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Introduction: Treatment of reflux has been shown to improve time to healing of Venous Leg Ulcers (VLU). Terminal Interruption of the Reflux Source (TIRS) treats reflux within the plexus of veins around an active VLU using foam sclerotherapy. The efficacy of TIRS in managing VLU has never been tested. Methods: We performed a pragmatic, single centre, assessor-blinded, randomised controlled trial comparing endovenous ablation of the axial superficial veins (Axial Ablation-AA) vs TIRS. Patients of any age with VLU of any duration were eligible. Results: 98 Participants were randomised to AA or TIRS. 39/55, 70.9% (95%CI; 57.1-82.37) healed their VLU in the AA group, while 29/39, 74.36% (95%CI; 57.87-86.96) healed their VLU in the TIRS group, P = 0.45.4 were lost to follow-up. Median time to ulcer healing was 84 days (95%CI; 74.67-93.33) in the axial ablation group and 84 days (95%CI; 73.02-94.98) in the TIRS group. Hazard Ratio for ulcer healing with AA vs TIRS was 0.96 (95%CI 0.59-1.56). There were no significant quality of life differences. Conclusion: The AAVTIRS trial did not show that axial ablation was superior to TIRS in the primary outcome of number of VLU healed in 6 months, or time to VLU healing. This trial is not powered to show non-inferiority. TIRS is a viable option for treatment of VLU. Further investigation is necessary before it can be recommended as an alternative to axial ablation. Trial registered at clinicaltrials.gov NCT04484168. [ABSTRACT FROM AUTHOR]

Objective: Venous leg ulcers (VLUs) are often large and complicated wounds that, despite combinations of advanced wound care techniques and systemic treatment of underlying vascular issues, take many months to heal and have high rates of recurrence. In this study, we investigated the efficacy of a novel wound care solution—human keratin matrix (HKM). Method: A case series of VLUs were treated with HKM in conjunction with indicated vascular intervention and standard of care (SoC) procedures. For analysis, these wounds were divided into very large (>200 cm2) and smaller (<35 cm2) wounds. Results: The cohort comprised 16 VLUs (very large=7; smaller=9). Very large VLUs were reduced in size by an average of 71% within 10 weeks, and showed a 50% size reduction within four applications of HKM. Smaller VLUs reduced by 50% in size within the first three weeks of treatment, and 88.9% of these wounds healed completely with an average of 4.5 HKM applications over an average of 6.5 weeks. Conclusion: The results of this series highlight the potential of HKM, in combination with indicated systemic interventions and SoC, as an effective treatment for hard-to-heal (chronic) VLUs, even in very large wounds. [ABSTRACT FROM AUTHOR]

To gain a clearer understanding of the relationship between venous leg ulcers (VLUs) and knee osteoarthritis (KOA), we performed a two‐sample, bidirectional Mendelian randomization (MR) analysis in this study. The present MR was carried out using summary data from publicly available genome‐wide association studies. After filtering single‐nucleotide polymorphism (SNP), we applied a variety of MR methods including inverse variance weighted (IVW), MR egger, weighted mode, and weighted median. IVW analysis revealed that the genetic association between VLUs and KOA was not significant (β = −0.017; SE 0.039; p = 0.658). In agreement with the IVW analysis, the findings of the weighted median estimator (β = −0.017; SE 0.052, p = 0.751), MR egger (β = 0.057; SE 0.084; p = 0.513), and weighted mode (β = 0.060; SE 0.078; p = 0.456) indicated the absence of a significant genetic association between VLUs and KOA. Furthermore, reverse causality analysis suggested a lack of genetic relationship between KOA and VLUs. In conclusion, the present MR study does not suggest a causal relationship or reverse causal relationship between VLUs and KOA. [ABSTRACT FROM AUTHOR]

Venous leg ulcers (VLUs) represent one of the most prevalent types of chronic wounds characterised by perturbed microbiome and biofilm‐forming bacteria. As one of the most abundant skin‐commensal, Staphylococcus epidermidis is known as beneficial for the host, however, some strains can form biofilms and hinder wound healing. In this study, S. epidermidis distribution in VLUs and associated resistome were analysed in ulcer tissue from patients. Virulence of S. epidermidis isolates from VLUs were evaluated by whole genome sequencing, antimicrobial susceptibility testing, in vitro biofilm and binding assays, and assessment of biofilm‐forming capability and pro‐inflammatory potential using human ex vivo wound model. We demonstrated that S. epidermidis isolates from VLUs inhibit re‐epithelialization through biofilm‐dependent induction of IL‐1β, IL‐8, and IL‐6 which was in accordance with impaired healing outcomes observed in patients. High extracellular matrix binding ability of VLU isolates was associated with antimicrobial resistance and expression levels of the embp and sdrG, responsible for bacterial binding to fibrinogen and fibrin, respectively. Finally, we showed that S. epidermidis from VLUs demonstrate pathogenic features with ability to impair healing which underscores the emergence of treatment‐resistant virulent lineages in patients with chronic ulcers. [ABSTRACT FROM AUTHOR]

The presence of microbial biofilms in many human chronic wounds led to the hypothesis that biofilms delay healing of these wounds. We tested this hypothesis in a population of 117 older individuals with venous leg ulcers who were receiving standardised therapy, including frequent debridement. Debridement specimens were analysed for the amount of bacterial biomass by two independent methods: a microscopic approach that scored the relative size and number of bacterial aggregates, interpreted as a biofilm metric, and conventional enumeration by agar plating for viable bacteria. The plating protocol yielded three distinct values: the total viable bacterial count, bleach‐tolerant bacteria, and the log reduction in viable bacteria upon bleach treatment. Wound healing rates over an 8‐week observation period were calculated as the rate of decrease of the equivalent diameter of the wound. There was no statistically significant association between wound healing and the biofilm metric in any of the three analyses performed (p ≥0.15). In all three statistical tests, wound healing was associated with the log reduction caused by bleach treatment (p ≤0.004); wounds that harboured bacteria that were more bleach‐susceptible healed more slowly. A refinement of the model of chronic wound infection pathogenesis is proposed in which dormant bacteria constitute a persistent nidus and outgrowth of metabolically active cells impairs healing. This model constitutes a new hypothesis as metabolic activity was not directly measured in this investigation. [ABSTRACT FROM AUTHOR]

The article focuses on a study on the use of compression therapy in the assessment and management of the venous and arterial aetiologies underlying leg ulceration as part of a holistic care plan, which was presented in an expert panel discussion held in October 2023.

Summary: Viscosity–vaso‐occlusion (VVO) and haemolysis–endothelial dysfunction (HED) are pathophysiological mechanisms and clinical subphenotypes of sickle cell disease (SCD). Recurrent vaso‐occlusive crises (VOC) may lead to neuroplastic changes and pain sensitization. Among 257 SCD participants, we assessed the relationship of subphenotypes with pain sensitivity using quantitative sensory testing to identify heat pain thresholds (HPT) and pressure pain thresholds (PPT). VOC history and sleep, social and emotional functioning were assessed using the Adult Sickle Cell Quality of Life Measurement Information System. The 'elbow method' determined the optimal number of clusters as three. Clustering was performed using K‐prototypes. Among clusters 2 and 3, VOC frequency and severity were higher. Clusters 1 and 3 had lower haemoglobin, higher reticulocytes and lactate dehydrogenase and more leg ulcers. In multivariate regression, cluster 3 was associated with approximately 13.6% lower PPT compared to cluster 1, and female sex was associated with decreases in PPT and HPT at the hands and feet (p < 0.001). Hydroxyurea use and unit increases in sleep functioning and age were associated with approximately 20.1% higher foot‐PPT, 6.8% higher hand‐PPT and 2.5% higher hand‐HPT and foot‐HPT respectively. Findings suggest that a third subphenotype with mixed VVO and HED features and worse pain sensitization may exist. [ABSTRACT FROM AUTHOR]

Background: Mixed Arterial and Venous Leg Ulcers (MAVLU) are challenging. Clinical evidence specific to MAVLU management is scarce. We evaluated our recent experience with MAVLU patients and reviewed current data regarding MAVLU epidemiology, aetiology, diagnostic assessment and management options. Methods: A prospective leg ulcer database was retrospectively interrogated to determine the prevalence and clinical outcome of MAVLU over 2-year period (2021-2022). The literature was reviewed to determine if optimal treatment strategies. Results: 307 patients attended the ulcer clinic over a 2-year period. Most were venous leg ulcers (71%), 24% were arterial and 5% were MAVLU. The highest healing rate was in MAVLU (93%), followed by (74%) and (41%), in arterial and venous leg ulcer groups, respectively. Conclusion: Evidence-based guidelines for MAVLU remain lacking. Well-developed randomised controlled trials are warranted to guide current clinical practice. [ABSTRACT FROM AUTHOR]

Venous stasis ulcers are nonhealing lesions due to venous hypertension secondary to valvular dysfunction or deep venous outflow obstruction. We describe a case of a 71-year-old male with a history of polycythemia vera, secondary myelofibrosis, and massive splenomegaly up to 38 cm who presented with chronic, perimalleolar venous stasis ulcers and pain on the left lower extremity. CT showed significant compression of the left common iliac vein due to mass effect from the spleen. He was managed medically while being evaluated for partial splenic artery embolization but expired due to other chronic conditions before any intervention could be performed. Partial splenic artery embolization may be considered as a treatment option for patients with symptomatic iliac vein compression due to massive splenomegaly secondary to myelofibrosis, as long as extramedullary hematopoiesis is not compromised. [ABSTRACT FROM AUTHOR]

Suboptimal management of leg ulcers is a growing burden on NHS nursing and financial resources (Guest et al, 2015; 2017; 2020). Compression therapy plays a crucial role in leg ulcer management by improving outcomes and reducing the burden of disease, however it is not routinely applied in practice and knowledge and confidence between bandage types and application styles often varies greatly (Guest et al, 2017; Hopkins, 2023). This article focuses on the importance of compression therapy in the management of leg ulceration and how to select the appropriate compression therapy based on the patient's presenting symptoms. It identifies possible barriers to application and offers potential strategies and suggestions to support the use of compression options in the community. [ABSTRACT FROM AUTHOR]

Lower limb ulcers are one of the most common chronic wounds in the UK and have a negative impact on health-related quality of life (Phillips et al, 2020). Venous leg ulcers (VLUs) often present with excessive exudate, which may damage the wound bed and periwound skin; and therefore act as a barrier to wound healing. Cleaning and debridement are key to the management of devitalised tissue and exudate. Although debridement helps promote the healing of both arterial and venous leg ulcers, its use may be restricted by pain levels associated with the procedure (Claeys et al, 2011). Because pain can be a barrier to patients tolerating debridement, this may compromise the healing process (Roberts et al, 2019). A small-scale evaluation was recently completed to investigate the efficacy of wound debridement pads, together with patient perceptions of the treatment. The impact on pain and tolerance of pain during the use of pads was explored. Spending time explaining the potential benefits of debridement on wound healing and listening to patient concerns appeared to have a positive impact on acceptance of treatment. [ABSTRACT FROM AUTHOR]

Objective: Several national and international guidelines recommend lipidocolloid technology with a nano-oligosaccharide factor (TLC-NOSF) dressings (UrgoStart dressing range, Laboratoires Urgo, France) for treating patients with chronic wounds. However, these dressings are still often reported as second-line options, potentially leading to loss of opportunity for patients and additional costs for payers. This review aimed to explore the reported wound healing and patient outcomes as well as the related costs when the dressings were used as first-line treatment in patients with different types of chronic wounds. Method: A systematic review of the literature was conducted. Databases (MEDLINE, Embase, Emcare, and Google Scholar) were searched up to 1 February 2024, without any language or time period limitations. Studies were eligible if the evaluated dressings had been used as a first-line treatment for chronic wounds, that is, as an integral part of the standard of care (SoC) at the patient's first presentation and/or in recent wounds. The main evaluation criteria included: wound healing rate; time to reach wound closure; change in patients' quality of life (QoL); and associated costs. The quality of evidence of the included studies was appraised using well-recognised risk-of-bias tools suitable for different study designs. A narrative synthesis describes the findings in three sections depending on the type of comparison. This report followed the principles of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: A total of 17 studies published between 2017 and 2024 met the eligibility criteria. A comparative analysis between TLC-NOSF dressings and standard dressings, both of which were used as first-line treatment, was reported in nine studies. A comparative analysis between the use of TLC-NOSF dressings as first-line and second-line treatments was reported in eight studies, and five studies reported a systematic use of the TLC-NOSF dressing as first-line treatment without a control group. Overall, the included studies had a relatively low risk of bias for the respective types of evidence. Data of 10,191 patients of both sexes and different age groups with a total of 10,203 wounds (diabetic foot ulcers, leg ulcers, pressure injuries, and other types of chronic wounds) were included in the analysis: 7775 treated with the evaluated dressing and 2428 treated with a comparator dressing. The data suggested that using TLC-NOSF as a first-line treatment for chronic wounds consistently resulted in significantly higher healing rates, shorter healing times, and cost savings compared with standard dressings used under similar conditions. Real-life evidence confirmed the results obtained in clinical trials and economic models, within similar ranges, regardless of the settings involved or of the characteristics of the patients and wounds treated. The wound healing rates ranged around 70-80% by week 20/24 and time-to-heal was reported on average around seven weeks, with slightly longer times reported in wounds with a more severe prognosis. Furthermore, the dressings were shown to improve patient QoL, and were well tolerated and accepted, supporting a wider adoption approach. Conclusion: The results of this review are aligned with the current guidelines recommending the use of TLC-NOSF dressings in the treatment of patients with chronic wounds. They support its wider implementation as a first-line treatment and as an integral part of SoC for these wounds in the daily practice of all centres involved in their management. [ABSTRACT FROM AUTHOR]

Objective: Delayed or stalled healing in open wounds can result from persisting chronic inflammation related to infection and/or persistent bacterial colonisation and biofilm. Treatment of hard-to-heal wounds focuses on debridement and exudate management, but also on infection prevention and control. Silver dressings have been evaluated in randomised clinical trials (RCTs); this meta-analysis evaluated the efficacy and safety of a silver ion-releasing foam dressing (Biatain Ag; Coloplast A/S, Denmark) to treat hard-to-heal wounds. Method: Literature databases (PubMed and Cochrane Library) were searched for studies on silver ion-releasing foam dressings in the treatment of hard-to-heal wounds. Individual patient data from four RCTs were obtained and included in the meta-analysis. Results: Findings showed that treatment with the silver ion-releasing foam dressing was associated with a significantly higher relative reduction in wound area after four (least squares-mean difference (LS-MD): -12.55%, 95% confidence interval (CI): (-15.95, -9.16); p<0.01) and six weeks of treatment (LS-MD: -11.94%, 95%CI: (-17.21, -6.68); p<0.01) compared with controls. Significant benefits were also observed for time to disappearance of odour (hazard ratio: 1.61, 95%CI: (1.31, 1.98); p<0.01), relative reduction of exudate (LS-MD: -5.15, 95%CI: (-7.36, -2.94); p<0.01), proportion of patients with periwound erythema (relative risk (RR): 0.81, 95%CI: (0.69; 0.94); p<0.01), and less pain at dressing removal (LS-MD: -0.35, 95%CI: (-0.63, -0.06); p=0.02). No differences regarding safety outcomes were identified. Conclusion: This meta-analysis has demonstrated beneficial outcomes and a good tolerability profile for silver ion-releasing foam dressings in the treatment of moderate-to-highly exuding wounds with delayed healing compared with control dressings. [ABSTRACT FROM AUTHOR]

Objective: Hard-to-heal (chronic) wounds are treated differently at varying healing stages and often require long periods of time to heal completely. Therefore, it is often very difficult to achieve this primary endpoint in clinical trials with wound products which are used temporarily. Thus, it seems reasonable to use valid wound healing parameters determined at an early stage, such as the percentage (wound) area reduction (PAR), as surrogates for predicting complete wound healing. Method: To identify studies on the association between potential surrogate endpoints and complete wound healing, a systematic literature search in MEDLINE, Embase and the Cochrane Library databases was performed. The findings of the studies were summarised qualitatively. Results: A total of 23 publications with a focus on hard-to-heal wounds (n=10 diabetic foot ulcers (DFUs), n=10 venous leg ulcers (VLUs), n=3 other ulcers) and various wound care regimens were identified. All studies showed a high bias potential. The available clinical evidence confirmed that the PAR at week 4 showed a good discriminatory capacity to predict which wounds would eventually heal and which would not. The chance to achieve complete wound healing was significantly higher for wounds achieving a PAR of >40% (VLU) or ≥50% (DFU) at week 4. Conclusion: The PAR thresholds of 40% (VLU) and 50% (DFU) can be used to identify the proportion of the wounds that will heal, and those that will not heal, to compare the efficacy of different wound dressings as early as week 4 in the setting of clinical trials. The available evidence may be limited by a potential risk of bias. [ABSTRACT FROM AUTHOR]

The cutaneous microbiome represents a highly dynamic community of bacteria, fungi and viruses. Scientific evidence, particularly from the last two decades, has revealed that these organisms are far from being inconsequential microscopic hitchhikers on the human body, nor are they all opportunistic pathogens waiting for the chance to penetrate the skin barrier and cause infection. In this review, we will describe how dermatological diseases have been found to be associated with disruptions and imbalances in the skin microbiome and how this new evidence had shaped the diagnosis and clinical practice relating to these disorders. We will identify the microbial agents which have been found to directly exacerbate skin diseases, as well as those which can ameliorate many of the symptoms associated with dermatological disorders. Furthermore, we will discuss the studies which suggest that bacteriotherapy, either by topical use of probiotics or by bacteria‐derived compounds, can rectify skin microbial imbalances, thereby offering a promising alternative to antibiotic treatment and reducing the risks of antibiotic resistance. [ABSTRACT FROM AUTHOR]

Pain in patients suffering from hard‐to‐heal wounds is a serious problem that hinders the healing process and affects their quality of life. Virtual reality (VR) is increasingly being used for pain relief. The aim of the study was to assess whether the use of VR during mechanical cleansing of venous leg ulcers would result in a reduction in patients' pain. Sixty patients were randomly divided into two groups. The experimental group included patients who used VR goggles during wound cleansing, and the control group included patients who did not use such equipment during wound cleansing. The Oculus Quest 2 VR Goggles were used in the experiment. After wound cleaning, the patient assessed the intensity of his pain on a numerical pain rating scale from 0 to 10 points. The difference between the intensity of pain during wound cleansing in patients from the experimental and control group turned out to be statistically significant (p < 0.001). It was on average 1.13 ± 0.68 points in the experimental group, and in the case of people from the control group, it was 4.73 ± 1.2 points. To conclude, the use of VR in patients with venous leg ulcers reduces pain during wound cleansing. [ABSTRACT FROM AUTHOR]

This study evaluates the cost‐effectiveness of the geko device a neuromuscular electro‐stimulator technology with standard of care (SoC) versus SoC alone for venous leg ulcer (VLU) treatment, from the UK National Health Service (NHS) perspective over 12 months. Research was conducted across NHS UK facilities, primarily within community services and outpatient leg ulcer clinics, encompassing a total of 51 patients. A partitioned survival model, based on a two‐arm randomised controlled trial, assessed wound healing rates using Kaplan–Meier curves and parametric extrapolations over a 12‐month time horizon. Costs were derived from UK reference costs the British National Formulary, and the Personal Social Services Research Unit (2021/22). The primary outcome measured was the incremental cost per quality‐adjusted life‐year gained. The geko device provides additional benefits by stimulating the lateral popliteal nerve, augmenting venous, arterial, and microvascular flow. The addition of the geko device to SoC significantly enhanced outcomes, increasing healing probability by 68% compared to SoC. This integration would result in a cost saving of £774.14 per patient when compared to the SoC alone across the NHS. Economic analyses indicate that integrating the geko device into SoC protocols would reduce the overall NHS expenditure on VLU wound management by as much as 15%. The approach also positively impacted health‐related quality of life. The geko™ device when used adjunctively with SoC would be a cost‐effective method for managing chronic VLUs within the NHS, improving healing rates and offering economic benefits. [ABSTRACT FROM AUTHOR]

Summary Leg Ulcer (LU) pathophysiology is still not well understood in sickle cell anaemia (SCA). We hypothesised that SCA patients with LU would be characterised by lower microvascular reactivity. The aim of the present study was to compare the microcirculatory function (transcutaneous oxygen pressure (TcPO2) on the foot and laser Doppler flowmetry on the arm) and several blood biological parameters between nine SCA patients with active LU (LU+) and 56 SCA patients with no positive history of LU (LU−). We also tested the effects of plasma from LU+ and LU− patients on endothelial cell activation. We observed a reduction of the TcPO2 in LU+ compared to LU− patients. In addition, LU+ patients exhibited lower cutaneous microvascular vasodilatory capacity in response to acetylcholine, current and local heating compared to LU− patients. Inflammation and endothelial cell activation in response to plasma did not differ between the two groups. Among the nine patients from the LU+ group, eight were followed and six achieved healing in 4.4 ± 2.5 months. Among thus achieving healing, microvascular vasodilatory capacity in response to acetylcholine, current and local heating and TcPO2 improved after healing. In conclusion, microcirculatory function is impaired in patients with LU, and improves with healing. [ABSTRACT FROM AUTHOR]

Background: Fibroblast cells have the ability to improve skin conditions through regenerative medicine and cell-based therapies. The purpose of this scoping review is to assess the contribution of fibroblast cells to skin homeostasis and extracellular matrix deposition in clinical trials involving skin disorders and cosmetic applications. Methods: Using targeted search terms, published publications from January 2000 to August 2023 that addressed fibroblast uses in clinical trials of skin conditions were obtained from bibliographic databases like PubMed, Scopus, and Web of Science (WoS). Precise inclusion and exclusion criteria were used during the screening process. The potential benefits of induction treatment with fibroblasts lead to the choosing of clinical trials for this kind of treatment. Results: Out of the 820 published ppapers initially identified, only 35 studies fulfilled our meticulous eligibility criteria after careful screening. To ensure clarity, we methodically eliminated any duplicate or irrelevant published papers, thereby offering a transparent account of our selection process. Conclusion: This study highlights the advantages of fibroblast therapy in treating skin conditions such as diabetic foot, venous leg ulcers, and cosmetic reasons. Fibroblasts possess remarkable regenerating capabilities, making dermal fibroblast therapy crucial in cell-based and skin regenerative treatments. Nevertheless, additional research is required for more disorders and cosmetic applications. [ABSTRACT FROM AUTHOR]

Chronic non-healing wounds are characterized by persistent inflammation, excessive matrix-degrading proteolytic activity and compromised extracellular matrix (ECM) synthesis. Previous studies showed that S100A8/A9 are strongly dysregulated in delayed wound healing and impair the proper function of immune cells. Here, we demonstrate an unrecognized pathological function of S100A9 overexpression in wounds with impaired healing that directly affects ECM functions in fibroblasts. S100A9 was analyzed in two different mouse models mimicking the features of the two most prominent types of non-healing wounds in humans. Db/db mice were used as a model for diabetes-associated impaired wound healing. Iron-overloaded mice were used to mimic the conditions of impaired wound healing in chronic venous leg ulcers. The skin wounds of both mouse models are characterized by delayed wound closure, high and sustained expression of pro-inflammatory mediators and a substantially decreased ECM deposition, all together the hallmarks of non-healing wounds in humans. The wounds of both mouse models also present a solid and prolonged expression of S100A8 and S100A9 that coincides with a compromised ECM deposition and that was confirmed in chronic wounds in humans. Mechanistically, we reveal that S100A9 directly affects ECM deposition by shifting the balance of expression of ECM proteins and ECM degrading enzymes in fibroblasts via toll-like-receptor 4-dependent signaling. Consequently, blocking S100A9 during delayed wound healing in db/db mice restores fibroblast ECM functions eliciting increased matrix deposition. Our data indicate that the dysregulation of S100A9 directly contributes to a compromised ECM deposition in chronic wounds and further suggests S100A9 as a promising therapeutic target to improve tissue repair in chronic wounds. [ABSTRACT FROM AUTHOR]

Objective: This case series examines the use of a multimodal wound matrix (MWM) trialled in a selection of clinical practice settings and on a variety of hard-to-heal wounds. The objective was to evaluate the effects of MWM and its performance in managing such wounds, regardless of clinical setting and ulcer type. Method: Treatment of the MWM was conducted by independent wound care practitioners on wounds that were of >4 weeks duration. Treatment was once a week. Assessment was taken after four weeks and at week 12 of the study to assess percentage area reduction (PAR) compared to baseline measurements taken at the first treatment visit. Complete (100%) re-epithelialisation was also recorded. Results: A total of 63 wounds were treated with MWM, and ulcer types were grouped as: diabetic foot ulcers (n=21); venous leg ulcers (n=18); pressure injuries (n=10); and others (n=14). Of the wounds, 78% had 100% re-epithelialisation, with an average PAR of 57% at four weeks and 86% at 12 weeks. The average time to resolution for those wounds that closed was 7.9 weeks. Conclusion: Results from this series of independent case studies support the application of MWM to potentially benefit healing in hard-to-heal wounds of different aetiologies of any duration and in a variety of clinical settings. [ABSTRACT FROM AUTHOR]

Objectives: This systematic review aimed to assess the efficacy of Leukocyte- and Platelet-Rich Fibrin (L-PRF) for the treatment of vascular leg ulcers. Method: Following PRISMA guidelines, a literature search was done for studies where L-PRF was used to treat vascular leg ulcers. Results: Among six included articles, a total of 76 venous leg ulcers were treated with L-PRF. None of the studies included ulcers of arterial or lymphatic origin. Fifty-seven (75.0%) of the venous ulcers completely healed at end of follow-up. Mean time to complete healing was 6.7 weeks (SD = 5.0). All non-healed ulcers showed an important reduction in wound area. No adverse effects related to L-PRF therapy were reported. Conclusions: The results suggest that L-PRF could be a safe, simple to use and effective therapeutic option for the treatment of venous leg ulcers, however, caution is advised as the results are based on small sample sizes. [ABSTRACT FROM AUTHOR]

Cytokines are commonly deregulated in venous leg ulcers. We have investigated cytokine stability by incubating sterile‐filtered wound fluids from chronic venous leg ulcers in vitro. Incubation of wound fluids for 24 h at 37°C decreased IL‐1β levels by 88% and TNF‐α levels by 64%. IL‐1β was degraded by serine proteinases and metalloproteinases while the mechanism for reduced TNF‐α remains elusive. The levels of the other peptides did not change significantly (p > 0.05). Normal human dermal fibroblasts exposed to five of the six wound fluids showed increased proliferation with the length of prior incubation using an assay optimised for evaluation of wound fluid bioactivity. Exogenous IL‐1β and TNF‐α unexpectedly increased (p < 0.001) cell proliferation at concentrations that were measured in the wound fluids. In conclusion, the stability of the eight investigated cytokines in wound fluids differed and presumably the loss of detrimental factors, unlikely IL‐1β or TNF‐α, resulted in increased fibroblast proliferation. [ABSTRACT FROM AUTHOR]

Objective: Multicomponent bandages (MCBs) are recommended by the French Authority for Health (Haute Autorité de Santé) as first-line treatment for venous leg ulcers (VLUs). A first analysis of the data collected from the French administrative healthcare database (Système National des Données de Santé (SNDS)) on 25,255 patients with a VLU supported superiority of MCBs versus short stretch bandages when considering the healing outcomes and costs associated with closure of these wounds. The aim of this study was to assess how beneficial the primary dressing (technology lipido-colloid nano-oligosaccharide factor (TLC NOSF) or control dressing group (CDG)) could be, when used in combination with MCBs in the treatment of VLUs. Method: Data from the SNDS were collected for patients meeting the following inclusion criteria: treatment for a VLU with MCBs and with the same dressing type (TLC-NOSF or CDG) during the whole treatment period. Healing outcomes were documented on the global cohorts and propensity score-matched cohorts. The mean healthcare cost and the ecological impact were calculated for those patients healed within the study period. Results: In total, 12,507 patients met the criteria for treatment with both MCBs and TLC-NOSF dressings (n=1134) versus MCBs and CDG (n=11,373); with 1134 and 2268 patients per group following propensity score matching. Healing outcomes were favourable for the TLC-NOSF group in the global cohort and were enhanced in the propensity score-matched cohorts. At every point of the analysis, the adjusted healing rates were significantly higher in the TLC-NOSF group than in the CDG group (p<0.001). In the propensity score-matched cohorts (n=3402), the healing rate at three months was 52% in the TLC-NOSF group versus 37% in the CDG group (p<0.001). The median healing time was 87 days versus 125.5 days in the TLC-NOSF and CDG groups, respectively (p<0.0001). TLC-NOSF dressings significantly reduced the average treatment cost per healed ulcer (€2099) by 23.7% compared with dressings without TLC-NOSF (€2751) (p<0.001), as well as the resources used. Conclusion: This SNDS analysis confirms, in the largest real-life study performed in VLU management, the superiority of the TLC-NOSF dressings versus those not impregnated with the NOSF compound. Better clinical outcomes associated with cost savings and a positive ecological impact support the combination of MCBs and TLC-NOSF dressings and should be considered as an optimal standard of care for the global management of VLUs. These outcomes reinforce the current positions of the international guidelines on the use of NOSF impregnated dressings (UrgoStart range; Laboratoires Urgo, France) in this pathology. [ABSTRACT FROM AUTHOR]

The normal physiology of wound healing is impacted by sickle cell disease (SCD). With SCD, the red blood cells are misshapen due to an abnormality of haemoglobin S. Sickle cell leg ulcers usually occur around the ankle and have very poor healing rates, with a detrimental impact on quality of life, particularly as they usually develop in patients who are in their 20s (Marti-Carvajal et al, 2021). This article looks at some of the treatment options for SCD and whether these treatments have an impact, either positively or to the detriment of leg ulcer/wound healing. There are multiple physiological factors influencing the development of sickle cell leg ulcers, and their [ABSTRACT FROM AUTHOR]

The treatment and care of patients suffering from Venous Leg Ulceration (VLU) constitutes a significant portion of wound care delivered in the UK. Despite the abundance of empirical evidence in this field, across the UK there is considerable variation in care. There is an underuse of evidence-based practice and overuse of ineffective practices. The accessibility of evidence-based care is key to enhancing healing rates. Service leaders are urged to promptly assess their existing clinical pathways and service provision to ensure that patient groups are able to access care that is supported by empirical data. Only through facilitating such access can unwarranted variations in care be reduced, resulting in enhanced healing rates, decreased risk of recurrence and, ultimately, an improved quality of life for patients [ABSTRACT FROM AUTHOR]

Following the evaluation of leg ulcer services in one NHS Trust, it was identified that staff did not perceive lower limb wound care as a priority. Vascular assessments were repeatedly deferred, and follow-up compression visits became irregular. The team had limited capacity due to job vacancies, maternity leave and long-term sickness, leading to practitioners working approximately 300 hours extra per month. A solution was required to allow effective skill mix use and to improve patient care while improving wound healing rates. This paper presents a 6-month quality improvement programme (QiP) that was introduced within the Trust to improve the referral process for people with leg ulcers by promoting the effective use of staff time, reducing excessive workloads and implementing the effective use of compression hosiery, improving clinical outcomes for patients. Evaluation of the QiP demonstrated an improvement in consistency and continuity of care of the lower limb, aligning with the Trust's 5-year strategy plan to reduce the risk of lower limb amputations. Wound healing rates improved and facilitated the timely identification of potential vascular issues, leading to appropriate referrals. An evaluation of staff time highlighted team savings of 15,840 minutes/264 hours/35.2 days of nursing time per month, equating to an average financial saving of £5,944.75 in nursing time and £1,066 in dressings per month. [ABSTRACT FROM AUTHOR]

The article focuses on the significant wound care crisis and its economic and personal costs. Topics include the substantial annual expenditure on wound management, the crucial role of General Practice Nurses (GPNs) in preventing and treating venous leg ulcers, and the effectiveness of compression therapy as a key treatment strategy.

The transforming powder dressing (Altrazeal®, Uluru Inc, Addison, TX, USA) is simple to use, painless to apply and has a wear time of up to 30 days. This study aims to review the current literature to elucidate the impact of transforming powder dressing on healing, pain management and overall patient outcomes. We conducted a systematic review following Preferred Reporting Items of Systematic Reviews and Meta‐Analyses guidelines. Data including study characteristics, patient demographics and wound outcomes were extracted. Our systematic review included 26 articles (n = 175). Of these articles, 13 (50%) were case reports, 10 (38.5%) were case series, 2 (7.7%) were randomised controlled trials and 1 (3.8%) was a cohort study. Wound types included venous ulcer (23.9%), pressure sore (19.7%), burn (15.5%), skin graft (13.4%), diabetic foot ulcer (4.2%), Mohs defect (3.5%) and other (19.6%). Complete re‐epithelialization occurred in 90.1% of the wounds. A total of 19 studies (73%) discussed pain, each of which reported reduced pain with the use of transforming powder dressing. The evaluated studies collectively suggest that transforming powder dressing offers a promising re‐epithelialization rate and analgesic effect across various wound types. [ABSTRACT FROM AUTHOR]

The standard treatment for patients with confirmed Venous Leg Ulcers (VLUs) is compression therapy to improve the function of the calf muscle pump. There is a significant cohort of patients who are unable to tolerate optimal compression therapy or indeed any level of compression therapy. In addition, there is a cohort of patients who can tolerate compression whose ulcers show little or no evidence of healing. There is a need for ways to further improve calf muscle pump function and to improve venous ulcer healing in these patients. Published data were reviewed on the use of Muscle Pump Activation (MPA) using common peroneal nerve neuromuscular electrical stimulation (NMES) to improve calf muscle pump function. There is physiological evidence that MPA can improve calf muscle pump function and venous return in both control subjects and in patients with venous disease. The use of MPA has also been shown to improve venous flow volume and venous flow velocity on ultrasound scanning in patients with venous disease. MPA has been shown to improve microcirculation in the skin using Laser Doppler and laser Doppler Speckle Contrast Imaging, in both normal subjects as well as in patients with venous disease and VLU. A recent randomized controlled trial of MPA plus compression therapy compared with compression therapy alone, found significantly faster rates of healing with the use of MPA in addition to compression therapy. There are indications for the use of MPA as an adjunctive treatment to enhance calf muscle pump function in patients with VLU:who cannot tolerate compression therapywho can only tolerate suboptimal, low‐level compressionwhose ulcer healing remains slow or stalled with optimal compression. [ABSTRACT FROM AUTHOR]

Background: Venous leg ulcers affect 1.5% of the UK adult population. Leg ulcers are painful, can be malodourous and are associated with poor quality of life. Leg ulcers are predominantly cared for by nurses in the community. Frequently, patients receive suboptimal treatment through unwanted variations in care and simple ulcers deteriorate to become hard‐to‐heal wounds. It is important to understand the current UK system of care and how nurses and patients navigate through it. Aim: The aim of this paper was to understand how, when, for whom and in what context leg ulcers are cared for in the United Kingdom and specifically, the current system of care, the nurses' role and the patients' experience in this system of care. Design: A realist synthesis of the literature was undertaken, reported following the RAMESES publication standards: Realist syntheses. Data Sources: An iterative literature search was conducted across three recognized health collections from January 2010 to January 2022 that included descriptive studies as well as primary research. Results: 73 papers were included. Conclusion: In the absence of UK national guidance that recommends how leg ulcer care is organized and delivered, care is commissioned locally, with variable outcomes. Patients with venous leg ulcers would like to be looked after by knowledgeable, skilled and confident nurses, in well‐equipped and staffed clinics; nurses who have the ability to make clinical judgements to alter their treatment when necessary and are empowered to refer to specialist centres when further support is required. Implications for the Profession and/or Patient Care: This synthesis offers guidance to commissioners and providers to change how leg ulcer care is organized. Patient or Public Contribution: The views of a patient and public group was sought at each stage of the synthesis. [ABSTRACT FROM AUTHOR]

The article discusses the significant clinical and socioeconomic burden of venous leg ulcers (VLUs), the most severe form of chronic venous disease, which impacts patients' quality of life and strains healthcare resources. Topics include the recommended management strategies for VLUs, emphasizing wound care, compression therapy, and the treatment of venous insufficiency; the importance of proper assessment and timely referrals for optimal healing.

Objective: This work explores concurrent optical and magnetic stimulation (COMS) effects on hard-to-heal wounds in real-world settings. Method: In this case series, participants received COMS 1–3 times per week for up to 12 weeks alongside standard wound care. Results: A total of 27 patients (18 female and nine male) were included. Mean age was 72 years. Participants' wounds that were unresponsive to standard wound care included: venous leg ulcers (VLUs, n=13); mixed leg ulcers (MLUs, n=4); diabetic foot ulcers (DFUs, n=1); pressure ulcers (PUs, n=5); and traumatic wounds (TWs, n=4). On average, COMS was applied twice a week, resulting in an overall mean wound area reduction of 69%. In 24 participants, COMS was used primarily to achieve wound closure by the end of the 12-week period, of which: 12 were classified as complete wound closure (50%; VLUs=8, PUs=3 and TW=1); four as likely-to-heal (17%; VLUs=2 and MLUs=2); four as 'improved' (17%; MLU=1, DFU=1 and TWs=2); and four as 'non-responding' (17%; VLUs=3 and MLU=1). The best results were achieved in PUs and VLUs (respectively 100% and 62% categorised as completely healed). When used in participants where its purpose was other than that of achieving wound closure, COMS was successfully used to debride two PUs, and for wound bed preparation in one TW. Conclusion: In this case series, COMS showed positive effects and appeared to be beneficial in healing different types of hard-to-heal wounds in community health and homecare settings. Novel COMS therapy aspects emerged: (1) positive outcomes for PU and VLU treatment; (2) COMS as a potential debridement tool when sharp debridement is unfeasible; and (3) COMS as a promising method to prepare wound beds for subsequent skin grafting or skin replacement procedures. [ABSTRACT FROM AUTHOR]

Calciphylaxis is a rare but highly disabling disease, occurring both in chronic kidney disease (CKD) with renal replacement therapy (RRT) and in normal renal function. Given the frequent coexistence of atrial fibrillation (AF) and CKD, anticoagulation is often required. Warfarin, as a promoter of vascular calcification, is frequently reported as a triggering factor of calciphylaxis. Here, we present the case of a 71-year old male patient with a history of AF and a previous ischaemic stroke, on RRT for three years and warfarin therapy. The patient presented with two painful necrotic skin ulcers over the right leg and a skin biopsy confirmed calciphylaxis. After discontinuation of warfarin, the lesions completely healed with sodium thiosulfate intravenous infusion and local wound treatment. A literature search was performed up to 1 September 2022 through PubMed. The following terms were searched in different combinations: 'calciphylaxis'; 'VKA' [vitamin K antagonist]; 'warfarin'; 'haemodialysis'; 'end-stage renal disease'; and 'ulcer'. In our opinion, in patients requiring anticoagulant therapy, the introduction or continuation of vitamin K antagonists (VKAs) should be carefully balanced when calciphylaxis develops, and other options, such as enoxaparin or apixaban, should be considered. Clinical decisions for patients requiring haemodialysis and requiring anticoagulant therapy should take into account the possible risk of warfarin-induced calciphylaxis. Further studies are needed to clarify the safety, tolerability profile and outcomes of each currently available treatment in this patient population. [ABSTRACT FROM AUTHOR]

Objective: The aim was to evaluate the effectiveness of a marine omega fatty acid-containing multimodal wound matrix (MWM) in reducing bacterial contamination and supporting wound area reduction (WAR) in patients with hard-to-heal wounds of varying aetiologies. Method: A prospective, single-site, pilot case series of patients with hard-to-heal wounds. All wounds were considered non-healing prior to inclusion as they had failed to achieve at least 50% WAR after at least four weeks of standard of care (SoC) treatments. Patients were seen once weekly for wound assessments, matrix application and dressing changes. Baseline and weekly fluorescence images, standard wound images and wound measurements were obtained. Results: A total of three patients, two with venous leg ulcers (VLUs) and one with a diabetic foot ulcer (DFU) were enrolled in this pilot study. The mean baseline wound age prior to study enrolment was 24 weeks, with a mean baseline wound size of 8.61cm2. The two VLUs went on to complete closure. The DFU displayed a total WAR of 53% by six weeks, when the patient was lost to follow-up due to a geographical relocation. The mean percentage area reduction of all wounds combined was 82% upon study completion. Conclusion: The use of MWM proved to be effective and safe in this patient cohort. The wounds included in this case series failed to enter a healing trajectory with SoC wound therapies. The MWM supported wound closure and reduced bacterial loads in this patient cohort. [ABSTRACT FROM AUTHOR]

Background: In general practice, venous ulcers (stasis ulcers) are the most common and recurrent leg ulcers. Ignorance of it can have a severe detrimental effect on one's quality of life, cause gangrene, and even the limb amputation. Venous ulcers are the most dangerous and disabling side effect of chronic venous insufficiency. Leech therapy seems to be effective for the treatment of varicose ulcers due to its salivary secretions which it injects during bloodsucking. The saliva of leeches contains certain biochemical with vaso-dilating, anticoagulant, anesthetic, thrombolytic, antibiotic, analgesic, and anti-inflammatory properties. As a result, Irsal-e-Alaq (Hirudotherapy), one of the Unani regimens, can effectively control it. Objective: The purpose of this case report is to provide insight into the effects of Irsal-e-Alaq (Hirudotherapy) on venous ulcers. Intervention: A 60-year-old male has a complaintof ulceration in his left lower leg near the medial malleolus with swelling, pain, discharge, and darkening of the skin of the left lower limb. Four leeches were applied once every week for 2 months. Efficacy of leech therapy was assessed on every 15th day by pain /leg discomfort on 4 point scale ranging from 0-3, limb girth at calf, ankle & foot, pigmentation color on 4 point scale, pigmentation area, pain in ulcer on 4 point scale from 0-3, ulcer depth, PUSH Score. Hb% was assessed every 15th day to check anemia, colour flow Doppler was done to assess any change in vein anatomy. Result: In this case report, the ulcers were completely healed, and also showed remarkable improvement in other variables. Conclusion: Irsal-e-Alaq has been proven beneficial in treating venous ulcers and enhancing patient’s quality of life. [ABSTRACT FROM AUTHOR]

Chronic ulcer patients form a heterogenous group of patients with various medical backgrounds. Cost‐effective targeted treatment necessitates more knowledge about specific features related to different subgroups of ulcer patients. Hence, this study aimed to characterize ulcer patients according to gender and ulcer aetiology. A total of 946 consecutively recorded chronic ulcer patients in the Tampere Wound Registry (TWR) were included and data were gathered from the TWR and patient medical records. Comparisons were made between males and females and patients with venous‐, arterial or mixed‐, diabetic foot‐, pressure‐ and atypical ulcers. Male patients were found to have diabetes, hypercholesterolemia and obesity significantly more often than females (59.2% vs. 39.6%; p < 0.001, 46.5% vs. 33.3%; p = 0.001, 42.7% vs. 35.9%; p = 0.017 respectively), whereas autoimmune diseases were more common among females (30.6% vs. 15.6%; p < 0.001). Recurrence of ulcers was most common among patients with venous ulcers (p < 0.001) and multimorbidity among those with diabetic foot ulcers (p < 0.001). To conclude, males with chronic ulcers would benefit particularly from lifestyle advice, multidisciplinary treatment should be targeted specifically at those with diabetic and arterial or mixed ulcers and preventive measures at those with venous ulcers. [ABSTRACT FROM AUTHOR]

A chronic wound is one that fails to progress through a normal timely sequence of repair, or in which the repair process fails to restore anatomic and functional integrity after 3 months. The most common chronic wounds include venous, ischaemic and mixed leg ulcers, diabetic foot ulcers and pressure injuries. Chronic wounds place immense physical and psychosocial burden on patients and exact heavy costs for healthcare systems, with many patients continuing to live with chronic wounds even after all management options have been exhausted. The muscle pump activator (MPA) device can be used to bridge this therapeutic gap. By stimulating the common peroneal nerve to activate venous muscle pump of the leg and foot, the MPA device increases blood flow to the lower leg and foot to improve conditions for healing. Currently, evidence in the literature exist to show that the MPA device improves wound outcomes over standard compression therapy, decreases edema and increases wound healing rates. In this review, we also present a series of chronic wound patients treated with the MPA device in multicentre clinics to demonstrate the ability of the MPA device to improve wound outcomes, reduce pain and edema and improve patient quality of life. [ABSTRACT FROM AUTHOR]

The Wound Healing Society guidelines for the treatment of arterial insufficiency ulcers were originally published in 2006, with the last update in 2014. These guidelines provided recommendations, along with their respective levels of evidence, on seven categories: diagnosis, surgery, infection control, wound bed preparation, dressings, adjuvant therapy and long‐term maintenance. Over the last 9 years, additional literature regarding these aspects of arterial ulcer management has been published. An advisory panel comprised of academicians, clinicians and researchers was chosen to update the 2014 guidelines. Members included vascular surgeons, internists, plastic surgeons, anaesthesiologists, emergency medicine physicians and dermatologists, all with expertise in wound healing. The goal of this article is to evaluate relevant new findings upon which an updated version of the guidelines will be based. [ABSTRACT FROM AUTHOR]

Traumatic arteriovenous fistula (AVF) is not a common disorder, and dermatological signs and heart failure caused by AVF are rarely reported. We present the case of a 55-year-old woman who was referred for congestive heart failure symptoms. Echocardiography revealed preserved left ventricular ejection fraction. Due to edema of the right leg with a long-standing leg ulcer and palpable femoral thrill, duplex ultrasonography was performed. It showed an AVF between the right superficial femoral artery (SFA) and the right femoral vein (FV). The patient recalled a 32-year-old gunshot injury that was not medically treated. After the diagnosis of AVF she was referred to a surgeon for an AVF ligation, with subsequent resolution of her symptoms. The differential diagnosis of leg ulcer with leg edema should include the possibility of AVF as a cause. [ABSTRACT FROM AUTHOR]

Summary: Patients with sickle cell disease (SCD) often experience painful vaso‐occlusive crises and chronic haemolytic anaemia, as well as various acute and chronic complications, such as leg ulcers. Leg ulcers are characterized by their unpredictability, debilitating pain and prolonged healing process. The pathophysiology of SCD leg ulcers is not well defined. Known risk factors include male gender, poor social conditions, malnutrition and a lack of compression therapy when oedema occurs. Leg ulcers typically start with spontaneous pain, followed by induration, hyperpigmentation, blister formation and destruction of the epidermis. SCD is characterized by chronic haemolysis, increased oxidative stress and decreased nitric oxide bioavailability, which promote ischaemia and inflammation and consequently impair vascular function in the skin. This cutaneous vasculopathy, coupled with venostasis around the ankle, creates an ideal environment for local vaso‐occlusive crises, which can result in the development of leg ulcers that resemble arterial ulcers. Following the development of the ulcer, healing is hindered as a result of factors commonly observed in venous ulceration, including venous insufficiency, oedema and impaired angiogenesis. All of these factors are modulated by genetic factors. However, our current understanding of these genetic factors remains limited and does not yet enable us to accurately predict ulceration susceptibility. [ABSTRACT FROM AUTHOR]

BACKGROUND As a chronic disease, venous leg ulcers can be treated in a number of ways. One of the more recent techniques is platelet-rich fibrin (PRF), which improves wound healing by containing fibroblast growth factor (GF), vascular endothelial GF, and platelet-derived GF. The potential of platelet-rich fibrin to promote healing in patients with lower extremity ulcers that do not heal over time was evaluated. AIM To determine the efficacy of PRF for management in chronic non healing ulcers of lower limb. MATERIALS AND METHODS Preliminary data were obtained from this prospective comparative study.25 cases were treated with PRF and 25 controls were treated with saline dressings. Age groups taken into consideration from 18 to 60 years. Initial ulcer size was less than 9 cm in longest dimension. Each PRF was placed and secondary dressing done and removed after 1 week. RESULTS Patients were followed Percentage reduction in the wound size is 84.55% in patients treated with PRF and 14.26% in patients with saline dressings weekly for 6 weeks. CONCLUSION PRF shows significant result for healing of chronic ulcers. [ABSTRACT FROM AUTHOR]

Objective: In previous studies, venous ulcers (VUs) have been found to occur more often in patients with lower socioeconomic status. The aim of this study was to explore if socioeconomic factors influence the delay of referral to a vascular service or the time to healing after superficial venous intervention. Method: In this prospective study, patients answered a questionnaire about the duration and recurrence of their VU, comorbidities, body mass index (BMI), smoking, alcohol, social and physical activities, ambulatory status, education, marital status, housing, perceived economic status and dependence on home care. Postoperative complications, VU healing and recurrence were noted one year after superficial venous intervention. Results: A total of 63 patients were included in this study (30 females and 33 males), with a mean age of 71.2 years (range: 37–92 years). Duration of the present VU in patients was: <3 months in 48%; 3–6 months in 27%; 6–12 months in 11%; and >12 months in 14%. Risk factors for delayed referral were recurrent VU (odds ratio (OR): 4.92; p=0.021); walking impairment (OR: 5.43; p=0.009) and dependence on home care (OR: 4.89: p=0.039) in a univariable analysis. The latter was the only significant finding in a multivariable analysis with socioeconomic risk factor (OR: 4.89; p=0.035). In 85% of patients, their VU healed without recurrence during one year follow-up. Healing took longer if the patients: were of older age (p=0.033); had a normal BMI (independent samples t-test, p=0.028); had a recurrent VU (OR: 5.00; p=0.049); or walking impairment (Fishers exact test, OR: 9.14; p=0.008), but no significant socioeconomic risk factors were found. Conclusion: In this study, socioeconomic factors were not important risk factors for delayed referral of VU patients to a vascular service or prolonged healing time after superficial venous intervention. Declaration of interest: This work was supported by the Scandinavian Research Foundation for Varicose Veins and other Venous Diseases (SFÅV) and by ALF funding from Region Örebro County. The authors have no conflicts of interest to declare. [ABSTRACT FROM AUTHOR]

Summary: This S2k guideline on venous leg ulcers was created on the initiative and under the leadership of the German Society of Phlebology and Lymphology (DGPL). The guideline group also consisted of representatives from the German Society for Phlebology and Lymphology, German Dermatological Society, German Society for General Medicine, German Society for Angiology, German Society for Vascular Surgery and Vascular Medicine, German Society for Surgery, German Society for Dermatosurgery, German Society for Wound Healing and Wound Treatment, Professional Association of Phlebologists and Lymphologists and Initiative Chronische Wunden. The aim of this guideline is to combine the different approaches and levels of knowledge of the respective professional groups on the basis of consensus, so that a basic concept for the best possible treatment of patients with venous leg ulcers can be provided. A total of 70 specific recommendations were formulated and agreed upon, divided into the subject areas of diagnostics, therapy, prevention of recurrences, and everyday challenges. The guideline thus reflects the current state of scientific knowledge and is intended to be widely used as the best available document for the treatment of patients with venous leg ulcers in everyday clinical practice. [ABSTRACT FROM AUTHOR]

Venous leg ulcers (VLUs) are hard-to-heal wounds and are prone to microbial colonization. Innovative and improved therapies are thus required to resolve local infection and enhance the wound healing process. The objective of this study was to evaluate the effectiveness of medical-grade honey (MGH) for the treatment of clinically infected and non-healing VLUs. This prospective case series included nine patients with an average age of 83.4 years (range: 75–91 years) with a total of eleven VLUs, previously ineffectively treated with various products. Major risk factors for the appearance of VLUs were chronic venous insufficiency, advanced age, multiple comorbidities (particularly cardiovascular diseases), and impaired mobility. All wounds presented with local signs of infection. Upon presentation, treatment was commenced with a range of MGH-based products (L-Mesitran®). Clinical signs of infection were eliminated by MGH after 2.2 weeks on average (range: 1–4 weeks), and wounds were completely healed after 7 weeks on average (range: 3–18 weeks). No further complications or recurrences were observed. MGH has a broad-spectrum antimicrobial activity and promotes rapid healing, thus improving patients' quality of life. Moreover, MGH-based products are safe, easy to use, cost-effective, and can effectively treat VLUs alone or in combination with standard-of-care therapies. [ABSTRACT FROM AUTHOR]

The uncertainty concerning the physiological effects of compression bandaging on the peripheral blood flow is a challenge for healthcare professionals. The main objective was to determine the haemodynamic impact on the distal posterior tibial artery after the application of a high‐compression leg multicomponent bandaging system using 4D flow magnetic resonance imaging. Leg dominance disparities of the posterior tibial artery before and after the application of the compressive bandage were also analysed. Twenty‐eight healthy female volunteers were recruited (mean: 25.71, standard deviation: 4.74 years old) through a non‐probability convenience sampling. The 4D flow magnetic resonance imaging of the distal tibial posterior artery was performed in all participants, first under standard resting conditions and after the application of a compression bandage in the leg. When the strong compressive bandage was applied, the area of the assessed artery decreased by 14.2%, whilst the average speed increased by 19.6% and the flow rate increased by 184.8%. There were differences between the haemodynamic parameters of both legs according to dominance, being statistically significantly lower in the dominant leg. The application of strong compressive bandaging significantly increases the arterial flow and mean velocity in the distal segment of the posterior tibial artery, in healthy volunteers by 4D flow magnetic resonance imaging. In this study, leg dominance influenced some of the haemodynamic parameters. According to the results, leg compression bandages cannot be contraindicated in vascular ulcers with arterial compromise. [ABSTRACT FROM AUTHOR]

The annual cost to the NHS of managing 3.8 million patients with a wound was estimated in 2020 to be £8.3 billion, of which £5.6 billion was spent on the 30% of wounds that did not heal and £2.7 billion on the 70% of wounds that healed (Guest, 2020). One of the main symptoms associated with chronic 'hard-to-heal' wounds is the production of excess exudate (Atkin et al, 2019). This is due to a prolonged chronic inflammatory response stimulated by a physiological cause. This article describes what exudate is and its importance in the wound healing process, highlighting the consequences of too little or excessive wound exudate associated with any wound. The article goes on to describe a case series observational study involving a range of patients (n=47; 33 male/14 female), aged between 33 and 91 years (mean 67.4 years), with a variety of acute (n=11) and chronic exuding wounds (n=44). In total, 55 wounds of various aetiologies were managed with DryMax Super (a dressing whose design includes superabsorbent polymers) in order to evaluate and report on the absorption and fluid-handling properties of the product. [ABSTRACT FROM AUTHOR]

Background: Chronic leg ulcers present a global challenge in healthcare, necessitating precise wound measurement for effective treatment evaluation. This study is the first to validate the "split-wound design" approach for wound studies using objective measures. We further improved this relatively new approach and combined it with a semi-automated wound measurement algorithm. Method: The algorithm is capable of plotting an objective halving line that is calculated by splitting the bounding box of the wound surface along the longest side. To evaluate this algorithm, we compared the accuracy of the subjective wound halving of manual operators of different backgrounds with the algorithm-generated halving line and the ground truth, in two separate rounds. Results: The median absolute deviation (MAD) from the ground truth of the manual wound halving was 2% and 3% in the first and second round, respectively. On the other hand, the algorithm-generated halving line showed a significantly lower deviation from the ground truth (MAD = 0.3%, p < 0.001). Conclusions: The data suggest that this wound-halving algorithm is suitable and reliable for conducting wound studies. This innovative combination of a semi-automated algorithm paired with a unique study design offers several advantages, including reduced patient recruitment needs, accelerated study planning, and cost savings, thereby expediting evidence generation in the field of wound care. Our findings highlight a promising path forward for improving wound research and clinical practice. [ABSTRACT FROM AUTHOR]

Background: Chronic venous ulcers are prevalent, its incidence (1%) in the general population. Venous ulcers are quite a challenge for physicians to treat. Among the numerous pathological causes, venous hypertension remains the leading cause. This study aims to compare the safety, efficacy, short-term complications, factors affecting wound healing as well as pathological outcomes of ultrasound-guided foam sclerotherapy (UGFS) in conjunction with the four-layer compression bandage in the management of chronic venous ulcers. Methods: Retrospective analysis of a hundred patients with chronic venous ulcers treated between December 2018 and December 2021. Two groups were studied: the control group, which received conventional compression, and the study group, which underwent injection sclerotherapy and conventional compression. Punch skin biopsies were taken from both groups before and after treatment to compare the histological effects of the two methods. Results: Complete healing was achieved in 100% of the patients, with a shorter healing time in the study group (34.82 ± 4.7). Additionally, the degree of inflammation was significantly decreased but there was a higher local complication rate in the study group. Conclusions: UGFS in conjunction with the compression bandage showed superior clinical and pathological results but, risk of complication was increased. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To enhance your understanding of age-related skin changes and susceptibility to wounds in older age • To increase your awareness of the principles of wound assessment and management in older people • To recognise that wound healing is not always achievable or realistic in an older person. Age-related skin changes lead to increased susceptibility to skin damage and delayed wound healing, which is exacerbated by comorbidities such as cardiovascular disease and diabetes mellitus. In some cases, wound healing is not achievable or realistic and this needs to be reflected in the wound management plan. To improve outcomes and experience in older people presenting with wounds it is important to select wound management products that protect the wound bed and surrounding skin, minimise trauma, reduce symptoms and/or promote healing. This article explores how conducting holistic wound assessments, setting realistic treatment aims, and using wound management strategies tailored to each person’s needs and wishes can have a positive effect on older people’s quality of life. [ABSTRACT FROM AUTHOR]