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PubMed2000

Oral zinc for arterial and venous leg ulcers.

BACKGROUND: Leg ulcers affect up to 1 per cent of people at some time in their life. Management includes care of the ulcer using dressings and treatment of underlying medical problems such as malnutrition, lack of minerals, vitamins, poor blood supply or infection. OBJECTIVES: To assess the effectiveness of oral zinc in healing arterial or venous leg ulcers. SEARCH STRATEGY: Searches of 19 databases, hand searching of journals and conference proceedings from 1948 onwards, and examination of bibliographies. The company manufacturing zinc sulphate tablets was asked for references to relevant trials. SELECTION CRITERIA: Randomised controlled trials comparing oral zinc sulphate with placebo or no treatment in patients with arterial or venous leg ulcers. There was no restriction on date or language. The main outcome measure used was complete healing of the ulcers. Trials were eligible for inclusion if they measured ulcer healing objectively, by time to complete healing, proportion of ulcers healed during the study, or healing rates of ulcers. DATA COLLECTION AND ANALYSIS: All data extraction and assessment of trial quality were done by both authors independently. MAIN RESULTS: There were six eligible trials. All are small and serum zinc was measured at baseline or during the trial in 4 trials. Overall there is no evidence of a beneficial effect of treatment with zinc sulphate on the number of ulcers healed at the end of the trials. There is some evidence that oral zinc might have a beneficial effect on healing of venous ulcers in people with a 'low' serum zinc level at baseline. REVIEWER'S CONCLUSIONS: Overall, oral zinc sulphate does not appear to aid healing of leg ulcers, although it might be beneficial in those with venous leg ulcers and low serum zinc. Further research is needed to ascertain the serum zinc concentration below which treatment with zinc might be beneficial, and the dose required. [This abstract was prepared centrally]

Administration, Oral↗
PubMedDate not supplied

Treatments and healing rates in a community leg ulcer clinic.

Leg ulcer management is increasingly becoming a nurse-led specialty with practitioners implementing evidence-based care that is efficient, effective and resourceful. A large percentage of patients with leg ulceration are treated in the community. This article will discuss the healing rates and management of venous leg ulcers, many of which were longstanding problems, in a community leg ulcer clinic.

Community Health Centers↗
PubMed1987

Flucloxacillin in chronic leg ulcers. Penetration of flucloxacillin into chronic leg ulcer exudate and the effect on the bacteria.

The penetration of flucloxacillin into ulcer exudate was investigated in six patients with chronic leg ulcers. The flucloxacillin dosage used was 1 g orally three times daily for three days, and the serum and exudate concentrations were measured repeatedly during a 10 h-period following the first and the seventh dose. All the ulcers were contaminated with (S. aureus) Staphylococcus aureus either in pure culture (three ulcers) or in culture mixed with Gram-negative bacteria (three ulcers). Bacterial counting in the ulcers was performed twice before and twice during the antibiotic treatment. The flucloxacillin concentrations measured in the ulcer exudate were found to be lower than the corresponding serum concentrations. However, the exudate concentrations were found to be above the minimum inhibitory concentration (MIC) for the contaminating S. aureus during an average of 7 h after each dose, and the number of S. aureus during the treatment period was reduced to less than 0.01% of the initial number. The Gram-negative bacteria were not susceptible to flucloxacillin. The number of these bacteria decreased before flucloxacillin treatment but increased again during treatment, probably owing to the changed conditions in the ulcers following the marked decrease in the number of S. aureus.

Aged↗
PubMedDate not supplied

A new approach in the management of chronic nonhealing leg ulcers.

Chronic leg ulcers are a major cause of mortality and morbidity. The efficacy of hyperbaric oxygen treatment is being evaluated in the management of nonhealing leg ulcers to improve skin graft survival. Twenty-seven patients with 36 chronic leg ulcers were examined. Each wound received 12 preoperative hyperbaric oxygen treatments, split-thickness skin grafting, followed by 12 postoperative hyperbaric oxygen treatments. Wound transcutaneous oxygen tension measurements (TCOM) were taken. The graft take was evaluated. At 18 months follow-up, 18 skin grafts (50%) showed complete take, 15 (41.7%) demonstrated partial take, and 3 (8.3%) failed. Hyperbaric oxygen treatment is an effective adjunct in the management of chronic leg ulcers, and its use resulted in increased graft take and survival.

Adult↗
PubMed2004

Topical effectiveness of molgramostim (GM-CSF) in sickle cell leg ulcers.

BACKGROUND: Leg ulcers are a frequently neglected, severe complication of sickle cell disease (SCD), responsible for significant altering quality of life. The management of leg ulcers remains disappointing. Local application of recombinant human granulocyte-macrophage colony-stimulating factor has been shown to be effective in several types of chronic wound healing. METHODS: We report 5 homozygous sickle cell patients with 14 leg ulcers lasting from 1 month to 6 years, treated with topical dripping of molgramostim solution. RESULTS: Healing was obtained for 9/14 ulcers, with no local or systemic adverse reactions. COMMENTS: Molgramostim solution appears to be an adequate therapy for SCD leg ulcers but a more conclusive evaluation will depend on larger series of patients and other types of formulations for topical applications could be even more effective in the future.

Administration, Topical↗
PubMed1995

A model for change in delivering community leg ulcer care.

Leg ulcer care has largely been provided by community nursing staff in the UK. However, the treatment of leg ulcers has been accompanied by high cost and poor healing rates. As part of an initiative in a single district of the UK, six community leg ulcer clinics were established and a system of audits implemented to monitor their progress over two years. Improvements were demonstrated in the success of the patient referral system, correct assessment of patients with significant arterial leg disease, effective use of dressings, follow-up to prevent ulcer recurrence, improved nursing education in leg ulcer care, vastly improved healing rates during the first twelve weeks of treatment compared to patients in a pre-study audit, reduced pain and increase in the ability of patients to perform activities inside and outside the home, and a cost reduction from an estimated $680,000 per annum to $250,000 in the study district. The model of care implemented in these community clinics can be adapted to other communities. Priority must be given to auditing outcomes and changes to ensure that the most effective care is delivered in each community.

Aftercare↗
PubMed2006

A potential role of interferon-gamma in the pathogenesis of venous leg ulcers.

Venous leg ulcer is the most severe expression of chronic venous insufficiency. Venous ulcerations are always associated with venous ambulatory hypertension, but the exact mechanism leading from pathological hemodynamics in venous circulation to the necrotic lesions in the skin still remains undiscovered. It has been shown that tissue injury in venous ulcer patients was induced by leukocytes. However, though infiltrating leukocytes have at their disposal a powerfully cytotoxic arsenal, it has not been discovered which molecular mechanisms may contribute to the skin damage. The search for this hypothetical factor responsible for the development of ulceration should be focused on mechanisms leading to apoptosis of keratinocytes, on pathogenesis of related dermatological pathologies, on other pathologies associated with epithelial lesions, and on mechanisms responsible for the expression of adhesion molecules. A thorough review of the literature, with special regard to cytokines, has revealed that proinflammatory cytokine--interferon-gamma (INFgamma)--could be a pivotal cytokine in the pathogenesis of venous ulceration. This cytokine, however, has not been investigated in venous leg ulcer patients before. INFgamma is a glycoprotein with numerous immunological and antiproliferative activities. The most important message from recent investigations is the fact that INFgamma seems to be the main mediator of keratinocyte apoptosis. INFgamma mediates also leukocyte chemotaxis, and enhances the expression of adhesion molecules involved in the pathophysiology of chronic venous insufficiency. Therapeutic injections of interferons can result in skin necrosis. If it were proven that INFgamma was responsible for the development of venous leg ulcers, this fact would have important clinical consequences. In such a case, anti-INFgamma agent could be used, either in the management of active ulceration, or in the prevention of recurrent ulcer.

Humans↗
PubMed1983

Management of leg ulcers.

Although leg ulcers have many causes, the most common etiology is venous or arterial insufficiency. The prime objective in the evaluation of leg ulcers is to uncover the precipitating pathologic process, and the first goal of therapy is to correct or control this underlying condition. Simple laboratory tests and office procedures are adjuncts in diagnosis. Topical care of leg ulcers includes gentle debridement, use of wet dressings and, in selected cases, skin grafting.

Anti-Bacterial Agents↗
PubMed1992

Systemic amyloidosis secondary to chronic leg ulcers.

Chronic leg ulcers due to any cause are almost invariably associated with an inflammatory process. As with any long-standing inflammation, leg ulcers may be complicated by systemic amyloidosis, which occurs in rheumatoid arthritis, cystic fibrosis, tuberculosis, and other disorders. There are, however, very few reports on the association between these two conditions. We report a patient with severe leg ulcers of twenty years' duration in whom reactive systemic amyloidosis presented as a nephrotic syndrome.

Aged↗
PubMed1986

Leg ulcers: epidemiology and aetiology.

In a regional Health District with a population of 198,900, 357 patients with 424 ulcerated legs were documented, an overall prevalence of 0.18 per cent. The prevalence of ulceration in the 92,100 aged greater than 40 years was 0.38 per cent. Fifty per cent of the lesions had been present for more than one year, and 62 per cent of patients had never attended any hospital. The patients were stratified by history of peripheral arterial disease. A random sample (100 patients, 193 legs) was examined by ultrasound and photoplethysmography to assess the venous and arterial circulation; 38 per cent had evidence of deep vein involvement and 43 per cent had superficial vein incompetence. An ischaemic element was present either in isolation (9 per cent) or combined with venous disease (22 per cent) in a total of 31 per cent, with a mean pressure index of 0.62 (s.d. 0.14). Simple objective methods of assessment together with dedicated community staff with ready access to specialized facilities can enhance the service provided to patients with leg ulcers.

Adult↗
PubMed1998

Shave therapy is a simple, effective treatment of persistent venous leg ulcers.

BACKGROUND: Leg ulcers in deep venous insufficiency, especially the postthrombotic type, are often resistant to therapy. OBJECTIVE: The purpose of this study was to evaluate short-term and long-term effects of shave therapy in persistent or recurrent venous ulcers. METHODS: From January 1994 to October 1997, 80 patients with 105 chronic leg ulcers were treated by shave therapy. This method involved removing ulcers together with the surrounding lipodermatosclerosis and covering the wounds with meshed split-skin graft. Fifty-nine patients with 76 ulcers were examined after 3 months for assessment of short-term results. The first 18 patients with 26 ulcers from the years 1994 and 1995 were evaluated for long-term results. RESULTS: The short-term healing rate after 3 months in 59 patients was 79%. Of 8 patients from 1995 (follow-up period, 1 year and 8 months), 7 patients had complete healing and 1 patient had a small ulcer. Of 10 patients from 1994 (average follow-up period, 2 years and 8 months), 8 patients had complete healing and 2 patients showed small superficial ulcerations within the transplanted areas. From these results, a long-term healing rate of 88% was calculated in 18 patients. Two of the 3 patients with recurrences had stopped compression therapy after good short-term results. CONCLUSION: For patients with recalcitrant leg ulcers in deep venous insufficiency and/or postthrombosis, shave therapy is a simple, quick, and effective surgical method with favorable short-term and long-term results.

Adult↗
PubMedDate not supplied

Oxidative stress in chronic venous leg ulcers.

Venous leg ulcers are common and cause considerable morbidity in the population. As healing may be slow or may never be achieved, ulcers create persistent and substantial demands on clinical resources. Great efforts have been made to accelerate tissue repair in chronic venous leg ulcers with limited success. This may at least be partly due to the limited knowledge on the microenvironment of chronic wounds. In fact, the tremendous impact of the microenvironmental conditions on the outcome of wound healing has increasingly become apparent. Oxidative stress as a consequence of an imbalance in the prooxidant-antioxidant homeostasis in chronic wounds is thought to drive a deleterious sequence of events finally resulting in the nonhealing state. The majority of reactive oxygen species are most likely released by neutrophils and macrophages and to an unknown extent from resident fibroblasts and endothelial cells. As the inflammatory phase does not resolve in chronic wounds, the load of reactive oxygen species persists over a long period of time with subsequent continuous damage and perpetuation of the inflammation. In this article, we will critically discuss recent findings that support the role of oxidative stress in the pathophysiology of nonhealing chronic venous leg ulcers.

Chronic Disease↗
PubMedDate not supplied

Giving information on compression to patients with venous leg ulcers.

Venous leg ulceration is a common condition that is more likely to affect the elderly (Alexander House Group, 1992; Coupe and Walukiewicz, 2000) and often has a psychological, as well as physical, impact on the individual (Charles, 1995). Many of those affected are cared for within the community (Maylor, 2002) and may become isolated because of the difficulties caused by their condition (Charles, 1995). Compression bandaging therapy has been shown as an effective treatment for venous leg ulcers (Loftus and Wheatley, 2000) but the bandages must be worn continually during treatment and therefore need to be socially and psychologically acceptable if the patient is to be happy with the treatment regimen (Pudner, 1998). Nurses need to be competent in the care of leg ulcers so that pain and discomfort are minimized and patients need to be willing to accept the treatment given.

Aged↗
PubMed2001

Developing a one-stop clinic for leg ulcer patients.

Leg ulceration may be caused by a variety of different factors and specialist assessment is required. Patients with complex leg ulcers in Nottingham are assessed at a one-stop dermatology/vascular clinic. Nurses undertake assessments, provide education and support and liaise with the community nursing services.

Ambulatory Care Facilities↗
PubMed2004

The Lindsay Leg Club Model: a model for evidence-based leg ulcer management.

Leg Club is a unique model of community-based leg ulcer care. By providing nursing care in a non-medical, social environment, the model has several benefits: it removes the stigma associated with leg ulcers and helps isolated older people reintegrate into their communities, which in turn improves concordance and has a positive impact on healing and recurrence rates. In an atmosphere of de-stigmatisation, empathy and peer support, positive health beliefs are promoted and patients take ownership of their treatment. The Leg Club model creates a framework in which nurses, patients and local community can collaborate as partners in the provision of holistic care. The model also provides an environment for appropriate supportive education, advice and information.

Community Health Centers↗
PubMed1995

Use of split-skin grafting in the treatment of chronic leg ulcers.

Chronic leg ulcers are a common problem for which many different forms of treatment have been used. In this study we reviewed the results of split-skin grafting of ulcers of different aetiologies; 26 patients were reviewed. The mean duration of ulceration was 27.5 months. Of the 28 ulcers, ten were due to venous disease, three arterial disease, six rheumatoid arthritis, seven traumatic, and two diabetic. Healing rates of 85% for traumatic and 67% for rheumatoid ulcers were achieved, whereas rates of only 20% and 33% were achieved for venous and arterial ulcers (P < 0.02 Fisher's exact test). We conclude that in the presence of vascular disease, split-skin grafting is not an effective treatment for chronic leg ulceration. Vascular assessment and treatment should be carried out before attempting skin grafting.

Adult↗
PubMedDate not supplied

Compression therapy in leg ulcer management.

Leg ulcer management is an important consideration for all nurses involved in the care of older people. Non-specialists in tissue viability might not always be aware of the evidence base for best practice. The authors examine the effectiveness of multilayer and single-layer long- or short-stretch bandage systems in leg ulcer management.

Bandages↗
PubMed1990

Zinc chloride paste for the debridement of chronic leg ulcers.

Chronic leg ulcers present a difficult therapeutic problem, and their management requires frequent debridement. Thorough debridement of painful or extensive ulcerations is not always possible. Frequently, it must be done in the operating room, a situation accompanied by the potential complications of general anesthesia and by considerable expense. We present evidence for the effectiveness of zinc chloride paste as a relatively painless debriding agent in the management of chronic leg ulcers. When applied to the wound bed, zinc chloride paste fixes the tissue and leads to the formation of an eschar that falls off within a few days, leaving a granulating ulcer suitable for grafting.

Administration, Topical↗