Characteristics Of Studies Awaiting Assessment
|41 people with venous, arterial or mixed leg ulcers.|
|Interventions||Nitrous oxide oxygen mixture or lidocaineprilocaine cream.|
|Outcomes||Pain before and after debridement on VAS and VRS.|
|Inclusion criteria unclear from abstract.|
|Interventions||A hydrobalanced cellulose based dressing or a foam wound dressing with Ibuprofen.|
|Outcomes||Pain on VAS, quality of life, wound size reduction or healing time.|
|Notes||Contacted authors requesting results for VLU participants only. Awaiting reply.|
Treating The Ulcer Medically
Care Of Surrounding Skin
General care of the skin surrounding an ulcer is essential to maintain skin integrity and minimize the risk of further ulceration. Gentle washing and emollients have been shown to be effective in all forms of eczema/dermatitis. They help to restore the barrier function and reduce the role of infective organisms as a cause of damage. Washing for about 10 min twice a day is optimal. Water just above body temperature is most desirable, and more natural the emollient soap, more supportive it is of the epidermis .
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What Does A Venous Leg Ulcer Look Like And What Causes Them
Venous leg ulcers are sores that develop between your knee and ankle, but they typically form inside the leg near or around the ankle. They are large, shallow ulcers with uneven edges that drain or weep a lot.
Youll likely see swelling in your leg, with red, itchy skin around the wound. You may also experience tightness in your calves, as well as aching, throbbing or a feeling of heaviness in your legs. Pooled and trapped blood often causes discolored splotches in the area.
The sores sometimes affect only the skin or they may sink deeper into the fat layer, muscle, tendon and bone, she says. Severe ulcers are more likely to become infected and take longer to heal.
Your veins carry blood back to your heart, and valves in the veins stop the blood from flowing backward. When your veins have trouble sending blood from your limbs to the heart, its known as venous insufficiency. In this condition, blood doesnt flow back properly to the heart, causing blood to pool in the veins in your legs.
Our veins are just like pipes, says Ehren. When theres persistently high blood pressure in the veins of the legs with a valve that doesnt work correctly, it causes damage to the skin, which eventually breaks down and forms an ulcer.
Other possible causes for venous leg ulcers include:
- Varicose veins.
- Swelling of a superficial vein .
Referral To A Specialist
In some cases, your GP or nurse may decide to refer you to a specialist in conditions affecting the blood vessels .
For example, you may be referred to a vascular specialist if your GP or nurse is unsure about your diagnosis, or if they suspect your ulcer may be caused by artery diseases, diabetes or rheumatoid arthritis.
After taking your medical history and examining you, the vascular specialist may need to arrange further investigations to plan your treatment.
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Getting A Specialist Vascular Referral
If you have venous hypertension, intervention to your veins from a vascular specialist might help with healing and stop your wound or sore from coming back. Sometimes varicose veins can be treated by laser therapy. If you have peripheral arterial disease, you may require further investigations and the vascular team will be able to assess the need to improve the blood supply to your leg or whether your ulcer can be managed in other ways such as reduced/modified compression. Ask your nurse or doctor for a referral to your local vascular team to talk about how their input might help you.
Diagnosing A Venous Leg Ulcer
See your doctor if you think you may have a venous leg ulcer. A venous leg ulcer is diagnosed based on your symptoms and a physical examination of your affected leg. Additional tests may also be required.
Your doctor or nurse will first perform a physical examination on your leg when you are standing and when you are lying down. Varicose veins will be more obvious when you are standing and it will be easier to look at the ulcer when you are lying down.
They will look for symptoms of a venous leg ulcer, such as severe skin damage arising from venous disease and dark pigmentation of the skin near the ulcer due to vein problems. They will feel your pulse at your ankles to make sure the arteries in your leg are working properly.
Your doctor or nurse may also try to determine the cause of the ulcer by asking you about any underlying conditions you may have, such as diabetes or deep vein thrombosis , and any previous injuries, ulcers or surgery you may have had on your affected leg.
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Symptoms Of Leg Ulcers
- that they are commonly found on the lower leg and ankle
- a sunken, asymmetrically shaped wound
- the edges of the ulcer are clearly defined from the surrounding skin
- the surrounding skin is intact, but inflamed
- the surrounding skin may be pigmented, hardened or calloused
- yellowish-white exudate
- varicose veins in the leg.
Synthesis Of Data And Analysis
There was a large diversity among the included studies regarding aim and focus of research. All studies assessed pain in persons with CVLUs and were considered sufficiently homogenous to provide a meaningful summary. Only baseline data were extracted from the studies with repeated measures. The inclusion criteria in effect studies were generally more detailed than in descriptive studies, typically resulting in more selected samples with fewer comorbidities. Therefore, we stratified the analysis by study design.
In the studies reporting pain intensity, a great variation of tools were used to assess pain intensity. Data were synthesised using standardised methods for converting different pain rating scales,- providing an NRS of pain ranging from 0 to 10. In studies only providing information about median pain score and range, mean pain score and SD were calculated as described by Hozo et al.
To explore sources of heterogeneity in pain intensity, we performed univariable random-effects meta-regression analyses. We considered the following variables: study design year of publication and participant’s age, gender, and wound duration. Meta-regression analyses were not performed for pain prevalence because of the small number of publications .
We used the forest plot to present the summary estimates overall and stratified by study design. Publication bias was assessed by Egger’s test.
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Data Collection And Analysis
Two review authors independently performed study selection, ‘Risk of bias’ assessment and data extraction. We conducted this NMA using frequentist metaregression methods for the efficacy outcome the probability of complete healing. We assumed that treatment effects were similar within dressings classes . We present estimates of effect with their 95% confidence intervals for individual treatments focusing on comparisons with widely used dressing classes, and we report ranking probabilities for each intervention . We assessed the certainty of the body of evidence using GRADE for each network comparison and for the network as whole.
After The Ulcer Has Healed
Once you have had a venous leg ulcer, another ulcer could develop within months or years.
The most effective method of preventing this is to wear compression stockings at all times when you’re out of bed.
Your nurse will help you find a stocking that fits correctly and you can manage yourself.
Various accessories are available to help you put them on and take them off.
Page last reviewed: 11 January 2019 Next review due: 11 January 2022
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Treatment For Leg Ulcers
- cleaning the wound using wet and dry dressings and ointments, or surgery to remove the dead tissue
- specialised dressings a whole range of products are available to help the various stages of wound healing. Dressings are changed less often these days, because frequent dressing changes remove healthy cells as well
- occlusive dressings ulcers heal better when they are covered. These dressings should be changed weekly
- compression treatment boosts internal pressure, using either elasticised bandages or stockings. This is particularly effective if multiple layers are used
- medication includes pain-relieving medication and oral antibiotics if infection is present
- supplements there is evidence that leg ulcers may heal faster with mineral and vitamin supplements, but only if the person suffers from a deficiency. Zinc, iron and vitamin C may be used
- skin graft is a surgical procedure, where healthy skin is grafted onto the prepared wound site
- skin cancer and infection if ulcers fail to heal or if they increase in size, both these conditions will need to be ruled out
- hyperbaric oxygen this is now an accepted treatment for ulcers that resist other methods of healing, such as diabetic ulcers.
What Can Cause Leg Ulcers
Venous hypertension / insufficiency the most common cause of poor healing on the lower leg is venous hypertension. This is when the veins struggle to take the blood back up the leg, so the blood can pool at the ankle creating pressure in your veins
Peripheral arterial disease another reason why our lower leg wound might not be healing is because not enough blood is getting down to our feet to heal the wound. This is then the opposite of the problem described above with veins.
Diabetes peripheral arterial disease is a known complication of diabetes, which can lead to developing a leg ulcer or diabetic foot ulcer.
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How Are Venous Ulcers Diagnosed
For a leg wound that isnt healing or may be infected, the doctor will do a visual examination of the sore and the surrounding skin to determine if it is a venous ulcer. The doctor will also evaluate the patients medical history to determine if there is a history of ongoing conditions, such as diabetes or hardening of the arteries.
In some cases, the doctor may also perform tests such as X-rays or a CT scan to check the veins and the area around the ulcer in more detail.
In some cases, an MRI and noninvasive vascular studies may be ordered to help develop a treatment plan. Other tests include:
- Ankle-Brachial Index . A test to compare the blood pressure measured at the ankle with the blood pressure measured at the arm to determine if there is also arterial insufficiency.
- Doppler ultrasonography. A noninvasive test estimates blood flow by bouncing high-frequency sound waves off circulating red blood cells.
- Venography. Using X-rays with an intravenous contrast dye to visualize the veins. The dye causes the blood vessels to appear opaque on the X-ray image, allowing the doctor to see the blood vessels. This is one of the more accurate tests to diagnose deep vein thrombosis and other abnormalities.
Sometimes, an ulcer can lead to serious skin and bone infections. In rare cases, a venous ulcer can lead to skin cancer.
Risk Of Bias In Included Studies
Risk of bias summary: review authors’ judgements about each risk of bias item for each included trial.
Random sequence generation
For the trial reported by Arapoglou 2011 a computergenerated list was described as the method of generating the randomisation sequence and this trial was, therefore, classified as being at low risk of bias for this domain. None of the other reports of included trials described any details concerning the method for generation of the randomisation sequence, and the trials were, therefore, classified as being at an unclear risk of bias.
The Arapoglou 2011, Gottrup 2008 and Hansson 1993 reports each described the use of sealed envelopes to conceal group allocation. The envelopes, however, were not described as opaque or sequentially numbered. These trials were classified as being at unclear risk of bias. No details regarding allocation concealment were reported by any of the other included trials. These were also classified as presenting an unclear risk of bias.
Blinding of participants and personnel
Blinding of outcome assessment
Incomplete outcome data
Other potential sources of bias
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Leg Ulcers: How To Relieve The Pain At Home
Patients most often present with either of the two main types of leg ulcers: venous or arterial. Less frequently, people suffering from diabetes can develop neuropathic ulcers as a result of unstable blood sugar.
Most often associated with varicose veins, venous ulcers make up the lionâs share of leg ulcers with 85% of diagnoses. These ulcers take a long time to heal, and it is a painful process. Worse still, 75% of these painful ulcers will reoccur. Home treatment and surgical intervention can help ease the pain associated with these types of wounds.
How Are Leg Ulcers Diagnosed
- A physical examination is the most common way to diagnose it.
- A doppler machine can also be used to diagnose leg ulcers based on the blood supply to your legs.
- In some cases, your doctor may refer you to a vascular specialist if he is not able to confirm your condition.
Once you are diagnosed with leg ulcers, you tend to look for different options to treat the condition. And what could be better than being able to do so naturally? Listed below are some of the best home remedies that can help you in treating leg ulcers naturally.
What You Have To Do
How Often You Should Do This
Do this 2-3 times daily.
Why This Works
Aloe vera is a therapeutic herb that is widely used to treat various ailments. It is extremely effective in healing leg ulcers as it not only inhibits the growth of bacteria but also prevents further infection . It contains compounds like anthraquinones and certain hormones that are said to render wound healing properties to it .
What You Have To Do
How Often You Should Do This
Do this at least 2-3 times daily.
Why This Works
What You Have To Do
How Often You Should Do This
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About Venous Leg Ulcers
A leg ulcer is a long-lasting sore that takes more than 4 to 6 weeks to heal. They usually develop on the inside of the leg, just above the ankle.
The symptoms of a venous leg ulcer include pain, itching and swelling in the affected leg. There may also be discoloured or hardened skin around the ulcer, and the sore may produce a foul-smelling discharge.
See your GP if you think you have a leg ulcer, as it will need specialist treatment to help it heal.
Your GP will examine your leg and may carry out additional tests to rule out other conditions.
Read more about how a venous leg ulcer is diagnosed.
Symptoms Of Venous Leg Ulcers
Venous leg ulcers are open, often painful, sores in the skin that take more than a month to heal. They usually develop on the inside of the leg, just above the ankle.
If you have a venous leg ulcer, you may also have:
- swollen ankles
- discolouration and darkening of the skin around the ulcer
- hardened skin around the ulcer, which may make your leg feel hard or even resemble the shape of an upside-down champagne bottle
- a heavy feeling in your legs
- aching or swelling in your legs
- red, flaky, scaly and itchy skin on your legs
- swollen and enlarged veins on your legs
- an unpleasant and foul-smelling discharge from the ulcer
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Appendix 3 Ovid Embase Search Strategy
1 exp ANALGESIA/ 7 exp Nonsteroid Antiinflammatory Agent/ 8 .ti,ab. 9 or/18 10 exp Topical Drug Administration/ 11 .ti,ab. 14 exp Local Anesthetic Agent/ 15 adj3 ).ti,ab. 16 adj3 analges$).ti,ab. 17 or/1316 20 exp Hydrogel/ 21 exp Alginic Acid/ 22 .ti,ab. 23 exp Ointment/ 24 .ti,ab. 25 or/1824 30 17 or 29 31 exp Leg Ulcer/ 32 or stasis ulcer$).ti,ab. 33 or/3132