Dressings and topical agents for arterial leg ulcers

Published on Jun 29, 2015in Cochrane Database of Systematic Reviews7.89
· DOI :10.1002/14651858.CD001836.PUB3
Rachel Forster8
Estimated H-index: 8
(Edin.: University of Edinburgh),
Fania Pagnamenta3
Estimated H-index: 3
(Newcastle upon Tyne Hospitals NHS Foundation Trust)
Sources
Abstract
Background It is estimated that people in industrialised countries have a 1% chance of suffering from a leg ulcer at some time in their life. The majority of leg ulcers are associated with circulation problems; poor blood return in the veins causes venous ulcers (around 70% of ulcers) and poor blood supply to the legs causes arterial ulcers (around 22% of ulcers). Treatment of arterial leg ulcers is directed towards correcting the poor arterial blood supply, for example by correcting arterial blockages (either surgically or pharmaceutically). If the blood supply has been restored, these arterial ulcers can heal following principles of good wound care. Dressings and topical agents make up a part of good wound care for arterial ulcers but there are many products available and it is unclear what impact these have on ulcer healing. This is an update of a review first published in 2003. Objectives To determine whether topical agents and wound dressings affect healing in arterial ulcers. To compare healing rates, patient-centred outcomes and costs between wound dressings and topical agents. Search methods For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched November 2014) and The Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library) (2014, Issue 10). Selection criteria Randomised controlled trials (RCTs), or controlled clinical trials (CCTs) evaluating dressings and topical agents in the treatment of arterial leg ulcers were eligible for inclusion. The participants had to have ulcers that were described as arterial, and the time to healing, proportion completely healed, or rate of reduction in ulcer area had to be reported. All wound dressings and topical agents were eligible for inclusion in this review. Data collection and analysis The two review authors independently extracted information on the participants' characteristics, the interventions, and outcomes using a standardised data extraction form. Disagreements between the review authors were resolved through discussion. Main results One trial met the inclusion criteria, which was a small trial that compared 2% ketanserin ointment in polyethylene glycol (PEG) with vehicle alone (PEG) control, changed twice a day in 40 participants with arterial leg ulcers. The overall quality of the evidence was low with a single small included study which showed inadequate reporting of the results and had too short a follow-up time (eight weeks) to be able to capture sufficient healing events to allow comparisons to be made. In addition, the study was of low methodological quality. The majority of the 'risk of bias' domains received an 'unclear' risk rating as very little information was provided in the text on the methods of the study. The trial demonstrated increased wound healing in the ketanserin group, compared with the control group, but the trial was too small and had too short a follow-up period (eight weeks) to be able to determine whether there was any difference in healing rates. It should also be noted that ketanserin is not licensed in all countries for use in humans. Authors' conclusions There is insufficient evidence to determine whether the choice of topical agent or dressing affects the healing of arterial leg ulcers.
📖 Papers frequently viewed together
53 Citations
295 Citations
16 Citations
References69
Newest
#1Raffaele CapoanoH-Index: 12
#2Rita Businaro (Sapienza University of Rome)H-Index: 18
Last. Serafino RicciH-Index: 16
view all 12 authors...
OBJECTIVE: Treatment of wounds difficult to heal concerns 50% of the elderly population in Italy and is therefore an extreme relevance social burden. The present study shows how the treatment with autologous leuco-platelets reduces the healing time of wounds improving the functional recovery. PATIENTS AND METHODS: One hundred patients with ulcers of the legs were divided in two groups: 1) 50 patients treated with conventional therapies; 2) 50 patients treated with autologous leuco-platelet conce...
4 CitationsSource
#1Marco RomanelliH-Index: 66
#2Adrienne M. Gilligan (UNT: University of North Texas)H-Index: 9
Last. Valentina DiniH-Index: 19
view all 4 authors...
Importance Difficult-to-heal wounds pose clinical and economic challenges, and cost-effective treatment options are needed.
2 CitationsSource
#1Matthias Augustin (UHH: University of Hamburg)H-Index: 61
#2Katharina Herberger (UHH: University of Hamburg)H-Index: 20
Last. Reinhard RychlikH-Index: 1
view all 6 authors...
Although chronic wounds have a high socio-economic impact, data on comparative effectiveness of treatments are rare. UrgoStart® is a hydroactive dressing containing a nano-oligosaccharide factor (NOSF). This study aimed at evaluating the cost-effectiveness of this NOSF-containing wound dressing in vascular leg ulcers compared with a similar neutral foam dressing (UrgoCell® Contact) without NOSF. Cost-effectiveness analysis from the perspective of the German statutory health care system was perfo...
19 CitationsSource
#1Edoardo Raposio (University of Parma)H-Index: 26
#2Guido Libondi (University of Parma)H-Index: 2
Last. Michele P. Grieco (University of Parma)H-Index: 8
view all 5 authors...
Recent research suggests that statins might be useful in the process of wound healing, playing a positive immune-modulatory role, improving microvascular function and reducing oxidative stress. The aim of this pilot study was to evaluate the efficacy of topic application of Simvastatin-based cream in the treatment of chronic vascular cutaneous ulcers, comparing this type of treatment to a collagen-based dressing, proven to be effective for ulcer treatment. A total of 20 ulcers were studied in 2 ...
8 CitationsSource
#1Xiaohui MoH-Index: 1
#2John CenH-Index: 1
Last. Steven L. Percival (University of Liverpool)H-Index: 40
view all 5 authors...
Abstract Chitosan, a natural polysaccharide derivate from chitin, offers a promising alternative biomaterial for use in wound dressings. In this work, the safety and efficacy of a next-generation KA01 chitosan wound dressing in facilitating the healing of nonhealing chronic wounds was studied. This open multicenter comparative prospective randomized clinical study was conducted at three medical centers in China. A total of 90 patients (45 in test group and 45 in control group) with unhealed chro...
12 CitationsSource
#1Neda BaroutiH-Index: 1
#2Carlo MainettiH-Index: 1
Last. Olivier SorgH-Index: 24
view all 4 authors...
Background: The aryl hydrocarbon receptor has been shown to be involved in wound healing. Objective: The aim of this study was to assess the effect of tryptophan on wound healing in vitro and in a clinical trial. Methods: The ability of tryptophan and 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) to increase wound healing was assessed in an in vitro scratch wound model in human keratinocytes. Topical tryptophan and vehicle were assessed for 12 weeks in 51 patients with lower limb ulcers that were r...
15 CitationsSource
#1Christine Moffatt (University of Nottingham)H-Index: 35
#2Julie StantonH-Index: 1
Last. Peter Franks (Glas.: University of Glasgow)H-Index: 104
view all 6 authors...
Abstract This study was to evaluate the potential benefits of two products (Oxyzyme ® and Iodozyme ® ) into a leg ulcer service in South Staffordshire, UK. A randomised controlled trial (RCT) was used to evaluate time to ulcer healing, quality of life, pain and cost effectiveness. 100 patients were randomised to receive either Oxyzyme/Iodozyme (active group) or standard care (control group) with venous or mixed arterio-venous ulcers. Patients were evaluated weekly up to 12 weeks, with further fo...
9 CitationsSource
#1Svetlana N. Zykova (University of Tromsø)H-Index: 16
#2Ksenia A BalandinaH-Index: 1
Last. Tatiana A ZykovaH-Index: 1
view all 6 authors...
Aims/Introduction Dysregulated inflammatory response is believed to be an important factor in the pathogenesis of several late complications of diabetes mellitus. β-Glucans are potent inducers of immune function. The present randomized, double blind, two-center, placebo-controlled study was undertaken to explore safety, tolerability and efficacy of soluble β-1,3/1,6-glucan (SBG) as a local treatment of diabetic foot ulcers. Materials and Methods A total of 60 patients with type 1 or 2 diabetes a...
31 CitationsSource
#1Simon Palfreyman (Northern General Hospital)H-Index: 20
#2E Andrea Nelson (University of Leeds)H-Index: 26
Last. Jonathan Michaels (Northern General Hospital)H-Index: 33
view all 4 authors...
Background Venous leg ulcers, sometimes called varicose or stasis ulcers, are a consequence of damage to the valves in the veins of the legs, leading to raised venous pressure. Venous ulcers are characterised by a cyclical pattern of healing and recurrence. The main treatment is the application of compression, either in the form of compression bandages or hosiery. Dressings are usually applied beneath the compression to aid healing, comfort and to control exudate. Wounds heal quicker in a moist ...
122 CitationsSource
#1Sylvie MeaumeH-Index: 21
#2Joachim DissemondH-Index: 32
Last. Serge BohbotH-Index: 20
view all 12 authors...
Objective: To evaluate the performance (efficacy, safety and acceptability) of a new micro-adherent absorbent dressing (UrgoClean®) compared with a hydrofiber dressing (Aquacel®) in the local management of venous leg ulcers, in their debridement stage. Method: A non-inferiority European randomised controlled clinical trial (RCT) was conducted in 37 centres, on patients presenting with venous or predominantly venous, mixed aetiology leg ulcers at their sloughy stage (with more than 70% of the wou...
15 CitationsSource
Cited By7
Newest
#1Ling Xiao (Third Military Medical University)
view all 9 authors...
Wound moisture management is very important in wound healing. Previous wound management has included dry healing and moist healing, and the theory of wound moisture balance is currently generally accepted. However, current studies have not reported which humidity is suitable for wound healing and how to appropriately use antibacterial compounds when the humidity is suitable. Our study explored the moisture balance of polyurethane foam dressings through a moisture balance test and constructed a s...
Source
Abstract Background Chronic leg ulcers affect a large portion of the adult population and cause a significant social and economic impact, related to outpatient and hospital care, absence from work, social security expenses, and reduced quality of life. The correct diagnosis and therapeutic approach are essential for a favorable evolution. Objective To gather the experience of Brazilian dermatologists, reviewing the specialized literature to prepare recommendations for the diagnosis and treatment...
2 CitationsSource
#1Jie Geng (Lanzhou University)
#2Yitong Cai (Lanzhou University)H-Index: 2
Last. Zhihong Wei (Lanzhou University)
view all 5 authors...
Background Pressure ulcer (PU) is defined as a lesion or trauma to the skin and underlying tissue resulting from unrelieved pressure, shear, friction, moisture, or a combination of all these, usually appearing over a bony prominence. We aim to evaluate the credibility of systematic reviews and meta-analyses that assess the effectiveness, safety, and economy of the dressing treatments for PU through an overview. Methods We searched the following electronic bibliographic databases: PubMed, Embase,...
Source
#1Trish A GrayH-Index: 7
#2Paul WilsonH-Index: 24
Last. Nicky CullumH-Index: 64
view all 4 authors...
Objectives Research has found unwarranted variation across community wound care services in the North of England, with underuse of evidence-based practice and overuse of interventions where there is little or no known patient benefit. This study explored the factors that influence care in community settings for people with complex wounds, to develop a deeper understanding of the current context of wound care and variation in practice. Design Qualitative focus group study using the Theoretical Do...
6 CitationsSource
#1Chelsea J. Stephens (Cornell University)H-Index: 1
#2Jason A. Spector (Cornell University)H-Index: 35
Last. Jonathan T. Butcher (Cornell University)H-Index: 40
view all 3 authors...
Wound chronicity due to intrinsic and extrinsic factors perturbs adequate lesion closure and reestablishment of the protective skin barrier. Immediate and proper care of chronic wounds is necessary for a swift recovery and a reduction of patient vulnerability to infection. Advanced therapies supplemented with standard wound care procedures have been clinically implemented to restore aberrant tissue; however, these treatments are ineffective if local vasculature is too compromised to support mini...
Source
1 CitationsSource
#1Jaiben George (Cleveland Clinic)H-Index: 17
#2Mhamad Faour (Cleveland Clinic)H-Index: 10
Last. Carlos A. Higuera (Cleveland Clinic)H-Index: 25
view all 7 authors...
Negative-pressure wound therapy (NPWT) is being increasingly used in the management of different types of wounds over the last few decades. It relies on generating a negative pressure on the surface of the wound, which is believed to promote wound healing. Although NPWT is used for various types of chronic wounds, acute wounds, and surgical incisions, not all types of wounds may benefit from NPWT. A thorough understanding of the principles of NPWT is crucial for its appropriate use. This chapter...
Source
Wounds are classified as acute or chronic. Acute wounds are divided into traumatic and surgical. In intact skin, the normal bacterial colonization is balanced. A wound jeopardizes this balance and infection may occur. In acute wounds, the presence of particular bacterial species such as Staphylococcus aureus seems to be a risk factor for the occurrence of an infection. To reduce the risk of surgical site infections preoperative skin preparation is necessary. In chronic wounds aerobic or facultat...
Source