Efficacy and Safety of Intralesional Platelet Rich Plasma (PRP) Therapy in the Management of Chronic Non-healing Leg Ulcers in our Population

Background: Autologous Platelets Rich Plasma (PRP) therapy not only hastens chronic wounds and ulcers healing but also diminishes the rate of amputations of lower leg caused by non-healing recalcitrant ulcers. In this study we have demonstrated the magical results of intralesional autologous PRP in the healing of resistant to heal chronic leg ulcers. Methods: In this metacentric study 26 patients having 30 chronic leg ulcers of more than 6 weeks duration and various etiologies, were treated with intralesional autologous PRP application on weekly basis for a duration of 8 weeks and the final results were calculated by percentage improvement in the volume and area of the ulcer/wound. Results: In our study 26 patient with 30 chronic recalcitrant leg ulcers/wounds were treated with intralesional autologous PRP therapy on weekly basis. Mean age of the included patients was 34.5 years. 19 were male patients and 7 were female. The mean time period of the healing of chronic ulcers was 5.3 weeks. The final mean percentage improvement outcome in the volume and area of the ulcers was calculated as 86% and 88% respectively. Conclusions: PRP therapy is safe, cost effective office based simple procedure in treating recalcitrant chronic leg ulcer/wounds. Keywords: Non-healing, intralesional, autologous platelet rich plasma, chronic ulcers

Experience in the complex therapy of chronic leg ulcers

With patients suffering from chronic ulcers of the legs, it is necessary to meet a practical doctor relatively often both in a hospital setting and in a clinic. At the same time, despite the variety of methods of their treatment, the percentage of failures is still significant.

Efficacy of adipose-derived stromal vascular fraction cells in the management of chronic ulcers: a randomized clinical trial

Background: Cell therapy is a promising method for improving healing in chronic ulcers through delivery of isolated adipose-derived stromal vascular fraction. Objectives: This study investigates the autologous stem cell yield of adipose tissue and its efficacy in chronic ulcers compared with conventional methods. Methods: This study was a randomized controlled trial. After the study design and protocol were established and ethical committee approval was obtained, we enrolled 100 patients divided into study and control groups. In the study group, we performed debridement and autologous stem cells injection every 3 weeks. The control group was treated with debridement and conventional dressing. Assessments included clinical and histological parameters. Results: The study group showed improved healing. Conclusion: Using autologous adipose-derived stromal vascular fraction cells is an effective treatment method for chronic ulcers. This study was registered on the Pan-African Clinical Trial Registry and the number of the registry was PACTR201709002519185 .

A randomized comparison study of conventional normal saline and silver nanocrystalline gel as topical wound dressings in non-healing wounds

Background: Non-healing wounds and chronic ulcers are being consequence of the abnormality in healing process and disturbance in the recovery pathway. Picking an ideal choice of topical application and dressing helps in enhancing the wound heal in addition to the antibiotics administration. To identify the outcome of topical dressing in chronic ulcers by using, silver nanocrystalline gel dressing (AgNP) and conventional normal saline dressing (NS).Methods: This study was an open label randomized study in patient with chronic non-healing wound. The wound healing outcomes of two different dressing methods were compared, which was evaluated by independent assessor. The primary outcome is area reduction of wound and duration of healing. The secondary outcome is the formation of healthy granulation, slough and discharge and wound site infection control.Results: The outcome of AgNP and conventional NS dressing was compared. The 100 patients with non-healing wounds were randomized in the ratio of 1:1. The primary outcome was study group had better area of reduction of 41.97% (SD-7.41) with statistical significance (p<0.0001) and mean duration of healing, 15.64 weeks. The secondary outcome of healthy granulation tissue and reduced slough and discharge at the end of 3 weeks with topical silver nanocrystalline dressing was significant. Conclusions: Topical silver nanocrystalline dressing shall be an effective dressing option to achieve apposite recovery of healing process in non-healing wounds.

Overriding defective FPR chemotaxis signaling in diabetic neutrophil stimulates infection control in diabetic wound

Infection is a major co-morbidity that contributes to impaired healing in diabetic wounds. Although impairments in diabetic neutrophils have been blamed for this co-morbidity, what causes these impairments and whether they can be overcome, remain largely unclear. Diabetic neutrophils, extracted from diabetic individuals, exhibit chemotaxis impairment but this peculiar functional impairment has been largely ignored because it appears to contradict the clinical findings which blame excessive neutrophil influx (neutrophilia) as a major impediment to healing in chronic diabetic ulcers. Here, we report that exposure to glucose in diabetic range results in impaired chemotaxis signaling through the FPR1 chemokine receptor in neutrophils, culminating in reduced chemotaxis and delayed neutrophil trafficking in wound in diabetic animals, and rendering diabetic wound vulnerable to infection. We further show that at least some auxiliary chemokine receptors remain functional under diabetic conditions and their engagement by the pro-inflammatory cytokine CCL3, overrides the requirement for FPR1 signaling and substantially improves infection control by jumpstarting the neutrophil response toward infection, and stimulates healing in diabetic wound. We posit that CCL3 may have real therapeutic potential for the treatment of diabetic foot ulcers if it is applied topically after the surgical debridement process which is intended to reset chronic ulcers into acute fresh wounds.

Management and antisepsis in wound care: The experience of an Italian region (Liguria) in the treatment of older people affected by chronic ulcers

Liguria is one of the Italian regions with the highest percentage of elderly people. The European Union declared the region as a “reference site”, for experimenting cutting-edge solutions and assistance models in health management of elderly people. Chronic ulcers become a problem of considerable importance looking at the number of involved elderly patients and of the necessary resources for their care, as well for the impact on the patient’s quality of life, due to the painful and limiting nature of the pathology. This study aims to evaluate the appropriate wound management in older people affected by chronic ulcers. A group of wound care experts operating in the Liguria region met with the aim of reviewing the epidemiology of chronic skin lesions, analyzing the diagnostic/therapeutic approach currently in use, focusing on the importance of the antisepsis in wound management. In Liguria region general practitioners reported a 3.9% prevalence of chronic skin lesions in 2018, and up to 7.35% in women over 85 years; about 90% of the lesions managed at home were pressure lesions. An overall assessment of the patient and the lesion, appropriate cleansing and antisepsis phases and a multidisciplinary management are essential to facilitate the wound’s healing process among the elderly.

The outcome of natural honey used in chronic ulcers

The unique characteristics of natural honey obtained in any source in topical chronic nonhealing ulcers have been decreased discomfort, oedema, inflammation, deodorization, disinfect, neo-vascularization, collagen synthesis, granulation, epithelization and hence the ulcer treatment method. In that study, 200 patients were treated in a forward-looking, unrandomized experiment, with persistent, unhealing ulcers found in various areas of their body in the two groups keeping 100 in Group A and used honey dressing and Group B managed without using honey. Natural honey from multiple sources has been used. The main explanation for reduced mobility and loss of work illustrates productivity being pain and fever. The leading causes of healing delays were bacterial infection, necrotic tissue involvement, bedridden state, age, fatigue, Ulcer located near the joint. The quality, the simplicity of application and the efficiency make the control of recurrent nonhealing Ulcers easier for natural honey. For low cost, easy access, and improved healing make it a valuable option for natural honey to handle chronic, nonhealing ulcers, as well as healthy use in diabetic patients.

Innovations in drug delivery for chronic wound healing

: Wound healing is a varied and complex process designed to promptly restore standard skin structure, function, and appearance. To achieve this goal, different immune and biological systems participate in coordination through four separate steps, including homeostasis, inflammation, proliferation, and regeneration. Each step involves the function of other cells, cytokines, and growth factors. However, chronic ulcers, which are classified into three types of ulcers, namely vascular ulcers, diabetic ulcers, and pressure ulcers, cannot heal through the mentioned natural stages. It causes mental and physical problems for these people and, as a result, imposes high economic and social costs on society. In this regard, using a system that can accelerate the healing process of such chronic wounds, as an urgent need in the community, should be considered. Therefore, in this study, the innovations of drug delivery systems for the healing of chronic wounds using hydrogels, nanomaterial, and membranes are discussed and reviewed.

A study to compare the effect of topical phenytoin dressing and conventional saline dressing in chronic non-healing ulcers

Background: Chronic non-healing ulcers; particularly diabetic and venous ulcers impose a major healthcare burden and affect quality of living. Efficacy of conventional strategies used for treatment of chronic non-healing ulcers is limited due to factors like microbial infection, necrotic tissues, tissue hypoxia, and other prevailing co-morbidities. The aim of the study was to compare efficiency of topical phenytoin-based dressings to conventional saline-based dressings for treatment of chronic non-healing wound ulcers.Methods: A prospective observational study was conducted on 60 patients who were divided in two groups. First group received conventional saline dressing-based treatment and second received topical phenytoin dressing based treatment for chronic non-healing ulcers. Efficiency of the treatment strategy was determined by statistically comparing parameters like duration of hospital stay, nature of discharge, appearance of healthy granulation tissue, and pus culture evaluation upon admission and post one and two weeks of treatment.Results: Diabetes and trauma were observed to be two major causes of chronic non-healing ulcers. No cases of venous impairment and osteomyelitis were observed in participating patients. Topical phenytoin dressing based treatment significantly reduced the duration of hospital stay and number of patients with serous discharge and aided in rapid formation of healthy granulation tissue in comparison to conventional saline based dressings. Topical phenytoin dressings also prevented microbial infection and colonization on chronic non-healing ulcers.Conclusions: Topical phenytoin-based dressing was concluded to efficiently and rapidly heal chronic ulcers while preventing microbial infection in comparison to conventional saline-based dressings.

Malignant Tumours Presenting as Chronic Leg or Foot Ulcers

Our purpose was to collect data on the incidence of malignant skin tumours presenting as chronic leg or foot ulcers in a tertiary centre, and to analyse the frequency and type of initial clinical misdiagnoses in these cases. A retrospective chart review of cases with melanoma or other malignant neoplasms of the skin of the lower extremity treated in a tertiary centre during January 2010 until February 2020 was conducted to identify cases that presented as chronic ulcers. Out of 673 cases, 26 (3.9%) were identified with a total of 27 malignant tumours presenting as chronic ulcers of the lower leg or foot. Therefrom, seven were diagnosed as melanoma, eight as squamous cell carcinoma, and twelve as basal cell carcinoma. The mean interval until diagnosis for all tumour types was 44.4 months (median 24 months). A delay in correct treatment occurred in 12 out of 26 cases (46%) as a result of misdiagnosis with subsequent treatment as chronic leg or foot ulcers of a different etiology. Misdiagnoses were venous ulcer, traumatic wound, mixed arterial and venous ulcer, arterial ulcer, and ulcer of an unknown origin. Malignant ulcers presenting as chronic ulcers are rare, but often lead to misdiagnosis.