Patients with venous leg ulcers can be managed safely in the community ----results of an observational comparison study in Singapore.

AIM: To examine the healing outcomes of patients with venous leg ulcers requiring compression bandaging in community care versus tertiary care. METHOD: This was an analytical observational cohort study. Venous leg ulcer (VLU) patients who required compression bandaging were recruited from an outpatient vascular clinic between May 2021 and August 2022. Eligible patients received two-or four-layer compression bandaging and followed up with the community care or tertiary care centre nurses. The primary outcome was the difference in the total surface area of the VLU after 12 weeks, and the secondary outcome was the patient's quality of life, as measured by the Cardiff Wound Impact Schedule (CWIS). RESULTS: Forty-seven VLU patients were recruited; 27 received compression bandaging in the community care and 20 by the tertiary care centre. Mean age 70 years old (SD 11.04). The two most prevalent comorbidities were hypertension (51.06 %) and diabetes mellitus (38.29 %). Among those who completed follow-up (12 weeks), the median difference of the total surface area of the VLU between community-based care (p = 0.02) versus tertiary-based care (0.003) was significant. However, there was no difference in the healing status between community and tertiary-based care (p = 0.68). There was no difference in the quality of life of patients between groups. CONCLUSION: This first tropical study comparing VLU healing outcomes between community and tertiary care found no significant difference in healing with compression bandaging by nurses in either setting. However, the small sample size and high dropout rate limit the generalizability of the findings, necessitating a larger-scale study with longer follow-up. Despite these limitations, the study is a crucial step toward improving wound care services in Singapore, and highlights the need for further research to guide future community wound care implementation.

A Double-Blind Study on the Effectiveness of Polarized Light Therapy in the Treatment of Venous leg Ulcers-Pilot Study.

Vein diseases are one of the most common civilization diseases. The most advanced form chronic venous insufficiency are venous leg ulcers. The study included 40 patients, 20 male (50%) and 20 female (50%) in age between 52 and 88 years (mean age: 68.00 ± 8.55 years) with venous leg ulcers lasting 12.50 ± 5.45 months. Patients were distributed randomly in a double-blind study into two equal groups including 20 patients each (group 1-polarized light therapy and group 2-sham exposure). Patients from both groups received routine pharmacological treatment, specialistic medical dressings and compression therapy. In addition, patients were exposed to a cycle of polarized light therapy procedures or to sham exposures (30 procedures performed in two series of 15 procedures). Wound surface area was evaluated by computerized planimetry and pain intensity was assessed with the use of Visual Analog Scale (VAS) before and after therapy (2.5 months). The analysis showed a statistically significant reduction of surface ulcers area between groups 1 and 2. The median (IQR) size of wounds in group 1 was 2.4 (1.95-2.9) cm2, in group 2; 2.8 (2.6-3.1) cm2 (p = 0.038). The level of pain (VAS) after treatment was assessed in group 1, median (IQR): 2 (2-3) points, in group 2 4.5 (4-5) points; and the observed difference was also statistically significant (p < 0.001). In group 1, after treatment, the area of ulcers decreased-median (IQR): 33.05 (28.7-41.48) %, in group 2 by 18.99 (15-24.4) % (p < 0.001). In group 1, the pain intensity measured using the VAS scale decreased with a median (IQR): 71.42 (61.25-71.42) %, in group 2: 37.5 (28.57-50) % (p < 0.001). Complex therapy with polarized light therapy added to standard care was more effective than standard care alone in reducing of ulcers surface area and intensity of pain ailments in patients with chronic venous leg ulcers.

Axial Ablation versus Terminal Interruption of the Reflux Source (AAVTIRS): A Randomised Controlled Trial.

INTRODUCTION: Treatment of reflux has been shown to improve time to healing of Venous Leg Ulcers (VLU). Terminal Interruption of the Reflux Source (TIRS) treats reflux within the plexus of veins around an active VLU using foam sclerotherapy. The efficacy of TIRS in managing VLU has never been tested. METHODS: We performed a pragmatic, single centre, assessor-blinded, randomised controlled trial comparing endovenous ablation of the axial superficial veins (Axial Ablation-AA) vs TIRS. Patients of any age with VLU of any duration were eligible. RESULTS: 98 Participants were randomised to AA or TIRS. 39/55, 70.9% (95%CI; 57.1-82.37) healed their VLU in the AA group, while 29/39, 74.36% (95%CI; 57.87-86.96) healed their VLU in the TIRS group, P = 0.45.4 were lost to follow-up. Median time to ulcer healing was 84 days (95%CI; 74.67-93.33) in the axial ablation group and 84 days (95%CI; 73.02-94.98) in the TIRS group. Hazard Ratio for ulcer healing with AA vs TIRS was 0.96 (95%CI 0.59-1.56). There were no significant quality of life differences. CONCLUSION: The AAVTIRS trial did not show that axial ablation was superior to TIRS in the primary outcome of number of VLU healed in 6 months, or time to VLU healing. This trial is not powered to show non-inferiority. TIRS is a viable option for treatment of VLU. Further investigation is necessary before it can be recommended as an alternative to axial ablation.Trial registered at clinicaltrials.gov NCT04484168.

Integrating new approaches to care in a vascular wound clinic.

INTRODUCTION: An evidence-based approach is essential in the treatment of wounds to optimise healing, reduce costs and improve patient outcomes. AIM: This case study aimed to demonstrate our model of care, which assesses and manages patients with venous disease and complex wounds. In this case, venous leg ulcer (VLU) was treated with TLC-NOSF dressing and therapeutic compression. The wound was serially assessed using a smart App that gave the patient a graphic representation of their progress. DESIGN: Descriptive Observational Case Study. CLINICAL CARE: An evidence-based approach for managing a chronic, severe VLU. The patient was initially seen at the Outpatient Vascular Wound Clinic twice weekly, then every two weeks for conservative sharp wound debridement, skin care, dressing change, and compression therapy using a compression (Ready) wrap. Wound progress was monitored by the digital application 'Tissue Analytics', a "purposedesigned digital wound management platform that records, tracks, and analyses wounds". RESULTS: Week 1: On initial review, ulcer length was 3.15cm, width was 3.1 cm, and total surface area was 6.31 cm2. The wound base was mildly sloughy (<25%), with areas of good granulation tissue on view. Week 12: Length was 1.32 cm, width 1.50 cm, and total surface area of 1.45 cm2, a 77% reduction in wound size. Week 24: The length was 0.48 cm, the width was 0.64 cm, and the total surface area was 0.18 cm2. This represented a 97% reduction in wound size. Week 36: Length was 0.01 cm, the width 0.06 cm, with a total surface area of 0.00 cm2. This represented a 99.99% reduction in wound size. CONCLUSION: The patient's treatment for a complex venous leg ulcer included the application of TLC-NOSF dressing in combination with individualised therapeutic compression therapy. We found TLC-NOSF was very effective in combination with the best standard of VLU care (i.e. therapeutic graduated compression therapy). The clinician and patient were impressed with the healing rate at 12 weeks, as the wound dimensions were the lowest since the wound started six years ago. This dramatically improved patient concordance and engagement in care. Despite incomplete healing at 36 weeks, the wound-healing journey over the 36 weeks indicated wound closure was close. In addition, using a wound assessment App, the patient could immediately see the benefits of the new treatment, facilitating patient compliance with the treatment.

Comparison of two ablation procedures combined with high ligation and foam sclerotherapy and compression therapy for patients with venous leg ulcers.

AIM: To compare the ablation techniques' efficacy of endovenous microwave ablation (EMA) combined with high ligation (HL), foam sclerotherapy (FS) and compression therapy (CT) and endovenous laser ablation (EVLA) combined with HL-FS-CT in the treatment of VLUs. METHOD: 301 consecutive patients with VLUs from 2013 to 2022 in a 3200-bed hospital were intervened by EMA combined with HL-FS-CT and EVLA combined with HL-FS-CT were retrospectively compared. RESULTS: One hundred thirty-four patients underwent EMA+HL-FS-CT and 167 patients underwent EVLA+HL-FS-CT. The primary outcome of the ulcer healing time was 1.45(0.75-1.5) months and 1.86(0.5-2.5) months, respectively, in the two groups (HR for ulcer healing was 1.26, 95% CI [0.96-1.66], p = 0.097). Secondary outcomes included that no significant difference was found in ulcer recurrence and GSV recanalization and complications between the two groups, and the postoperative VCSS and AVVQ were significantly lower than the baseline values in the respective groups (p = 0.0001). CONCLUSION: EMA+HL-FS-CT and EVLA+HL-FS-CT are both effective at treating VLUs. Both of the two comprehensive treatments were beneficial to the healing of ulcers, but no evidence showed which one was superior in the ulcer healing time.

The (dis)organization of leg ulcer care: A realist synthesis.

BACKGROUND: Venous leg ulcers affect 1.5% of the UK adult population. Leg ulcers are painful, can be malodourous and are associated with poor quality of life. Leg ulcers are predominantly cared for by nurses in the community. Frequently, patients receive suboptimal treatment through unwanted variations in care and simple ulcers deteriorate to become hard-to-heal wounds. It is important to understand the current UK system of care and how nurses and patients navigate through it. AIM: The aim of this paper was to understand how, when, for whom and in what context leg ulcers are cared for in the United Kingdom and specifically, the current system of care, the nurses' role and the patients' experience in this system of care. DESIGN: A realist synthesis of the literature was undertaken, reported following the RAMESES publication standards: Realist syntheses. DATA SOURCES: An iterative literature search was conducted across three recognized health collections from January 2010 to January 2022 that included descriptive studies as well as primary research. RESULTS: 73 papers were included. CONCLUSION: In the absence of UK national guidance that recommends how leg ulcer care is organized and delivered, care is commissioned locally, with variable outcomes. Patients with venous leg ulcers would like to be looked after by knowledgeable, skilled and confident nurses, in well-equipped and staffed clinics; nurses who have the ability to make clinical judgements to alter their treatment when necessary and are empowered to refer to specialist centres when further support is required. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: This synthesis offers guidance to commissioners and providers to change how leg ulcer care is organized. PATIENT OR PUBLIC CONTRIBUTION: The views of a patient and public group was sought at each stage of the synthesis.

The Efficacy of Extracorporeal Shockwave Therapy Compared with Compression Therapy in Healing Venous Leg Ulcers.

Background: Innovative methods of physical therapy delivered via modern medical devices have significantly extended the possibility of applying conservative treatments in healing venous leg ulcers. The primary objective of this study was to compare the therapeutic efficacy of selected mechanical physical therapies (intermittent pneumatic compression vs. radial extracorporeal shockwave vs. focal extracorporeal shockwave) vs. standard care in the treatment of venous leg ulcers over a 4-week period. Materials: This study included 69 patients, comprising 45 females (65%) and 24 males (35%), with a mean age of 67.1 ± 8.6 years (range: from 52.0 to 80.0 years). Methods: The patients were allocated into four groups: the IPC group was treated with intermittent pneumatic compression therapy, the R-ESWT group was treated with radial extracorporeal shockwave therapy, the F-ESWT group was treated with focal extracorporeal shockwave therapy, and the SC group was treated with standard care. Results: After one month of therapy, the median percentage decrease in wound total surface area after treatment was as follows: in the IPC group, there was a 52.9% decrease (range: 3.3-100%); in the R-ESWT group, there was a 31.6% decrease (range: 2.4-95.8%); in the F-ESWT group, there was an 18.0% decrease (range: 1.9-76.1%); and in the SC group, there was a 16.0% decrease (range: 1.5-45.8%). Conclusions: All the studied therapies caused a statistically significant reduction in the surface area of venous leg ulcers. The best results were observed with the intermittent pneumatic compression, while the radial and focal extracorporeal shockwave therapies appeared less effective. The standard care alone turned out to be the least effective. Our results did not show statistically significant changes in the values of RBC deformability at the investigated shear rates.

Effects of electromagnetic therapy in treating patients with venous leg ulcers: An overview of systematic reviews.

This study aims to evaluate the effects of electromagnetic therapy (EMT) on the treatment of venous leg ulcers (VLUs) by synthesising and appraising available meta-analyses (MAs) and systematic reviews (SRs). A comprehensive literature search was conducted across major databases up to 10 January 2024, focusing on SRs/MAs that investigated the use of EMT for VLUs. Selection criteria followed the PICO framework, and dual-author extraction was used for accuracy. Quality assessment tools included AMSTAR2, ROBIS, PRISMA, and GRADE. The search yielded five eligible studies. The reviews collectively presented moderate methodological quality and a low risk of bias in several domains. Reporting quality was high, albeit with inconsistencies in fulfilling certain PRISMA checklist items. The evidence quality, primarily downgraded due to small sample sizes, was rated as moderate. Whilst some studies suggest potential benefits of EMT in the treatment of VLUs, the overall evidence is inconclusive due to methodological limitations and limited sample sizes. This review underscores the need for future research with more rigorous methodologies and larger cohorts to provide clearer insights into the efficacy of EMT for VLUs.

Supporting patients with venous leg ulcers in self-care monitoring: an interview study with primary health care professionals.

OBJECTIVE: This study described the experiences and perceptions of how primary health care professionals (PHCPs) support patients with venous leg ulcers (VLUs) in self-care monitoring. DESIGN: A qualitative approach with reflexive thematic analysis was used, with 24 individual qualitative open interviews. SETTING: Primary health care clinics and community health care in four southern regions in Sweden. SUBJECTS: Registered nurses, district nurses and nurse assistants who had experience of caring for patients with VLUs. In total, 24 interviews were conducted with PHCPs in Sweden. RESULTS: PHCPs have a vital role in promoting patient independence and responsibility, identifying needs and adapting care strategies, while also recognising unmet needs in patients with VLUs. CONCLUSION: PHCPs actively monitor patients' self-care and establish caring relationships. They see a need for a structured primary health care work routine for ulcer management.

PHCPs described encouraging patients by identifying needs, adapting care and promoting self-care monitoring using various skills and strategies.PHCPs described unmet needs and insufficient care practices for patients with VLUs.PHCPs pointed out the importance of establishing caring relationships in order to involve patients in their VLU treatment.

Timolol in the treatment of hard-to-heal wounds: a comprehensive review.

OBJECTIVE: The aims of this study were to ascertain the effectiveness and safety of the off-label use of topical timolol as an adjunct treatment for hard-to-heal (chronic) wounds. Furthermore, to review and analyse the existing literature regarding the use of topical timolol on wounds of varying aetiologies. METHOD: A systematic review of literature in the English language published between May 1961-May 2021 on the application of topical timolol for hard-to-heal wounds in adults was performed. Each research study was evaluated by two reviewers independently. Studies eligible for inclusion in the review were randomised controlled trials (RCTs), clinical trials, observational studies of at least 4 weeks' duration, case series and case studies. Search strategies were performed according to PRISMA guidelines and included MeSH terms and keyword searches. RESULTS: An initial 878 articles were identified from a search of PubMed, Ovid Medline, Embase, Cochrane, and SCOPUS. Of these, 699 were reviewed for eligibility, 19 were read in full-text, and 12 were selected for inclusion in the review. In total, two RCTs and 10 observational studies, including five case studies, were analysed. All studies demonstrated efficacy and safety of topical timolol; however, statistical analysis remained limited by lack of blinding and small sample sizes. CONCLUSION: This review concludes with all currently available evidence that topical timolol may be considered as an effective and safe adjunct treatment for refractory wounds, primarily venous leg ulcers and diabetic foot ulcers. Given the overall safety, low cost and ease of application of topical timolol, this review provides evidence in favour of off-label use and should prompt further, more rigorous studies.

Comparison of the therapeutic efficacy of magneto-LED therapy and magnetostimulation applied as the adjuvant treatment of venous leg ulcers - preliminary study.

PURPOSE: Venous leg ulcers are chronic wounds that are difficult to cure. The aim of the study was to compare the therapeutic efficacy of two methods of physical medicine - magneto-LED therapy and magnetostimulation, applied as adjuvant treatment in the treatment of venous leg ulcers. METHODS: The study included 81 patients, 37 male (45.6%) and 44 female (54.3%) ones, age range between 45 and 90 years, with venous leg ulcers. The patients were assigned to two study groups: magneto-LED therapy (group 1) or magnetostimulation (group 2). In both groups, a total of 40 daily procedures were performed. Wound healing was evaluated using computerized planimetry and the pain intensity on numeric rating scale. RESULTS: After treatment, the decrease in healing rate in group 1 was statistically significantly higher in comparison to group 2 (p < 0.001), while a statistically significant reduction in the surface area of ulcers was obtained, amounting on the average from 6.34 ± 1.29 cm2 to 2.31 ± 1.25 cm2 in group 1 (p < 0.001), and from 6.52 ± 1.20 cm2 to 4.79 ± 1.17 cm2 in group 2 (p < 0.001). The percentage changes of ulcers area in group 1 (64.21 ± 17.94%) were statistically significantly greater as compared to group 2 (25.87 ± 14.07%) (p < 0.001). After treatment, the decrease in pain relief in group 1 was statistically significantly higher in comparison to group 2 (p = 0.006), while pain intensity after treatment decreased statistically significantly in both compared groups of patients (p < 0.001). CONCLUSIONS: Magneto-LED therapy and magnetostimulation caused significant reduction of surface area of the treated venous leg ulcers and pain intensity, yet magneto-LED therapy was more efficient. Both evaluated methods also significantly reduced pain intensity.

Chronic wounds are wounds, which despite ongoing treatment, do not heal within 6­8 weeks. A wound that occurs as a result of an ongoing disease process is called an ulcer. Leg ulcers are still a significant challenge for modern medicine because they are characterized by complex etiology, chronic pain and require specific diagnostic and therapeutic measures. In many cases, the inability to heal ulcers quickly is associated with social isolation, long-term suffering and deterioration of the quality of life of treated patients. In addition to standard treatment including surgery, pharmacotherapy and compression therapy, new more effective methods of ulcer therapy are still being sought. Nowadays, physical treatment methods are increasingly used as a supporting treatment the healing of chronic wounds. In the study, variable magnetic fields and low-energy light were used in the treatment of 81 patients (including 44 women and 37 men) in aged 45­90 years. All patients had chronic, non-healing of venous leg ulcers accompanied by severe pain. After completion of treatment, both groups of patients experienced a significant reduction of surface area of treated ulcers and a reduction in the intensity of pain ailments. According to our study results, the use of magnetic field and light therapy can be an important supportive treatment option in patients with venous leg ulcers.

Association of Tryptophan/Kynurenine Metabolites with Healing in Chronic Venous Leg Ulcers.

Objective: Chronic wound healing is a complex process that is still not well understood. The tryptophan (TRP)-l-kynurenine (KYN) pathway has recently been under increased scrutiny with regard to wound healing. The study applied metabolomics to elucidate the TRP-l-KYN pathway associated with wound healing in chronic venous leg ulcers (CVLUs). Approach: This study used a longitudinal comparative design of 60 serum samples collected from 30 older adult patients with CVLUs, receiving weekly sharp debridement at a wound clinic. The serum samples were collected at baseline and week 4 (healed wounds) or week 8 (nonhealed wounds). Liquid chromatography-mass spectrometry (LC-MS) metabolomics was used to analyze targeted metabolites. A Bayesian approach was used to examine robust correlations between changes in metabolite values and linear healing slope and to compare by group. Results: The mean age was 71.13 (±9.46 years). Half of the sample were female and the minority (17%) were Black. The mean values of evaluated metabolites for the nonhealed group were consistently lower than those for the healed group. The healed group (n = 12) had higher KYN values. Those on a healing trajectory (n = 23) had lower KYN levels and higher TRP levels at baseline and over time. There was moderate support (Bayes factor = 3.70) for a negative association between change in kynurenic acid and linear healing slope (r = -0.35, credibility intervals [CrI] = -0.62, -0.04; probability of direction [PD] = 98%). Results suggest that KYN and TRP may be markers for healing in individuals with CVLUs. Innovation and Conclusion: Gaining a better understanding of the associations between the TRP-l-KYN pathway and the healing of CVLUs may help to clarify the links of inflammation with the rate and success of wound healing. Biomarker development focused on the TRP-l-KYN pathway could be pursued, if the associations are further supported by focused research studies.

A systematic review of the impact of compression therapy on quality of life and pain among people with a venous leg ulcer.

AIM: To gain a greater understanding of how compression therapy affects quality of life, this systematic review appraised existing published studies measuring the impact of compression therapy on health quality of life (HRQoL), and pain, among people with venous leg ulcers (VLU). METHOD: Five databases were searched, and two authors extracted data and appraised the quality of selected papers using the RevMan risk of bias tool. Due to heterogeneity in the types of compression and instruments used to evaluate HRQoL, meta-analysis was not appropriate; thus, a narrative synthesis of findings was undertaken. RESULTS: Ten studies were included, 9 RCTs and one before-after study. The studies employed nine different HRQoL tools to measure the impact of a variety of compression therapy systems, with or without an additional exercise programme, versus other compression systems or usual care, and the results are mixed. With the use of the Cardiff Cardiff Wound Impact Schedule, the SF-8 and the SF-12, study authors found no differences in QoL scores between the study groups. This is similar to one study using QUALYs (Iglesias et al., 2004). Conversely, for studies using EuroQol-5D, VEINES-QOL, SF-36 and CIVIQ-20 differences in QoL scores between the study groups were noted, in favour of the study intervention groups. Two further studies using QUALYs found results that favoured a two-layer cohesive compression bandage and the TLCCB group, respectively. Results for the five studies that assessed pain are also mixed, with one study finding no difference between study groups, one finding that pain increased over the study period and three studies finding that pain reduced in the intervention groups. All studies were assessed as being at risk of bias in one or more domains. CONCLUSION: Results were varied, reflecting uncertainty in determining the impact of compression therapy on quality of life and pain among people with a venous leg ulcer. The heterogeneity of the compression systems and the measures used to evaluate HRQoL make it a challenge to interpret the overall evidence. Further studies should strive for homogeneity in design, interventions and comparators to enhance both internal and external validity.

Association between venous leg ulcers and chronic heart failure: A Mendelian randomization study.

An association between venous leg ulcers (VLU) and chronic heart failure (CHF) has been suggested by observational research. This study used Mendelian randomization (MR) methods to look into any possible bidirectional causal links between VLU and CHF. The 'TwoSampleMR' R package was employed for MR analyses. The association of VLU and CHF was assessed via methods of inverse variance weighted (IVW), weighted mode, MR Egger and weighted median. Results of IVW suggested no association between VLU and CHF (ß 0.008356; SE 0.01889; p = 0.6582). The weighted median estimator (ß -0.005777; SE 0.02059, p = 0.7791), MR-Egger (ß -0.08955; SE 0.04557; p = 0.07296) and weighted mode (ß -0.01202; SE 0.02467; p = 0.6341) showed consistent results. Conversely, evidence indicating that the presence of CHF increased the risk of VLU was lacking. In conclusion, there is no bidirectional causal relationship between VLU and CHF. Further studies are required to validate the findings of this study.

First clinical evaluation of the safety and efficacy of tarumase for the debridement of venous leg ulcers.

We report the first clinical evaluation of a new enzymatic wound debridement product containing tarumase in venous leg ulcer patients. As a first-in-human study, this was a prospective, open-label, multi-centre, dose escalation study across five dose cohorts and involving a total of 43 patients treated three times weekly for up to 4 weeks (12 applications). The primary and secondary endpoints of the study were to assess the systemic safety, local tolerability, and early proof of concept both for wound debridement and healing. Results indicated that the tarumase enzyme was well tolerated when applied topically to wounds, with no indications of systemic absorption, no evidence of antibody generation, and no systemic effects on coagulation pathways. Locally, there was no evidence of pain on application, no local itching, no increases in erythema, oedema, exudate or bleeding and only a few treatment emergent adverse events were reported. As the concentration of tarumase was escalated, trends towards faster and improved effectiveness of wound debridement were observed, especially in patients with significant slough at baseline. Trends towards faster rates of healing were also noted based on observations of increased granulation tissue, increased linear healing and reduction in surface area over the 4-week treatment period.

Association between stroke and venous leg ulcers: A Mendelian randomization study.

To investigate any potential bidirectional causal relationships between stroke and venous leg ulcers (VLUs), Mendelian randomization (MR) analyses were carried out in this study. The exposure factor was stroke, the outcome factor was VLUs. The two-sample MR study was carried out based on the online analysis platform (http://app.mrbase.org/). The association of stroke and VLUs was analysed via methods of Inverse Variance Weighted (IVW), Weighted Median, MR-Egger and weighted mode. IVW method suggested no association between stroke and VLUs ((ß 1.06; SE 9.321; p = 0.9095)). Weighted median estimator (ß 5.906; SE 11.99, p = 0.6223), MR-Egger (ß -0.8677; SE 21.89; p = 0.9691) and weighted mode (ß 9.336; SE 17.77; p = 0.6089) showed consistent results. Conversely, evidence indicating that the presence of VLUs increased the risk of stroke was lacking. According to this MR study, there is no causal connection between stroke and VLUs, which suggests that therapies targeting stroke may not be effective against VLUs.

Prevention strategies for the recurrence of venous leg ulcers: A scoping review.

Venous leg ulcer (VLU) is the most severe manifestations of chronic venous disease, which has characterized by slow healing and high recurrence rates. This typically recalcitrant and recurring condition significantly impairs quality of life, prevention of VLU recurrence is essential for helping to reduce the huge burden of patients and health resources, the purpose of this scoping review is to analyse and determine the intervention measures for preventing recurrence of the current reported, to better inform healthcare professionals and patients. The PubMed, Embase, Web of Science, Cochrane Library databases, Chinese National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Wan Fang Data and Chongqing VIP Information (CQVIP) were accessed up to June 17, 2023. This scoping review followed the five-steps framework described by Arksey and O'Malley and the PRISMA extension was used to report the review. Eleven articles were included with a total of 1503 patients, and adopted the four effective measures: compression therapy, physical activity, health education, and self-care. To conclude, the use of high pressure compression treatment for life, supplementary exercise therapy, and strengthen health education to promote self-care are recommended strategies of VLU prevention and recurrence. In addition, the importance of multi-disciplinary teams to participate in the care of VLU in crucial.

Associations Among Wound-Related Factors Including Biofilm, Wound-Related Symptoms and Systemic Inflammation in Older Adults with Chronic Venous Leg Ulcers.

Objective: The purposes of this observational prospective study were to (1) characterize the wound-related factors (wound area, the presence of biofilm, and total bacteria), wound-related symptoms (fatigue, pain, exudate, itching, and edema or swelling), and systemic inflammation (level of serum C-reactive protein [CRP]), and (2) explore associations between wound-related factors, wound-related symptoms, and systemic inflammation in older individuals with chronic venous leg ulcers (CVLUs) over 8 weeks of wound treatment. Approach: A total of 117 participants who received standardized care (weekly sharp debridement) for chronic venous ulcer were enrolled. We collected clinical data every 2 weeks during the 8 weeks of the study period or until the wound was healed (if healed before 8 weeks). Associations among variables were estimated using a Bayesian approach applied to general linear mixed models. Results: Based on Bayes factor (BF) value, there was extremely strong evidence for the association of biofilm with mean total bacteria (BF >1,000). There was moderate evidence of a direct association between biofilm presence and levels of CRP (BF 4.3) and moderate evidence of direct associations between biofilm and wound-related symptoms, pain and exudate (BF 5.12, 8.49, respectively). Innovation: Wound-related symptoms and the level of systemic CRP were associated with biofilm among patients who were receiving weekly sharp debridement. Symptom severity associated with CVLUs requires assessment and management of wound-related factors and levels of inflammation in addition to symptom assessment. Conclusion: This study is the first to examine associations among biofilm, as wound-related factors, systemic inflammation, wound-related symptoms, and wound healing in clinical settings. Symptom severity, level of systemic CRP, and wound-related factors should be considered as well as assessment of biofilm in CVLU in older individuals with CVLU.

Cost-effectiveness analysis of intralesional and perilesional recombinant human epidermal growth factor vs hydrocolloid therapy in venous ulcer treatment in the Colombian context.

OBJECTIVE: To perform a comparative analysis of health care expenses and outcomes in response to the question: What is the cost-effectiveness of intralesional and perilesional recombinant human epidermal growth factor (rhEGF) compared with hydrocolloid therapy in patients diagnosed with chronic venous insufficiency without infection in Colombia? METHODS: A Markov model was used to determine cost effectiveness over a 5-year period, considering the perspective of the health system in Colombia. The study included patients aged >18 years diagnosed with chronic venous insufficiency and used clinical studies to calculate the probabilities of epithelialization, infection, recurrence, and mortality. RESULTS: RhEGF is more expensive per unit than hydrocolloids, but it is proven to be effective at healing ulcers in 8 to 12 weeks, even in complex cases. Hydrocolloids, in contrast, typically require 29.5 weeks on average, and ≤46 weeks for complex cases. Despite the cost, rhEGF is more cost effective because it achieves results comparable with hydrocolloid therapy at a lower cost per additional quality-adjusted life-year. CONCLUSIONS: Based on cost-effectiveness analysis, rhEGF is a superior alternative to hydrocolloids for treating venous ulcers in Colombia. Not only is it more affordable, but it also enhances patients' quality of life and streamlines the health care system's resource use.