A New Approach in the Management of Chronic Nonhealing Leg Ulcers

Saber, Alan A.; Yahya, Kareem Z.; Rao, Arun S; Castellano, Michael A.; Cioroiu, Michael; Grossi, Robert; Tornambe, Robert M.

doi:10.1080/08941930500328821

Cited by 10 publications

(7 citation statements)

References 6 publications

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“…Saber [43] conducted a case series with time comparison (ie, time series) of 35 patients with intractable, chronic, large ulcers that were of venous, arterial, or diabetic type: mean ulcer duration was 2.8 years, size 73 cm 2 . All received 10 daily preoperative HBOT treatments at 2.0 ATA and 120 min, deep excision and split-thickness skin grafting and 10 postoperative HBOT treatments.…”

Section: Surgical Reconstruction (Without Flaps or Grafts)mentioning

confidence: 99%

Hyperbaric Oxygen Therapy for Wound Healing and Limb Salvage: A Systematic Review

Goldman

2009

PM&R

125

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This article is a systematic review evaluating published clinical evidence of the efficacy of hyperbaric oxygen therapy (HBOT) for wound healing and limb salvage. The data source is the Ovid/Medline database for key word "Hyperbaric Oxygenation" with search limits (human studies, 1978-2008). Results were combined by Boolean AND with 1 of the 3 following searches: (a) wound healing (10 permutations); (b) compromised flap or graft (3); and (c) osteomyelitis (1). The author evaluated 620 citations, of which 64 reported original observational studies and randomized controlled trials (RCTs) on HBOT and healing outcomes. All citations with 5 subjects were selected for full text review (44 articles) and evaluated according to GRADE criteria for high, medium, low, or very low level of evidence. A Cochrane review identified 1 additional study with a low level of evidence. This systematic review discusses and tabulates every article of high or moderate level of evidence. For patients with diabetic foot ulcers (DFU) complicated by surgical infection, HBOT reduces chance of amputation (odds ratio [OR] 0.242, 95% CI: 0.137-0.428) (7 studies) and improves chance of healing (OR 9.992, 95% CI: 3.972-25.132) (6 studies). Positive efficacy corresponds to HBOT-induced hyperoxygenation of at-risk tissue (7 studies) as measured by transcutaneous oximetry. HBOT is associated with remission of about 85% of cases of refractory lower extremity osteomyelitis, but an RCT is lacking to clarify extent of effect. There is a high level of evidence that HBOT reduces risk of amputation in the DFU population by promoting partial and full healing of problem wounds. There is a moderate level of evidence that HBOT promotes healing of arterial ulcers, calciphylactic and refractory vasculitic ulcers, as well as refractory osteomyelitis. There is a low to moderate level of evidence that HBOT promotes successful "take" of compromised flaps and grafts.

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Section: Surgical Reconstruction (Without Flaps or Grafts)mentioning

confidence: 99%

Hyperbaric Oxygen Therapy for Wound Healing and Limb Salvage: A Systematic Review

Goldman

2009

PM&R

125

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“…Use of direct-current electrical field, hyperbaric oxygen therapy, and pharmacologic applications of phenytoin, tretinoin, and fibrin tissue adhesive glue have been reported. [3][4][5][6][7][8][9][10] Growth factors are members of a large functional group of polypeptide regulatory molecules, secreted by many different cell lines through autocrine and paracrine fashions, influencing the biologic activities of responsive cells. 14,15 Experimental studies have found that the levels of growth factors increased at the wound sites, which promoted nutrient flow, angiogenesis, and vascular remodeling necessary for skin graft survival.…”

Section: Discussionmentioning

confidence: 99%

“…Previously, some efforts have been made to improve skin graft take in such wounds, including use of direct-current electrical field, hyperbaric oxygen therapy, and pharmacologic applications of phenytoin, tretinoin, and fibrin tissue adhesive glue. [3][4][5][6][7][8][9][10] The results from these methods were inconsistent.…”

mentioning

confidence: 99%

Improvement of Full-Thickness Skin Graft Survival by Application of Vascular Endothelial Growth Factor in Rats

Zhang

Oswald

Lin

et al. 2008

Annals of Plastic Surgery

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The effect of vascular endothelial growth factor (VEGF) on skin graft survival was studied in rats. Models of skin grafting on muscle and periosteum were designed. For the study of skin grafting on muscle model, 32 rats were divided into 4 groups. VEGF was administrated systemically after skin graft placement intrafascially injected into the recipient bed at the time of graft placement and topically applied to the recipient bed at the time of graft placement. Control groups consisted of grafts placed on sites without systemic or local VEGF treatment. With the study of skin grafting on periosteum, 40 rats were divided into 4 groups. VEGF was systemically, intraperiosteally, and topically applied to the recipient bed. The control animals received no treatment. On the fifth postoperative day, the survival area of each skin graft was measured and the graft was harvested for histology with CD31 immunohistochemical staining. The results showed that in skin grafting on muscle model, the mean viable percentage of the skin graft was 66.1% +/- 10.2% in the group receiving systemic application of VEGF and 56.1% +/- 9.8% in the group receiving VEGF intrafascia injection. The survival percentages were significantly higher than those found in the control group (22.5% +/- 7.7%) and the group with VEGF topical application (30.8% +/- 4.1%). In skin grafting on periosteum, the group receiving VEGF intraperiosteum injection reached a survival percentage of 50.5% +/- 4.3%, significantly higher than the groups with VEGF systemic application (28.7 +/- 5.5%), VEGF topical application (32.5% +/- 4.8%), and the control (25.8% +/- 6.0%). Histology showed that sections taken from grafts with VEGF intrafascia and intraperiosteum treatment revealed angiogenesis. The data demonstrated that administration of VEGF into the either muscular or periosteal recipient beds for skin grafting can improve the skin graft survival.

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“…Ulcers may or may not be painful. 1 The patient generally has a swollen leg and may feel burning or itching. There may also be a rash, redness, brown discoloration, or dry, scaly skin.…”

Section: Introductionmentioning

confidence: 99%

Nonhealing Ulcer treated with Jalaukāvacāraṇa (Bloodletting): A Single Case Study

Reddy¹,

Talekar²

2017

Journal of Research in Ayurvedic Sciences

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Chronic leg ulcers are a major cause of mortality and morbidity. The efficacy of hyperbaric oxygen treatment is being evaluated in the management of nonhealing leg ulcers to improve skin graft survival. We are presenting a case of nonhealing ulcer where skin graft was rejected three succeeding times. Suśrūta has indicated Visrāvan. a or Raktamoks. an. a (bloodletting) in the management of ulcers. Jalaukāvacāran. a (leech application) is one of the methods of Raktamoks. an. a (bloodletting). A case report of 27-year-old female patient was presented with the complaints of swelling over the right ankle joint, with chronic lymphadenitis referred by the plastic surgeon. She was diagnosed as nonhealing ulcer and was treated by the plastic surgeon and skin grafting was performed. But it failed three succeeding times. Her constitution rejected all three skin grafts. This patient was then treated with Jalaukāvacāran. a (bloodletting through leech application) after fourth time skin graft and it was accepted thereafter.

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A New Approach in the Management of Chronic Nonhealing Leg Ulcers

Cited by 10 publications

References 6 publications

Hyperbaric Oxygen Therapy for Wound Healing and Limb Salvage: A Systematic Review

Hyperbaric Oxygen Therapy for Wound Healing and Limb Salvage: A Systematic Review

Improvement of Full-Thickness Skin Graft Survival by Application of Vascular Endothelial Growth Factor in Rats

Nonhealing Ulcer treated with Jalaukāvacāraṇa (Bloodletting): A Single Case Study

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