficient. To determine intraobserver reliability, 2 of the raters repeated the measurement of the set 1 week after the first reading. The interrater model displayed an interclass correlation coefficient of 0.99 with 95% confidence interval of 0.999 to 1.000, showing excellent reliability. The intrarater model of both examiners showed excellent reliability. In conclusion, analyzing digital images of leg ulcers with ImageJ estimates wound area with excellent reliability. This method provides a free, rapid, and accurate way to measure wounds and could routinely be used to document wound healing in daily clinical practice.

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General practitioners’ perceptions of their role and their collaboration with district nurses in wound care

Primary Health Care Research & Development ◽

10.1017/s1463423618000464 ◽

2018 ◽

Vol 20 ◽

Author(s):

Anne Friman ◽

Desiree Wiegleb Edström ◽

Samuel Edelbring

Keyword(s):

Primary Care ◽

General Practitioners ◽

Wound Care ◽

Healing Time ◽

County Council ◽

Leg Ulcers ◽

Negative Consequences ◽

Individual Interviews ◽

Structured Care ◽

District Nurses

AbstractAimTo explore the perceptions of general practitioners (GPs) regarding their role and their collaboration with district nurses (DNs) in the management of leg ulcers in primary healthcare.BackgroundEarlier research regarding the treatment of leg ulcers in a primary care context has focussed primarily on wound healing. Less is known about GPs’ understandings of their role and their collaboration with DNs in the management of leg ulcers. Since the structured care of patients with leg ulcers involving both GP and DN is currently rather uncommon in Swedish primary care, this study sets out to highlight these aspects from the GP’s perspective.MethodsSemi-structured individual interviews with 16 GPs including both private and county council run healthcare centres. Thematic analysis was used to analyse the data.ResultsFour themes were identified. The first theme: ‘role as consultant and coordinator’ shows how the GPs perceived their role in wound care. In the second theme: ‘responsibility for diagnosis’ the GPs’ views on responsibility for wound diagnosis is presented. The third theme: ‘desire for continuity’ is based on the GPs’ desire for continuity concerning various aspects. In the fourth theme: ‘collaboration within the organisation’ the importance of the organisation for collaboration between GPs and DNs is presented.ConclusionsThe GP’s often work on a consultation-like basis and feel that they become involved late in the patients’ wound treatment. This can have negative consequences for the medical diagnosis and, thereby, lead to a prolonged healing time for the patient. Shortcomings regarding collaboration are mainly attributed to organisational factors.

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Use of a bacterial fluorescence imaging system to target wound debridement and accelerate healing: a pilot study

Journal of Wound Care ◽

10.12968/jowc.2020.29.sup7.s44 ◽

2020 ◽

Vol 29 (Sup7) ◽

pp. S44-S52 ◽

Cited By ~ 1

Author(s):

Windy Cole ◽

Stacey Coe

Keyword(s):

Wound Healing ◽

Fluorescence Imaging ◽

Imaging System ◽

Wound Care ◽

Point Of Care ◽

Bacterial Load ◽

Case Series ◽

Wound Area ◽

Wound Debridement ◽

Wound Bed Preparation

Objective: Optimal wound-bed preparation consists of regular debridement to remove devitalised tissues, reduce bacterial load, and to establish an environment that promotes healing. However, lack of diagnostic information at point-of-care limits effectiveness of debridement. Method: This observational case series investigated use of point-of-care fluorescence imaging to detect bacteria (loads >104CFU/g) and guide wound bed preparation. Lower extremity hard-to-heal wounds were imaged over a 12-week period for bacterial fluorescence and wound area. Results: A total of 11 wounds were included in the study. Bacterial fluorescence was present in 10 wounds and persisted, on average, for 3.7 weeks over the course of the study. The presence of red or cyan fluorescent signatures from bacteria correlated with an average increase in wound area of 6.5% per week, indicating stalled or delayed wound healing. Fluorescence imaging information assisted in determining the location and extent of wound debridement, and the selection of dressings and/or antimicrobials. Elimination of bacterial fluorescence signature with targeted debridement and other treatments correlated with an average reduction in wound area of 27.7% per week (p<0.05), indicative of a healing trajectory. Conclusion: These results demonstrate that use of fluorescence imaging as part of routine wound care enhances assessment and treatment selection, thus facilitating improved wound healing.

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Clinical and cost efficacy of advanced wound care matrices in the treatment of venous leg ulcers: a systematic review

Journal of Wound Care ◽

10.12968/jowc.2021.30.7.553 ◽

2021 ◽

Vol 30 (7) ◽

pp. 553-561

Author(s):

Sameer Massand ◽

Joseph A Lewcun ◽

Charles A LaRosa

Keyword(s):

Systematic Review ◽

Assessment Tool ◽

Wound Care ◽

Cochrane Library ◽

Skin Substitute ◽

Dermal Substitute ◽

Leg Ulcers ◽

Venous Leg Ulcers ◽

Wound Matrix ◽

Cost Efficacy

Background: Venous leg ulcers (VLUs) are hard-to-heal, recurrent and challenging to treat. Advanced wound care matrices (AWCMs) have been developed to supplement conventional therapies. These costly AWCMs warrant careful comparison as healthcare expenditures are subjected to increasing scrutiny. Aim: This study was designed to compare AWCMs in their ability to heal VLUs and their cost efficacy through a systematic review of randomised controlled trials (RCTs). Method: An organised search of Medline, Cochrane Library, Central and CINAHL databases identified RCTs that compared AWCMs to standard compression therapy in the healing of VLUs. Bias was assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies. Eight studies analysing bilayered skin substitute (BSS) (Apligraf), dehydrated human amnion/chorion membrane (dHACM) (Epifix), human fibroblast-derived dermal substitute (HFDDS) (Dermagraft), extracellular wound matrix (ECM) (Oasis), advanced matrix (AM) (Talymed) and matrix wound dressing (MWD) (Promogran) met the inclusion criteria. Results: Four studies reported significant improvement over standard therapy: BSS, dHACM, ECM and AM. Incremental cost per additional successful treatment was determined for each trial, ranging from $2593 (MWD) to $210,800 (HFDDS). Conclusion: Our consolidated analysis of eight major RCTs of AWCMs in the treatment of VLUs revealed a great variation in clinical and cost efficacy among these products. The included trials were inconsistent in methodology, and these limitations should be noted, but, in the absence of RCTs to compare these products, our systematic review may serve as a guide for practitioners who seek to optimise wound healing while considering cost efficacy.

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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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Effectiveness of an extracellular matrix graft (OASIS Wound Matrix) in the treatment of chronic leg ulcers: A randomized clinical trial

Yearbook of Vascular Surgery ◽

10.1016/s0749-4041(08)70616-x ◽

2007 ◽

Vol 2007 ◽

pp. 361-362

Author(s):

J.D. Raffetto

Keyword(s):

Clinical Trial ◽

Extracellular Matrix ◽

Randomized Clinical Trial ◽

Leg Ulcers ◽

Wound Matrix ◽

Chronic Leg Ulcers

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Compression Therapy Is Not Contraindicated in Diabetic Patients with Venous or Mixed Leg Ulcer

Journal of Clinical Medicine ◽

10.3390/jcm9113709 ◽

2020 ◽

Vol 9 (11) ◽

pp. 3709

Author(s):

Giovanni Mosti ◽

Attilio Cavezzi ◽

Luca Bastiani ◽

Hugo Partsch

Keyword(s):

Treatment Protocol ◽

Compression Therapy ◽

Healing Time ◽

Leg Ulcer ◽

Venous Disease ◽

Diabetic Patients ◽

Leg Ulcers ◽

Foam Sclerotherapy ◽

Compression Pressure ◽

A Minor

The aim of this study was to investigate if compression therapy (CT) can be safely applied in diabetic patients with Venous Leg Ulcers (VLU), even when a moderate arterial impairment (defined by an Ankle-Brachial Pressure Index 0.5–0.8) occurs as in mixed leg ulcers (MLU). Materials and methods: in one of our previous publications we compared the outcomes of two groups of patients with recalcitrant leg ulcers. Seventy-one patients were affected by mixed venous and arterial impairment and 109 by isolated venous disease. Both groups were treated by tailored inelastic CT (with compression pressure <40 mm Hg in patients with MLU and >60 mm Hg in patients with VLU) and ultrasound guided foam sclerotherapy (UGFS) of the superficial incompetent veins with the reflux directed to the ulcer bed. In the present sub analysis of the same patients we compared the healing time of 107 non-diabetic patients (NDP), 69 with VLU and 38 with MLU) with the healing time of 73 diabetic patients (DP), 40 with VLU and 33 with MLU. Results: Twenty-five patients were lost at follow up. The results refer to 155 patients who completed the treatment protocol. In the VLU group median healing time was 25 weeks for NDP and 28 weeks in DP (p = 0.09). In the MLU group median healing time was 27 weeks for NDP and 29 weeks for DP (p = −0.19). Conclusions: when providing leg ulcer treatment by means of tailored compression regimen and foam sclerotherapy for superficial venous refluxes, diabetes has only a minor or no effect on the healing time of recalcitrant VLU or MLU.

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