Chronic leg ulcer: does a patient always get a correct diagnosis and adequate treatment?

2016 ◽  
Vol 31 (1_suppl) ◽  
pp. 68-73 ◽  
Author(s):  
Michael C Mooij ◽  
Laurens C Huisman
Keyword(s):  
Correct Diagnosis ◽  
Compression Therapy ◽  
Healing Time ◽  
Leg Ulcer ◽  
Ulcer Recurrence ◽  
Leg Ulcers ◽  
Venous Leg Ulcer ◽  
Adequate Treatment ◽  
Custom Made ◽  
Elastic Stockings

Patients with chronic leg ulcers have severely impaired quality of life and account for a high percentage of annual healthcare costs. To establish the cause of a chronic leg ulcer, referral to a center with a multidisciplinary team of professionals is often necessary. Treating the underlying cause diminishes healing time and reduces costs. In venous leg ulcers adequate compression therapy is still a problem. It can be improved by training the professionals with pressure measuring devices. A perfect fitting of elastic stockings is important to prevent venous leg ulcer recurrence. In most cases, custom-made stockings are the best choice for this purpose.

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

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.

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 Prognostic factors related to delayed healing of venous leg ulcer treated with compression therapy

2015 ◽  
Vol 33 (4) ◽  
pp. 206-209 ◽  
Author(s):  
Vesna Karanikolic ◽  
Aleksandar Karanikolic ◽  
Dejan Petrovic ◽  
Milenko Stanojevic
Keyword(s):  
Prognostic Factors ◽  
Compression Therapy ◽  
Leg Ulcer ◽  
Venous Leg Ulcer ◽  
Delayed Healing

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.

Evaluation of Compression under an Elastic Tubular Bandage Utilised as an Introduction to Compression Therapy in the Treatment of Venous Leg Ulcers

2000 ◽  
Vol 15 (2) ◽  
pp. 53-59 ◽  
Author(s):  
J. M. Melhuish ◽  
D. Wertheim ◽  
M. Llewellyn ◽  
R. Williams ◽  
K. G. Harding
Keyword(s):  
Cohort Studies ◽  
Healthy Volunteers ◽  
Outcome Measure ◽  
Compression Therapy ◽  
Calf Muscle ◽  
Physical Parameters ◽  
Leg Ulcers ◽  
Venous Leg Ulcer ◽  
Main Outcome Measure ◽  
Venous Leg Ulcers

Objective: To investigate the physical parameters of an elasticated tubular bandage (Tubigrip) on the leg and in durability studies. Design and setting: Cohort studies. Participants: Six healthy volunteers and 16 patients. Main outcome measure: Sub-bandage pressure. Results: Median pressures recorded under the Tubigrip bandage system at the lower, middle and upper calf muscle in 6 healthy volunteers, while sitting were 26, 25 and 12.5 mmHg, and for standing were 32, 40 and 16 mmHg. The median pressures recorded at the lower, middle and upper calf muscle in 16 venous leg ulcer patients while sitting were 18, 20 and 14 mmHg, and for standing were 32.5, 29.5 and 18 mmHg. Tubigrip durability studies demonstrated no decrease in sub-bandage compression over 8 days when applied to a model leg and volunteer leg. However, sub-bandage pressure decreased by more than 29% when the bandage was subjected to four wash-dry cycles. Conclusions: The pressures measured under Tubigrip were consistent with the ranges seen in other compression therapies. Laundering reduced the applied sub-bandage pressure.

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.

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