Acupuncture for rheumatoid vasculitis complicated by refractory foot ulcer: A case report.

INTRODUCTION: Rheumatoid vasculitis (RV) is a frequently encountered complication of rheumatoid arthritis (RA), wherein skin vasculitis lesions are observed as a common clinical manifestation, encompassing skin purpura, erythema, vascular occlusion, ulcers, and gangrene. As a matter of fact, it marks the most severe extra-articular manifestation of RA. And the resultant ulcers tend to pose a greater challenge with regard to therapeutic interventions. We report a case of RV complicated by refractory foot ulcer that was successfully treated with puncture. CASE PRESENTATION: A 62-year-old man with RV caused by RA developed refractory foot ulcers. Despite the application of topical antibiotics, the wound gradually expanded and remained unhealed for 7 months. Consequently, the patient sought an integrated therapeutic approach involving Traditional Chinese Medicine and was subsequently treated with acupuncture. After 12 weeks of acupuncture, the foot ulcers healed completely. CONCLUSION: Acupuncture has the potential to facilitate wound healing and may serve as a viable alternative treatment modality for wounds unresponsive to traditional therapeutic interventions.

Influência da ozonioterapia na cicatrização de úlceras do pé diabético / Influence of ozone therapy on the healing of diabetic foot ulcers

Úlcera do pé diabético é uma das complicações de diabetes mellitus que ocorre por causas multifatoriais. A abordagem multidisciplinar e multiprofissional do paciente com pé diabético é recomendada, uma vez que a afecção possui alta prevalência e que as ações de prevenção e controle das lesões são potencialmente eficazes. Há um crescente interesse da comunidade científica e boa aceitação do tratamento com ozônio pelas revistas acadêmicas, apesar de o número de pesquisas acerca do assunto não ser amplo. Desse modo, o objetivo da presente pesquisa foi avaliar a influência da ozonioterapia em pacientes com feridas do pé diabético. Metodologia: Tratou-se de revisão narrativa de literatura acerca da terapia com ozônio para tratamento de ferida do pé diabético. Foram utilizados os termos "ozônio", "ozônioterapia", "ozonização", "pé diabético", úlcera do pé diabético", bem como suas traduções para o inglês "ozone", "ozonetherapy", "diabetic foot", "diabetic foot ulcer". Foram consultadas as bases acadêmicas PubMed, Scielo, Lilacs e EBSCOhost. Resultados/Discussão: Muitas vezes o tratamento convencional para feridas é ineficiente devido à multiplicação de bactérias resistentes. Para feridas infectadas, primeiramente pode-se empregar o ozônio como desinfetante, pois o gás é tanto bactericida como fungicida, e para se obter uma ferida livre de patógenos; posteriormente, pode-se aplicar doses baixas da mistura gasosa oxigênio-ozônio para acelerar a cicatrização da lesão. Dentre as formas de tratamento com ozônio estão a utilização de óleo ozonizado sobre a ferida e a aplicação local de uma mistura de gases ozônio e oxigênio diretamente sobre a úlcera. Além disso, o ozônio funciona bem quando insuflado em microambiente controlado (saco plástico). a ozonização, quando comparada ao uso de antibióticos convencionais, pode reduzir o tamanho das lesões e abreviar o tempo de internação dos pacientes a curto prazo, mas aparentemente não promove a cura total da úlcera nem reduz o número de complicações. Conclusão: Há um crescente interesse pela comunidade científica e boa aceitação do tratamento com ozônio pelas revistas acadêmicas, apesar de o número de pesquisas acerca do assunto não ser grande. Diversos trabalhos demonstraram resultados positivos da utilização de ozônio como adjuvante da terapia convencional para úlceras do pé diabético, e concluíram que a ozonioterapia é uma ferramenta terapêutica complementar ao tratamento convencional. Apesar disso, ainda há muito a aprofundar acerca do tema e mais pesquisas devem ser conduzidas para validar a ozonioterapia na prática clínica.

Diabetic foot ulcer is one of the complications of diabetes mellitus that occurs due to multifactorial causes. The multidisciplinary and multidisciplinary approach of patients with diabetic feet is recommended, since the condition has a high prevalence and the actions for the prevention and control of injuries are potentially effective. There is growing interest from the scientific community and Good acceptance of ozone treatment by academic journals, although the number of studies on the subject is not large. Thus, the objective of the present research was to evaluate the influence of ozone therapy in patients with diabetic foot wounds. Methodology: It was a narrative literature review about ozone therapy for the treatment of diabetic foot wounds. The terms "ozone", "ozone therapy", "ozonization", "diabetic foot", diabetic foot ulcer were used, as well as their English translations "ozone", "ozonetherapy", "diabetic foot", "diabetic foot ulcer ". The academic bases PubMed, Scielo, Lilacs and EBSCOhost were consulted. Results / Discussion: The conventional treatment for wounds is often inefficient due to the multiplication of resistant bacteria. For infected wounds, ozone can first be used as a disinfectant, as the gas is both bactericidal and fungicidal, and to obtain a pathogen-free wound; subsequently, low doses of the oxygen-ozone gas mixture can be applied to accelerate the healing of the lesion. Among the forms of treatment with ozone are the use of ozonized oil on the wound and the local application of a mixture of ozone and oxygen gases directly on the ulcer. In addition, ozone works well when inflated in a controlled microenvironment (plastic bag). ozonation, when compared to the use of conventional antibiotics, can reduce the size of the lesions and shorten the patients' hospitalization time in the short term, but apparently does not promote a complete healing of the ulcer or reduce the number of complications. Conclusion: There is a growing interest in the scientific community and good acceptance of ozone treatment by academic journals, although the number of studies on the subject is not large. Several studies have shown positive results from the use of ozone as an adjunct to conventional therapy for diabetic foot ulcers, and concluded that ozone therapy is a therapeutic tool complementary to conventional treatment. Despite this, there is still much to be done about the topic and more research must be conducted to validate ozone therapy in clinical practice.

Do Antibiotic-impregnated Calcium Sulfate Beads Improve the Healing of Neuropathic Foot Ulcers With Osteomyelitis Undergoing Surgical Debridement?

BACKGROUND: Neuropathic foot ulcers are common and difficult to treat. Calcium sulfate (CAS) has been used for antibiotic delivery in the treatment of osteomyelitis with success. Recent case series suggest success in treating osteomyelitis of the foot with CAS in a mean time to healing of 4 months; however, few studies with a control group for comparison exist. OBJECTIVE: This study aims to determine if antibiotic-impregnated CAS beads improved the healing of neuropathic foot ulcers with proven osteomyelitis undergoing surgical debridement. MATERIALS AND METHODS: A consecutive retrospective cohort study of 50 patients undergoing surgical debridement of neuropathic foot ulcers for osteomyelitis from December 2015 to May 2016 was performed. Exclusion criteria consisted of amputations and microbiology findings inconsistent with osteomyelitis. Patients were divided into 2 groups: the surgical debridement (SD) group was treated with SD alone and the other (CAS) was treated with debridement and implantation of vancomycin- and gentamicin-impregnated CAS beads. RESULTS: After exclusion criteria, 42 patients were included: 13 in the SD group and 29 in the CAS group. In the SD group, the mean time to healing was 5.8 months (range, 2-9 months), and in the CAS group, it was 5.5 months (range, 2-13 months). There was no significant difference in ulcer healing (P = .81), time to healing (P = .79), reoperation rate (P = .51), length of stay (P = .74), or mortality (P = .13) between the 2 groups. CONCLUSIONS: Ulcer healing in patients treated with antibiotic-impregnated CAS beads did not show statistical significance. Healing rates in both groups were similar to those in recent literature. Surgical debridement alone may be as effective as supplementation with local antibiotics in a bioabsorbable carrier.

[The Clinical Status and Process of Hydrosurgery System].

This paper reviews the principle and clinical application of hydrosurgery system, including the burn debridement, diabetic foot wounds debridement and other trauma debridement. Meanwhile, this paper introduces the development direction of waterjet technology. Furthermore, the safety, effectiveness and suitability can be discussed.

Phototherapy for treating foot ulcers in people with diabetes.

BACKGROUND: Foot ulcers are a disabling complication of diabetes that affect 15% to 25% of people with diabetes at some time in their lives. Phototherapy is a relatively new, non-invasive, and pain-free treatment method, which promotes the ulcer repair process through multiple mechanisms such as increased cell growth and vascular activity. Phototherapy may be used as an alternative approach for the treatment of foot ulcers in people with diabetes, but the evidence for its effect compared with placebo or other treatments has not yet been established. OBJECTIVES: To assess the effects of phototherapy for the treatment of foot ulcers in people with diabetes. SEARCH METHODS: We searched the Cochrane Wounds Specialised Register (11 October 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2016, Issue 10), Ovid MEDLINE (11 October 2016), Ovid MEDLINE (In-Process & Other Non-Indexed Citations) (11 October 2016), Ovid Embase (11 October 2016), EBSCO CINAHL Plus (11 October 2016), and China National Knowledge Infrastructure (24 June 2017). We also searched clinical trials registries for ongoing and unpublished studies on 24 June 2017, and screened reference lists to identify additional studies. We used no restrictions with respect to language, date of publication, or study setting. SELECTION CRITERIA: Randomised controlled trials or cluster randomised controlled trials that 1) compared phototherapy with sham phototherapy, no phototherapy, or other physical therapy modalities, 2) compared different forms of phototherapy, or 3) compared phototherapy of different output power, wavelength, power density, or dose range, in adults with diabetes and an open foot ulcer of any severity, in any setting. DATA COLLECTION AND ANALYSIS: Two review authors independently performed study selection, data extraction, and 'Risk of bias' assessment. We combined the study outcomes when appropriate. MAIN RESULTS: Eight trials with 316 participants met the inclusion criteria. Most of the included studies were single-centre studies that were carried out in clinics or hospitals with a sample size ranging from 14 to 84. We generally considered the included studies to be at unclear or high risk of bias, as they had one domain at high risk of bias, or three or more domains at unclear risk of bias.We did not identify any studies that reported valid data for time to complete wound healing. Meta-analysis of four studies including 116 participants indicated that participants receiving phototherapy may experience a greater proportion of wounds completely healed during follow-up compared with those receiving no phototherapy/placebo (64.5% for the phototherapy group versus 37.0% for the no phototherapy/placebo group; risk ratio 1.57, 95% confidence interval 1.08 to 2.28; low-quality evidence, downgraded for study limitations and imprecision). Two studies mentioned adverse events in the results; one study with 16 participants suggested that there were no device-related adverse events, and the other study with 14 participants suggested that there was no clear difference between phototherapy and placebo group.Four studies reported change in ulcer size, but primarily due to high heterogeneity, they were not combined. Results from individual trials (including 16 participants to 84 participants) generally suggested that after two to four weeks of treatment phototherapy may result in a greater reduction in ulcer size but the quality of the evidence was low due to unclear risk of bias in the original trial and small sample size. We based the analyses for quality of life and amputations on only one study each (28 participants and 23 participants respectively); both outcomes showed no clear difference between the phototherapy group and the no phototherapy/placebo group. AUTHORS' CONCLUSIONS: This systematic review of randomised trials suggested that phototherapy, when compared to no phototherapy/placebo, may increase the proportion of wounds completely healed during follow-up and may reduce wound size in people with diabetes, but there was no evidence that phototherapy improves quality of life. Due to the small sample size and methodological flaws in the original trials, the quality of the evidence was low, which reduces our confidence in these results. Large, well-designed randomised controlled trials are needed to confirm whether phototherapy could be an effective option for the treatment of foot ulcers in people with diabetes.

Wound bed preparation: A novel approach using HydroTherapy.

Wounds that fail to heal quickly are often encountered by community nursing staff. An important step in assisting these chronic or stalled wounds progress through healing is debridement to remove devitalised tissue, including slough and eschar, that can prevent the wound from healing. A unique wound treatment called HydroTherapy aims to provide an optimal healing environment. The first step of HydroTherapy involves HydroClean plus™, this dressing enables removal of devitalised tissue through autolytic debridement and absorption of wound fluid. Irrigation and cleansing provided by Ringer's solution from the dressing further removes any necrotic tissue or eschar. Once effective wound bed preparation has been achieved a second dressing, HydroTac™, provides an ongoing hydrated wound environment that enables re-epithelialisation to occur in an unrestricted fashion. This paper presents 3 case studies of slow healing wounds treated with HydroClean plus™ which demonstrates effective wound debridement.

Solución del caso 11. Úlcera plantar secundaria a pie de Charcot de un año de evolución / Solution to case 11: Plantar ulcer secondary to Charcot foot of one year onset

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A Randomized, Controlled Clinical Trial of Honey-Impregnated Dressing for Treating Diabetic Foot Ulcer.

OBJECTIVE: To investigate the effect of Beri-honey-impregnated dressing on diabetic foot ulcer and compare it with normal saline dressing. STUDY DESIGN: A randomized, controlled trial. PLACE AND DURATION OF STUDY: Sughra Shafi Medical Complex, Narowal, Pakistan and Bhatti International Trust (BIT) Hospital, Affiliated with Central Park Medical College, Lahore, from February 2006 to February 2010. METHODOLOGY: Patients with Wagner's grade 1 and 2 ulcers were enrolled. Those patients were divided in two groups; group A (n=179) treated with honey dressing and group B (n=169) treated with normal saline dressing. Outcome measures were calculated in terms of proportion of wounds completely healed (primary outcome), wound healing time, and deterioration of wounds. Patients were followed-up for a maximum of 120 days. RESULTS: One hundred and thirty six wounds (75.97%) out of 179 were completely healed with honey dressing and 97 (57.39%) out of 169 wtih saline dressing (p=0.001). The median wound healing time was 18.00 (6 - 120) days (Median with IQR) in group A and 29.00 (7 - 120) days (Median with IQR) in group B (p < 0.001). CONCLUSION: The present results showed that honey is an effective dressing agent instead of conventional dressings, in treating patients of diabetic foot ulcer.

Hyperbaric oxygen therapy in treating post-ischemic pain caused by polycythemia vera complications: a case report.

One of the complications of polycythemia vera (PV) can be acute thrombotic occlusion. The severity and prolonged duration of this condition can lead to nerve damage. In this case a 34-year-old male had thrombotic occlusions of the popliteal artery, resulting in chronic limb ischemia, which was treated with thrombectomy and amputation of one digit. The administered therapy consisted of hydroxyurea, analgesics, antidepressants and acetylsalicylic acid. When the patient was admitted he suffered from ischemic pain, he had developed an ulcer on his big toe and he was emotionally unstable, with suicidal thoughts. The patient was treated with 14 hyperbaric oxygen (HBO2) treatments in total. There was evident paint relief after four treatments and healing of the ulcerous tissue after three weeks. During the patient's medical examination eight months after the treatment, his condition was still satisfactory, with no presence of pain, ulcer or signs of depression, and with no changes in hemodynamics. This case provides additional evidence to the data for HBO2 use in ischemic pain management.

Reduction of diabetic foot ulcer healing times through use of advanced treatment modalities.

Diabetic wounds are a major health care problem associated with delayed healing and high amputation rates. This review systematically evaluated newer wound care therapies for the treatment of diabetic wounds. More recent means of approaching diabetic foot ulcers include various dressings, off-loading shoes, and bioengineered skin constructs and growth factors. Electrical stimulation, phototherapy, electromagnetic fields, and shockwave therapy have been further proposed as potential treatments. A brief overview of these treatments is presented using peer-reviewed evidenced-based literature. A review of the literature demonstrated that treatment of diabetic wounds has focused on either prevention of the wounds in the form of off-loading shoes or adequate protective dressings or on direct treatment of wounds with bioengineered skin constructs, growth factors, or medical devices that accelerate wound healing. The authors' conclusion, following extensive literature review, is that although excellent national and international guidelines exist regarding suggested approaches to the treatment of the diabetic foot ulcer, there is no definitive or universal consensus on the choice of specific treatment modalities. The importance of optimizing comorbidities and the disease state, hemodynamics, local and peripheral skin and wound care, and metabolic challenges while reducing biological and bacterial burden and minimizing trauma remain the primary approach, followed by choice of the most appropriate treatment material or product.

[transcutaneous oximetry--between theory and practice]. / Transkutana oksimetrija (TcPO2)--izmedu teorije i prakse.

Transcutaneous oximetry is a procedure used to measure the pressure of oxygen in tissue and to determine oxygenation level. It is essential to determine the state of microcirculation and is used to assess the necessity and level of amputation and the effect of revascularization procedures, as a predictor of wound healing and hyperbaric oxygen therapy (HBOT) effectiveness tool. The measurement is done by the application electrode measuring point and the result is measured in mm Hg. Tissue with adequate oxygen level has a value greater than 50 mm Hg. Values between 20 and 40 mm Hg are considered hypoxic, while those below 20 mm Hg indicate extreme hypoxia. In Croatia, TcPO2 is commonly used for HBOT assessment but there is the need of broader application to objectify and facilitate procedures in the care of persons with impaired microcirculation.

Increased growth factors play a role in wound healing promoted by noninvasive oxygen-ozone therapy in diabetic patients with foot ulcers.

Management of diabetic foot ulcers (DFUs) is a great challenge for clinicians. Although the oxygen-ozone treatment improves the diabetic outcome, there are few clinical trials to verify the efficacy and illuminate the underlying mechanisms of oxygen-ozone treatment on DFUs. In the present study, a total of 50 type 2 diabetic patients complicated with DFUs, Wagner stage 2~4, were randomized into control group treated by standard therapy only and ozone group treated by standard therapy plus oxygen-ozone treatment. The therapeutic effects were graded into 4 levels from grade 0 (no change) to grade 3 (wound healing). The wound sizes were measured at baseline and day 20, respectively. Tissue biopsies were performed at baseline and day 11. The expressions of vascular endothelial growth factor (VEGF), transforming growth factor-ß (TGF-ß), and platelet-derived growth factor (PDGF) proteins in the pathologic specimens were determined by immunohistochemical examinations. The effective rate of ozone group was significantly higher than that of control group (92% versus 64%, P < 0.05). The wound size reduction was significantly more in ozone group than in control group (P < 0.001). After treatment, the expressions of VEGF, TGF-ß, and PDGF proteins at day 11 were significantly higher in ozone group than in control group. Ozone therapy promotes the wound healing of DFUs via potential induction of VEGF, TGF-ß, and PDGF at early stage of the treatment. (Clinical trial registry number is ChiCTR-TRC-14004415).

Hyperbaric oxygen therapy for diabetic ulcers: systematic review and meta-analysis.

OBJECTIVES: Approximately 10-15 percent of individuals with diabetes mellitus develop foot ulcers, which precede 85 percent of amputations. Increased oxygen, through the use of hyperbaric oxygen therapy (HBOT), has been suggested to encourage ulcer healing thus reducing the risk of amputation. The objective of this systematic review is to evaluate the efficacy of systemic HBOT for nonhealing ulcers of the lower limb in diabetes patients. METHODS: A systematic search, using controlled and keyword terms focusing on "HBOT" and "lower limb diabetic ulcers," was conducted. Databases searched included Medline, EMBASE, CINAHL, PubMed, Wiley's Cochrane Library, and Biosis. Randomized controlled trials (RCTs) and observational studies were included. Pooled estimates of outcomes were determined when appropriate. RESULTS: Of the 654 citations identified, 157 articles underwent full-text review. Data were abstracted from twelve publications (six RCTs and six comparative observational studies). Pooled analysis of the RCT and observational data showed that treatment with HBOT reduced the risk of major amputation by 60 percent (p = .29) and 61 percent (p = .003) compared with standard wound care, respectively. The RCT data revealed that the relative risk of having an unhealed wound following HBOT was 0.54 (p = .10) and 0.24 (p < .0001) based on observational data. CONCLUSIONS: Due to the limited RCT evidence, it is not possible to conclusively establish the benefits and harms of treating diabetic lower limb ulcers with HBOT. No significant effects on amputation rates were found in the RCT evidence and in the high quality studies, no difference was found.

The effect of hyperbaric oxygen in the enhancement of healing in selected problem wounds.

Problem wounds represent a significant and growing challenge to our healthcare system. The incidence and prevalence of these wounds are increasing in the population, resulting in growing utilization of healthcare resources and dollars expended. Venous leg ulcers represent the most common lower-extremity wound seen in ambulatory wound care centers, with recurrences frequent and outcomes often less than satisfactory. Pressure ulcers are common in patients in long-term institutional care settings adding significant increases in cost, disability and liability. Foot ulcers in patients with diabetes contribute to more than half of lower-extremity amputations in the United States in a group at risk, representing only 3 percent of the population. In response to this challenge, specialized programs have emerged designed to identify and manage these patients, using standardized protocols and a variety of new technologies to improve outcomes. Hyperbaric oxygen treatment (HBO2T) has been increasingly utilized in an adjunctive role in the care of many of these patients, coinciding with optimized patient and local wound care.

Visible light-induced healing of diabetic or venous foot ulcers: a placebo-controlled double-blind study.

BACKGROUND AND OBJECTIVES: Non-healing ulcers represent a significant dermatological problem. Recently, conventional therapy-resistant chronic ulcers have been treated with low energy lasers or light-emitting diodes in the visible and near IR region, but only a few placebo-controlled double-blind studies have been performed to support the efficacy of this approach. The aim of the present study was to evaluate the efficacy of a broadband (400-800 nm) visible light device in the treatment of leg or foot ulcers. METHODS: A placebo-controlled double-blind study using broadband light source (400-800 nm) was performed on patients with diabetic foot ulcers or patients with chronic leg ulcers. The treatment group was illuminated with 180 mW/cm(2) broadband light twice a day for 4 min/session, while patients in the placebo group received non-healing light fluency (10 mW/cm(2)) projections. The treatment group included 10 patients with a total of 19 ulcers, whereas in the placebo group, 6 patients had 6 ulcers. The follow-up period was 12 weeks. RESULTS: At the end of the follow up, all the wounds were closed in 9 out of 10 patients (90%) from the treatment group, whereas in the placebo group only 2 out of 6 patients exhibited closed wounds (33%). The reduction in wound size in the treatment group versus the placebo group was 89% and 54%, respectively. CONCLUSIONS: In this small scale placebo-controlled double-blind study, broadband (400-800 nm) visible light was an effective modality for the treatment of leg or foot ulcers.

'Honey ointment': a natural remedy of skin wound infections.

BACKGROUND: Honey is a gift of nature, principally identified and valued to possess antimicrobial and anti-inflammatory activity and has been used as a natural remedy of wounds since ancient times. The objectives of this study were to evaluate the antimicrobial activity of honey against micro-organisms, to formulate a honey ointment and to evaluate the efficacy of such ointment by conducting clinical trials on skin wound infection. METHODS: This experimental study was conducted at Department of Pharmaceutics, Faculty of Pharmacy, University of Karachi and Out-patient Department of Dermatology, Fauji Foundation Hospital, Rawalpindi from November 2009 to October 2010. The antimicrobial activity of Pakistani floral sources (Trachysperm copticum, Acacia nilotica species indica, Zizyphus) honey samples was investigated by disc diffusion method against freshly isolated wound infecting bacteria (Staphylococci aureus, Staphylococci epidermidis, Streptococcus faecalis, Pseudomonas aeruginosa, Klebsiella pneumonia, Escherichia coli, Proteus vulgaris and Candida albicans), and Staphylococci aureus ATCC 6538, Pseudomonas aeruginosa ATCC 9022, Escherichia coli ATCC 25922, Candida albican ATCC 15146. An ointment containing 20% active antimicrobial honey was formulated. The efficacy of such ointment was evaluated by passing thought clinical trials. A total number of 27 patients (23 skin wound infection, and 4 diabetic foot ulcer) were involved in the study. Thin layer of newly formulated honey ointment on gauze were applied two to three times per day till complete healing. RESULTS: In microbiological assay the honey samples were found to exhibit a very promising antimicrobial activity against all the micro-organisms tested. In clinical trial very significant results (99.15%) healing was observed in skin wound infections cases with mean healing time of 5.86 (2-20) days, and 95% diabetic foot ulcers healed with the mean healing time of 20 (8-40) days. CONCLUSION: Newly formulated ointment containing 20% active antimicrobial honey is very effective and alternative low-cost product for the treatment of wound infections.

Refractory vasculitic ulcer of the toe in an adolescent suffering from systemic lupus erythematosus treated successfully with hyperbaric oxygen therapy.

Skin ulcers are a dangerous and uncommon complication of vasculitis. We describe the case of a teenager suffering from Systemic Lupus Erythematosus with digital ulcer resistant to conventional therapy, treated successfully with Hyperbaric Oxygen Therapy. The application of hyperbaric oxygen, which is used for the treatment of ischemic ulcers, is an effective and safe therapeutic option in patients with ischemic vasculitic ulcers in combination with immunosuppressive drugs. Further studies are needed to evaluate its role as primary therapy for this group of patients.

The combined effect of a three-channel electrode delivery system with local heat on the healing of chronic wounds.

BACKGROUND: Historically, electrical stimulation (ES) has been used as a treatment for wound care. However, some studies show wounds healing with ES, whereas others do not. Part of the difficulty can be resolved by using heat to help dilate blood vessels, but an inherent problem with ES is uneven currents across the wound due to the use of only two electrodes. Therefore, we designed and tested a multi-electrode ES device in combination with local warming of the wound in non-healing chronic ulcers. STUDY DESIGN: Eighteen subjects (mean +/- SD age, 35.7 +/- 21.3 years) with chronic ulcers (no healing for 26.1 +/- 24.6 months) received ES treatment three times a week for 4 weeks. A heat lamp was used before and during ES to keep the wound and area surrounding the wound warm (37 degrees C). ES was applied for 30 min with biphasic sine wave stimulation at a frequency of 30 Hz, pulse width of 250 micros, and current of about 20 mA. Skin blood flow (BF) in and around the wound was measured with a laser Doppler imager. Wound size was measured prior to each treatment. RESULTS: Over the 1-month period, the mean wound area significantly decreased by 43.4 +/- 44.5% (P < 0.05), and wound volume decreased by 57.0 +/- 27.9% (P < 0.05). Skin BF significantly increased after application of ES and local heat (P < 0.05). The skin BF response decreased as time progressed and the wound healed. CONCLUSIONS: Thus, in this pilot study, application of a three-channel ES system in combination with local heat is effective in the healing of non-healing chronic wounds. Future studies should examine a larger population with variables such as treatment duration, number of days, or length of treatment to optimize the effect of ES on healing of non-healing chronic wounds.

Successful topical hemotherapy with a new occlusive dressing for an intractable ulcer on the toe.

Topical hemotherapy is a method of applying heparinized venous blood directly onto the surface of an ulcer, which is covered with an occlusive hydrocolloidal dressing. It is often effective on chronic ulcers with thick necrosis, because some proteinases and growth factors in plasma are probably involved in the digestion of necrotic tissues and the acceleration of granulation and epithelization. We treated a patient with an intractable ulcer on the toe caused by a peripheral circulatory disturbance due to her systemic sclerosis. As conventional topical hemotherapy cannot be applied to ulcers on the round tip of a toe, we made a device for occlusive dressing of topical hemotherapy which could successfully improve the previously refractory ulcer.