Leg ulcers that do not heal.

Ackroyd, Jenny S.; Young, A. E.

doi:10.1136/bmj.286.6360.207

Cited by 31 publications

(11 citation statements)

References 1 publication

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“…Tissue biopsy is the gold standard for diagnosis of cutaneous malignancy. Ackroyd and Young recommend performing a biopsy if a chronic wound failed to respond satisfactorily after 3 months of reasonable treatment, whereas Hansson and Andersson recommend waiting for 4 months . In our experience, any sudden and suspicious change in the characteristics of a chronic wound should prompt the suspicion of a malignant transformation and biopsy is the only diagnostic test.…”

Section: Discussionmentioning

confidence: 85%

Ten years of experience in chronic ulcers and malignant transformation

Onesti

Fino

Fioramonti

et al. 2013

International Wound Journal

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Malignant degeneration of wounds is rare and often misdiagnosed. Delay in diagnosis may result in a worse prognosis. The aim of this study is to determine the number of skin cancers associated with chronic skin ulcers in our facility over a period of 10 years. Between January 2002 and December 2012, a total of about 1000 patients had consulted with us for chronic wounds, especially of vascular, diabetic and traumatic origin and pressure ulcers. Thirteen skin cancers had been detected: seven squamous cell and five basal cell carcinomas and one melanoma. We highlight how important it is to be aware of the signs suggesting a malignant change and the importance of biopsy at regular intervals during the life cycle of any chronic wound.

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Section: Discussionmentioning

confidence: 85%

Ten years of experience in chronic ulcers and malignant transformation

Onesti

Fino

Fioramonti

et al. 2013

International Wound Journal

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“…For example, some authors have suggested that all ulcers that do not heal in four months should be biopsied to rule out the possibility of malignancy. 5 The results of our study suggest that such a criteria would result in three quarters of all chronic leg ulcers being biopsied.…”

Section: Introductionmentioning

confidence: 80%

Chronic ulcer of the leg: clinical history.

Callam¹,

Harper²,

Dale³

et al. 1987

BMJ

355

197

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Six hundred patients with chronic leg ulcers were studied by detailed history and examination as part of a population survey. In 22% ulceration began before the age of40, and in this group the sex incidence was equal. Over age 40 there was an increasing preponderance of women. Ulcers were significantly more common in the left leg in women but not in men. The site of 26% of ulcers did not include the classical medial gaiter area. The median duration of the ulceration at the time of the survey was nine months and 20% had not healed in over two years. The great majority of patients had had recurrence, 66% having had episodes of ulceration for more than five years.Healing of ulcers is a serious problem, but preventing recurrence is the greater challenge. IntroductionChronic leg ulceration affects about 1% of the population at some point in their lives.'4 The results of current management appear to be unsatisfactory, and although a great deal has been published on the merits of a vast range of treatments, few controlled trials have

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“…There are no studies focused primarily on the safety of performing wound biopsies in chronic wounds. However, several practice guidelines have recommended performing wound biopsies for histological diagnosis or microbiologic testing in wounds that have not improved within 2–6 weeks of appropriate management 16–23 . The Food and Drug Administration (FDA) recommends performing biopsies of the wound, when needed clinically, as an objective tool to exclude neoplastic, immune‐mediated or primary infectious disease.…”

Section: Discussionmentioning

confidence: 99%

Wound edge biopsy sites in chronic wounds heal rapidly and do not result in delayed overall healing of the wounds

Panuncialman

Hammerman

Carson

et al. 2010

Wound Repair and Regeneration

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Wound biopsies are an essential diagnostic component in the management of chronic wounds. First, the possibility of malignancy or infection in the wound often requires sampling of the wound edge and its bed. Secondly, several practice guidelines recommend biopsying wounds that have not responded to treatment after 2-6 weeks. However, there has always been a concern that the biopsy may worsen the wound and delay overall healing. In this report, we investigated the safety and effects of wound biopsies on overall chronic wound healing rates (advance of the wound edge per week toward the center) before and after the biopsy was performed. In a cohort of 14 consecutive patients with chronic wounds of the lower extremity, we found that postbiopsy chronic wound healing rates (0.99 AE 1.18 mm/week; mean AE SD) were not decreased and were actually higher than prebiopsy chronic wound healing rates (0.49 AE 0.85 mm/week; mean AE SD, p < 0.05). In addition, we documented that healing of the biopsy sites up to the original wound edge occurred within 6 weeks in 11 of the 14 subjects. Therefore, we conclude that chronic wounds do not worsen after being biopsied and that wound biopsies are a safe procedure that does not delay overall healing of the chronic wound.Chronic wounds are sometimes biopsied for diagnostic purposes and in experimental protocols when information regarding the wound bed or the wound edge is required. In addition, also in experimental protocols, wound biopsies are sometimes performed to grow cells in vitro from the nonhealing wound. This cellular analysis has led to a better understanding of the phenotypic cellular changes occurring in impaired healing.1-3 Our investigative group has been involved in performing wound biopsies for at least two decades. We initially noted that an obvious worsening of the wound did not occur after a biopsy of the edge was taken. Indeed, this led us to state that biopsying the wound is not deleterious to healing of the wound and that the biopsy site heals up to the original edge of the wound.4 However, lingering concerns remain about the safety of biopsying nonhealing wounds, and questions are often raised by clinicians about whether this procedure worsens the outcome of the wound. Moreover, there are biological implications regarding the notion that a biopsy site would heal in the context of a chronic wound that, otherwise, has not responded to treatment. Therefore, an important question is whether, indeed, one can document that the biopsy heals up to the original wound's edge.In this report, we analyzed our recent experience with a cohort of patients with nonhealing wounds which were biopsied at the wound edge and were followed after the biopsy was taken. In order to develop a more complete answer to our questions, we included patients on conventional therapy alone and those who were undergoing experimental treatment. It was our hypothesis that, in agreement with our previous but more anecdotal clinical experience, there is no deleterious effect of a biopsy to the ove...

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Leg ulcers that do not heal.

Cited by 31 publications

References 1 publication

Ten years of experience in chronic ulcers and malignant transformation

Ten years of experience in chronic ulcers and malignant transformation

Chronic ulcer of the leg: clinical history.

Wound edge biopsy sites in chronic wounds heal rapidly and do not result in delayed overall healing of the wounds

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