Incidence of Recurrent Venous Ulcer in Patients Treated at an Outpatient Clinic: Historical Cohort

The recurrence of venous ulcers is the wound reopening after a period of completed epithelisation of a previous ulcer due to exposure to causal factors and lack of prevention. Venous ulcers have a high recurrence rate that may increase through the years. Epidemiological evidence on its incidence and risk factors is scarce due to the lack of patient follow-up in outpatient clinics and adherence to treatment after healing. The objective was to analyze the incidence of venous ulcers recurrency in outpatients and the risk factors for its occurrence. It is an observational historical cohort with retrospective data collection, performed through electronic medical records. Setting: private health insurance outpatient clinic. The participants were adult patients with healed venous ulcers. Incidence of venous ulcer recurrence was calculated within individuals with healed ulcers from 2014 and 2018 with a follow-up of at least one year. Bivariate analysis and logistic regression were used to explore risk factors considering demographic, clinical, and wound-related variables. As a result, sixty-five (65) of the 134 patients with healed venous ulcers had a recurrence, leading to an incidence of 48.5%, with a mean onset time of 230.1 (SD 267) days. Patients with recurrent venous ulcers were primarily women (39/48.1%), with a mean age of 64 (SD 15.5) years, 57 (50.8%) had some comorbidity, with systemic arterial hypertension as the most frequent (47/51%). Obesity (15/88.2%) increased the risk of venous ulcers recurrence by 8.7 (OR 95% CI 2.1-60.8; P = .009) times. In conclusion, venous ulcers recurrence incidence was 48.5%, with obesity as a risk factor. This study demonstrates that the clinical approach of people with venous ulcers should not finish when the wound is healed. For ulcer recurrence prevention interventions addressing systemic factors, besides topical management of the wound, are essential.

The presence of anemia in patients with leg ulcer: laboratory test

ABSTRACT Objective: To evaluate the presence of anemia in patients with chronic lower limb ulcers based on profile and hematometric indices. Method: This is a cross-sectional study carried out in a university hospital in Rio de Janeiro. The sample was composed of 64 participants with lower limb ulcers and evolution time greater than 12 weeks. Data was collected between May/2016 and December/2017 from hematological analyses, records from medical records, and wound assessment form. Results: 36 (56.2%) were male; 38 (59.4%) between 60 and 80 years old; 56 (87.5%) with chronic diseases and 52 (81.2%) with venous ulcers. 6 years mean of active ulceration. Anemia was detected in 36 (56.2%), 27 (75%) of which were normochromic and normocytic; 14 (38.8%) had deficiency anemia recorded in their medical chart. Conclusion: The low hemoglobin concentration is recurrent among the participants characterizing an anemia condition, whose profile reveals congruence to the anemia of chronic disease.

Stasis Ulcers – The Unifying Concept

Chronic stasis dermatitis, usually confined to the lower legs, is a complication of longstanding interstitial edema and inflammation, due either to venous hypertension or disorders having in common excessive lymph overload. Heart failure, renal failure, liver cirrhosis, secondary and primary diseases of lymph vessels may complicate with stasis dermatitis. The same mechanisms causing stasis dermatitis can also generate skin ulcers superimposed on stasis dermatitis. In the appropriate context such skin ulcers are called "venous ulcers" or, in different situations, “stasis ulcers”. The distinction between venous and other stasis ulcers is usually possible at the bedside. Also, some general measures of therapy are similar for venous and other stasis ulcers: such are elastic compression, topical skin care and ulcer care. In having in common the pathophysiological mechanisms, in bearing clinical resemblance, and responding to similar therapies, a unifying concept may be opportune to comprise the spectrum of stasis dermatitis, venous and other stasis ulcers. The present work is an appeal to this aim.

Genome-wide, integrative analysis of microRNA-mediated gene regulation in human wounds reveals cooperating microRNAs as therapeutic targets

MicroRNAs (miR), as important epigenetic control factors, reportedly regulate wound repair. However, our insufficient knowledge of clinically relevant miRs hinders their potential therapeutic use. For this, we performed miR and mRNA paired expression profiling in human acute wounds and chronic non-healing venous ulcers (VU) and presented our findings on a browsable web portal (http://130.229.28.87/shiny/miRNA_Xulab/). Integrative miR and mRNA-omics analysis unraveled miR-mediated gene regulatory networks in each repair phase of the wound repair process. Importantly, we identified 17 pathologically relevant miRs exhibiting abnormal expression in VU and displaying their targetome enriched in the VU gene signature. Study of the targetome and functions of eight clinically relevant miRs in skin cells revealed that the miRs upregulated in VU (i.e., miR-34a/c-5p, miR-424-5p, miR-450-5p, miR-7704, and miR-516-5p) promoted inflammation but inhibited proliferation. In contrast, the miRs downregulated in VU (i.e., miR-218-5p and miR-96-5p) were required for cell growth and activation. Moreover, we demonstrated miR-34a, miR-424, and miR-516 cooperativity in regulating keratinocyte growth and inflammatory response. Collectively, our study suggests that VU-dysregulated miRs cooperatively contribute to stalled wound healing characterized by failed transition from inflammatory-to-proliferative phase. Targeting cooperating miRNAs provide mew opportunity for development of clinically-relevant targeted therapy to attain higher therapeutic efficacy and specificity.

Assessment of frailty in elderly patients attending a multidisciplinary wound care centre: a cohort study

Background The incidence of frailty and non-healing wounds increases with patients’ age. Knowledge of the relationship between frailty and wound healing progress is greatly lacking. Methods The aim of this study is to characterize the degree of frailty in elderly patients attending a multidisciplinary wound care centres (MWCC). Additionally, we seek to assess the impact of frailty on the wound healing rate and wound healing time. An open cohort study was conducted on 51 consecutive patients aged > 70 years treated for wounds at an MWCC of an intermediate care hospital. The frailty score was determined according to the Frail-VIG index. Data were collected through patient questionnaires at the beginning of the study, and at 6 months or upon wound healing. Wounds were followed up every 2 weeks. To analyse the relationship between two variables was used the Chi-square test and Student’s or the ANOVA model. The t-test for paired data was used to analyse the evolution of the frailty index during follow-up. Results A total of 51 consecutive patients were included (aged 81.1 ± 6.1 years). Frailty prevalence was 74.5% according to the Frail-VIG index (47.1% mildly frail, 19.6% moderately frail, and 7.8% severely frail). Wounds healed in 69.6% of cases at 6 months. The frailty index (FI) was higher in patients with non-healing wounds in comparison with patients with healing wounds (IF 0.31 ± 0.15 vs IF 0.24 ± 0.11, p = 0.043). A strong correlation between FI and wound healing results was observed in patients with non-venous ulcers (FI 0.37 ± 0.13 vs FI 0.27 ± 0.10, p = 0.015). However, no correlation was observed in patients with venous ulcers (FI 0.17 ± 0.09 vs FI 0.19 ± 0.09, p = 0.637). Wound healing rate is statically significantly higher in non-frail patients (8.9% wound reduction/day, P25-P75 3.34–18.3%/day;AQ6 p = 0.044) in comparison with frail patients (3.26% wound reduction/day, P25-P75 0.8–8.8%/day). Conclusion Frailty is prevalent in elderly patients treated at an MWCC. Frailty degree is correlated with wound healing results and wound healing time.

Mechanism of Action of Elastic Compression Therapy in Phlebolymphology

Compression is the best therapy in the treatment of venous ulcers. The intensity of the bandage compression essentially depends on four factors: the physical structure and elastomeric properties of the bandage, the shape of the limb the bandage is applied to, the ability and experience of the doctor or nurse who applies it and the ability of the patient to deambulate [1, 2]. The development of construction technologies can help reduce the variability of inter- and intra-bandage tension: one of the most promising possibilities is the manufacturing of a vari-stretch elastomer, capable of exerting a relatively constant pressure regardless of limited variations in extension.

Comparison of the effectiveness of various conservative treatment options for trophic ulcers and varicose eczema

Introduction. It has been for a long time considered that treatment of trophic venous ulcers and varicose eczema should be operative only. However, practice shows that such treatment doesn’t guarantee the complete healing of an ulcer or eczema and doesn’t always prevent the recurrence of pathological processes. It suggests the need for an integrated approach to the treatment of trophic venous ulcers and varicose eczema.Aim. Analyze the effectiveness of various methods of non-surgical treatment of venous trophic ulcers (TU) and varicose eczema (VE) to create an optimal algorithm for managing this category of patients in outpatient practice.Materials and methods. A prospective comparative cohort study of 252 patients with C4-C6 CVD classes (CEAP) was conducted. 178 people (71%) had venous TU , 74 (29%) – VE. 3 groups of patients were formed: 1 gr. – (n = 68) was treated with traditional medicines and standard topical therapy (control); 2 gr. – (n = 90) received MOFF, elastic compression (Pütterbinde bandage), systemic antibiotic therapy for TU and corticosteroids for VE, dressings using Hartmann wound coverings; 3 gr. – (n = 94) in addition to the treatment similar to group 2, sclerotherapy (ST) of pathological venous reflux was performed. The follow-up lasted 6 months (8 visits) with a comprehensive clinical, laboratory and instrumental assessment. Statistical processing of the results was carried out using the STATISTICA software package (StatSoft, Inc., 2001, version 6.0).Results. By the end of the study, the following positive trends were registered in group 2 compared to group 1: the total VCSS index was 1.5 times lower, and according to the 10 – point VAS – 3 times; TU healing/ VE remission occurred 2 months earlier, complete healing of TU was noted in 75% of patients vs 63%, remission of VE-in 81% vs 47%. The combination of elimination of pathological reflux by CT and MOFF therapy (group 3 patients) was particularly effective. When comparing group 1 with group 3, it turned out that in the latter, by the end of the study, the total VCSS index was 3 times lower; the total indicator for the 10 – point VAS was 5.5 times lower for TU, 10 times higher for VE; TU healing/VE remission occurred 4 months earlier, complete healing was noted in TU in 88% of patients vs 63%, remission of VE in 96% vs 47%. Based on the obtained data, therapeutic algorithms were proposed for the management of patients with venous TU and VE in outpatient settings.Conclusions. Conservative treatment of venous TU and VE can be an alternative to surgical treatment, or an addition to it. MOFF is the most effective venotonic of complex action prescribed for the treatment of TU/VE in the form of monotherapy. Sclerosing therapy is a full-fledged element of the complex treatment of venous TU. The use of the proposed treatment algorithms makes it possible to speed up the healing process of venous TU and achieve remission of VE by three times.

Efficacy of Mobiderm® Bandage in Compression Therapy for Venous Ulcers: A Prospective Case Series

Background: Venous leg ulcers severely affect patients’ quality of life due to its high morbidity and recurrent nature. Currently, compression therapy is the first-line treatment for venous leg ulcers. Aim: This study sought to evaluate the efficacy of the Mobiderm® technology developed by Thuasne in a prospective case series of venous leg ulcers. Methods: Nine patients ( N = 9) with venous leg ulcers were enrolled into this case series. Mobiderm® bandage was applied on to the affected limbs of the patients in the multi-component bandages system. The bandages were changed as frequent as the patients had their wound dressing for their standard treatment in a 12-week duration. Wound size and calf circumference were measured at week 0 and week 12. Paired sample t-test was used to compare the mean values of wound size and calf circumference pre- and post-treatment. Results: Reductions in wound size and calf circumference were observed in all nine patients (100%). Five patients were evaluable at week 12. The wound sizes significantly reduced by 27.2% to 53.2% ( p = 0.02), and the calf circumferences significantly reduced by 3.2% to 26.0% ( p = 0.02) after 12 weeks ( N = 5). Safety was unremarkable, with no occurrence of treatment-emergent-related adverse event. Conclusion: Mobiderm® bandage was reported to be effective in promoting wound healing and reducing swelling, suggesting it to be integrated in the compression therapy for the management of venous leg ulcers.