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Dermatology (Basel, Switzerland) 2016This review presents a closer look at four diseases which are probably closely related to one another pathophysiologically: (a) calciphylaxis (distal pattern); (b)... (Review)
Review
This review presents a closer look at four diseases which are probably closely related to one another pathophysiologically: (a) calciphylaxis (distal pattern); (b) calciphylaxis (proximal pattern); (c) Martorell hypertensive ischemic leg ulcer; (d) calciphylaxis with normal renal and parathyroid function (synonym: eutrophication). The four diseases have largely the same risk factors: (1) arterial hypertension, (2) diabetes mellitus (types 1 and 2), (3) secondary or tertiary hyperparathyroidism (in end-stage kidney disease) and (4) oral anticoagulation with vitamin K antagonists. They share the same clinical patterns: necrotizing livedo, skin infarctions at typical locations and acral gangrene in calciphylaxis. They also share the same histopathology: ischemic subcutaneous arteriolosclerosis and small-artery disease and 'miniaturizing' Mönckeberg medial calcinosis. The treatment concept for the acute phase of the diseases is also broadly similar. In addition to an optimized control of the cardiovascular risk factors, a proactive wound approach (necrosectomy, negative pressure wound treatment with vacuum dressings, and early skin grafts supported by systemic antibiotic therapy) leads most rapidly and effectively to a reduction of the initially severe wound pain, and finally to complete healing of the wound. Oral anticoagulation with vitamin K antagonists should be stopped. In extensive cases, the use of intravenous sodium thiosulfate is recommended. All four diagnoses are little known in the medical schools of most countries. The need to improve familiarity with these four closely related disorders is therefore great. In particular, the risk of confusion with pyoderma gangrenosum is a major diagnostic problem which can lead to false and even damaging treatment.
Topics: Anticoagulants; Calciphylaxis; Diabetes Complications; Humans; Hyperparathyroidism, Secondary; Hypertension; Infarction; Leg Ulcer; Skin; Vitamin K
PubMed: 27622522
DOI: 10.1159/000448245 -
Australian Journal of General Practice Nov 2021
Topics: Humans; Leg Ulcer; Pain
PubMed: 34713286
DOI: 10.31128/AJGP-05-20-5450 -
Postgraduate Medical Journal Dec 1995This paper reports a rare form of ulceration of the lower leg and, as a result of subsequent investigations and literature review, readdresses a recent debate regarding... (Review)
Review
This paper reports a rare form of ulceration of the lower leg and, as a result of subsequent investigations and literature review, readdresses a recent debate regarding the legitimate classification of these ulcers as a separate disease entity.
Topics: Female; Humans; Leg Ulcer; Middle Aged
PubMed: 8552533
DOI: 10.1136/pgmj.71.842.717 -
Ugeskrift For Laeger Feb 2022Chronic ulcers are most often seen as a complication to venous leg ulcers, diabetic foot ulcers and pressure ulcers. Ulcers often display an underlying medical... (Review)
Review
Chronic ulcers are most often seen as a complication to venous leg ulcers, diabetic foot ulcers and pressure ulcers. Ulcers often display an underlying medical condition, which makes it mandatory to treat these individuals in a multidisciplinary setting. Modern ulcer therapy has changed over the latest decade, and as described in this review a number of new modalities have been included. The major group of ulcers often presents with well-defined features, but attention should be directed towards ulcers with atypic appearance such as ulcers related to calciphylaxis, hypertension (Martorell) and pyoderma.
Topics: Calciphylaxis; Diabetic Foot; Humans; Hypertension; Leg Ulcer; Ulcer
PubMed: 35244009
DOI: No ID Found -
PloS One 2023The level of personal health literacy of patients with venous leg ulcers is likely to affect their ability to self-manage their condition impacting on their adherence to... (Review)
Review
BACKGROUND
The level of personal health literacy of patients with venous leg ulcers is likely to affect their ability to self-manage their condition impacting on their adherence to treatment and influences healing and recovery outcomes.
OBJECTIVES
To scope existing research that examined the level of health literacy in venous leg ulcer patients, to identify how this may link to self-management behaviours (particularly physical activity and compression adherence), and venous leg ulcer healing outcomes.
METHODS
This scoping review was based on the PRISMA-ScR six-stage framework. We searched MEDLINE, EMBASE, the Cochrane Library, PsycInfo and Health, Open Grey, and Google Scholar for publications examining general and specific health literacy in those with venous leg ulcers and for those examining any potential links of health literacy with self-management/healing generally, published between 2000-2020. This search was guided by a published protocol; studies that described other types of ulcers or did not examine health literacy were excluded. After applying inclusion and exclusion criteria the initial search identified 660 articles.
RESULTS
We included five articles. Four studies used randomised controlled trials or experimental designs to test the effect of specific health literacy interventions on venous leg ulcer knowledge, compression therapy use, or healing outcomes. One study was a cross- sectional survey with qualitative elements, assessing health literacy in venous leg ulcer patients. Broadly, the research suggested that health literacy was suboptimal amongst those with venous leg ulcers, and health literacy interventions had limited effects on improving key venous leg ulcer specific outcomes.
CONCLUSION
This review provides a synthesis of extant literature examining health literacy in patients with venous leg ulcers. We identified a dearth of literature investigating the value of general and specific health literacy interventions in this space. Most importantly, no recent research on general health literacy and venous leg ulcers was identified, despite strong theoretical utility to do so. The few studies identified largely indicated that targeting health literacy of patients with venous leg ulcers is a viable area of research and intervention, encouraging future researchers and clinicians to consider patient health literacy in venous leg ulcer management.
Topics: Humans; Health Literacy; Leg Ulcer; Self-Management; Varicose Ulcer; Wound Healing
PubMed: 36652467
DOI: 10.1371/journal.pone.0279368 -
The Cochrane Database of Systematic... Jan 2021The frequency of skin ulceration makes an important contributor to the morbidity burden in people with sickle cell disease. Many treatment options are available to the... (Review)
Review
BACKGROUND
The frequency of skin ulceration makes an important contributor to the morbidity burden in people with sickle cell disease. Many treatment options are available to the healthcare professional, although it is uncertain which treatments have been assessed for effectiveness in people with sickle cell disease. This is an update of a previously published Cochrane Review.
OBJECTIVES
To assess the clinical effectiveness and harms of interventions for treating leg ulcers in people with sickle cell disease.
SEARCH METHODS
We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Haemoglobinopathies Trials Register. We searched LILACS (1982 to January 2020), ISI Web of Knowledge (1985 to January 2020), and the Clinical Trials Search Portal of the World Health Organization (January 2020). We checked the reference lists of all the trials identified. We also contacted those groups or individuals who may have completed relevant randomised trials in this area. Date of the last search of the Cochrane Cystic Fibrosis and Genetic Disorders Group's Haemoglobinopathies Trials Register: 13 January 2020; date of the last search of the Cochrane Wounds Group Trials Register: 17 February 2017.
SELECTION CRITERIA
Randomised controlled trials of interventions for treating leg ulcers in people with sickle cell disease compared to placebo or an alternative treatment.
DATA COLLECTION AND ANALYSIS
Two authors independently selected studies for inclusion. All three authors independently assessed the risk of bias of the included studies and extracted data. We used GRADE to assess the quality of the evidence.
MAIN RESULTS
Six studies met the inclusion criteria (198 participants with 250 ulcers). Each trial investigated a different intervention and within this review we have grouped these as systemic pharmaceutical interventions (L-cartinine, arginine butyrate, isoxsuprine) and topical pharmaceutical interventions (Solcoseryl cream, arginine-glycine-aspartic acid (RGD) peptide dressing and topical antibiotics). No trials on non-pharmaceutical interventions were included in the review. All trials had an overall unclear or high risk of bias, and drug companies sponsored four of them. We were unable to pool findings due to the heterogeneity in outcome definitions, and inconsistency between the units of randomisation and analysis. Three interventions reported on the change in ulcer size (arginine butyrate, RGD peptide, L-cartinine). Of these, only arginine butyrate showed a reduction of ulcer size compared with a control group, mean reduction -5.10 cm² (95% CI -9.65 to -0.55), but we are uncertain whether this reduces ulcer size compared to standard care alone as the certainty of the evidence has been assessed as very low. Three trials reported on complete leg ulcer closure (isoxsuprine, arginine butyrate, RGD peptide matrix; very low quality of evidence). None reported a clinical benefit. No trial reported on: the time to complete ulcer healing; ulcer-free survival following treatment for sickle cell leg ulcers; quality of life measures; incidence of amputation or harms.
AUTHORS' CONCLUSIONS
Given the very low quality of the evidence identified in this updated Cochrane Review we are uncertain whether any of the assessed pharmaceutical interventions reduce ulcer size or result in leg ulcer closure in treated participants compared to controls. However, this intervention was assessed as having a high risk of bias due to inadequacies in the single trial report. Other included studies were also assessed as having an unclear or high risk of bias. The harm profile of the all interventions remains inconclusive.
Topics: Anemia, Sickle Cell; Bandages; Humans; Leg Ulcer; Quality of Life; Wound Healing
PubMed: 34559425
DOI: 10.1002/14651858.CD008394.pub4 -
Journal Der Deutschen Dermatologischen... Sep 2012To evaluate the evidence on the impact of different debridement techniques on healing and their efficacy in the treatment of leg ulcers. (Meta-Analysis)
Meta-Analysis Review
AIM
To evaluate the evidence on the impact of different debridement techniques on healing and their efficacy in the treatment of leg ulcers.
METHODS
Web-based search (PubMed) for trials investigating surgical, enzymatic, autolytic, osmotic, ultrasound-assisted, and biosurgical wound debridement on leg ulcers with regard to healing and efficacy.
RESULTS
Both surgical and hydrosurgical methods proved to be effective debridement techniques. For conventional surgical debridement, a significantly greater reduction of the wound surface area and a higher healing rate were reported. Studies on autolytic, osmotic, and enzymatic wound debridement showed effective debridement for krill enzymes, dextranomer and manuka honey. Only for manuka honey was there a significantly greater reduction of the wound surface area compared to standard treatment. One study comparing fibrinolysin/DNAse with placebo and one comparing autolytic with enzymatic debridement showed no significant differences between the respective techniques. Trials on ultrasound-assisted wound debridement reported a positive impact on healing. A significant wound surface area reduction was demonstrated in one of them. Maggot therapy led to effective debridement. The largest trial showed no significantly improved healing.
CONCLUSIONS
Further studies are needed to strengthen the evidence for a significant impact of wound debridement on the healing of leg ulcers.
Topics: Debridement; Dermatologic Surgical Procedures; Humans; Leg Ulcer; Postoperative Complications; Prevalence; Treatment Outcome; Wound Healing
PubMed: 22591415
DOI: 10.1111/j.1610-0387.2012.07952.x -
Wounds : a Compendium of Clinical... Oct 2017Chronic leg ulcers persist for > 6 weeks and show no tendency to heal after 3 or more months. They can be distressing to patients, both directly through physical... (Review)
Review
Chronic leg ulcers persist for > 6 weeks and show no tendency to heal after 3 or more months. They can be distressing to patients, both directly through physical symptoms caused by the disease and indirectly through limitations on work capacity, social activity, and personal hygiene. The quality of life (QoL) of patients with leg ulcers can be impaired by a complex set of aspects. Restrictions in their ability to perform paid employment, handle household duties, and engage in personal hygiene adversely affect patients' QoL. Patients with chronic leg ulcers frequently experience negative emotions such as shame, embarrassment, and loneliness, and they present higher levels of depression and anxiety compared with healthy individuals. When the expected healing results do not occur, these patients feel as if they have no control over their condition; this ongoing frustration leads them to feel depressed. The ulcers contribute to anxiety and psychological stress, creating a vicious, difficult-to-manage circle. This review aims to describe the negative psychosocial impacts on patients with chronic leg ulcers and emphasize their impaired QoL.
Topics: Activities of Daily Living; Anxiety; Chronic Disease; Depression; Humans; Leg Ulcer; Quality of Life; Self Concept; Shame; Stress, Psychological; Wound Healing
PubMed: 29091039
DOI: 10.25270/wnds/2017.10.306310 -
Vascular Medicine (London, England) Apr 2016
Review
Topics: Humans; Leg Ulcer; Lower Extremity; Predictive Value of Tests; Risk Factors; Treatment Outcome; Varicose Ulcer
PubMed: 26858182
DOI: 10.1177/1358863X16629233 -
Journal of Wound Care Oct 2023This article aims to review the scarce available evidence on the effectiveness of the Well Leg Programme within the Lindsay Leg Clubs in terms of preventing wound... (Review)
Review
This article aims to review the scarce available evidence on the effectiveness of the Well Leg Programme within the Lindsay Leg Clubs in terms of preventing wound recurrence and improving members' wellbeing. It collates the numerical data on members' wounds and healing rates from the Lindsay Leg Club relational database and members' narratives from a qualitative service evaluation of the Lindsay Leg Clubs. Findings of the review suggest that remaining within the Well Leg regime for several months (or longer) after having had a healed ulcer seems to provide further opportunity to prevent recurrence, and may also provide non-clinical benefits, such as improved wellbeing. Based on the review of available published evidence into the effectiveness of the Well Leg regime, we conclude that there is scope for further studies, including a comparison with other existing treatment and prevention protocols.
Topics: Humans; Leg; Leg Ulcer; Self-Help Groups; Varicose Ulcer; Wound Healing
PubMed: 37830830
DOI: 10.12968/jowc.2023.32.10.642