Background: Chronic ulcers are responsible for considerable morbidity and significantly contribute to the escalation in the cost of health care. Chronic leg ulcers (CLUs) are susceptible to microbial infections and se...Background: Chronic ulcers are responsible for considerable morbidity and significantly contribute to the escalation in the cost of health care. Chronic leg ulcers (CLUs) are susceptible to microbial infections and serious complications such as tissue necrosis and osteomyelitis, can result without the timely control of infections. Recent studies have also reported an increase in the association of fungal infections with chronic non-healing ulcers. Aim: To determine the prevalence of bacterial and fungal infections among patients reporting with chronic leg ulcers in participants without co-morbidities. Methods: A prospective cross-sectional study was conducted among patients with chronic leg ulcers at the National Reconstructive Plastic Surgery and Burns Centre, Korle-Bu Teaching Hospital (NRPS/BC-KBTH) and those who consented were enrolled. Characteristics of the wound as well as micro-organisms cultured from wound swabs were recorded. Results: A total of 50 participants were enrolled for the study with the mean (SD) age of 40.7 (10.7) years. Eighty percent of the participants presented with post traumatic leg ulcers with 80% being artisans and traders in the age group 31 - 50 years. There was no statistically significant association between sex and the organism cultured for post traumatic and cellulitis (p-value > 0.05). The prevalence of bacterial and fungal infection was 79.3% and 20.7% respectively. Pseudomonas species was the most isolated bacteria (61.5%) while Aspergillus niger was the most isolated fungi (41%). Conclusion: From this study, fungal infections should be included in managing chronic leg ulcers, especially among artisans, famers and gardeners even though there was a significantly higher burden of bacterial infections.展开更多
Evaluating patients with chronic venous leg ulcers(CVLUs)is essential to find the underlying etiology.The basic tenets in managing CVLUs are to remove the etiological causes,to address systemic and metabolic condition...Evaluating patients with chronic venous leg ulcers(CVLUs)is essential to find the underlying etiology.The basic tenets in managing CVLUs are to remove the etiological causes,to address systemic and metabolic conditions,to examine the ulcers and artery pulses,and to control wound infection with debridement and eliminating excessive pressure on the wound.The first-line treatments of CVLUs remain wound care,debridement,bed rest with leg elevation,and compression.Evidence to support the efficacy of silver-based dressings in healing CVLUs is unavailable.Hydrogen peroxide is harmful to the growth of granulation tissue in the wound.Surgery options include a high ligation with or without stripping or ablation of the GSVs depending on venous reflux or insufficiency.Yet,not all CVLUs are candidates for surgical treatment because of comorbidities.When standard care of wound for 4 wk failed to heal CVLUs effectively,use of advanced wound care should be considered based on the available evidence.Negative pressure wound therapy facilitates granulation tissue development,thereby helping closure of CVLUs.Autologous split-thickness skin grafting is still the gold standard approach to close huge CVLUs.Hair punch graft appears to have a better result than traditional hairless punch graft for CVLUs.Application of adipose tissue or placenta-derived mesenchymal stem cells is a promising therapy for wound healing.Autologous platelet-rich plasma provides an alternative strategy for surgery for safe and natural healing of the ulcer.The confirmative efficacy of current advanced ulcer therapies needs more robust evidence.展开更多
Introduction: The benefit of intermittent pneumatic compression (IPC) for the prevention of venous thromboembolism and lymphedema has been well established in the literature. Recent evidence suggests that IPC plays a ...Introduction: The benefit of intermittent pneumatic compression (IPC) for the prevention of venous thromboembolism and lymphedema has been well established in the literature. Recent evidence suggests that IPC plays a beneficial role in circulation, hemodynamic peripheral pump, intravascular coagulation and arterial skin perfusion. Despite such evidence, the use of IPC in the treatment of resistant and chronic venous leg ulcers, has received little attention in practice. Case Presentation: We would like to report the case of successfully treated chronic and bilateral venous leg ulcer in an obese patient with IPC application and a review of the literature. Results: The use of IPC as an adjuvant therapy to the traditional multilayered compression therapy permitted significant resolution of the ulcers, reduced secondary infection incidence and prevented ulcer recurrence. Conclusion: In obese, minimally mobile patients with venous ulcers not responding to the traditional multilayered compression therapy application of IPC, an adjuvant therapy is recommended.展开更多
目的:探讨中药生肌长皮膏促进下肢慢性溃疡愈合的临床疗效。方法:2010年3月至2011年9月外科门诊和中医科收治的64例患有下肢慢性溃疡病人随机分为实验组和对照组,每组32例。实验组溃疡创面应用中药生肌长皮膏,对照组采用普通换药治疗,...目的:探讨中药生肌长皮膏促进下肢慢性溃疡愈合的临床疗效。方法:2010年3月至2011年9月外科门诊和中医科收治的64例患有下肢慢性溃疡病人随机分为实验组和对照组,每组32例。实验组溃疡创面应用中药生肌长皮膏,对照组采用普通换药治疗,均为每天1次。两组病人于治疗后第3、7、14和21 d观察并计算创面愈合率,并分别取创面肉芽组织标本行HE染色、Masson染色和免疫组织化学检测CD34,观察组织结构变化、总胶原的分布和微血管密度(MVD)。结果:与对照组相比,实验组在第14、21 d创面愈合率明显较高;胶原着色深、面积广[(68.7±7.7)比(48.9±9.3),P<0.05]。治疗后第7、14、21 d CD34表达增强,新生血管和MVD较多(P<0.05)。结论:中药生肌长皮膏可促进创面肉芽组织生长、胶原合成和血管新生,从而促进溃疡愈合,有益于治疗下肢慢性溃疡。展开更多
文摘Background: Chronic ulcers are responsible for considerable morbidity and significantly contribute to the escalation in the cost of health care. Chronic leg ulcers (CLUs) are susceptible to microbial infections and serious complications such as tissue necrosis and osteomyelitis, can result without the timely control of infections. Recent studies have also reported an increase in the association of fungal infections with chronic non-healing ulcers. Aim: To determine the prevalence of bacterial and fungal infections among patients reporting with chronic leg ulcers in participants without co-morbidities. Methods: A prospective cross-sectional study was conducted among patients with chronic leg ulcers at the National Reconstructive Plastic Surgery and Burns Centre, Korle-Bu Teaching Hospital (NRPS/BC-KBTH) and those who consented were enrolled. Characteristics of the wound as well as micro-organisms cultured from wound swabs were recorded. Results: A total of 50 participants were enrolled for the study with the mean (SD) age of 40.7 (10.7) years. Eighty percent of the participants presented with post traumatic leg ulcers with 80% being artisans and traders in the age group 31 - 50 years. There was no statistically significant association between sex and the organism cultured for post traumatic and cellulitis (p-value > 0.05). The prevalence of bacterial and fungal infection was 79.3% and 20.7% respectively. Pseudomonas species was the most isolated bacteria (61.5%) while Aspergillus niger was the most isolated fungi (41%). Conclusion: From this study, fungal infections should be included in managing chronic leg ulcers, especially among artisans, famers and gardeners even though there was a significantly higher burden of bacterial infections.
文摘Evaluating patients with chronic venous leg ulcers(CVLUs)is essential to find the underlying etiology.The basic tenets in managing CVLUs are to remove the etiological causes,to address systemic and metabolic conditions,to examine the ulcers and artery pulses,and to control wound infection with debridement and eliminating excessive pressure on the wound.The first-line treatments of CVLUs remain wound care,debridement,bed rest with leg elevation,and compression.Evidence to support the efficacy of silver-based dressings in healing CVLUs is unavailable.Hydrogen peroxide is harmful to the growth of granulation tissue in the wound.Surgery options include a high ligation with or without stripping or ablation of the GSVs depending on venous reflux or insufficiency.Yet,not all CVLUs are candidates for surgical treatment because of comorbidities.When standard care of wound for 4 wk failed to heal CVLUs effectively,use of advanced wound care should be considered based on the available evidence.Negative pressure wound therapy facilitates granulation tissue development,thereby helping closure of CVLUs.Autologous split-thickness skin grafting is still the gold standard approach to close huge CVLUs.Hair punch graft appears to have a better result than traditional hairless punch graft for CVLUs.Application of adipose tissue or placenta-derived mesenchymal stem cells is a promising therapy for wound healing.Autologous platelet-rich plasma provides an alternative strategy for surgery for safe and natural healing of the ulcer.The confirmative efficacy of current advanced ulcer therapies needs more robust evidence.
文摘Introduction: The benefit of intermittent pneumatic compression (IPC) for the prevention of venous thromboembolism and lymphedema has been well established in the literature. Recent evidence suggests that IPC plays a beneficial role in circulation, hemodynamic peripheral pump, intravascular coagulation and arterial skin perfusion. Despite such evidence, the use of IPC in the treatment of resistant and chronic venous leg ulcers, has received little attention in practice. Case Presentation: We would like to report the case of successfully treated chronic and bilateral venous leg ulcer in an obese patient with IPC application and a review of the literature. Results: The use of IPC as an adjuvant therapy to the traditional multilayered compression therapy permitted significant resolution of the ulcers, reduced secondary infection incidence and prevented ulcer recurrence. Conclusion: In obese, minimally mobile patients with venous ulcers not responding to the traditional multilayered compression therapy application of IPC, an adjuvant therapy is recommended.
文摘目的:探讨中药生肌长皮膏促进下肢慢性溃疡愈合的临床疗效。方法:2010年3月至2011年9月外科门诊和中医科收治的64例患有下肢慢性溃疡病人随机分为实验组和对照组,每组32例。实验组溃疡创面应用中药生肌长皮膏,对照组采用普通换药治疗,均为每天1次。两组病人于治疗后第3、7、14和21 d观察并计算创面愈合率,并分别取创面肉芽组织标本行HE染色、Masson染色和免疫组织化学检测CD34,观察组织结构变化、总胶原的分布和微血管密度(MVD)。结果:与对照组相比,实验组在第14、21 d创面愈合率明显较高;胶原着色深、面积广[(68.7±7.7)比(48.9±9.3),P<0.05]。治疗后第7、14、21 d CD34表达增强,新生血管和MVD较多(P<0.05)。结论:中药生肌长皮膏可促进创面肉芽组织生长、胶原合成和血管新生,从而促进溃疡愈合,有益于治疗下肢慢性溃疡。
