Impaired Healing Risk Factors among Venous Leg Ulcer Patients: Recommended Protective Measures
- Zeinab Mohamed El-Sayed
UNLABELLED Venous ulcers are prevalent, challenging wounds; their incidence is rising with the increasing age of the general population. Physical mo- dalities often are used to help heal these chronic wounds. A prospective study was conducted to investigate the application of high-voltage stimu- lation (HVS), ultrasound therapy (US), low-level laser therapy (LLLT, 810 nm, 65 mW, 4 J/cm2), and compression therapy (CT), with and without surgical intervention; along with standard of care comprising drug therapy (micronized flavonoid fraction in two 500-mg tablets once daily) and wet dressings of 0.9% sodium chloride on venous leg ulcer healing. METHODS The 305-patient study was conducted between 1994 and 2008 among persons with venous ulcers in 3 facilities in Poland. After surgery involving crossectomy, partial [short] stripping of the greater or short saphenous vein, local phlebectomy, and ligation of insufficient perforators, 4 groups of patients were treated with the standard of care drug/dressing therapy and HVS, US, LLLT, or CT, and 1 group received the drug/dressing ther- apy only. Four non-surgical groups received HVS, US, LLLT, or CT and drug/dressing therapy, and 1 group received drug/dressing therapy only. Changes in wound area and volume were compared among all the groups receiving the various treatments using the Gilman index. In all groups therapy lasted 7 weeks. The computed planimetry method for observation of healing process was used. RESULTS The Gilman index values at 4 weeks were significantly higher in the compression plus surgery compared with other groups (P = 0.01). After therapy for patients from the CT + surgery group, the Gilman index was 1.18 cm (P ≤ 0.001 compared with other groups). The percentage total surface area regression analysis confirmed that compression plus surgery is the most efficient in venous leg ulcer therapy (61.89% reduction after 4 weeks of therapy and 78.19% at the end of study) compared to the other groups (P ≤ 0.001). The HVS and US appeared useful only in conservatively treated patients (P < 0.05). The LLLT did not accelerate reduction of the ulceration surface. CONCLUSION Venous surgery plus compression therapy is the most effi- cient treatment for venous leg ulcers. Compression therapy should be provided to both surgically and conservatively non-surgically treated pa- tients. High-voltage stimulation and ultrasound therapy are useful meth- ods in conservative treatment of venous leg ulcers. For surgically treated patients, these physical modalities are not effective. Low-level laser ther- apy is not an efficient method for treating venous leg ulcers. .