Management of Lower Extremity Wounds in Patients With Peripheral Arterial Disease: A Stratified Conservative Approach

Significance: The incidence of pressure ulcers is increasing due to our aging population and the increase in the elderly living with disability. Learning how to manage pressure ulcers appropriately is increasingly important for all professionals in wound care. Recent Advances: Many new dressings and treatment modalities have been developed over the recent years and the goal of this review is to highlight their benefits and drawbacks to help providers choose their tools appropriately. Critical Issues: Despite an increased number of therapies available on the market, none has demonstrated any clear benefit over the others and pressure ulcer treatment remains frustrating and time-consuming. Future Directions: Additional research is needed to develop products more effective in prevention and treatment of pressure ulcers.

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“…In the extremities, the adequacy of perfusion should be accessed via the ankle-brachial index and vascular studies. 34 …”

Section: Diagnosis and Assessmentmentioning

confidence: 99%

Review of the Current Management of Pressure Ulcers

Boyko

Longaker

Yang

2018

Advances in Wound Care

223

144

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“…For example, patients with peripheral artery disease will greatly benefi t from revascularization and ruling out metabolic disorders such as diabetes [ 74 ] , whereas those with venous insuffi ciency tend to benefi t from compression therapy [ 81 ] as well as surgical or endovenous treatment [ 82 ] . Glycemic control, regular tests of protective sensation, pressure mitigation, appropriate perfusion, and infection control constitute top priorities in the prevention and treatment of diabetic foot ulcers [ 83 ] .…”

Section: Challenges and Perspectives In The Treatment Of Chronic Wounmentioning

confidence: 99%

“…For instance, venous leg ulcers are predominantly located on the inner aspects of the lower extremities, and may present with signs such as dermatitis, edema, lipodermatosclerosis, hemosiderosis, or loss of pigment and dilated capillary loops (referred to as atrophie blanche) (Figure 2 ) [ 73 ] . Wounds related to peripheral artery disease, on the other hand, primarily affect the distal areas of the extremities and are frequently associated with pain, a sensation of coldness, and changes in skin color following leg elevation ( Figure 3 ) [ 74 ] .…”

Section: -Mycosis -Bacterial and Viral Infections -Protozoamentioning

confidence: 99%

“…In rare cases, malignant transformation of chronic wounds may also occur (Marjolin's ulcer). Moreover, several autoimmune diseases including vasculitis ( Figure 6 ) and rheumatoid arthritis [ 73 ] , as well as metabolic disorders such as calciphylaxis [ 74 ] and neutrophilic dermatoses such as pyoderma gangrenosum ( Figure 7 ) [ 76 ] should also be considered in the differential diagnosis. Histological evaluation of a biopsy taken from the ulcer margins may be helpful with Table 1 Continued.…”

Section: -Mycosis -Bacterial and Viral Infections -Protozoamentioning

confidence: 99%

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Pathogenesis of wound healing disorders in the elderly

Makrantonaki

Wlaschek

Scharffetter‐Kochanek

2017

J Deutsche Derma Gesell

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Summary The elderly constitute the age group most susceptible to wound healing disorders and chronic wounds, the most prevalent being venous leg ulcers, pressure ulcers, and diabetic foot ulcers. However, other age‐associated diseases should also be taken into consideration in the diagnostic workup of chronic wounds, and not be underestimated. A better understanding of the pathomechanisms involved in the wound healing process is of key importance in combatting the difficulties associated with the treatment of chronic wounds. In recent decades, considerable progress has been made in the development of pioneering therapeutic strategies for chronic wounds. In this context, the use of growth factors and cytokines, tissue engineering, and cell therapy – including stem cells – have proven very promising. Nevertheless, prior to their introduction into routine clinical practice, large controlled clinical trials are required to assess the safety of these techniques.

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“…[3][4][5] Spontaneous healing therefore may explain the reduction in ulcer area in the open-label phase. Because more patients in the cell injection groups underwent amputation than those in the placebo group, remaining ulcers in the cell injection groups would be a selection of the best in those groups and therefore more prone to heal than those remaining in the placebo group.…”

Section: To the Editormentioning

confidence: 99%

Letter by Dregelid Regarding Article, “Intra-Arterial Administration of Bone Marrow Mononuclear Cells in Patients With Critical Limb Ischemia: A Randomized-Start, Placebo-Controlled Pilot Trial (PROVASA)”

Dregelid

2011

Circ: Cardiovascular Interventions

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Management of Lower Extremity Wounds in Patients With Peripheral Arterial Disease: A Stratified Conservative Approach

Cited by 42 publications

References 11 publications

Review of the Current Management of Pressure Ulcers

Review of the Current Management of Pressure Ulcers

Pathogenesis of wound healing disorders in the elderly

Letter by Dregelid Regarding Article, “Intra-Arterial Administration of Bone Marrow Mononuclear Cells in Patients With Critical Limb Ischemia: A Randomized-Start, Placebo-Controlled Pilot Trial (PROVASA)”

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