Topical agents or dressings for pain in venous leg ulcers

Briggs, Michelle; Nelson, E Andrea; James, Marrissa Martyn-St

doi:10.1002/14651858.cd001177.pub3

Cited by 101 publications

(67 citation statements)

References 73 publications

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“…As a result of this, several topics were pinpointed as suitable candidates for Cochrane reviews, either as new reviews or updates of existing reviews. Eleven reviews were undertaken overall on interventions for diabetic foot ulcers (five reviews [192][193][194][195]244 ), venous leg ulcers (five reviews 184,[197][198][199]245 ) and surgical wounds (one review 246 ). All used standard Cochrane systematic review methodology as described in the Cochrane Handbook for Systematic Reviews of Interventions 163 and all were carried out under the auspices of the Cochrane Wounds Group (see http://wounds.cochrane.org/).…”

Section: Introductionmentioning

confidence: 99%

Wounds research for patient benefit: a 5-year programme of research

Cullum

Buckley

Dumville

et al. 2016

Programme Grants Appl Res

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BackgroundComplex wounds are those that heal by secondary intention and include lower-limb ulcers, pressure ulcers and some surgical wounds. The care of people with complex wounds is costly, with care mainly being delivered by community nurses. There is a lack of current, high-quality data regarding the numbers and types of people affected, care received and outcomes achieved.ObjectivesTo (1) assess how high-quality data about complex wounds can be captured effectively for use in both service planning and research while ensuring integration with current clinical data collection systems and minimal impact on staff time; (2) investigate whether or not a clinical register of people with complex wounds could give valid estimates of treatment effects, thus reducing dependence on large-scale randomised controlled trials (RCTs); (3) identify the most important research questions and outcomes for people with complex wounds from the perspectives of patients, carers and health-care professionals; (4) evaluate the potential contributions to decision-making of individual patient data meta-analysis and mixed treatment comparison meta-analysis; and (5) complete and update systematic reviews in topic areas of high priority.MethodsTo meet objectives 1 and 2 we conducted a prevalence survey and developed and piloted a longitudinal disease register. A consultative, deliberative method and in-depth interviews were undertaken to address objective 3. To address objectives 4 and 5 we conducted systematic reviews including mixed treatment comparison meta-analysis.ResultsFrom the prevalence survey we estimated the point prevalence of all complex wounds to be 1.47 per 1000 people (95% confidence interval 1.38 to 1.56 per 1000 people). Pressure ulcers and venous leg ulcers were the most common type of complex wound. A total of 195 people with a complex wound were recruited to a complex wounds register pilot. We established the feasibility of correctly identifying, extracting and transferring routine NHS data into the register; however, participant recruitment, data collection and tracking individual wounds in people with multiple wounds were challenging. Most patients and health professionals regarded healing of the wound as the primary treatment goal. Patients were greatly troubled by the social consequences of having a complex wound. Complex wounds are frequently a consequence of, and are themselves, a long-term condition but treatment is usually focused on healing the wound. Consultative, deliberative research agenda setting on pressure ulcer prevention and treatment with patients, carers and clinicians yielded 960 treatment uncertainties and a top 12 list of research priorities. Of 167 RCTs of complex wound treatments in a systematic review of study quality, 41% did not specify a primary outcome and the overall quality of the conduct and reporting of the research was poor. Mixed-treatment comparison meta-analysis in areas of high priority identified that matrix hydrocolloid dressings had the highest probability (70%) of being the most effective dressing for diabetic foot ulcers, whereas a hyaluronan fleece dressing had the highest probability (35%) of being the most effective dressing for venous ulcers; however, the quality of this evidence was low and uncertainty is high.ConclusionsComplex wounds are common and costly with a poor evidence base for many frequent clinical decisions. There is little routine clinical data collection in community nursing. A prospective complex wounds register has the potential to both assist clinical decision-making and provide important research evidence but would be challenging to implement without investment in information technology in NHS community services. Future work should focus on developing insights into typical wound healing trajectories, identifying factors that are prognostic for healing and assessing the cost-effectiveness of selected wound treatments.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Section: Introductionmentioning

confidence: 99%

Wounds research for patient benefit: a 5-year programme of research

Cullum

Buckley

Dumville

et al. 2016

Programme Grants Appl Res

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“…The mean duration of ulcers in admission was 5.5 months (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). The most common symptom was edema (83%).…”

Section: Resultsmentioning

confidence: 99%

“…Venous hypertension causes cutaneous protein and hemosiderin accumulation looks like hyperpigmentations around the ulcerated lesion. Most common localization of a venous stasis ulcer is between ankle and upper calf, especially medial malleolus is a classical localization (13). However, diabetic ulcers are usually on the plantar area.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Treatment outcomes in the management of lower extremity venous stasis ulcers

Dinç¹,

Düzgün²,

Bekmez³

et al. 2014

Gaziantep Med J

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The aim of the study is to present the treatment outcomes in patients with venous stasis ulcer and summarize results with a brief review of the literature. Thirty patients with venous leg ulcers referred to a single chronic wound care unit with a minimum one year follow-up were included. Demographic features, co-morbidities, localization and characteristics of the ulcerated lesions, symptoms, arterial and venous Doppler ultrasound examination results, wound culture results, and outcomes of medical and surgical treatments were summarized. The treatment approach includes treating superficial and deep infections, obtaining tissue revascularization, compression, daily wound care, oral pentoxifylline, reconstruction of the major skin defects with split thickness skin grafts and hyperbaric oxygen therapy in refractory lesions. Mean age was 54 (32-85). Male to female ratio was 87%. Most common symptom was edema (83%). Mean size of ulcers were 20 cm² (4-45). Seven (23%) patients were hospitalized. Eighty % of patients had venous insufficiency. Most common isolated pathogen was P. aeruginosa (23%). Most common complication was osteomyelitis (5%). Hyperbaric oxygen therapy was applied to 3 patients. Split thickness grafts were used for the treatment of the skin defects in six (%20) patients. There was no recurrence of lesion in any patients at one year follow-up. Despite chronic lower extremity venous stasis ulcers are difficult to treat and related with a high risk of recurrence, it is possible to obtain good results with patient education and a systematic treatment approach. Keywords: Choronic wound treatment; compression; varices; venous leg ulcers Özet Venöz bacak ülserleri, hastalar ve sağlık sistemleri açısından önemli külfetler oluşturmaktadır. Çalışmamızda, yara bakım polikliniğine 6 aylık bir zaman diliminde venöz bacak ülseri tanısı ile başvuran hastaların değerlendirilmesi, hastalığın tanı, takip ve tedavisindeki önemin vurgulanması ve literatür eşliğinde tartışılması amaçlanmaktadır. Tek merkeze bağlı kronik yara tedavi polikliniğine başvuran, 30 venöz ülserli hasta çalışmaya dahil edildi. Hastaların; demografik özellikleri, aile hikayesi, yandaş hastalık, ülser sayısı ve ortalama boyutu, ülser lokalizasyonu ve özellikleri, osteomyelit varlığı, geçirilmiş venöz hastalık cerrahisi, arter ve venöz Doppler ultrason sonuçları, yara kültür sonuçları, uygulanan medikal ve cerrahi tedaviler ve tedavi sonuçları değerlendirilmiştir. Hastaların 26'sı (%87) erkek, ortalama yaş 54 idi. On altı hastada (%53) ağrı genel şikâyet olup 21 hastada (%70) kaşıntı vardı. Ortalama ülser boyutu 20 cm² olarak hesaplandı. On sekiz (%60) hastada dörtlü kompresyon bandajı kullanıldı. Yedi (%23) hasta yatırılarak takip edildi. Yatan hastalarda bacak elevasyonu, oral pentoksifilin, düşük molekül ağırlıklı heparin tedavisi, hyalogran ile pansuman, kültür sonucuna göre sistemik antibiyotik tedavisi yapıldı. Eksüda kontrolü sonrasında kompresyon tedavisi, taburculuk sonrası ise varis çorabı kullanıldı. Yatan 3 hastaya hiperbarik oksi...

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“…9 Venous ulcers are often recurrent, and open ulcers can persist from weeks to many years. [10][11][12] A correct diagnosis is essential to avoid inappropriate treatment that may delay wound healing, cause deterioration of the wound, or harm the patient.…”

Section: Introductionmentioning

confidence: 99%

To evaluate lower extremity ulcer cases in respect of their aetiological basis

Wagh²

2017

Int Surg J

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Background: Lower extremity ulcer is most common in our population due to their chronicity. Lower extremities are exposed to injury and having a circulation strained by upright posture. This has reason for researchers and surgeon who have been concerned with the reasons for their common occurrence and difficulty in their cure. Researcher interested to study the lower extremity ulcer cases in respect of their aetiological basis.Methods: 100 patients of lower extremity ulcer with various types were admitted in surgical wards of Mallareddy Institute of Medical Sciences, Hyderabad during study period. The cases were examined in detail and investigated thoroughly. If there is clinically doubtful case, the diagnosis was made only after histopathological examination.Results: Most common type of ulcer was found in the present was venous 25 (25%) cases, contributed by male (21) and female (04) followed by diabetic 22 (22%) and Traumatic 18 (18%). Most of cases belongs to the age group 41-60 years (45) and male (37 cases). High saphenous vein ligation with stripping of veins (21.4%) and conservative (21.4%) treatment were common surgical procedures used for the treatment of Venous ulcer.Conclusions: In the present, Venous ulcers are the most common of all leg ulcers with high morbidity. The surgical procedures are directed at prevention of venous reflux at various levels.

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Topical agents or dressings for pain in venous leg ulcers

Cited by 101 publications

References 73 publications

Wounds research for patient benefit: a 5-year programme of research

Wounds research for patient benefit: a 5-year programme of research

Treatment outcomes in the management of lower extremity venous stasis ulcers

To evaluate lower extremity ulcer cases in respect of their aetiological basis

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