Treatment of venous leg ulcers

About 1 % of the adult population suffer from venous leg ulcers in the UK. The condition mainly affects the elderly, especially women, and is a result of a previous venous thrombosis or incompetent venous valve within the 

The diagnosis of lower limb ulceration must start by determining the patient s full clinical history, together with a physical examination of the condition. It is essential to identify possible risk factors that could cause ulceration or impact on the treatment of the ulcer. These risk factors could include arterial insufficiency, trauma, diabetes, sickle cell disease, infection, malignancy, and inflammatory disorders.  

A number of non-invasive test methods are available to the clinician for investigating the cause of leg ulceration and venous insufficiency. These test 

Colour duplex ultrasound scanning is currently the technique of choice in order to assess the venous system of the lower limb. This technique combines ultrasound imaging with pulsated Doppler ultrasound, and provides detailed anatomic information of the superficial, deep, and perforating venous systems. It can identify specific veins in which blood reflux occurs, or obstructions which may be contributing to venous hypertension. 

Photoplethysmography and air plethysmography are simple tests designed to evaluate calf muscle dysfunction and degree of venous reflux. These techniques are used to observe the change in blood volume within the lower limb before and after exercise. Application of a tourniquet to restrict blood flow within the superficial system allows the deep venous system to be assessed for a potential obstruction. 

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Vasodilators such as naftidrofuryl (Praxilene) and oxpentifylline (pentoxifylline) (Trental) increase blood flow to skin rather than muscle they have also been successfully used in the treatment of venous leg ulcers (varicose and traumatic). 

Peripheral neuropathy from long-term treatment of venous leg ulcers with silver sulfadiazine cream has been observed in one patient (13). 

Thomas, S., 1998. Compression Bandaging in the Treatment of Venous Leg Ulcers. World Wide Wounds. 

An innovative research and development programme has been undertaken in the University of Bolton into the development of a smart single layer novel compression therapy system for the treatment of venous leg ulcers. The novel single layer... 

A STUDY OF THE PRESSURE PROFILE OF COMPRESSION BANDAGES AND COMPRESSION GARMENTS FOR TREATMENT OF VENOUS LEG ULCERS... 

S Johnson, Compression hosiery in the prevention and treatment of venous leg ulcer , J of Tissue Viability, 2002 12(2) 67-74. 

Venous ulceration is a common disease affecting around 1% of adult population in the UK and Australia. The direct and indirect cost of the treatment in Germany is more than 1 billion DM. The estinuitedaimual cost in Sweden is 25 million. In the US, about 2 million working days are lost each year because of leg ulco problem and the treatment cost is enormous. It is estimated that the direct cost of maruigemont and treatment of venous leg ulcers to the National Health Sovice (NHS) in the UK is in excess of 800 millioiL... 

It will be noticed that increase in applied pressure does not influence the pressure transference at any one point and the variation is marginal in all the samples. This affirms that these spacer febrics can be used as ideal padding bandages, and by controlling the tension it will be possible to generate the required pressure for the treatment of venous leg ulcers. 

Mermet L Pettier N, SainthiUier JM, Malugani C, Cairey-Remonnay S, Maddens S, et al. Use of amniotic membrane transplantation in the treatment of venous leg ulcers. Wound Repair Regen Jul-Aug 2007 15(4) 459-64. 

The performance and properties of the novel bandages are superior to existing multilayer commercial compression bandages. This fuMls the requirement of ideal variable pressure from ankle to below knee positions of the limb for the treatment of venous leg ulcers. 

Because of the problems assodated with the currently available bandages for the treatment of venous leg ulcers as discussed under the heading 6.7, it is vital to research and develop an alternative bandaging regimen that meets aU the requirements of an ideal compression system. 

McGuckrn, M., Stmeman, M., Goin, X and WiUiams, S. (1996) Draft guideline diagnosis and treatment of venous leg ulcers. Ostomy Wound Manage, 42, 4, 48-78. 

In First World Conference on 3D Fabrics and Their Applications. Texeng Ltd., Manchester. Anand, S.C., Rajendran, S., 2006. Effect of fibre type and structure in designing orthopaedic wadding for the treatment of venous leg ulcers. In Anand, S.C., Kennedy, J.F., Miraftab, M., Rajendran, S. (Eds.), Medical Textiles and Biomaterials for Healthcare. Woodhead Publishing, Cambridge. 

Zaulyanov L, KirsnerRS. A review of a bi-layered living cell treatment (Apligraf ) in the treatment of venous leg ulcers and diabetic foot ulcers. Clin Interv Aging 2007 2 93-8. 

Ortonne IP. A controlled study of the activity of hyaluronic acid in the treatment of venous leg ulcers. J Dermatol Treatment 1996 7 75-81. 

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