Venous stasis ulcer: Difference between revisions
imported>D. Matt Innis (another contribution to the party!) |
imported>Robert Badgett (→Treatment: adapted from content I helped with at WP) |
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==Treatment== | ==Treatment== | ||
A [[randomized controlled trial]] found that surgery | Venous ulcers are costly to treat, and there is a significant chance that they will reoccur after [[healing]];<ref name="pmid16023934"/><ref name="pmid15223495">{{cite journal |author=Brem H, Kirsner RS, Falanga V |title=Protocol for the successful treatment of venous ulcers |journal=Am. J. Surg. |volume=188 |issue=1A Suppl |pages=1-8 |year=2004 |pmid=15223495 |doi=10.1016/S0002-9610(03)00284-8}}</ref> one study found that up to 48% of venous ulcers had recurred by the fifth year after healing.<ref name="pmid15223495"/> | ||
A review by [http://clinicalevidence.com Clinical Evidence] concluded that several beneficial treatments exist.<ref name="pmid16973096">{{cite journal |author=Nelson EA, Cullum N, Jones J |title=Venous leg ulcers |journal=Clinical evidence |volume= |issue=15 |pages=2607-26 |year=2006 |pmid=16973096 |doi= |url=http://clinicalevidence.com/ceweb/conditions/wnd/1902/1902.jsp}}</ref> | |||
===Compression therapy=== | |||
Non-elastic, ambulatory, below knee (BK) compression aggressively counters the impact of reflux on venous pump failure.<ref>{{cite web |url=http://www.veinclinics.com/5research_5.html |title=Venous Stasis Ulcer |accessdate=2007-08-05 |author=B. McDonagh, S. Sorenson, A. Cohen, T. Eaton, D.E. Huntley, M. Schul, C. Martin, C. Gray, P. Putterman, T. King, J.L. Harry, R.C. Guptan|format= |work=}}</ref> Compression therapy is used for venous leg ulcers and can decrease blood vessel diameter and pressure, which increases their effectiveness, preventing blood from flowing backwards.<ref name="pmid15223495"/> Compression is also used <ref name="pmid15223495"/><ref name="pmid15885771">{{cite journal |author=Taylor JE, Laity PR, Hicks J, ''et al'' |title=Extent of iron pick-up in deforoxamine-coupled polyurethane materials for therapy of chronic wounds |journal=Biomaterials |volume=26 |issue=30 |pages=6024-33 |year=2005 |pmid=15885771 |doi=10.1016/j.biomaterials.2005.03.015}}</ref> to increase release of inflammatory [[cytokine]]s, lower the amount of fluid leaking from [[capillary|capillaries]] and therefore prevent [[edema|swelling]], and prevent [[clotting]] by decreasing activation of [[thrombin]] and increasing that of [[plasmin]].<ref name="pmid16023934"/> | |||
Compression is applied using elastic bandages or boots specifically designed for the purpose.<ref name="pmid15223495"/> It is not clear whether non-elastic systems are better than a multilayer elastic system.<ref name="pmid16973096"/> Patients should wear as much compression as is comfortable. <ref name="pmid17012004">{{cite journal |author=Nelson EA, Harper DR, Prescott RJ, Gibson B, Brown D, Ruckley CV |title=Prevention of recurrence of venous ulceration: randomized controlled trial of class 2 and class 3 elastic compression |journal=J. Vasc. Surg. |volume=44 |issue=4 |pages=803-8 |year=2006 |pmid=17012004 |doi=10.1016/j.jvs.2006.05.051}}</ref> The type of dressing applied beneath the compression does not seem to matter, and [[hydocolloid]] is not better than simple low adherent dressings.<ref name="pmid16855958">{{cite journal |author=Palfreyman SJ, Nelson EA, Lochiel R, Michaels JA |title=Dressings for healing venous leg ulcers |journal=Cochrane database of systematic reviews (Online) |volume=3 |issue= |pages=CD001103 |year=2006 |pmid=16855958 |doi=10.1002/14651858.CD001103.pub2}}</ref><ref name="pmid17631512">{{cite journal |author=Palfreyman S, Nelson EA, Michaels JA |title=Dressings for venous leg ulcers: systematic review and meta-analysis |journal=BMJ |volume=335 |issue=7613 |pages=244 |year=2007 |pmid=17631512 |doi=10.1136/bmj.39248.634977.AE}}</ref> | |||
===Pentoxifylline=== | |||
A [[meta-analysis]] of [[randomized controlled trials]] by the [[Cochrane Collaboration]] found that "Pentoxifylline is an effective adjunct to compression bandaging for treating venous ulcers and may be effective in the absence of compression".<ref name="pmid17636683">{{cite journal |author=Jull A, Arroll B, Parag V, Waters J |title=Pentoxifylline for treating venous leg ulcers |journal=Cochrane database of systematic reviews (Online) |volume= |issue=3 |pages=CD001733 |year=2007 |pmid=17636683 |doi=10.1002/14651858.CD001733.pub2}}</ref> | |||
===Artificial skin=== | |||
Artificial skin, made of collagen and [[cell culture|cultured]] skin cells, is also used to cover venous ulcers and excrete [[growth factor]]s to help them heal.<ref name="Mustoe2005">Mustoe T. 2005. [http://www.pasteur.fr/applications/euroconf/tissuerepair/Mustoe_abstract.pdf Dermal ulcer healing: Advances in understanding.] Presented at meeting: Tissue repair and ulcer/wound healing: molecular mechanisms, therapeutic targets and future directions. Paris, France, March 17-18, 2005. Available. </ref> A [[meta-analysis]] of [[randomized controlled trials]] by the [[Cochrane Collaboration]] concluded "Bilayer artificial skin, used in conjunction with compression bandaging, increases the chance of healing a venous ulcer compared with compression and a simple dressing".<ref name="pmid17443510">{{cite journal |author=Jones JE, Nelson EA |title=Skin grafting for venous leg ulcers |journal=Cochrane database of systematic reviews (Online) |volume= |issue=2 |pages=CD001737 |year=2007 |pmid=17443510 |doi=10.1002/14651858.CD001737.pub3}}</ref> | |||
===Surgical correction of superficial venous reflux=== | |||
A [[randomized controlled trial]] found that surgery "reduces the recurrence of ulcers at four years and results in a greater proportion of ulcer free time".<ref name="pmid17545185">{{cite journal |author=Gohel MS, Barwell JR, Taylor M, ''et al'' |title=Long term results of compression therapy alone versus compression plus surgery in chronic venous ulceration (ESCHAR): randomised controlled trial |journal=BMJ |volume=335 |issue=7610 |pages=83 |year=2007 |pmid=17545185 |doi=10.1136/bmj.39216.542442.BE}}</ref> | |||
==References== | ==References== | ||
Revision as of 22:40, 5 September 2007
Venus stasis ulcers are the result of the breakdown of the tissues usually in the lower legs as the result of diminished circulation. As the tissues lose their source of nutrition and waste removal, breakdown in the skin occurs resulting in ulcerated lesions that resist healing. The most likely cause is lost efficiency of the valves in the deep veins of the leg increasing the pressure in the veins and thus decreasing the exchange of blood from arteries through the capillaries. Any mechanism that might block or diminish flow through the deep veins can cause the condition. These would include long term causes such as atherosclerotic lesions or plaques building within the venous walls or can be caused by short term conditions that result in swelling and increased vascular pressure such as sprained ankles, knee effusions, and even improperly applied wraps or bandages.
Treatment
Venous ulcers are costly to treat, and there is a significant chance that they will reoccur after healing;[1][2] one study found that up to 48% of venous ulcers had recurred by the fifth year after healing.[2]
A review by Clinical Evidence concluded that several beneficial treatments exist.[3]
Compression therapy
Non-elastic, ambulatory, below knee (BK) compression aggressively counters the impact of reflux on venous pump failure.[4] Compression therapy is used for venous leg ulcers and can decrease blood vessel diameter and pressure, which increases their effectiveness, preventing blood from flowing backwards.[2] Compression is also used [2][5] to increase release of inflammatory cytokines, lower the amount of fluid leaking from capillaries and therefore prevent swelling, and prevent clotting by decreasing activation of thrombin and increasing that of plasmin.[1]
Compression is applied using elastic bandages or boots specifically designed for the purpose.[2] It is not clear whether non-elastic systems are better than a multilayer elastic system.[3] Patients should wear as much compression as is comfortable. [6] The type of dressing applied beneath the compression does not seem to matter, and hydocolloid is not better than simple low adherent dressings.[7][8]
Pentoxifylline
A meta-analysis of randomized controlled trials by the Cochrane Collaboration found that "Pentoxifylline is an effective adjunct to compression bandaging for treating venous ulcers and may be effective in the absence of compression".[9]
Artificial skin
Artificial skin, made of collagen and cultured skin cells, is also used to cover venous ulcers and excrete growth factors to help them heal.[10] A meta-analysis of randomized controlled trials by the Cochrane Collaboration concluded "Bilayer artificial skin, used in conjunction with compression bandaging, increases the chance of healing a venous ulcer compared with compression and a simple dressing".[11]
Surgical correction of superficial venous reflux
A randomized controlled trial found that surgery "reduces the recurrence of ulcers at four years and results in a greater proportion of ulcer free time".[12]
References
- ↑ 1.0 1.1 Cite error: Invalid
<ref>tag; no text was provided for refs namedpmid16023934 - ↑ 2.0 2.1 2.2 2.3 2.4 Brem H, Kirsner RS, Falanga V (2004). "Protocol for the successful treatment of venous ulcers". Am. J. Surg. 188 (1A Suppl): 1-8. DOI:10.1016/S0002-9610(03)00284-8. PMID 15223495. Research Blogging.
- ↑ 3.0 3.1 Nelson EA, Cullum N, Jones J (2006). "Venous leg ulcers". Clinical evidence (15): 2607-26. PMID 16973096. [e]
- ↑ B. McDonagh, S. Sorenson, A. Cohen, T. Eaton, D.E. Huntley, M. Schul, C. Martin, C. Gray, P. Putterman, T. King, J.L. Harry, R.C. Guptan. Venous Stasis Ulcer. Retrieved on 2007-08-05.
- ↑ Taylor JE, Laity PR, Hicks J, et al (2005). "Extent of iron pick-up in deforoxamine-coupled polyurethane materials for therapy of chronic wounds". Biomaterials 26 (30): 6024-33. DOI:10.1016/j.biomaterials.2005.03.015. PMID 15885771. Research Blogging.
- ↑ Nelson EA, Harper DR, Prescott RJ, Gibson B, Brown D, Ruckley CV (2006). "Prevention of recurrence of venous ulceration: randomized controlled trial of class 2 and class 3 elastic compression". J. Vasc. Surg. 44 (4): 803-8. DOI:10.1016/j.jvs.2006.05.051. PMID 17012004. Research Blogging.
- ↑ Palfreyman SJ, Nelson EA, Lochiel R, Michaels JA (2006). "Dressings for healing venous leg ulcers". Cochrane database of systematic reviews (Online) 3: CD001103. DOI:10.1002/14651858.CD001103.pub2. PMID 16855958. Research Blogging.
- ↑ Palfreyman S, Nelson EA, Michaels JA (2007). "Dressings for venous leg ulcers: systematic review and meta-analysis". BMJ 335 (7613): 244. DOI:10.1136/bmj.39248.634977.AE. PMID 17631512. Research Blogging.
- ↑ Jull A, Arroll B, Parag V, Waters J (2007). "Pentoxifylline for treating venous leg ulcers". Cochrane database of systematic reviews (Online) (3): CD001733. DOI:10.1002/14651858.CD001733.pub2. PMID 17636683. Research Blogging.
- ↑ Mustoe T. 2005. Dermal ulcer healing: Advances in understanding. Presented at meeting: Tissue repair and ulcer/wound healing: molecular mechanisms, therapeutic targets and future directions. Paris, France, March 17-18, 2005. Available.
- ↑ Jones JE, Nelson EA (2007). "Skin grafting for venous leg ulcers". Cochrane database of systematic reviews (Online) (2): CD001737. DOI:10.1002/14651858.CD001737.pub3. PMID 17443510. Research Blogging.
- ↑ Gohel MS, Barwell JR, Taylor M, et al (2007). "Long term results of compression therapy alone versus compression plus surgery in chronic venous ulceration (ESCHAR): randomised controlled trial". BMJ 335 (7610): 83. DOI:10.1136/bmj.39216.542442.BE. PMID 17545185. Research Blogging.