Wound digest: Pressure ulcers


Wound digest


standardised treatment protocol in 16 cases. J Burn Care Res 2010; 31: 776–780


Leg Ulcers 9


Causes of chronic leg ulceration in patients in Germany


Readability Relevance to daily practice Novelty factor


n The aim of this questionnaire-based study was to gain insight into the aetiology of chronic leg ulcers in patients in Germany; although the incidence and prevalence of chronic leg ulcers is known to be rising, data on etiology are currently lacking


n 100 wound care experts (dermatologists, surgeons and internists) were selected based on their experience and practice of treating wounds. They received a written one-page questionnaire and were asked to complete questions relating to etiology and diagnosis of chronic leg ulcers


n Overall, 70 of the returned questionnaires were evaluable, containing data relating to 31,619 patients with chronic leg ulcers


n The most common etiology was venous leg ulcer (47.6%), followed by mixed leg ulcer (in which both chronic venous insufficiency and peripheral arterial disease are clinically relevant; 17.6%) and arterial leg ulcer (14.5%). Other etiologies included vasculitis (5.0%) and pyoderma gangrenosum (3.0%)


n The most commonly used diagnostic investigations included Doppler/duplex, serology, swab culture and calculation of brachiotibial index; their use varied slightly between specialities


n This survey differed from others in attributing relatively rare causes of chronic leg ulcers in around 30% of cases; other studies indicate around 10%


n The experts surveyed also appeared to perform a greater number of diagnostic procedures than those in other studies


n The authors acknowledge the lack of clear definition of chronic leg ulcer and the consequent difficulty in defining etiology


n They concluded that their survey confirmed the central role of chronic venous insufficiency and peripheral arterial disease in chronic leg ulceration, and stress the important of a multidisciplinary approach to diagnosis and treatment.


Körber A, Klode J, Al-Benna S, Wax C, Schadendorf D, Steinstraesser L, Dissemond J. Etiology of chronic leg ulcers in 31,619 patients in Germany analyzed by an expert survey. JDDG (Journal of the German Society of Dermatology); 2010: 8.


10


980nm diode laser treatment does not improve healing of chronic leg ulcers


Readability Relevance to daily practice Novelty factor


n The aim of this prospective randomised study was to investigate the healing potential and safety of 980nm diode laser treatment in patients with venous leg ulcers


n 34 patients (all Caucasian, with lower extremity leg ulcers of diameter 2-8cm2


, with no wound infection)


were randomised to receive either laser treatment or standard wound care. Both groups began with wound disinfection and debridement. The laser treatment group then received laser exposure designed to achieve local tissue temperature of 45-50ºC, followed by wound coverage with a hydrocellular dressing. Control patients received the same regimen without laser therapy (and no sham laser procedure was performed)


n Treatment was performed weekly for nine weeks. Complete ulcer healing, reduction in ulcer size, and pain during and between each procedure were evaluated at each weekly session


n The laser group consisted of 18 patients (16 female, two male, mean age 71 years) and the control group of 16 patients (13 women, three men, mean age 76 years). Ulcer duration was similar in both groups (mean duration 15 months versus 12 months respectively); the size and etiologies of ulcers were also similar in both groups


n 34 ulcers from the 34 patients were included in the study. One patient in the laser group withdrew at week 7 owing to infection


n Complete healing was seen in three of the 18 laser patients (16.7%) versus four of the 16 control patients (25%). This difference was not significant (p=0.62)


n Ulcer area decreased on average to 94.3% of the original area in the control patients versus 74.2% of the original area in the laser treated patients. Again, this difference was not significant (p=0.60)


n The laser treatment was deemed easy to administer and was very well tolerated by patients


n Given that there were no significant differences in healing and reduction in ulcer size between the treatment and control groups, the authors concluded that therapy with a 980nm diode laser does not promote chronic ulcer healing. They recommend that further studies be performed with larger patient numbers and increased treatment frequency in order to corroborate these findings.


Leclère FM, Puechguiral IR, Rotteleur G, Thomas P, Mordon SR. A prospective randomized study of 980nm diode laser-assisted venous ulcer healing on 34 patients. Wound Repair Regen. 2010 Nov-Dec;18(6):580-5


www.woundsinternational.com 40


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