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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]

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]

This descriptive, cross-sectional study aimed to identify whether having a chronic leg ulcer (CLU), in addition to diabetes, contributed to frailty in individuals ≥65 years old. It also explored the associations between frailty, pre-frailty and other factors. 125 participants aged ≥65 attending outpatient clinics in Ireland were categorised into three groups: (1) diabetes-only and no CLU, (2) CLU-only and no diabetes, and (3) diabetes and CLU. Frailty status was identified using the Groningen Frailty Indicator (GFI) and the Physical Frailty Phenotype (PFP). The mean age was 76.09 ± 7.31. Overall, 90 (72%) had diabetes, and 89 (71.2%) had CLU in the past 6 months. While 124 (99.2%) were frail according to the GFI, 122 (97.6%) were either physically frail (n = 40, 32%) or pre-frail (n = 82, 65.6%) based on the PFP. There was no difference between the three groups regarding general frailty status (p > 0.05). However, being aged ≥75, having CLU and having CLU in addition to diabetes were associated with frailty severity (p < 0.05). Slow gait, inability to go to the toilet and dress/undress independently were the common factors contributing to frailty. Age, comorbidities and CLU were associated with frailty severity. Incorporating multidimensional frailty screening into regular clinic visits for older adults with CLU is recommended., (© 2025 The Author(s). International Wound Journal published by Medicalhelplines.com Inc and John Wiley & Sons Ltd.)

This exploratory descriptive study aimed to describe characteristics and management of background pain related to chronic leg ulcers. A total of 121 participants were recruited from two wound care clinics using a consecutive sampling method. Data were obtained through screening interview, clinical examination, and questionnaires. The mean average background pain intensity was 4.5 (SD 2.56) (CI 95% 4.0‐5.0). Pain interfered mostly with general activity (mean 4.3), sleep (mean 4.1), and walking ability (mean 4.0) (0‐10 NRS). The most frequently reported descriptors of background pain were 'tender', 'stabbing', 'aching', and 'hot‐burning'. Most of the participants stated that the pain was intermittent. Less than 60% had analgesics prescribed specifically for ulcer related pain, and the respondents reported that pain management provided a mean pain relief of 45.9% (SD 33.9, range 0‐100). The findings indicate that ulcer related background pain is a significant problem that interferes with daily function, and that pain management in wound care is still inadequate. [ABSTRACT FROM AUTHOR]

Chronic leg ulcers are hard to treat and can be a burden, particularly in resource-limited settings where diagnosis is a challenge. Staphylococcus aureus is among the common bacteria isolated from chronic wounds with a great impact on wound healing, particularly in patients with co-morbidities. Antimicrobial resistance genes and virulence factors in Staphylococcus aureus isolates were assessed to support healthcare professionals to make better therapeutic choices, and importantly to curb the development and spread of antibiotic resistance. A cross-sectional study involved both inpatients and outpatients with chronic leg ulcers was conducted from August 2022 to April 2023 in 2 health facilities in Kilimanjaro region in Tanzania. Antimicrobial susceptibility testing was done using the disk diffusion method. Further, whole genome sequencing was performed to study the genotypic characteristics of the isolates. A total of 92 participants were recruited in which 9 participants were only positive for 10 Staphylococcus aureus isolates upon culture. Five STs among 9 isolates were identified. Most of them belonged to ST8 (44%), with 1 isolate does not belong to any ST. Additionally, 50% of the isolates were methicillin-resistant Staphylococcus aureus (MRSA). All S. aureus isolates had almost similar virulence factors such as hemolysin, proteases and evasions that promote toxin production, protease production and host immune evasion respectively. Moreover, all mecA positive S. aureus isolates were phenotypically susceptible to cefoxitin. Presence of mecA positive S. aureus isolates which are also phenotypically susceptible to cefoxitin implies the possibility of classifying MRSA as MSSA. This may result in the possible emergence of highly cefoxitin - resistant strains in health care and community settings when subsequently exposed to beta-lactam agents. Therefore, combination of whole genome sequencing and conventional methods is important in assessing bacterial resistance and virulence to improve management of patients. [ABSTRACT FROM AUTHOR]

Chronic leg ulcers adversely affect quality of life and are associated with a substantial economic burden. The congenital absence of the inferior vena cava (IVC) is a rare cause of these ulcers. This case report details a 52-year-old male patient from Kenya who had bilateral chronic leg ulcers. Despite undergoing venous stripping and contralateral ligation of perforators, his condition did not significantly improve. Further investigation revealed the absence of an IVC. His management included the use of compression devices, wound care, and wound coverage with skin grafting. Following this treatment, his ulcers healed satisfactorily, and he continues to use compression devices. The absence of risk factors for common causes, bilateral presentation of the ulcer, and the presence of prominent veins on the anterior abdominal wall should prompt clinicians to consider an absent IVC. An appropriate management strategy for ulcers resulting from an absent IVC consists of wound care, the use of compression devices, and wound coverage. [ABSTRACT FROM AUTHOR]

Introduction Chronic wounds lead to devastating health and economic consequences for individuals and the healthcare system. These wounds do not heal within expected timeframes, often recur, and/or are complicated by underlying comorbidities. There is a significant need to identify and implement evidence-based practice in the prevention and management of chronic wounds in Australia to minimise the impact to persons and healthcare systems. Objectives This scoping review aims to identify (i) current research activity and outcomes in assessment, management and prevention of chronic wounds and (ii) gaps in chronic wound research relevant to Australia. Methods The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Review (PRISMAS-ScR) framework will be used to guide this scoping review. Searches will be conducted in Medline, Embase, CINAHL, Joanna Briggs Institute Library, Cochrane Library, APA PsycInfo databases, websites and publications of relevant professional organisations, and clinical trial registries for publications between 2010-2021. Two independent researchers will review the identified records based on the inclusion criteria and any conflicts will be resolved by a third researcher. This scoping review will include Australian original studies, international and national systematic review and evidence-based guidelines or consensus statements on the assessment, management or prevention of chronic wounds. [ABSTRACT FROM AUTHOR]

The overall goal of wound bed preparation (WBP) is to create an optimal wound healing environment and enhance the effectiveness of therapeutic measures (Falanga, 2000; Schultz et al, 2003). All WBP should be based on holistic patient assessment, utilising a systematic approach to evaluate and eliminate barriers to healing (Dowsett and Newton, 2005). Debridement is a key focus that needs to be considered in all wounds. [ABSTRACT FROM AUTHOR]

Objective Chronic leg ulcers (CLUs) present an economic burden to health care system and significant reductions in quality of life for those affected. Low-level laser therapies (LLLTs) can play a useful role in healing of CLUs. This study aimed to evaluate the efficacy of using LLLT in CLU healing, and we focused on the use of dermoscopy in healing progress follow-up of different types of CLUs regarding some features. Patients and methods This was a case–control study. It included 60 patients recruited from dermatological and vascular outpatient clinics and divided equally into two groups: study group and control group; in each group, there were 10 patients who had arterial ulcer, 10 patients who had diabetic ulcer, and 10 patients who had venous ulcer. The ulcers in the study group were treated by LLLT and the control group received conventional treatment. Pressure ulcer scale for healing and dermoscopic evaluation before and after treatment was done. Results There was a statistically significant difference before and after LLLT, which indicates the progress of healing. The pressure ulcer scale for healing score is decreased in patients who were treated with LLLT compared with patients treated with conventional treatment (P=0.002). Good improvement (≥75%) was seen regarding push healing ratio in the arterial group. Conclusion LLLT is safe, inexpensive, and effective and increases the healing progress of CLUs, which were detected with push score ratio and a novel use of dermoscope.

Abstract Background The physical, occupational, social and psychological impact of chronic leg ulcers (CLUs) on an individual is considerable. Wound-related pain (WRP), the most common symptom, is frequently reported as moderate to severe and mostly occurs at dressing change. WRP pain may not be alleviated by oral analgesics alone. Persistent poorly controlled leg ulcer pain can negatively impact wound healing and health-related quality of life (HRQoL). Methods A pilot, parallel group, non-blinded, randomised controlled trial was conducted in six procedure clinics located in a public community nursing service in New South Wales, Australia to evaluate eutectic mixture of local anaesthetics (EMLA®) on painful CLUs when used as a primary dressing. The primary objective was to assess feasibility by using pre-determined criteria: at least 80% recruitment rate, 80% retention rate and 80% adherence to the study protocol. Key eligibility criteria were that participants had a painful CLU no larger than 100 cm2, a numerical rating scale (NRS) wound-related pain intensity score equal to or greater than 4, low to moderate exudate, no contraindications to EMLA® and capacity to consent. One hundred and seven patients with painful CLUs were screened for eligibility; 56% (n = 60) were eligible and consented to participate in the study. Participants were randomly assigned to the intervention (n = 30) or control (n = 30) groups. The intervention group received a measured dose of the topical anaesthetic EMLA® 5% cream daily as a primary dressing for 4 weeks followed by usual wound management for a further 8 weeks. The control group received usual wound management. Participants and investigators were not blinded to the treatment. WRP was measured at every dressing change. Wound healing and HRQoL were measured at baseline, 4 and 12 weeks. Results Recruitment rate was lower than expected which likely meant patients were missed. Study retention rate was 90% (n = 54). Intervention fidelity was impacted by availability of resources and patient factors such as increased WRP. Conclusion This study identified that a larger randomised controlled trial investigating EMLA® applied as a primary dressing on painful chronic leg ulcers is feasible with modifications to the study protocol. Trial registration Australian New Zealand Clinical Trials Register: Registered 16 December, 2009

During wound healing, cells have a high rate of protein synthesis and many proteins need to be folded post‐translationally to function, which occurs in the endoplasmic reticulum (ER). In addition to proliferation, several cellular stress conditions, such as hypoxia, in the wound micro‐environment lead to the accumulation of unfolded or misfolded proteins in the ER, causing ER stress. Eukaryotic cells have a signalling system to manage ER stress called the unfolded protein response (UPR). Mild UPR activation has a beneficial homeostatic effect; however, excessive UPR induces cell death. Herein, we examined venous leg ulcer biopsies versus normal acute incisional wounds in age‐matched elderly subjects and found a large increase in ER stress markers. To study the underlying mechanism, we established several cell cultures from amputated legs from the elderly that showed inherent ER stress. While both keratinocytes and fibroblasts migration was impaired by ER stress, migration of elderly leg skin keratinocytes was markedly improved after treatment with the chemical chaperone and clinically established drug 4‐phenylbutyrate (4‐PBA) and demonstrated a reduction in ER stress markers. In a full‐thickness human skin wound healing model, 4‐PBA improved the reepithelialisation rate, which suggests it as a promising drug repurposing candidate for wound healing. [ABSTRACT FROM AUTHOR]

Bacterial colonisation in wounds delays healing, mandating regular bacterial removal through cleaning and debridement. Real‐time monitoring of the efficacy of mechanical debridement has recently become possible through fluorescence imaging. Red fluorescence, endogenously produced during bacterial metabolism, indicates regions contaminated with live bacteria (>104 CFU/g). In this prospective study, conventional and fluorescence photos were taken of 25 venous leg ulcers before and after mechanical debridement, without use of antiseptics. Images were digitally segmented into wound bed and the periwound regions (up to 1.5 cm outside bed) and pixel intensity of red fluorescence evaluated to compute bacterial area. Pre‐debridement, bacterial fluorescence comprised 10.4% of wound beds and larger percentages of the periwound area (~25%). Average bacterial reduction observed in the wound bed after a single mechanical debridement was 99.4% (p<0.001), yet periwound bacterial reduction was only 64.3%. On average, across bed and periwound, a single mechanical debridement left behind 29% of bacterial fluorescence positive tissue regions. Our results show the substantial effect that safe, inexpensive, mechanical debridement can have on bacterial load of venous ulcers without antiseptic use. Fluorescence imaging can localise bacterial colonised areas and showed persistent periwound bacteria post‐debridement. Fluorescence‐targeted debridement can be used quickly and easily in daily practice. [ABSTRACT FROM AUTHOR]

Aims and objectives: To validate the ability of factors to predict infection in adults with chronic leg ulcers over a 12‐week period. Background: Leg ulcers affect ~3% of older adults and are often hard to heal. Infection is a leading contributor for delayed healing, causing delayed wound healing, increased hospitalisation, increased healthcare costs and reduced patient quality of life. The importance of early identification of infection has been highlighted for decades, yet little is known about factors that are associated with increased risk of infection in this specific population. Design: A longitudinal, prospective observational study in a single centre. Methods: Between August 2017 and May 2018, a total of 65 adults with chronic leg ulcers were prospectively observed for a 12‐week period. Patients were recruited from an outpatient wound clinic at a tertiary hospital in Australia. Data were collected from recruitment (baseline) and each visit (weekly or fortnightly) up until 12 weeks. Descriptive statistics were calculated for all variables. A Cox proportional hazards regression model was used to identify predictive factors for infection. The TRIPOD guidelines for reporting were followed (See Data S1). Results: The sample consisted of 65 adults with chronic leg ulcers, and 9.2% of these had their ulcer infected at baseline. Two predictive factors, using walking aids and gout, were found to be significantly related to increased likelihood of developing infection within 12 weeks. Conclusion: The present study showed that patients who either used walking aids or were diagnosed with gout were at greater risk of infection compared to those without these factors. Relevance to clinical practice: These findings provide new information for clinicians in early identification of patients at risk of infection, and for patients in enhancing their awareness of their own risk. [ABSTRACT FROM AUTHOR]

Background: The prevalence of chronic wounds is predicted to increase within the aging populations in industrialized countries. Patients experience significant distress due to pain, wound secretions, and the resulting immobilization. As the number of wounds continues to rise, their adequate care becomes increasingly costly in terms of health care resources worldwide. eHealth support systems are being increasingly integrated into patient care. However, to date, no systematic analysis of such apps for chronic wounds has been published., Objective: The aims of this study were to systematically identify and subjectively assess publicly available German- or English-language mobile apps for patients with chronic wounds, with quality assessments performed by both patients and physicians., Methods: Two reviewers independently conducted a systematic search and assessment of German- or English-language mobile apps for patients with chronic wounds that were available in the Google Play Store and Apple App Store from April 2022 to May 2022. In total, 3 apps met the inclusion and exclusion criteria and were reviewed independently by 10 physicians using the German Mobile App Rating Scale (MARS) and the System Usability Scale (SUS). The app with the highest mean MARS score was subsequently reviewed by 11 patients with chronic wounds using the German user version of the MARS (uMARS) and the SUS. Additionally, Affinity for Technology Interaction (ATI) scale scores were collected from both patients and physicians., Results: This study assessed mobile apps for patients with chronic wounds that were selected from a pool of 118 identified apps. Of the 73 apps available in both app stores, 10 were patient oriented. After excluding apps with advertisements or costs, 3 apps were evaluated by 10 physicians. Mean MARS scores ranged from 2.64 (SD 0.65) to 3.88 (SD 0.65) out of 5, and mean SUS scores ranged from 50.75 (SD 27) to 80.5 (SD 17.7) out of 100. WUND APP received the highest mean MARS score (mean 3.88, SD 0.65 out of 5) among physicians. Hence, it was subsequently assessed by 11 patients and achieved a similar rating (uMARS score: mean 3.89, SD 0.4 out of 5). Technical affinity, as measured with the ATI scale, was slightly lower in patients (score: mean 3.62, SD 1.35 out of 6) compared to physicians (score: mean 3.88, SD 1.03 out 6)., Conclusions: The quality ratings from physicians and patients were comparable and indicated mediocre app quality. Technical affinity, as assessed by using the ATI scale, was slightly lower for patients. Adequate apps for patients with chronic wounds remain limited, emphasizing the need for improved app development to meet patient needs. The ATI scale proved valuable for assessing technical affinity among different user groups., (© Tassilo Dege, Bernadette Glatzel, Vanessa Borst, Franziska Grän, Simon Goller, Caroline Glatzel, Matthias Goebeler, Astrid Schmieder. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org).)

Chronic and infected leg ulcers (LUs) are painful, debilitating, resistant to antibiotics, and immensely reduce a patient’s quality of life. The purpose of our study was to demonstrate the efficacy of photodynamic therapy (PDT) for the treatment of infected chronic LUs. Patients were randomized into two experimental groups: the first group received 5-aminolevulinic acid photodynamic therapy (ALA-PDT) (10 patients), and the second group of 10 patients received local octenidine dihydrochloride (Octenilin gel) exposed to a placebo light source with an inserted filter that mimiced red light. In the PDT group, we used 20% ALA topically applied for 4 hrs and irradiation from a Diomed laser source with a wavelength of 630 nm at a fluency of 80 J/cm2. ALA-PDT was performed 10 times during a 14-day hospitalization in 10 patients of both sexes aged 40–85 years with chronic leg ulcers. Treatments were carried out at 3-week intervals for 3–5 cycles. At 8-month follow-up with the PDT group, complete remission (CR) was obtained in four patients (40%), partial response (>50% reduction in ulcer diameter) in four patients (40%), and no response in two patients (20%) who additionally developed deterioration of the local condition with swelling, erythema, and inflammation. To assess the degree of pain during the trials, we used a numeric rating scale (NRS). From the preliminary results obtained, we concluded that PDT can be used to treat leg ulcers as a minimally invasive and effective method with no serious side effects, although further studies on a larger group of patients with LUs are warranted.

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Due to recent advances in diagnostic studies such as Doppler, Plethysmography there has been considerable gain in the knowledge about anatomy, pathophysiology of chronic leg ulcers. Even though there are various techniques and procedures in the management of chronic leg ulcers since the recent past, but the management of leg ulcers still remains a study. The objective was to study leg ulcers and their surgical management. All Patients visiting the surgical outpatient department with lower limb ulcers were included in this study. These cases were examined in detail and investigated thoroughly. This study included patients with venous ulcers, arterial ulcers, diabetic ulcers, non-healing ulcers and other rare types. In our study of 81 patients with leg ulcers, diabetic ulcers were the most common accounting for 38.27% of the cases, whereas venous ulcers accounted for 24.69% and arterial accounted for 13.58% cases. In our study amputations were mostly done in diabetic patients accounting for 57.89% cases. The risk of lower extremity amputation is 15 to 46 times higher in diabetics than in persons who do not have diabetes mellitus. Early detection and appropriate treatment of these ulcers may prevent up to 85 percent of amputations.

This study aimed to develop advanced biomaterial polysaccharide based dressings to manage pain associated with infected chronic leg ulcers in older adults. Composite carrageenan (CARR) and hyaluronic acid (HA) dressings loaded with lidocaine (LID) and AgNPs were formulated as freeze-dried wafers and functionally characterized for porous microstructure (morphology), mechanical strength, moisture handling properties, swelling, adhesion and LID release. Antimicrobial activity of AgNPs was evaluated (turbidity assay) against Escherichia coli , Pseudomonas aeruginosa and Staphylococcus aureus whilst cell viability studies (MTT) was performed on normal adult human primary epidermal keratinocyte cells. The wafers were soft, flexible and elegant in appearance. HA affected the wafer structure by increasing the resistance to compression but still possessed a balance between toughness and flexibility to withstand normal stresses and prevent damage to newly formed skin tissue respectively. Water uptake was influenced by HA, whilst equilibrium water content and LID release were similar for all the formulations, showing controlled release up to 6 h. AgNPs loaded CARR/HA wafers were effective in inhibiting the growth of both Gram positive and Gram negative bacteria. MTT assay showed evidence that the AgNPs/LID loaded wafers did not interfere with cell viability and growth. CARR/HA wafers seem to be a promising system to simultaneously deliver LID and AgNPs, directly to infected chronic leg ulcers. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the effect of EMLA 5% cream applied to painful chronic leg ulcers (CLUs) as a primary dressing on wound healing and health-related quality of life (HRQoL). A pilot, parallel-group, nonblinded, randomized controlled trial was conducted in 6 community nursing procedure clinics in New South Wales, Australia. A total of 60 participants with painful CLUs of varied etiology were randomly assigned to the intervention (EMLA daily for 4 weeks as a primary dressing, followed by usual care) or usual care only. Wound size and HRQoL were measured at baseline, end of the intervention period (week 4), and week 12. At baseline, wound sizes were similar for both the intervention and control groups. During the intervention period, there was no significant difference in wound sizes between groups (intervention group: median (cm2) = 2.4, IQR = 1.3-12.7; control group: median (cm2) = 5.0, IQR = 2.5-9.9; P = .05). Mean HRQoL scores for all subscales at baseline and weeks 4 and 12 were similar between groups except for Wellbeing, which was significantly higher in the intervention group at the end of the 4-week intervention period (intervention group: mean = 52.41, SD = 24.50; control group: mean = 38.15, SD = 21.25; P = .03; d = 0.62). The trial findings suggest that daily applications of EMLA as a primary dressing do not inhibit wound healing and may improve patient well-being. Studies with larger samples are required to more comprehensively evaluate the impact of this treatment on wound healing and HRQoL. [ABSTRACT FROM AUTHOR]

Introduction. Martorell's syndrome (MS) is a rare disease associated with chronic progressive hypertension which complicates ulcer defects on the extremities. It requests individual approach to treatment with antihypertensive medications, which help to reduce pathogenesis of the ulceration development. Therefore the aim of this study was to find new treatment methods of this disease. Case presentation. A 83-year-old female Ukrainian patient presented with an ulcer on the right calf, which was extremely painful at night. After all examination it was diagnosed: stage 2 hypertension, high risk, Martorell's syndrome, right lower limb trophic ulcer of the hypertonic genesis. For the treatment of MS we used the combination therapy, which included tissue suturing on the whole area of the ulcer and auto-dermoplasty with PRP applications. After that was noted intense regenerative processes and recovery of the patient. Conclusions. Chronic leg ulcers are rarely caused by Martorell's syndrome. It requires the complex approach to the treatment under obligatory antihypertensive therapy with its further prolongation. The complex therapy improved by the platelet-rich auto plasma activates the therapeutic effect, which results in intensive healing of the ulcer and faster improvement in pain relief. The platelet-rich auto plasma may become an economic method of treatment the ulcers of any genesis. [ABSTRACT FROM AUTHOR]

Major advances have been made in the development of new therapies for chronic wounds. Fenzian™, an electrostimulation system ( ES), has been clinically used for a variety of conditions. The ES was recently tested in the Barbadian population for tolerability and acceptability by asthma patients, with encouraging results. Barbados has an estimated 170 people with diabetes having some form of lower-extremity amputation annually. Here, we describe a case series of 21 chronic ulcer patients with diabetes recruited as inpatients ( n = 10) and outpatients ( n = 11) in a pilot study to evaluate the feasibility and acceptability of ES in the Barbadian population. Results showed statistically significant improvement among those in the inpatient- versus outpatient-recruited group for wound perimeter ( P = 0·04), wound surface area ( P = 0·03) and wound volume ( P = 0·08). We also demonstrate that the improvement continued after cessation of ES treatment. Participants reported increased levels of pain at the end of treatment, and there was no statistically significant change in the reported quality of life. Our results showed greater improvements in reduction of ulcer size for participants from the inpatient- versus outpatient-recruited group. [ABSTRACT FROM AUTHOR]

Wound healing is an articulated process that can be impaired in different steps in chronic wounds. Chronic leg ulcers are a special type of non-healing wounds that represent an important cause of morbidity and public cost in western countries. Because of their common recurrence after conventional managements and increasing prevalence due to an ageing population, newer approaches are needed. Over the last decade, the research has been focused on innovative treatment strategies, including stem-cell-based therapies. After the initial interest in embryonic pluripotent cells, several different types of adult stem cells have been studied because of ethical issues. Specific types of adult stem cells have shown a high potentiality in tissue healing, in both in vitro and in vivo studies. Aim of this review is to clearly report the newest insights on tissue regeneration medicine, with particular regard for chronic leg ulcers. [ABSTRACT FROM AUTHOR]

The objective of this study was to identify symptom clusters and their effect on quality of life (QOL) of adults with chronic leg ulcers of mixed venous and arterial aetiology. A secondary analysis of data from four existing prospective longitudinal studies conducted by a wound healing research group in Australia was undertaken. A total of 110 patients who met the inclusion criteria were selected for this study. Exploratory factor analysis (EFA) was used to identify symptom clusters and correlational analyses to examine relationships between the identified symptom clusters and QOL. The EFA identified two distinct symptom clusters: a 'systemic symptom cluster' consisting of pain, fatigue and depressive symptoms; and a 'localised-leg symptom cluster' including pain, fatigue, oedema, lower limb inflammation and exudate. Physical QOL correlated significantly with the systemic symptom cluster ( r = −0·055, P < 0·0001) and the localised-leg symptom cluster ( r = −0·054, P < 0·0001), whereas mental QOL was associated only with the systemic symptom cluster ( r = −0·038, P = 0·01). The results suggest that appropriate intervention strategies targeting specific symptom clusters should be developed. Targeting patients with symptom clusters is particularly important because they are at high risk and the most vulnerable for reduced QOL. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to evaluate the virulence profiles of Pseudomonas aeruginosa clinical strains recently isolated from patients hospitalized for chronic leg ulcers in the Dermatology Department of Central Military Emergency University Hospital "Carol Davila", Bucharest, Romania.Methods: The phenotypic screening evaluated eight soluble virulence factors (haemolysins, lecithinase, lipase, caseinase, gelatinase, amylase, DNase, aesculin hydrolysis), as well as adherence ability (Cravioto adapted method) and invasion capacity on HeLa cells (gentamicin protection assay). Seven virulence genes encoding for protease IV, 3 exoenzymes (exoS, exoT, exoU), two phospholipases plcH- haemolytic phospholipase C and plcN- non-haemolytic phospholipase C) and alginate were investigated by PCR.Results: The pore forming toxins and enzymes were expressed in variable proportions, the majority of the tested strains producing beta haemolysin (92.3 %), lipase (76.9 %) and lecithinase (61.5 %). The most frequent virulence genes detected in the analyzed strains were the ExoT (100 %) and AlgD (92.3 %) genes, genes codifying for phospholipases (84.6 % each of them) and for protease IV (61.5 %).Conclusions: This study reveals that correlating virulence profiles and infection clinical outcome is very useful for setting up efficient preventive and therapeutic procedures for hospitalized patients with chronic leg ulcers and positive P. aeruginosa cultures. [ABSTRACT FROM AUTHOR]

Leg ulcers are a common and often serious problem in older adults. Underlying conditions that increase risk include age-related increases in chronic venous insufficiency, peripheral artery disease, connective tissue and autoimmune conditions, reduced mobility, and diabetes mellitus (DM). Geriatric patients have a higher risk of multiple wound-related complications including infection, cellulitis, ischemia, and gangrene, any of which may lead to further complications including amputation. The very presence of these lower extremity ulcers in the elderly negatively impacts their quality of life and ability to function. Understanding and early identification of the underlying conditions and wound features are important for effective ulcer healing and complication mitigation. This targeted review focuses on the three most common types of lower extremity ulcers: venous, arterial, and neuropathic. The goal of this paper is to characterize and discuss the general and specific aspects of these lower extremity ulcers and their relevancy and impact on the geriatric population. The top five main results of this study can be summarized as follows. (1) Venous ulcers, caused by inflammatory processes secondary to venous reflux and hypertension, are the most common chronic leg ulcer in the geriatric population. (2) Arterial-ischemic ulcers are mainly due to lower extremity vascular disease, which itself tends to increase with increasing age setting the stage for an age-related increase in leg ulcers. (3) Persons with DM are at increased risk of developing foot ulcers mainly due to neuropathy and localized ischemia, both of which tend to increase with advancing age. (4) In geriatric patients with leg ulcers, it is important to rule out vasculitis or malignancy as causes. (5) Treatment is best made on a case-by-case basis, considering the patient's underlying condition, comorbidities, overall health status, and life expectancy., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Mayrovitz et al.)

Ignatzschineria larvae  ( I. larvae ) is a bacterium found in the digestive tract of some flies. A few cases of bacteremia by I. larvae are described in the literature. We present the case of a patient with chronic leg ulcer and poor hygienic and social conditions, who presented with bacteremia from I. larvae . As there are few cases described in the literature, there are no guidelines yet for the treatment of this bacteremia. We report a short review of the literature below., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Demurtas et al.)

Chronic wounds develop when the sequence of healing events are disrupted, usually in patients with underlying diseases such as diabetes mellitus, venous insufficiency, peripheral artery disease, and neuropathies and they affect most often the lower extremities. We present a 68-year-old woman with plantar ulceration, lasting for approximately 18 months, resistant to healing with conventional therapy and various modalities we used. The patient had a long history of seronegative enteropathic arthritis, Crohn’s disease, secondary fibrillar amyloidosis, multiplex neuropathy, and small vessel vasculitis, the latter being the trigger event for the ulceration of her right foot. Before the decision for a final surgical intervention, we implemented a mechanical periodic stimulus using a soft toothbrush, which resulted in the gradual and complete healing of the ulcer within a period of 6 weeks. Patient’s history and previous treatments are presented along with the procedures that led to the healing of the chronic wound. This report supports the idea that periodic mechanical stimulus is of great importance for the healing process and this could be the mechanism of action of some other methods that have been described in the medical literature. [ABSTRACT FROM AUTHOR]

Objectives. To assess the concepts of teledermatology (TD), a subspecialty of dermatology and one of the most common applications of telemedicine. Material and methods. This systematic review, totaling 32 works, is aimed to evaluate the advantages and limitations of teledermatology, which can be delivered in two ways: real-time (synchronous), using videoconference technology, and store-and-forward (SAF) methods (aynchronous), using digital images via internet, a cheaper and more convenient modality for the health care provider. Results. So far, teledermatology has been implemented in dermoscopy, dermatopathology and chronic wound care. However, other chronic skin disease, such as psoriasis, dermatitis, acne, rosacea and skin cancers can be evaluated and monitored using store-and-forward methods. Conclusions. In order to develop a teledermatology platform, Romanian dermatology requires specific protocols and equipment for taking and sending photographs. A dermatologist would then review the data using store-and- forward method and respond with a diagnosis and therapeutic algorithm. [ABSTRACT FROM AUTHOR]

Chronic leg ulcers affect 1-2% of the general population and are related to increased morbidity and health costs. Staphylococcus aureus and Pseudomonas aeruginosa are the most common bacteria isolated from chronic wounds. They can express virulence factors and surface proteins affecting wound healing. The co-infection of S. aureus and P. aeruginosa is more virulent than single infection. In particular, S. aureus and P. aeruginosa have both intrinsic and acquired antibiotic resistance, making clinical management of infection a real challenge, particularly in patients with comorbidity. Therefore, a correct and prompt diagnosis of chronic wound infection requires a detailed knowledge of skin bacterial flora. This is a necessary prerequisite for tailored pharmacological treatment, improving symptoms, and reducing side effects and antibiotic resistance. [ABSTRACT FROM AUTHOR]

Clinicians have long reported that hair-bearing areas tend to heal more rapidly than those lacking hair follicles. In the past decade, numerous scientific studies have corroborated clinical evidence, showing a direct nexus between the human hair follicle and the wound healing process. The migration of epithelial follicular stem cells to the skin surface to help in the wound re-epithelialization and the effect of the hair cycle on the wound healing rate underline the influence of the hair follicle in the healing process. In clinical practice, non-healing wounds are pathologies of high prevalence with significant associated burden costs for the healthcare system. As the population ages, the prevalence of this pathology is expected to increase in future years. The recent advances in understanding the biology of hair follicle stem cells have created the challenges of using this newly acquired knowledge in practical therapeutic applications. Chronic leg ulcers are an example of the targeted pathologies that urgently need better therapies. In this essay, our aim is to raise interest in this question, reviewing what is known in relation to the connections between hair follicles and wound healing, and elaborating on future directions that the field might take, including implications for clinical practice. [ABSTRACT FROM AUTHOR]

The prevalence of leg ulcers of is 0.12%—1.1% and >3,000 lower limb amputations are performed yearly in Australia due to non-healing leg or foot ulcers. Although evidence on leg ulcer management is available, a significant evidence-practice gap exists. To identify current leg ulcer management, a cross-sectional retrospective study was undertaken in Brisbane, Australia. A sample of 104 clients was recruited from a community specialist wound clinic and a tertiary hospital outpatients’ specialist wound clinic. All clients had an ulcer below their knee or on their foot for ≥4 weeks. Data were collected on ulcer care, health service usage and clinical history for the year prior to admission. On admission, participants reported having their ulcer for a median of 25 weeks (range 2-728 weeks); with 51% (53/104) reporting an ulcer duration of >24 weeks. Including the wound clinic, participants sought ulcer care from a median of three health care providers (range 2-7). General practitioners (GPs) provided ulcer care to 82% of participants. Nearly half (42%) had self-cared for their ulcer; 29% (30/104) received treatment by a community nurse. A gap was found between the community-based ulcer care experienced by this population and evidence-based guidelines in regard to assessment, management, advice and referrals. [ABSTRACT FROM AUTHOR]

Chronic leg ulcers are costly to manage for health service providers. Although evidence-based care leads to improved healing rates and reduced costs, a significant evidence-practice gap is known to exist. Lack of access to specialist skills in wound care is one reason suggested for this gap. The aim of this study was to model the change to total costs and health outcomes under two versions of health services for patients with leg ulcers: routine health services for community-living patients; and care provided by specialist wound clinics. Mean weekly treatment and health services costs were estimated from participants data (n=70) for the 12 months prior to their entry to a study specialist wound clinic, and prospectively for 24 weeks after entry. For the retrospective phase, mean weekly costs of care were A$130.30 (SD $12.64) and these fell to A$53.32 (SD $6.47) for the prospective phase. Analysis at a population level suggests if 10,000 individuals receive 12 weeks of specialist evidence-based care, the cost savings are likely to be A$9,238,800. Significant savings could be made by the adoption of evidence-based care such as that provided by the community and outpatient specialist wound clinics in this study. [ABSTRACT FROM AUTHOR]