Search Methods For Identification Of Studies
Electronic searches
The search methods section for the fourth update of this review can be found in Appendix 1.
For this fifth update we searched the following electronic databases:
- The Cochrane Wounds Group Specialised Register
- The Cochrane Central Register of Controlled Trials
- Ovid MEDLINE
- Ovid MEDLINE
- Ovid EMBASE
- EBSCO CINAHL
The following search strategy was used in The Cochrane Central Register of Controlled Trials : #1 MeSH descriptor Leg Ulcer explode all trees #2 or or or or or NEAR/2 ulcer*) or or ulcus cruris:ti,ab,kw #3 #4 MeSH descriptor Pentoxifylline explode all trees #5 pentoxifylline or oxpentifylline #6 trental or torental or techlon or tarontal or sipental or hemovas or harine or felxital or elorgan or ebisan or ceretal or azupentat or artal #7 #8
The search strategies for Ovid MEDLINE, Ovid EMBASE and EBSCO CINAHL can be found in Appendix 2, Appendix 3 and Appendix 4 respectively. The Ovid MEDLINE search was combined with the Cochrane Highly Sensitive Search Strategy for identifying randomised trials in MEDLINE: sensitivity and precisionmaximizing version Ovid format . The EMBASE and CINAHL searches were combined with the trial filters developed by the Scottish Intercollegiate Guidelines Network . We did not apply any date or language restrictions.
Searching other resources
Can Emuaid Help Relieve Diabetic Ulcers Naturally
Yes! Before we show you how EMUAID® works, theres something you must know.
Your skin is a barrier designed to keep bacteria and infections out. Most medications cannot penetrate deep into the skin to efficiently deliver the active ingredients to where they are needed the most.
No matter how effective the medication is, theres no use if it cant penetrate the skins barrier to treat your your diabetic ulcers.
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How To Heal 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 .
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Was The Allocation Sequence Randomly Generated
low risk of bias
The investigators describe a random component in the sequence generation process such as: referring to a random number table using a computer random number generator coin tossing shuffling cards or envelopes throwing dice drawing of lots.
high risk of bias
The investigators describe a nonrandom component in the sequence generation process. Usually, the description would involve some systematic, nonrandom approach, for example: sequence generated by odd or even date of birth sequence generated by some rule based on date of admission sequence generated by some rule based on hospital or clinic record number.
Unclear
Insufficient information about the sequence generation process to permit judgement of Yes or No.
The Latest Research On The Best Way To Heal Leg Ulcers
In total, 450 people agreed to take part in this study and were treated in 20 hospitals across England. Participants were randomly allocated to either early or delayed endovenous ablation and followed up for 12 months. The trial found that treating the veins early resulted in quicker ulcer healing than delaying treatment until the ulcer had healed. The trial also showed that participants had more time without an ulcer if the treatment was performed early rather than after ulcer healing. No safety issues with early intervention were identified. There is some evidence that quality of life was better in the early treatment group and that people in this group had less body pain. Treating ulcers early appears likely to be more cost-effective than delayed treatment.
This research was published 2 years ago but unfortunately, a survey published 6 months ago suggests that the UK has significantly longer referral times, longer waiting times to secondary care and longer times to intervention than other countries. This is supported elsewhere where it is suggested that the UK is possibly undertreating patients with chronic venous disease. This may relate to relative constraints of the National Health Service compared to other privatised health care systems globally.
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Apligraf: A Biomaterial For Wound Healing/human Skin Equivalent68
Apligraf is a new tissue engineered skin product cultured from human dermal fibroblasts and keratinocytes. Histologically it resembles a simplified version of skin. When applied, Apligraf seems to react to factors in the wound and may interact with the patient’s own cells to stimulate the production of growth factors. It is being extensively studied in diabetic ulcers, clean excision wounds, and burns. Human skin equivalent appeared to promote wound healing in three ways: apparent graft take, temporary wound closure, and stimulation of host healing by acting as a biological dressing. The efficacy of human skin equivalent suggests that it will prove useful for promoting the healing of venous ulcers.
What Treatment Might I Be Offered
Compression therapy if your wound isnt healing because of venous hypertension and there are no problems with the arterial blood supply to your legs, then you should be offered compression therapy. Compression therapy usually works very effectively and helps wounds to heal fast. It is thus essential to find a compression regime that is comfortable, provides the level of support you need and works. If this is inconsistently used or applied, this must be dealt with so that healing is not delayed
Compression therapy improves blood supply by applying pressure to the leg. This can be done by bandaging the lower leg or by wearing supportive socks, stockings or tights. To begin with it can be a little uncomfortable when you first start treatment but should not cause you any pain it should feel supportive to your leg. Any discomfort should reduce as the swelling goes down. If you do experience discomfort, talk to your nurse or doctor about it and they will advise you on ways of alleviating this.
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Venous Leg Ulcer Treatment:
If your patient has a venous leg ulcer, you will apply the wound management procedures with custom cleansing products and wounds dressings. It is very important to know that the treatment will only be successful if the compression bandages are worn as advised. This may be a perceived as a constraint, but the healing rates are considerably improved if the compression is maintained. Elevating legs and other preventive measures are very important to achieve rapid wound closure and to avoid re-occurrence of venous leg ulcers.
How Are Leg Ulcers Diagnosed
A vascular specialist a healthcare provider specializing in the circulatory system and knowledgeable about wound care can examine the ulcer. Your provider will examine your skin and the wound.
You may also get:
- Ankle-brachial index test, which uses ultrasound technology to measure blood pressure and blood flow in the legs.
- Biopsy to check skin cells and fluid from the wound for infections and skin diseases.
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Looking After Yourself During Treatment
The following advice may help your ulcer heal more quickly.
- Try to keep active by walking regularly. Sitting and standing still without elevating your legs can make venous leg ulcers and swelling worse.
- Whenever you’re sitting or lying down, keep your affected leg elevated.
- Regularly exercise your legs by moving your feet up and down, and rotating them at the ankles. This can help encourage better circulation.
- If you’re overweight, try to reduce your weight with a healthy diet and regular exercise.
- Stop smoking and moderate your alcohol consumption. This can help the ulcer heal faster.
- Be careful not to injure your affected leg, and wear comfortable, well-fitting footwear.
You may also find it helpful to attend a local healthy leg club, such as those provided by the Lindsay Leg Club Foundation, for support and advice.
Dressings And Topical Agents
Dressings are usually applied to open ulcers. As well as offering protection, dressings may be chosen for other reasons, such as antimicrobial properties or absorption of exudate. As well as a wide range of types of dressings available, there are a number of topical products, used to reduce infection risk, aid exudate absorption or promote wound healing by other means, as well as topical painkilling agents. Having reliable evidence to guide choices is important, and not only for healthcare professionals. Patients responding to Cochrane Wounds online open consultation on research priorities, conducted between May and November 2016, asked in particular for evidence relating to specific dressings.
There are high quality, recent evidence syntheses, including a number of Cochrane Reviews, on particular dressing types and topical agents, but the evidence is low quality and does not provide robust support for any specific dressing or treatment. What is needed is a network meta-analysis , a simultaneous comparison of linked, multiple, competing treatments in a single statistical regression model. This is being done in a new Cochrane Review for the outcome of venous leg ulcer healing, for alternative dressings and topical agents .
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Treating The Ulcer Medically
Causes Of Venous Ulcers
Venous ulcers most often form around the ankles.
Venous ulcers typically occur because of damage to the valves inside the leg veins. These valves control the blood pressure inside the veins. They allow it to drop when you walk. If the blood pressure inside your leg veins doesn’t fall as you’re walking, the condition is called sustained venous hypertension. That increase in blood pressure causes ulcers to form on your ankles.
Venous ulcers may also be caused by other problems with your leg veins. These include:
-
Varicose veins. These are large, bulging leg veins. They occur when valves in the leg veins dont work well, allowing blood to collect in the lower leg.
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Chronic venous insufficiency. Like varicose veins, this condition occurs when your leg veins cant pump blood back up to your heart. Blood then pools in your lower legs, causing your legs to swell. Since the blood can’t flow well in your legs, the swelling may be extreme. This extreme swelling can put so much pressure on your skin that venous ulcers form.
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Who Gets Foot And Toe Ulcers
Youre at higher risk for foot and toe ulcers if you are:
- Native American.
- Male.
- Elderly.
If you have an eye, kidney or heart disease related to diabetes, youre also at a higher risk. About 15% of people with diabetes will get an ulcer, typically on the bottom of their foot. Around 6% of that 15% will have to be hospitalized because of complications.
Youre also at a higher risk of getting foot and toe ulcers if you have any of the following:
- Problems with circulation.
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Topical Antimicrobials And Antiseptics
In chronic wounds, reduction of certain microbial species, such as anaerobic bacteria in order to limit undesirable odors or perhaps mixed communities of four or more bacterial species that impede healing, use of topical antibiotics may be justified .
Various studies on dressings incorporating antibiotics and antiseptics are reviewed, but no single consensus for any particular topical agent could be made. This is partly due to the different mechanism and spectrum of action of the antimicrobials. The most frequently used topical antimicrobials in wound care practice are chlorhexidine, iodine, silver containing products, mupriocin and fucidic acid. In the past, acetic acid, honey, hydrogen peroxide, sodium hypochlorite, potassium permanganate, and proflavine have been used.
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Risk Factors For Leg Ulcers
- Age peripheral circulation becomes less efficient with old age.
- Varicose veins the one-way valves that stop blood from travelling backwards in the vein stop working. The pooling of blood stretches and distorts the vein.
- Cigarette smoking tobacco is known to constrict the vessels of the circulatory system.
- Arterial disease vein problems are more likely if the person already has other diseases of the arteries.
- Certain disorders these include diabetes and arthritis.
- Pressure sores bed-bound people are at risk of pressure sores, which are areas of damage to the skin caused by constant pressure or friction.
- Medication some cardiovascular medications can contribute to leg oedema and altered circulation.
What Is An Arterial Ulcer
Arterial leg ulcers are caused by insufficient arterial blood flow to the lower extremities. The direct cause of reduced blood flow is vessel wall arteriosclerosis and atherosclerotic plaque accumulation causing vessel occlusion. Peripheral vascular disease associated with arterial insufficiency may result in limb tissue ischemia. In case this condition is prolonged, the skin on the leg becomes thin with loss of hair, subcutaneous tissue and muscles atrophy, nails become thickened, leg color and temperature change becoming pale and cool, pulses become difficult to palpate and pain increases with exercise or leg elevation.
The treatment of arterial leg ulcers requires a multidisciplinary approach. It is necessary to ensure a proper blood flow, which often involves surgical intervention. The patient must be encouraged to adopt and maintain healthy lifestyle changes which will help to improve tissue perfusion.
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What Are The Causes Of Leg Ulcers
As skin cells break down, air and bacteria can get in to the tissue below. Generally, the underlying cause of leg ulcers is disease in the veins of the leg, and problems with the blood supply to the skin. There are different types of leg ulcer with different causes:
- Venous ulcer, accounting for about 80% of all leg ulcers. This occurs when the veins in the leg do not function as they should.
- Arterial ulcer, accounting for 15% of leg ulcers, and occurring due to problems with the arteries.
- Leg ulcers caused by other conditions, such as diabetes and rheumatoid arthritis, accounting for the remaining 5% of ulcers.
Contributions Of Editorial Base:
Nicky Cullum: edited the review, advised on methodology, interpretation and review content. Approved the final review prior to submission. Sally BellSyer: coordinated the editorial process. Advised on methodology, interpretation and content. Edited and copy edited the review and the updated review. Ruth Foxlee: designed the search strategy, ran the searches and edited the search methods section for the update.
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When To Seek Medical Care
What Causes A Leg Ulcer
Venous Leg Ulcers can be caused by superficial veins which have faulty vein valves or by blockages in the deep veins. Faulty valves in the veins under the skin cause a condition called superficial venous reflux.
Deep Vein Thrombosis affects the deep veins which are located in the muscles of the leg. DVT can damage the deep veins valves causing deep vein reflux or the DVT may narrow the deep veins causing deep vein obstruction.
Superficial venous reflux can be effectively eradicated by non-invasive treatments.
The veins in your leg are blood vessels that carry the blood back from the foot towards your heart. The veins in your legs have one-way valves that make sure the blood flows up the leg and not back down towards the foot.
In some people, these valves are not very effective or they have been damaged by thrombosis in the veins. If the valves are faulty or damaged, blood can flow the wrong way down the veins, which results in a very high pressure in the veins when standing up. This abnormally high pressure in the veins damages the skin and leads to the ulcers.
As a result of the high back pressure in the veins, the capillaries in the skin circulation are deprived of nutrients and oxygen. Initially the skin damage looks like eczema and in the presence of varicose veins is called varicose eczema. In fact, varicose eczema is a warning sign that an ulcer is likely to develop.
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