An Analysis of the Effectiveness of Skin Grafting to Treat Chronic Venous Leg Ulcers.

AIM: This study assessed the effectiveness of skin autografting at 6 months post treatment. MATERIALS AND METHODS: A prospective analysis of the disease course and treatment of 2 groups of patients (group S contained patients who have been treated by performing the surgery of skin autografting, group C contained patients who have been treated only by nonoperative means of treatment) after 6 months who were treated from January 2001 to June 2005 at the Department of Plastic Surgery and Burns and at the Clinic of Skin and Venereal Diseases of Kaunas Medical University Hospital was performed. The analysis evaluated the influence on the speed of epithelization (healing) of ulcers by performing surgical skin autografting and conservative treatment. The speed of epithelization (the decrement of an area of an ulcer within 6 months) for the treatment of large chronic leg ulcers after the first 6-month period was also analyzed. RESULTS: Seventy-one patients (group S, n = 40; group C, n = 31) participated in the 6-month study period. Ulcers did not heal completely in any patients in group C (100%)-ulcer size increased in 17 patients and decreased in 14 patients. The average area of ulcers for group C was 171.12 cm2 (range = 8 cm2-720 cm2). Compared to the area before treatment (m = 182.29 cm2), the reduction in average area was not significant (P > 0.5). The contamination of ulcers did not change much in either group over the course of the study. Staphylococcus aureus and Pseudomonas aeruginosa were the most commonly found pathogens. In group S, the skin epithelized completely in 27 cases (67.5%) and did not epithelize in 13 cases (32.5%). The average ulcer area was 16 cm2 (range = 6 cm2-52 cm2). In comparison with the previous area (m = 279 cm2), the current area was rather small and did not (or was insignificant) influence patient quality of life. CONCLUSION: According to the data from all factors that were analyzed, age was the only influence on the origination of large chronic venous leg ulcers (CVLUs, P < 0.05). Large CVLUs (> 50 cm2) of 67.5% of elderly patients (> 60 years) were healed within 2-3 weeks by skin grafting compared to the conservatively treated group and maintained closure up to 6 months (ie, if the subjects were studied up to 6 months).

Changes in patient's quality of life comparing conservative and surgical treatment of venous leg ulcers.

Leg ulcers of different etiology disable up to 1% of total population, and up to 15% individuals over 70 years old. It is an old disease, which troubles the patients and medical personnel and is hard to cure. It might take several years to cure the ulcer fully. Most of the patients with leg ulcers are being treated at home, not in the outpatient departments or hospitals; therefore there is not much information on how the ulcer affects the patient's everyday life and its quality. The researchers often analyze only the financial part of this disorder forgetting its human part: pain, social isolation, and decreased mobility. There are many questionnaires and methods to analyze the quality of life of the patients with leg ulceration. It is often unclear if we should treat the ulcer conservatively for a long time or if part of resources should be used for operation (skin grafting) and the time of treatment should be shortened. To see the advantage of both methods and the influence of the ulcer treatment to the quality of life we decided to estimate the functionality of surgical and conservative treatment. We have analyzed the case histories and the data of special questionnaires of 44 patients, which were treated in Department of Plastic Surgery and Burns of Kaunas University of Medicine Hospital in the period of 2001 January-2004 February and had large trophic leg ulcers (m=254 cm2) for 6 months or more. Ten patients were treated conservatively and 34 patients were treated by skin grafting. All of them were interviewed after 3-6 months. We found that the pain in the place of the ulcers has decreased for the patients, who were treated surgically. By making the differences of the pain more exact we found out, that the patients have been feeling pain before the operation and when interviewing them the second time they told that they felt discomfort, not pain. The intensity of pain remained the same for the patients treated conservatively. The regression of pain also proves the decreased usage of painkillers in the group of the patients with the surgical treatment. All the patients (n=44) have had sleep disorders because of the ulcers. In the group of surgically treated patients, ulcers did not disturb the sleep after more than 3 months, and in the group, treated conservatively, the problem remained. We also found that after surgical treatment the patients were more optimistic and cried less. That shows the recovery of their emotional status. We have also found that the patients knew from the surgeon first than from the family doctor or other medical personnel about this disorder. We have made conclusions, that with the reduction of the ulcer area the pain is also reduced. Surgical treatment of ulcers (autodermoplasty) reveals a statistically reliable positive effect on patient life quality (sleep and emotions), but even 50% of patients are unaware of the real leg ulceration causes.

Treatment of the leg ulcers by skin grafting.

The ulcers, located below the knees and remaining for 6 weeks and more, are called trophic leg ulcers. The leg ulcers of different etiology disable 0.8-1% of total Earth population. It was found that blood vessel problems in legs account for more than 80% of ulcers; even 65% from these are caused by venous diseases. In Lithuania about 8000 patients suffer from venous trophic ulcers. Regardless of modern methods the treatment of leg ulcers remains an extremely expensive process. The treatment cost of trophic ulcers is the highest of all surgical wounds and also requires a lot of personal investments. In order to assess the efficiency of autodermoplastics in the treatment of large venous ulcers in legs a prospective study was carried out of 111 patients who were treated in the Department of Plastic Surgery and Burns of Kaunas University of Medicine Hospital from January 2001 to January 2004. The data was analyzed exceptionally of the operated 54 patients with venous origin ulcers open for more 6 months or exceeding 50 cm2. The above-mentioned patients were prepared for surgery by dressing the wounds with hydrocolloid Granuflex bandages and were operated by transplanting a 0.2-0.3 mm thick skin graft. The results were estimated by the surgeon during the dressings after the operation. The graft was taken in 35 (64.81%) cases; in 19 (35.19%) cases the graft was partially not taken and there were no cases when it was not taken at all. We came to the conclusions that skin graft transplantation is efficient in treatment of trophic venous leg ulcers larger than 50 cm2 and cures the trophic leg ulcers of vein origin completely in 2-3 weeks for 64.81% patients.

[The changes of characteristics of burn injuries and treatment data of burned adults in Kaunas University of Medicine Hospital in 1981-2001]. / Nudegusiu suaugusiuju traumatizmo ir stacionarinio gydymo rezultatu pokyciai Kauno medicinos universiteto klinikose 1981-2001 metais.

About 8000 people get burned in Lithuania every year; over 2000 of them have to be hospitalized. About 500 adults and children, who have heavy burn accidents, are treated in the specialized burn centers in Kaunas and Vilnius. With the flow of time, causes of burn accidents change; new treatment methods appear and are applied, the duration of treatment in the hospital as well as other burn accident data change. Consequently we can conclude that in Lithuania as well as all over the world burns are considered to be a serious medical, psychological, economic and social problem. A retrospective 723 in-patient case study was carried out in order to analyze accident and treatment data. The article deals with accident and in-patient treatment data analysis of the adults hospitalized in 1981, 1985, 1991, 1995 and 2001 at the Department of Plastic Surgery and Burns of Kaunas University of Medicine. In 1981, 1985, 1991, 1995 and 2001, respectively 156, 116, 174, 173 and 106 burn accident adult patients were treated. In all years number of burned male patients was twice higher than of female patients. It was noticed that in most cases people of the employable age got burned; the average age of patients 41.3 years. The main source of burns was flame (47.2%); town inhabitants got burned two times more frequently than villagers. It was found that the number of burns with hot liquids increased. The number of unemployed patients increased as well. The absolute majority of patients were treated due to deep burns (87.55%), the total average of burned area decreased from 12.66% in 1981 to 10.99% in 2001. The number of patients undergoing an operation has grown. Active surgery tactics and early operations gave the possibility to decrease almost twice the duration of in-patient treatment in 2001 in comparison to 1981. The time till the first operation decreased from 19.1 days in 1981 to 7 days in 2001.