Strategies and challenges in the treatment of chronic venous leg ulcers

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.

Combined debridement in chronic wounds:A literature review

Wounds debridement is important for healing of chronic wounds. Combined debridement is a new technique to deal with the complex chronic wounds. This review introduces several topical methods of combined debridement according to the various color classifications. Methods include combined sharp and hydrogel debridement, combined ultrasonic and enzymatic debridement, ultrasonic debridement combined with surgical debridement and vacuum aspiration on debridement, and other types of debridement. This article also explores why each combined debridement mentioned above can achieve a good effect.

Clinical Observation of Integrated Traditional Chinese and Western Medicine in the Treatment of Chronic Ulcerative Rectitis

Objective:To observe and compare whether the combination of traditional Chinese and Western medicine can achieve more satisfactory results in the treatment of patients with chronic ulcerative rectitis(UR).Methods:70 cases of chronic ulcerative rectitis were selected in all hospitals of our hospital for comparison.Observation and control were set up.The number of people was the same,but there were differences in methods.The control group retained enema,and the observation group was treated with traditional Chinese medicine.Rectal mucosa scores after different treatments were compared to evaluate the effect of intervention.Results:It was found that the observation group scored lower(P<0.05),and the effect was better.Conclusion:For the treatment of patients with chronic ulcerative rectitis,the combination of traditional Chinese and Western medicine will help to promote the prognosis of the disease,improve the problem of ulcer,promote the improvement of gastrointestinal function and bring a more positive impact.

What’s old is new again:Insights into diabetic foot microbiome

Diabetes is a chronic disease that is considered one of the most stubborn global health problems that continues to defy the efforts of scientists and physicians.The prevalence of diabetes in the global population continues to grow to alarming levels year after year,causing an increase in the incidence of diabetes complications and health care costs all over the world.One major complication of diabetes is the high susceptibility to infections especially in the lower limbs due to the immunocompromised state of diabetic patients,which is considered a definitive factor in all cases.Diabetic foot infections continue to be one of the most common infections in diabetic patients that are associated with a high risk of serious complications such as bone infection,limb amputations,and life-threatening systemic infections.In this review,we discussed the circumstances associated with the high risk of infection in diabetic patients as well as some of the most commonly isolated pathogens from diabetic foot infections and the related virulence behavior.In addition,we shed light on the different treatment strategies that aim at eradicating the infection.

Recombinant bovine basic fibroblast growth factor accelerates wound healing in patients with burns, donor sites and chronic dermal ulcers

Objective To evaluate the effect of recombinant bovine basic fibroblast growth factor(rbFGF) on accelerating healing of burn wounds, donor sites and chronic dermal ulcers in multicenters Methods One thousand and twenty four patients with burns, donor sites and chronic dermal ulcers were recruited for this prospective and multicenter clinical trial and another 641 patients with the similar wounds were used as controls All patients were divided into three groups: burn group, donor site group, and chronic dermal ulcer group In the burn group, 654 patients with superficial second degree burns( superficial Ⅱ ) or deep second degree burns( deep Ⅱ ) were treated topically with either recombinant bovine basic fibroblast growth factor (rbFGF plus vehicle, rbFGF 150 ?AU/cm 2/day, 330 patients) or placebo (vehicle without rbFGF, 324 patients) In the donor site group, 509 patients were treated with rbFGF and 317 patients with placebo in a similar way as described elsewhere In the chronic dermal ulcer group, 185 patients were treated with rbFGF and the controls were themselves Photography, histological evaluation and clinical examination were used to evaluate the results of wound healing Results All of superficial second degree burns, deep second degree burns and the donor sites treated with recombinant bovine basic fibroblast growth factor had an accelerated rate of granulation tissue formation and epidermal regeneration as compared with that in the controls Superficial second degree burns and deep second degree burns treated with recombinant bovine basic fibroblast growth factor healed in 9 89±2 45 and 17 04±4 56 days, respectively, whereas the average healing time in those receiving placebo was 12 35±2 74 and 21 21±4 88 days The donor sites treated with rbFGF or placebo healed in 10 68±4 55 and 14 74±6 46 days, respectively All chronic dermal ulcers except 12 patients treated with rbFGF healed within 6 weeks Histological evaluation of punch biopsy specimens from the burn wounds, donor sites and chronic dermal ulcers seven days after treatment supported the impression of accelerated wound healing after rbFGF treatment Conclusions rbFGF is effective in shortening the wound healing time and improving the wound healing quality Accelerating wound healing is of clinical benefit in reducing the length of hospitalization, costs and emotional burden of the patient

Maintenance treatment with infliximab for ulcerative ileitis after intestinal transplantation: A case report

BACKGROUND Evidence has been published on the successful applications of the anti-tumor necrosis factor alpha antibody infliximab,such as induction therapy,salvage treatment for acute cellular rejection,and treatment for chronic ulcerative inflammation,in intestinal transplant recipients.However,the optimal protocol for the effective use of infliximab remains largely undetermined due to scarcity of available clinical data.We report a continuative application of infliximab as maintenance therapy for recurrent chronic ulcerative ileitis in a recipient of isolated intestinal transplantation(ITx).CASE SUMMARY The patient was a 11-year-old boy with intestinal motility disorder classified as a hypogenic type of intestinal dysganglionosis.The patient underwent living-donor related intestinal transplant.His immunosuppression regimen consisted of daclizumab,tacrolimus,and steroids.Although he did not show rejection while on tacrolimus monotherapy,routine screening endoscopy showed several ulcerative lesions in the distal end of the graft 2 years after the intestinal transplant.Endoscopic work up to evaluate the progression of anemia revealed stenosis with ulcerative inflammatory changes and multiple longitudinal ulcers in the graft.Since the endoscopic findings suggested ulcerative lesions in Crohn’s disease,infliximab treatment was considered.Treatment with infliximab and a small dose of oral prednisolone afforded successful withdrawal of total parenteral nutrition and maintenance of a well-functioning graft without infectious complications for 5 years since the administration of the first dose of infliximab.CONCLUSION Infliximab is effective as maintenance therapy for recurrent chronic ulcerative ileitis in an isolated ITx patient.

Reconstruction of complex chest wall defects:A case report

BACKGROUND Chronic radiative chest wall ulcers are common in patients undergoing radiation therapy.If not treated early,then symptoms such as erosion,bleeding and infection will appear on the skin.In severe cases,ulcers invade the ribs and pleura,presenting a mortality risk.Small ulcers can be repaired with pedicle flaps.Because radioactive ulcers often invade the thorax,surgeons need to remove large areas of skin and muscle,and sometimes ribs.Repairing large chest wall defects are a challenge for surgeons.CASE SUMMARY A 74-year-old female patient was admitted to our department with chest wall skin ulceration after radiation therapy for left breast cancer.The patient was diagnosed with chronic radioactive ulceration.After multidisciplinary discussion,the authors performed expansive resection of the chest wall ulcers and repaired large chest wall defects using a deep inferior epigastric perforator(DIEP)flap combined with a high-density polyethylene(HDPE)patch.The patient was followed-up 6 mo after the operation.No pigmentation or edema was found in the flap.CONCLUSION DIEP flap plus HDPE patch is one of the better treatments for radiation-induced chest wall ulcers.

Clinical outcome of ileal pouch-anal anastomosis for chronic ulcerative colitis in China

Background The incidence of chronic ulcerative colitis （CUC） in China is remarkably increasing, while little information on surgical treatment has been reported. This study aimed to completely describe and analyze the clinical outcome of restorative proctocolectomy with ileal pouch-anal anastomosis （IPAA）for CUC in China. Methods Ninety-five consecutive patients, who suffered CUC and had surgical indications, were carefully selected. All patients underwent IPAA. Data on patient characteristics, surgical indications, surgical details, postoperative complications, functional outcome, and quality of life were collected. Results The mean patient age at the time of the operation was 32 years. Twenty-nine （31%） patients underwent an emergency operation, and 66 （69%） underwent elective procedures. Four patients with severe dysplasia underwent operations, but no carcinoma was histologically confirmed. A two-stage operation was performed in 87 （92%） patients, and a hand-sewn technique was applied in 88 （93%） patients. Sixteen patients （17.0%） experienced early complications, and there was a significant difference between the emergency surgery group and the elective group （31.0% vs. 10.6%, respectively; P 〈0.01）. Five （5.3%） patients developed pouchitis as a late complication. The mean stool frequency after the operation was 4.6 （2-11） during the first 24 hours and 1.5 （0-4） overnight. According to the Kirwan grading scale, 87 （91.8%） patients showed satisfactory anal continence function. The quality of life improved significantly from a preoperative mean value of 0.28-0.61 before ileostomy closure to 0.78 after ileostomy closure （P 〈0.01） according to the Cleveland Global Quality of Life index. Conclusions IPAA is an effective and safe surgical procedure for patients with CUC in China. However, some characteristics, such as the low incidence of pouchitis, require further study.

Chinese Medicine and the Surgeon

The surgeon aims at a direct,complete removal of the pathology.In spite of the modern advancements of imaging facilities and precision instrumentations,unsatisfactory results and recurrences are not uncommon.This paper provides a general review of the four specific areas in surgery that would benefit from Chinese medicine.Extensive searches were made on four surgical areas based on available English language journals,viz.low-back pain,chronic ulcers,renal calculus,and enuresis in children,in the past 10 years.The quoted communications are mainly related to clinical evidences,while a smaller number of crucial laboratory reports are also included.Low-back paln,a most frequent orthopaedic problem,would benefit from acupuncture treatment.Chronlc leg ulcers could achieve better results of healing using herbal supplements.Problems of renal stones,besides the conventional methods of removal,could be further supplemented with herbal drinks that aim at prevention of recurrences.Enuresis in children,an untreatable common condition,may respond well to acupuncture.Surgeons should keep an open mind.In case of difficulties,they could seriously consider options of traditional treatment.

Gastroprotective Effects of Ascaridole on Gastric Ulcer in Rats

Objective To evaluate the gastroprotective activity of ascaridole. Methods The gastroprotective effect of ascaridole was evaluated on ulcer healing in rats with acetic acid-induced chronic gastric ulcer, pylorus ligation- and Aspirin-induced gastric ulcer. Ascaridole was ig administered with the dosages of 10 and 20 mg/kg once daily for 7 d. Results Ascaridole showed the significant anti-ulcer effects. In acetic acid-induced gastric ulcer rats, the ulcer areas after 10 and 20 mg/kg of ascaridole treatment were (65.1 ± 20.0) and (50.6 ± 11.0) mm2, respectively, which were significant lower (P < 0.01) than that of the control group [(116.7 ± 35.8) mm2]. For pylorus ligation model, ascaridole showed a gastric ulcer healing effect in a dose-dependent manner. Ascaridole at the dose of 20 mg/kg showed 50% ulcer protection and had a significant (P < 0.05) gastroprotective activity since it decreased the total acidity and pepsin activity. Compared to the control group, the two dosages of ascaridole showed the significant reduction (P < 0.05) in the ulcer index on Aspirin-induced ulcer. Conclusion This study provides evidence that ascaridole shows potential efficacy on the healing of gastric ulcers induced by acetic acid, Aspirin, and pylorus ligation.