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At least 19 recordsLinked to original sources
PubMed2000

Management of leg ulcers.

Leg ulcer is a leading cause of morbidity among older subjects, especially women in the Western world. About 400 years BC, Hippocrates wrote, "In case of an ulcer, it is not expedient to stand, especially if the ulcer be situated on the leg". Hippocrates himself had a leg ulcer. The best treatment of any leg ulcer depends upon the accurate diagnosis and the underlying aetiology. The majority of leg ulcers are due to venous disease and/or arterial disease, but the treatment of the underlying cause is far more important than the choice of dressing. The aetiology, pathogenesis, treatment, and the future trends in the management of the leg ulcers are discussed in this review.

Angioplasty↗
PubMed1995

Cytokine and protease levels in healing and non-healing chronic venous leg ulcers.

Leg ulcers present a common and recurring problem in older people creating discomfort and distress for the patient and a great cost to the health care services. Cultured keratinocyte grafts have been used by many investigators to stimulate healing of chronic venous ulcers. It has been proposed that they may do this by producing cytokines which modulate the healing process. However, the types and levels of cytokines in the leg ulcer fluid before and during healing are not known. Wound fluid was collected from venous leg ulcers in 18 patients beneath occlusive Tegaderm dressing for 4 to 6 h. The leg ulcers were divided on clinical criteria into 'healing' and 'non-healing'. PDGF-AB, GM-CSF, IL-1 alpha, IL-1 beta, IL-6 and bFGF were measured by ELISA and the levels of IL-1 alpha, IL-1 beta and IL-6 were also measured using biological assays. The effect of leg ulcer wound fluid on fibroblast and keratinocyte proliferation was measured indirectly by 3H-thymidine incorporation and MTT assay. Total protein, albumin levels, fibronectin degrading activity and collagenase activity, both active and latent were measured. No statistically significant differences in the levels of cytokines or collagenase were identified between healing and non-healing leg ulcers in the sample of leg ulcers studied. However, this study does give valuable information concerning the levels of cytokines and collagenase in chronic leg ulcer wound fluid.

Aged↗
PubMed2004

Changes in patient's quality of life comparing conservative and surgical treatment of venous leg ulcers.

Leg ulcers of different etiology disable up to 1% of total population, and up to 15% individuals over 70 years old. It is an old disease, which troubles the patients and medical personnel and is hard to cure. It might take several years to cure the ulcer fully. Most of the patients with leg ulcers are being treated at home, not in the outpatient departments or hospitals; therefore there is not much information on how the ulcer affects the patient's everyday life and its quality. The researchers often analyze only the financial part of this disorder forgetting its human part: pain, social isolation, and decreased mobility. There are many questionnaires and methods to analyze the quality of life of the patients with leg ulceration. It is often unclear if we should treat the ulcer conservatively for a long time or if part of resources should be used for operation (skin grafting) and the time of treatment should be shortened. To see the advantage of both methods and the influence of the ulcer treatment to the quality of life we decided to estimate the functionality of surgical and conservative treatment. We have analyzed the case histories and the data of special questionnaires of 44 patients, which were treated in Department of Plastic Surgery and Burns of Kaunas University of Medicine Hospital in the period of 2001 January-2004 February and had large trophic leg ulcers (m=254 cm2) for 6 months or more. Ten patients were treated conservatively and 34 patients were treated by skin grafting. All of them were interviewed after 3-6 months. We found that the pain in the place of the ulcers has decreased for the patients, who were treated surgically. By making the differences of the pain more exact we found out, that the patients have been feeling pain before the operation and when interviewing them the second time they told that they felt discomfort, not pain. The intensity of pain remained the same for the patients treated conservatively. The regression of pain also proves the decreased usage of painkillers in the group of the patients with the surgical treatment. All the patients (n=44) have had sleep disorders because of the ulcers. In the group of surgically treated patients, ulcers did not disturb the sleep after more than 3 months, and in the group, treated conservatively, the problem remained. We also found that after surgical treatment the patients were more optimistic and cried less. That shows the recovery of their emotional status. We have also found that the patients knew from the surgeon first than from the family doctor or other medical personnel about this disorder. We have made conclusions, that with the reduction of the ulcer area the pain is also reduced. Surgical treatment of ulcers (autodermoplasty) reveals a statistically reliable positive effect on patient life quality (sleep and emotions), but even 50% of patients are unaware of the real leg ulceration causes.

Aged↗
PubMed2001

The pathophysiology of different types of leg ulcers.

Leg ulcers are wounds on the leg of 6 weeks or more duration, and may range in size from very small to very large. They are caused primarily by deterioration in the peripheral circulation of the affected individual, although this may arise from a number of conditions. This article discusses the major conditions leading to the formation of a leg ulcer, in order to improve understanding of the rationale for leg ulcer management techniques.

Arteries↗
PubMedDate not supplied

The identification and diagnosis of malignant leg ulcers.

Leg ulcers are predominantly managed by nurses working in primary care. One audit has suggested that 34 per cent of leg ulcer patients receive treatment without a documented diagnosis (Moffatt and Harper, 1997). Malignant leg ulceration is an uncommon condition but several recent reports suggest that its prevalence is increasing (Taylor, 1998; Yang et al, 1996). Tests such as tissue biopsy, which are required to exclude the less common causes of ulceration, are currently outside the role of the primary care nurse who has a vital part to play in referring patients to a specialist for further detailed assessment. This article raises awareness of the types of malignant leg ulcers and the clinical features associated with them.

Biopsy↗
PubMed2000

Compression bandages and stockings for venous leg ulcers.

OBJECTIVES: To assess the effectiveness and cost-effectiveness of compression bandaging and stockings in the treatment of venous leg ulcers. SEARCH STRATEGY: Searches of 19 databases, hand searching of journals, conference proceedings and bibliographies. Manufacturers of compression bandages and stockings and an Advisory Panel were contacted for unpublished studies. SELECTION CRITERIA: Trials that evaluated compression bandaging or stockings, as a treatment for venous leg ulcers. There was no restriction on date or language. Ulcer healing was the primary endpoint. DATA COLLECTION AND ANALYSIS: Details of eligible studies were extracted and summarised using a data extraction sheet. Data extraction was verified by two reviewers independently. MAIN RESULTS: Twenty two trials reporting 24 comparisons were identified. Compression was more effective than no compression (4/6 trials). When multi-layered systems were compared, elastic compression was more effective than non-elastic compression (5 trials). There was no difference in healing rates between 4-layer bandaging and other high compression multi-layered systems (3 trials). There was no difference in healing rates between elastomeric multi-layered systems (4 trials). Multi-layered high compression was more effective than single layer compression (4 trials). Compression stockings were evaluated in two trials. One found a high compression stocking plus a thrombo stocking to be more effective than a short stretch bandage. The second small trial reported no difference between the compression stockings and Unna's boot. There was insufficient data to draw conclusion about the relative cost-effectiveness of different regimens. REVIEWER'S CONCLUSIONS: Compression increases ulcer healing rates compared with no compression. Multi-layered systems are more effective than single-layered systems. High compression is more effective than low compression but there are no clear differences in the effectiveness of different types of high compression.

Bandages↗
PubMed1997

[Physiopathology of leg ulcers].

Leg ulcers occur more commonly in the elderly and represent in our ageing western countries a real public health problem. Different mechanisms can induce these cutaneous ulcerations. An underlying vascular insufficiency, venous, arterial or mixed can be demonstrated in most cases. The management of leg ulcers needs an identification of their cause(s) and a good knowledge of their physiopathology, in order to ensure adequate treatment. The purpose of this presentation is to remind of the diversity of physiopathological mechanisms involved in the onset of these ulcers.

Age Distribution↗
PubMed1995

Challenging the myths: the lived experience of chronic leg ulcers.

Leg ulcers are a chronic condition that affects a significant number of New Zealanders. While the management of the ulcers themselves has received much attention in the nursing and medical literature, little is known about what it is like to live with chronic leg ulcers, and how they impact on quality of life.

Chronic Disease↗
PubMedDate not supplied

The use of holistic assessment in the treatment of leg ulcers.

Leg ulcers are costly to both patients and also the NHS. It is therefore of paramount importance that the treatment regimen is based on a holistic assessment to determine the underlying aetiology. It is only then that an appropriate treatment plan can be formulated. This article reviews the issues involved in the holistic assessment of leg ulcers.

Causality↗
PubMed2004

Understanding the underlying causes of chronic leg ulceration.

Leg ulcers are debilitating and have a significant negative impact on patients' quality of life. It is particularly important to understand the underlying causes of leg ulcers that are described as 'slow to heal' to ensure they are managed effectively.

Arterial Occlusive Diseases↗
PubMed1993

Treatment of leg ulcers.

Leg ulcers represent the most common chronic wound in our population. This devastating problem often cripples patients, many of whom are in the prime of their working years. The resulting morbidity and financial cost are extraordinary. Fortunately, with the right approach, the vast majority heal with simple ambulatory outpatient therapy. The essential requirements for treating leg ulcers include a thorough understanding of lower extremity anatomy, vascular hemodynamics, and the management of trophic and inflammatory skin changes.

Bandages↗
PubMedDate not supplied

Treatment of mixed aetiology leg ulcers.

Leg ulcers that have a mixed arterial and venous component are not always amenable to the solutions currently available. This article examines some of the research-based treatment options.

Bandages↗
PubMed1998

Experience with a new human skin equivalent for healing venous leg ulcers.

Leg ulcers affect about 650,000 adults each year and in every setting--rural, urban, and both economically developed and impoverished areas. Both the physical and the psychologic aspects of treatment present challenges to the caregiver. The nurse must be aware of new techniques for treatment and be able to educate patients about potential modalities for healing. A human skin equivalent, Apligraf, will soon be available for treatment of these wounds. The results of controlled, multicenter studies indicate that human skin equivalent interacts with the patient's own cells, responds to individual wound characteristics, and promotes healing. The nursing professional can readily master the application technique and will find that this tissue-engineered skin product offers a new approach to wound management.

Adult↗
PubMed2000

An active contour model for measuring the area of leg ulcers.

Leg ulcers are chronic skin wounds that affect many people and take a long time to heal. The progress of wound healing and the effect of clinical treatments can be monitored partly by measuring the area of the wound. Measurements taken via manually based methods, such as using a computer pointing device to delineate the wound boundary in a digitized image, suffer from variations due to manual dexterity and differences of opinion between observers. An active contour model is presented that models the contour using piecewise B-spline arcs and uses the minimax principle to adaptively regularize the contour according to the local conditions in the wound image. The model makes use of the existing manual delineation process in order to initialize the solution and is shown to reduce the effect of the inherent variations upon the repeatability and consistency of area measurements in many cases.

Computer Simulation↗
PubMed1985

Current management of leg ulcers.

Leg ulceration is a common disease which is developed countries is age-related and a consequence of venous hypertension. Therapy should be founded on elevation of the leg and on exercise. Drug therapy is aimed at promoting granulation tissue and epithelialisation. However, the ulcer bed and surrounding skin is vulnerable and the clinician's first objective is to do no harm. The choice of a drug should therefore take into account its possible side effects.

Administration, Topical↗
PubMed1992

A prospective, randomized trial of Unna's boot versus Duoderm CGF hydroactive dressing plus compression in the management of venous leg ulcers.

Leg ulcers caused by chronic venous insufficiency plague an estimated 500,000 Americans, but there have been few improvements in conservative treatment in this century, and Unna's boot continues to be a mainstay of therapy. A recent report suggests that Duoderm CGF dressing provides greater patient comfort and enhanced compliance, but Duoderm alone (without compression) resulted in slower healing compared with Unna's boot. We enrolled 30 patients (30 ulcers) in a clinical trial to compare Duoderm CGF plus compression (Coban wrap) to Unna's boot. No significant difference was observed between the two groups with respect to age, sex, initial ulcer area, ulcer duration, or extent of venous insufficiency by duplex scan. Eight of 16 ulcers (50%) in the Duoderm group healed completely versus 6 of 14 ulcers (43%) in the Unna's boot group (p = 0.18). Healing rates (square centimeters per week) correlated significantly with initial ulcer area and initial ulcer perimeter for both groups but best correlated with initial ulcer perimeter (r = 0.88 with Duoderm, p less than 0.0001; r = 0.80 with Unna's boot, p less than 0.002). After adjusting for differences in initial ulcer perimeter, healing rates were significantly faster for patients on Duoderm than patients on Unna's boot during the first 4 weeks of therapy (0.384 +/- 0.059 cm2/wk/cm perimeter for Duoderm versus 0.135 +/- 0.043 cm2/wk/cm perimeter for Unna's boot; p = 0.002). At 12 weeks patients on Duoderm again appeared to heal faster than those on Unna's boot, although the result did not reach statistical significance (0.049 +/- 0.007 cm2/wk/cm perimeter for Duoderm versus 0.020 +/- 0.017 for Unna's boot, p = 0.11).(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗
PubMed2000

Surgical correction of isolated superficial venous reflux reduces long-term recurrence rate in chronic venous leg ulcers.

OBJECTIVES: surgical correction of isolated superficial venous reflux in ulcerated legs may reduce short term recurrence rates but the longer term benefits are unknown. DESIGN: prospective non-randomised cohort study. METHODS: consecutive patients with chronic leg ulcers were prospectively assessed at a one-stop clinic over a 4-year period from July 1995 to July 1999. All patients with ankle brachial pressure indices (ABPI)50.85 were initially treated with weekly four-layer bandaging. Venous duplex studies in all ulcerated legs assessed venous reflux pattern with surgery being offered to all those with isolated superficial reflux, of whom 56% accepted. Patients were advised to wear class two elastic compression stockings after healing. RESULTS: 766 legs in 669 patients were assessed. Six hundred and thirty-three legs had an ABPI50.85, 236 (39%) demonstrating isolated superficial venous reflux. Surgery was performed on 131 of these legs. Twelve and 24 week healing rates were 50% and 72% for operated legs and 62% and 74% for non-operated legs (p=0.67; Kaplan-Meier life table analysis). Recurrence rates at 1, 2 and 3 years were 14%, 20% and 26% for operated legs and 28%, 30% and 44% for non-operated legs (p=0.03; Kaplan-Meier life table analysis). CONCLUSION: surgical correction of superficial venous reflux in legs with chronic leg ulceration may reduce ulcer recurrence rate at 1, 2 and 3 years.

Adult↗