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Are venous ulcers curable?

Discussion in 'Diabetic Foot & Wound Management' started by NewsBot, Jun 30, 2011.

  1. NewsBot

    NewsBot The Admin that posts the news.

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    Is chronic venous ulcer curable? A sample survey of a plastic surgeon.
    Alamelu V.
    Indian J Plast Surg. 2011 Jan;44(1):104-9.
     
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    Press Release:
    National Health Service (NHS) recommends assessment for elevated protease activity using diagnostic test to help decide Venous Leg Ulcers treatment pathway, reports Systagenix
     
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    Admin2 Administrator Staff Member

  4. NewsBot

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    Press Release:
    UM Researchers Pinpoint Mechanism that Halts Healing of Venous Ulcers
    Induction of Specific MicroRNAs Inhibits Cutaneous Wound Healing
    Irena Pastar, Aly Azeem Khan, Olivera Stojadinovic, Elizabeth A. Lebrun, Mayrin Correa Medina, Harold Brem, Robert S. Kirsner, Joaquin J. Jimenez, Christina Leslie and Marjana Tomic-Canic
    J. Biol. Chem. 2012 287: 29324-29335
     
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    Validity of International Classification of Diseases, Ninth Revision, Clinical Modification codes for estimating the prevalence of venous ulcer
    Monika L. Gloviczki et al
    Journal of Vascular Surgery: Venous and Lymphatic Disorders; Available online 10 May 2014
     
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    NewsBot The Admin that posts the news.

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    Factors that influence healing of chronic venous leg ulcers: a retrospective cohort
    Marilia Formentini Scotton, Hélio Amante Miot, Luciana Patricia Fernandes Abbade
    An. Bras. Dermatol. vol.89 no.3 Rio de Janeiro May/June 2014
     
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    Ulcer pain in patients with venous leg ulcers related to antibiotic treatment and compression therapy.
    Akesson N, Oien RF, Forssell H, Fagerström C.
    Br J Community Nurs. 2014 Sep;19(Sup9):S6-S13.
     
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    Practice patterns of adjunctive therapy for venous leg ulcers.
    Aziz F et al
    Phlebology. 2016 Jan 14. pii: 0268355515625526
     
  9. David Smith

    David Smith Well-Known Member

    Is the question "are venous ulcers curable"? in the right terms?

    Of course the venous ulcer can be healed but the underlying pathology that results in a venous ulcer most often is not curable and the venous ulcer is not a disease in itself but a sequelae of those underlying pathologies such as venous insufficiency and Lymphoedema.
     
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    Study on the efficacy of surgery of the superficial venous system and of compression therapy at early stages of chronic venous disease for the prevention of chronic venous ulceration
    Raffaele Serra et al
    International Wound Journal; Early View
     
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    Fibrin gel versus papain gel in the healing of chronic venous ulcers: A double-blind randomized controlled trial
    Illymack CF de Araújo et al
    Phlebology October 4, 2016
     
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    A single-arm trial indirect comparison investigation: a proof-of-concept method to predict venous leg ulcer healing time for a new acellular synthetic matrix matched to standard care control
    Ronald Shannon, Andrea Nelson
    International Wound Journal; 20 November 2016
     
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    Refractory venous leg ulcers: observational evaluation of innovative new technology
    Connie et al
    International Wound Journal
     
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    Epidemiology of venous leg ulcers in primary health care: Incidence and prevalence in a health centre—A time series study (2010‐2014)
    Miriam Berenguer Pérez Pablo López‐Casanova Raquel Sarabia Lavín Héctor González de la Torre José Verdú‐Soriano
    First published: 04 November 2018
     
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    Cost of managing patients with venous leg ulcers
    Ceri J. Phillips Ioan Humphreys Dan Thayer Muhammad Elmessary Huw Collins Chris Roberts Gurudutt Naik Keith Harding
    07 May 2020
     
  17. NewsBot

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    NEWS RELEASE 23-SEP-2020
    Early treatment for leg ulcers leads to better outcomes for patients

    Venous leg ulcers are common and distressing, affecting around 1 in 300 adults in the UK. They are open, often painful, sores on the leg that take months to heal and can develop after a minor injury. People with enlarged veins known as varicose veins are at high risk of developing venous leg ulcers, as they have persistently high pressure in the veins leading to skin damage.

    In a clinical trial, led by researchers at Imperial College London and clinicians at Imperial College Healthcare NHS Trust, 450 patients with venous leg ulcers were treated with early surgical interventions. This resulted in faster healing and a reduced risk of the condition coming back compared with current methods of treating patients with compression stockings and delayed surgical interventions.

    The researchers behind the study, published in JAMA Surgery, suggest that current guidelines on treating leg ulcers should be revised to include early assessment of varicose veins and surgical treatment of leg ulcers to deliver clinical benefits and cost savings for the NHS. They suggest that this early treatment intervention could save the NHS an estimated £100 million per year.

    Lead author of the study Professor Alun Davies, Professor of Vascular Surgery at Imperial College London and a Consultant Surgeon at Imperial College Healthcare NHS Trust, said:

    "Venous leg ulcers cause enormous physical and mental distress to patients as well as having a financial impact on the NHS. Our study is the first to show that early surgical treatment of leg ulcers leads to faster healing and the reduced risk of the ulcer coming back compared to current methods.

    The NHS spends around 2 per cent of its budget on managing lower limb wounds and there is an urgent need to find more effective treatments. We believe that the current guidelines should be changed so that patients with leg ulcers are treated with surgery at an earlier stage. This approach will lead to better outcomes and improve patients' quality of life."

    The main treatment for leg ulcers is compression bandages or stockings, to improve the vein function in the legs. There are also surgical treatments such as endovenous ablation - a 'keyhole' treatment to close varicose veins. The treatment, under local or general anaesthetic, involves a small fibre passed through a catheter and positioned at the top of the varicose vein. The fibre delivers bursts of energy that heat up the vein and seal it closed. However, under current guidelines this treatment is not usually offered until the ulcer has been present for many months, if at all. Furthermore, if the underlying cause of the ulcer is not treated there's a high risk of the ulcer coming back after treatment.

    The researchers wanted to see whether performing endovenous ablation to treat varicose veins at an earlier stage can lead to faster healing and reduce the risk of venous leg ulcers returning, requiring further treatment.

    Researchers recruited 450 patients with venous leg ulcers from October 2013 to September 2016. All patients had leg ulcers of less than six months old and were treated at 20 hospitals in the UK, including Imperial College Healthcare NHS Trust hospitals. Two hundred and twenty four patients were randomly assigned to receive endovenous ablation within two weeks of randomisation followed by wearing compression stockings. The rest of the patients were given compression stockings but the endovenous ablation treatment was delayed by six months or until the ulcer was healed. The researchers then followed up over a period of five years to compare how quickly they healed and the rate of leg ulcer recurrence after treatment.

    Of the 426 participants whose leg ulcer had healed, 121 participants experienced at least one recurrence during follow-up. In the early-intervention group, 56 patients experienced recurrence during follow-up. In comparison, 65 participants in the delayed intervention group experience recurrence during follow-up. The rate of recurrent ulcers was 60 per cent higher in the deferred intervention group (0.16 per year of follow-up compared to 0.1 per year in the early-intervention group). They also found that healing was shorter in the early intervention compared to the deferred intervention group.

    The team compared the cost of early surgical intervention with delayed intervention over three years and found that early intervention was, on average, the less costly strategy over three years.
     
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