Low-grade elastic compression regimen for venous leg ulcers--an effective compromise for patients requiring daily dressing changes.

Venous leg ulcers (VLUs) affect millions of patients worldwide and are a tremendous financial burden on our health care system. The hallmark of venous disease of the lower extremities is venous hypertension, and compression is the current mainstay of treatment. However, many patients are non-compliant, partly because of the complexity of the dressings and the difficulties with application and removal. The aim of our study was to test an effective compression dressing regimen for patients with VLUs who require changing the ulcer primary dressing twice daily. We used two layers of a latex-free tubular elastic bandage for compression. The primary endpoint of our study was increased wound-healing rate and our secondary endpoint was complete wound closure. All active study subjects had positive healing rates at week 4 and week 8. Two subjects achieved complete wound closure by week 8. We conclude that compression with a latex-free tubular elastic bandage can be safely used in patients with VLUs requiring frequent dressing changes. This type of compression allows for daily inspection of wounds, dressing changes at home, flexibility in the context of clinical trials, and is a compromise for patients who are intolerant to compression dressings.

Wound edge biopsy sites in chronic wounds heal rapidly and do not result in delayed overall healing of the wounds.

Wound biopsies are an essential diagnostic component in the management of chronic wounds. First, the possibility of malignancy or infection in the wound often requires sampling of the wound edge and its bed. Secondly, several practice guidelines recommend biopsying wounds that have not responded to treatment after 2-6 weeks. However, there has always been a concern that the biopsy may worsen the wound and delay overall healing. In this report, we investigated the safety and effects of wound biopsies on overall chronic wound healing rates (advance of the wound edge per week toward the center) before and after the biopsy was performed. In a cohort of 14 consecutive patients with chronic wounds of the lower extremity, we found that postbiopsy chronic wound healing rates (0.99+/-1.18 mm/week; mean+/-SD) were not decreased and were actually higher than prebiopsy chronic wound healing rates (0.49+/-0.85 mm/week; mean+/-SD, p<0.05). In addition, we documented that healing of the biopsy sites up to the original wound edge occurred within 6 weeks in 11 of the 14 subjects. Therefore, we conclude that chronic wounds do not worsen after being biopsied and that wound biopsies are a safe procedure that does not delay overall healing of the chronic wound.

Completeness in the reporting of dermatologic adverse drug reactions associated with monoclonal antibody epidermal growth factor receptor inhibitors in phase II and III colorectal cancer clinical trials.

The epidermal growth factor receptor inhibitors cetuximab and panitumumab have demonstrated activity against colorectal cancer (CRC), with decreased systemic toxicities compared with cytotoxic chemotherapy. However, most patients experience dermatologic adverse drug reactions (dADRs). Our study examines completeness of reporting of dADRs to cetuximab and panitumumab in clinical trials for CRC. The PubMed MEDLINE database was searched for "cetuximab and CRC" or "panitumumab and CRC." Searches were limited to phase II or phase III clinical trials. Each result was evaluated for type of dADRs, grades included, correlation with survival, and dose modification. Ten of the 13 cetuximab articles (76.9%) analyzed included data on dADRs. Eight of ten (80%) reported all grades of rash, effect on dose modification was reported in 20%, and patient discontinuation in 30%. Five (50%) reported a positive correlation between dADRs and survival or response. Three of 7 (42.9%) panitumumab articles reported dADRs. None of the articles reported lower-grade rash. Information on drug dose adjustments was reported in one (33.3%), while discontinuation was reported 3 (100%) articles. Correlation between dADRs and survival was included in 2 panitumumab articles (66.6%). Our results indicate considerable variability in reporting of dADRs. This suggests that the ability to determine patient risk and the capability to compare dermatologic toxicity profiles between agents is limited by current reporting methods. To improve patient counseling and prophylactic antitoxicity interventions, implementation of standards for reporting of dADRs is critical.