Objective: To test the therapeutic effect of integrated traditional Chinese and western medicine on venous ulcer of lower limbs by Meta analysis method, and then to propose the best clinical treatment scheme. Methods:...Objective: To test the therapeutic effect of integrated traditional Chinese and western medicine on venous ulcer of lower limbs by Meta analysis method, and then to propose the best clinical treatment scheme. Methods: Domestic databases in the past 20 years (January 1999-December 2019) were searched by computer, including China Journal Full-text Database (CNKI), VIP, Wanfang and CBM. Literature was screened according to inclusion and exclusion criteria. Cochrane risk assessment tool was used to evaluate the quality of the included literature. Two-classification method was used to extract data. RevMan 5.3 software was used to make statistical analysis of the data. Results: Eleven articles were finally included, totaling 1,576 patients, 804 cases in the treatment group and 772 cases in the control group. Meta-analysis results show that there is no difference in heterogeneity and bias among the included literatures. The total effective rate (risk ratio [RR]=1.12, 95% confidence interval [CI]=1.09-1.15) of integrated traditional Chinese and western medicine in treating venous ulcer of lower limbs is higher, which is obviously better than that of western medicine alone. Conclusion: Through data analysis, it is concluded that in the study population, the treatment of integrated traditional Chinese and western medicine has a significant effect on venous ulcer of lower limbs. Make up for the deficiency of simple western medicine treatment, improve the cure rate and reduce the recurrence rate. However, there is currently a lack of relevant high-quality literature, so a large sample size, rigorous and standardized experimental design and randomized double-blind clinical study are needed to further test the conclusions.展开更多
BACKGROUND Management of chronic refractory wounds is one of the toughest clinical challenges for surgeons.Because of poor blood supply,less tissue coverage,and easy exposure,the lower leg is a common site for chronic...BACKGROUND Management of chronic refractory wounds is one of the toughest clinical challenges for surgeons.Because of poor blood supply,less tissue coverage,and easy exposure,the lower leg is a common site for chronic refractory wounds.The current therapeutic regimens often lead to prolonged hospital stay and higher healthcare costs.Concentrated growth factor(CGF)is a novel blood extract that contains various growth factors,platelets,and fibrins to promote wound healing process.However,there has been little research reported on the treatment of lower extremity wounds with CGF.CASE SUMMARY A 37-year-old man,without any past medical history,presented an ulcerated chronic wound on his right lower leg.The skin defect exhibited clear boundaries,with a size of 2.0 cm×3.5 cm.The depth of wound was up to the layer of deep fascia.Staphylococcus aureus was detected by bacterial culture.The final diagnosis was right lower extremity ulcers with infection.Cefathiamidine,silver sulfadiazine,and mupirocin cream were applied to control the infection.CGF gel was prepared from the patient’s blood sample,and was used to cover the wound after thorough debridement.The skin wound was successfully healed after three times of CGF treatment.CONCLUSION CGF displays an excellent wound healing promoting effect in patients with lowerextremity chronic refractory wounds.展开更多
Venous ulcer of lower extremities is a serious manifestation of venous insufficiency of lower extremities in the later stage,which is characterized by inflammatory exudation at the initial stage,followed by skin ruptu...Venous ulcer of lower extremities is a serious manifestation of venous insufficiency of lower extremities in the later stage,which is characterized by inflammatory exudation at the initial stage,followed by skin rupture,and finally forms the whole layer of skin atrophy and necrosis,which does not heal for a long time.How to promote ulcer healing is the most important problem in the treatment of venous ulcers of lower extremities.Vacuum sealing drainage(VSD)is constantly used in clinic and plays a unique advantage in wound healing.This paper mainly reviews the present situation of venous ulcer of lower extremities and summary,principle,application progress,attentions and prospect of VSD at home and abroad.展开更多
Introduction: Cutaneous manifestations of systemic sclerosis (SSc) include skin ulceration;4% - 12% of patients with SSc develop lower extremity ulcers of various etiologies. Limited data, significant morbidity, and s...Introduction: Cutaneous manifestations of systemic sclerosis (SSc) include skin ulceration;4% - 12% of patients with SSc develop lower extremity ulcers of various etiologies. Limited data, significant morbidity, and substantial cost of wound care led us to undertake this study to describe and identify risk factors. Methods: After Institutional Review Board approval, we identified 30 patients with SSc and lower extremity ulcers over a 10-year period at a single center with an SSc clinic, which were included in a descriptive analysis. Results: Median age of onset of lower extremity ulcers was 59.5 years (range 20 - 84). Ninety percent of patients were female, 60% were Caucasian, 63% had limited SSc, 13% diffuse SSc and 23% an overlap syndrome. Immunomodulators or steroids were prescribed in 53%;hypercoagulable state identified in 16%. Ulcers were attributed to venous stasis (27%), SSc (20%), trauma (20%), arterial disease (17%), and multifactorial/unknown (17%). In patients with ulcers attributed to SSc, age at onset was lower (45.5 vs 59.5 years). Biopsies generally did not contribute to management. Multidisciplinary treatment was routine;20% required amputation, 10% endovascular intervention, 20% frequent surgical debridement, 10% hyperbaric oxygen, 26% local treatment and antibiotics and 13% received immunosuppression for wound treatment. Conclusion: Lower extremity ulcers are a serious clinical problem in patients with SSc. The clinical exam, venous dopplers, ankle-brachial indices and assessment of vascular risk factors helped define causality. In younger patients, ulcers were more frequently attributed to SSc and these patients were more likely to be on immunosuppressants/DMARDS, possibly indicating severe phenotype of SSc.展开更多
基金National Natural Science Foundation of China Youth Program(No.81804095)Project of Collaborative Innovation Center for Traditional Chinese Medicine Health Services in Shanghai(No.ZYJKFW201701002)
文摘Objective: To test the therapeutic effect of integrated traditional Chinese and western medicine on venous ulcer of lower limbs by Meta analysis method, and then to propose the best clinical treatment scheme. Methods: Domestic databases in the past 20 years (January 1999-December 2019) were searched by computer, including China Journal Full-text Database (CNKI), VIP, Wanfang and CBM. Literature was screened according to inclusion and exclusion criteria. Cochrane risk assessment tool was used to evaluate the quality of the included literature. Two-classification method was used to extract data. RevMan 5.3 software was used to make statistical analysis of the data. Results: Eleven articles were finally included, totaling 1,576 patients, 804 cases in the treatment group and 772 cases in the control group. Meta-analysis results show that there is no difference in heterogeneity and bias among the included literatures. The total effective rate (risk ratio [RR]=1.12, 95% confidence interval [CI]=1.09-1.15) of integrated traditional Chinese and western medicine in treating venous ulcer of lower limbs is higher, which is obviously better than that of western medicine alone. Conclusion: Through data analysis, it is concluded that in the study population, the treatment of integrated traditional Chinese and western medicine has a significant effect on venous ulcer of lower limbs. Make up for the deficiency of simple western medicine treatment, improve the cure rate and reduce the recurrence rate. However, there is currently a lack of relevant high-quality literature, so a large sample size, rigorous and standardized experimental design and randomized double-blind clinical study are needed to further test the conclusions.
基金Supported by Shenzhen Longhua District Science and Innovation Bureau for Key Laboratory Construction,No.20160919A0410022Shenzhen Longhua District Science and Innovation Bureau Fund for Medical Institutions,No.2020038 and No.2017136。
文摘BACKGROUND Management of chronic refractory wounds is one of the toughest clinical challenges for surgeons.Because of poor blood supply,less tissue coverage,and easy exposure,the lower leg is a common site for chronic refractory wounds.The current therapeutic regimens often lead to prolonged hospital stay and higher healthcare costs.Concentrated growth factor(CGF)is a novel blood extract that contains various growth factors,platelets,and fibrins to promote wound healing process.However,there has been little research reported on the treatment of lower extremity wounds with CGF.CASE SUMMARY A 37-year-old man,without any past medical history,presented an ulcerated chronic wound on his right lower leg.The skin defect exhibited clear boundaries,with a size of 2.0 cm×3.5 cm.The depth of wound was up to the layer of deep fascia.Staphylococcus aureus was detected by bacterial culture.The final diagnosis was right lower extremity ulcers with infection.Cefathiamidine,silver sulfadiazine,and mupirocin cream were applied to control the infection.CGF gel was prepared from the patient’s blood sample,and was used to cover the wound after thorough debridement.The skin wound was successfully healed after three times of CGF treatment.CONCLUSION CGF displays an excellent wound healing promoting effect in patients with lowerextremity chronic refractory wounds.
基金General project of national natural science foundation(No.81774310)The national natural science foundation youth project(No.81804095).
文摘Venous ulcer of lower extremities is a serious manifestation of venous insufficiency of lower extremities in the later stage,which is characterized by inflammatory exudation at the initial stage,followed by skin rupture,and finally forms the whole layer of skin atrophy and necrosis,which does not heal for a long time.How to promote ulcer healing is the most important problem in the treatment of venous ulcers of lower extremities.Vacuum sealing drainage(VSD)is constantly used in clinic and plays a unique advantage in wound healing.This paper mainly reviews the present situation of venous ulcer of lower extremities and summary,principle,application progress,attentions and prospect of VSD at home and abroad.
文摘Introduction: Cutaneous manifestations of systemic sclerosis (SSc) include skin ulceration;4% - 12% of patients with SSc develop lower extremity ulcers of various etiologies. Limited data, significant morbidity, and substantial cost of wound care led us to undertake this study to describe and identify risk factors. Methods: After Institutional Review Board approval, we identified 30 patients with SSc and lower extremity ulcers over a 10-year period at a single center with an SSc clinic, which were included in a descriptive analysis. Results: Median age of onset of lower extremity ulcers was 59.5 years (range 20 - 84). Ninety percent of patients were female, 60% were Caucasian, 63% had limited SSc, 13% diffuse SSc and 23% an overlap syndrome. Immunomodulators or steroids were prescribed in 53%;hypercoagulable state identified in 16%. Ulcers were attributed to venous stasis (27%), SSc (20%), trauma (20%), arterial disease (17%), and multifactorial/unknown (17%). In patients with ulcers attributed to SSc, age at onset was lower (45.5 vs 59.5 years). Biopsies generally did not contribute to management. Multidisciplinary treatment was routine;20% required amputation, 10% endovascular intervention, 20% frequent surgical debridement, 10% hyperbaric oxygen, 26% local treatment and antibiotics and 13% received immunosuppression for wound treatment. Conclusion: Lower extremity ulcers are a serious clinical problem in patients with SSc. The clinical exam, venous dopplers, ankle-brachial indices and assessment of vascular risk factors helped define causality. In younger patients, ulcers were more frequently attributed to SSc and these patients were more likely to be on immunosuppressants/DMARDS, possibly indicating severe phenotype of SSc.
