Vascular leg ulcers are very painful and result in a poor quality of life, with a direct correlation with both ulcer duration and ulcer area. Pain relief is required, particularly at dressing changes, as is the selection of advanced wound dressings.

An observational study of 2 years was promoted by the Italian Association for Cutaneous Ulcers (AIUC) in order to monitor the epidemiology of leg ulcers, the trend of healing and the more frequent therapeutic approaches in lower limb ulcers. Fifty-nine sites in 14 different Italian regions involved in the study, with 1333 enrolled patients (1163 patients fully evaluated and followed up for 9 months). A prevalence of females (62%) was observed with a mean age of 70 years and a high rate of hypertension (62%), diabetes (38%) and obesity (29%). Venous ulcer was most frequent (55%), followed by mixed (25%) and diabetic (8·3%) ulcers. Basically, all patients received a local therapy (LT) (compression and advanced local therapies), while 63% of patients have an associated systemic pharmaceutical treatment. Ulcer healing rates progressively increased throughout the study and despite the type of observational study does not allow conclusions on the treatment, it was observed that the patients receiving additional systemic drugs were associated with a more rapid acceleration of healing rates of ulcers compared to LT alone (3 months: 39·7% versus 29·2%; 6 months: 62·0% versus 47·0%; 9 months: 74·7% versus 63·8%). In particular, the Studio Ulcere Vascolari (SUV) study showed that a combination treatment with sulodexide and compression therapy allows for a greater increase in the healing rates in venous ulcers.

Chronic nonhealing cutaneous wounds are a worldwide problem with no agent able to promote healing. A naturally occurring, endogenous repair molecule, thymosin beta 4 (Tβ4), has many biological activities that promote dermal repair. It is released by platelets at the site of injury and initiates the repair cascade. Tβ4 accelerated dermal healing of full-thickness punch wounds in various animal models, including normal rats and mice, steroid-treated rats, diabetic mice, and aged mice. Furthermore, in two phase 2 clinical trials of stasis and pressure ulcers, it was found to accelerate healing by almost a month in those patients that did heal. Tβ4 likely acts to repair and regenerate wounds by promoting cell migration and stem cell mobilization and differentiation, and by inhibiting inflammation, apoptosis, and infection. We conclude that Tβ4 is a multifunctional regenerative peptide important in dermal repair.

This study was sponsored by ConvaTec.

The spread of the COVID-19 has profoundly affected the way we conduct our medical practices, resulting in a decrease in necessary medical care, including the wound healing specialty. The actual period of COVID-19 pandemic limits the ability to practice wound healing in normal conditions. Patients with vascular leg ulcers represent an extremely vulnerable population, with poor quality of life caused by the pain directly related to both ulcer duration and ulcer area. 1 These patients must not be overlooked because of the irreversible consequences that we will observe. If ischemic and venous wounds are not treated or managed, the results could be drastic, such as infections, sepsis, amputations, or even fatalities.