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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Venous leg ulcers</title><author><name sortKey="Nelson, E Andrea" sort="Nelson, E Andrea" uniqKey="Nelson E" first="E. Andrea" last="Nelson">E. Andrea Nelson</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">22189344</idno><idno type="pmc">3275133</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3275133</idno><idno type="RBID">PMC:3275133</idno><date when="2011">2011</date><idno type="wicri:Area/Pmc/Corpus">000483</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000483</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Venous leg ulcers</title><author><name sortKey="Nelson, E Andrea" sort="Nelson, E Andrea" uniqKey="Nelson E" first="E. Andrea" last="Nelson">E. Andrea Nelson</name></author></analytic><series><title level="j">BMJ Clinical Evidence</title><idno type="eISSN">1752-8526</idno><imprint><date when="2011">2011</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Introduction</title><p>Leg ulcers usually occur secondary to venous reflux or obstruction, but 20% of people with leg ulcers have arterial disease, with or without venous disorders. Between 1.5 and 3.0/1000 people have active leg ulcers. Prevalence increases with age to about 20/1000 in people aged over 80 years.</p></sec><sec><title>Methods and outcomes</title><p>We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of standard treatments, adjuvant treatments, and organisational interventions for venous leg ulcers? What are the effects of advice about self-help interventions in people receiving usual care for venous leg ulcers? What are the effects of interventions to prevent recurrence of venous leg ulcers? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2011 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).</p></sec><sec><title>Results</title><p>We found 101 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.</p></sec><sec><title>Conclusions</title><p>In this systematic review we present information relating to the effectiveness and safety of the following interventions: compression bandages and stockings, cultured allogenic (single or bilayer) skin replacement, debriding agents, dressings (cellulose, collagen, film, foam, hyaluronic acid-derived, semi-occlusive alginate), hydrocolloid (occlusive) dressings in the presence of compression, intermittent pneumatic compression, intravenous prostaglandin E1, larval therapy, laser treatment (low-level), leg ulcer clinics, multilayer elastic system, multilayer elastomeric (or non-elastomeric) high-compression regimens or bandages, oral treatments (aspirin, flavonoids, pentoxifylline, rutosides, stanozolol, sulodexide, thromboxane alpha<sub>2</sub> antagonists, zinc), peri-ulcer injection of granulocyte-macrophage colony-stimulating factor, self-help (advice to elevate leg, to keep leg active, to modify diet, to stop smoking, to reduce weight), short-stretch bandages, single-layer non-elastic system, skin grafting, superficial vein surgery, systemic mesoglycan, therapeutic ultrasound, and topical treatments (antimicrobial agents, autologous platelet lysate, calcitonin gene-related peptide plus vasoactive intestinal polypeptide, freeze-dried keratinocyte lysate, mesoglycan, negative pressure, recombinant keratinocyte growth factor, platelet-derived growth factor).</p></sec></div></front></TEI><pmc article-type="review-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">BMJ Clin Evid</journal-id><journal-id journal-id-type="iso-abbrev">BMJ Clin Evid</journal-id><journal-id journal-id-type="publisher-id">Clin Evid</journal-id><journal-title-group><journal-title>BMJ Clinical Evidence</journal-title></journal-title-group><issn pub-type="epub">1752-8526</issn><publisher><publisher-name>BMJ Publishing Group</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">22189344</article-id><article-id pub-id-type="pmc">3275133</article-id><article-id pub-id-type="publisher-id">1902</article-id><article-categories><subj-group subj-group-type="heading"><subject>Wounds</subject></subj-group><subj-group subj-group-type="secondary-section"><subject>Cardiovascular Disorders</subject><subject>Care of the Elderly</subject><subject>Skin Disorders</subject></subj-group></article-categories><title-group><article-title>Venous leg ulcers</article-title><alt-title alt-title-type="abridged">Venous ulcers</alt-title></title-group><contrib-group><contrib contrib-type="author" deceased="no"><name><surname>Nelson</surname><given-names>E. Andrea</given-names></name><degrees>BSc (Hons) RGN PhD</degrees><role>Professor in Wound Healing</role><aff><institution>University of Leeds</institution><addr-line>Leeds</addr-line><country>UK</country></aff></contrib></contrib-group><author-notes><fn><p>EAN is the author of studies referenced in the review. She was also an applicant in a trial for which Beiersdorf UK Ltd provided trial-related education.</p><p><italic>We would like to acknowledge the previous contributor of this review: June Jones.</italic></p></fn></author-notes><pub-date pub-type="epub"><day>21</day><month>12</month><year>2011</year></pub-date><pub-date pub-type="collection"><year>2011</year></pub-date><volume>2011</volume><elocation-id>1902</elocation-id><permissions><copyright-statement>© BMJ Publishing Group Ltd, All Rights Reserved</copyright-statement><copyright-year>2011</copyright-year></permissions><self-uri xlink:type="simple" xlink:href="http://www.clinicalevidence.bmj.com/ceweb/pmc/2011/12/1902/">This article is available from http://www.clinicalevidence.bmj.com/ceweb/pmc/2011/12/1902/</self-uri><abstract><sec><title>Introduction</title><p>Leg ulcers usually occur secondary to venous reflux or obstruction, but 20% of people with leg ulcers have arterial disease, with or without venous disorders. Between 1.5 and 3.0/1000 people have active leg ulcers. Prevalence increases with age to about 20/1000 in people aged over 80 years.</p></sec><sec><title>Methods and outcomes</title><p>We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of standard treatments, adjuvant treatments, and organisational interventions for venous leg ulcers? What are the effects of advice about self-help interventions in people receiving usual care for venous leg ulcers? What are the effects of interventions to prevent recurrence of venous leg ulcers? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2011 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).</p></sec><sec><title>Results</title><p>We found 101 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.</p></sec><sec><title>Conclusions</title><p>In this systematic review we present information relating to the effectiveness and safety of the following interventions: compression bandages and stockings, cultured allogenic (single or bilayer) skin replacement, debriding agents, dressings (cellulose, collagen, film, foam, hyaluronic acid-derived, semi-occlusive alginate), hydrocolloid (occlusive) dressings in the presence of compression, intermittent pneumatic compression, intravenous prostaglandin E1, larval therapy, laser treatment (low-level), leg ulcer clinics, multilayer elastic system, multilayer elastomeric (or non-elastomeric) high-compression regimens or bandages, oral treatments (aspirin, flavonoids, pentoxifylline, rutosides, stanozolol, sulodexide, thromboxane alpha<sub>2</sub> antagonists, zinc), peri-ulcer injection of granulocyte-macrophage colony-stimulating factor, self-help (advice to elevate leg, to keep leg active, to modify diet, to stop smoking, to reduce weight), short-stretch bandages, single-layer non-elastic system, skin grafting, superficial vein surgery, systemic mesoglycan, therapeutic ultrasound, and topical treatments (antimicrobial agents, autologous platelet lysate, calcitonin gene-related peptide plus vasoactive intestinal polypeptide, freeze-dried keratinocyte lysate, mesoglycan, negative pressure, recombinant keratinocyte growth factor, platelet-derived growth factor).</p></sec></abstract><abstract abstract-type="key-points"><title>Key Points</title><p>Leg ulcers are usually secondary to venous reflux or obstruction, but 20% of people with leg ulcers have arterial disease, with or without venous disorders.</p><p><xref ref-type="sub-article" rid="BMJ_1902_I1">Compression bandages and stockings</xref> heal more ulcers compared with no compression, but we don't know which bandaging technique is most effective.
<list list-type="bullet"><list-item><p>Compression is used for people with ulcers caused by venous disease who have an adequate arterial supply to the foot, and who don't have diabetes or rheumatoid arthritis.</p></list-item><list-item><p>The effectiveness of compression bandages depends on the skill of the person applying them.</p></list-item><list-item><p>We don't know whether <xref ref-type="sub-article" rid="BMJ_1902_I2">intermittent pneumatic compression</xref> is beneficial compared with compression bandages or stockings.</p></list-item></list></p><p><xref ref-type="sub-article" rid="BMJ_1902_I21">Occlusive (hydrocolloid) dressings</xref> are no more effective than simple low-adherent dressings in people treated with compression, but we don't know whether <xref ref-type="sub-article" rid="BMJ_1902_I3">semi-occlusive dressings</xref> are beneficial.</p><p><xref ref-type="sub-article" rid="BMJ_1902_I12">Peri-ulcer injections</xref> of granulocyte-macrophage colony-stimulating factor may increase healing, but we don't know whether other locally applied agents are beneficial, as we found few trials.</p><p><xref ref-type="sub-article" rid="BMJ_1902_I31">Oral pentoxifylline</xref> increases ulcer healing in people receiving compression, and oral <xref ref-type="sub-article" rid="BMJ_1902_I32">flavonoids</xref>, <xref ref-type="sub-article" rid="BMJ_1902_I33">sulodexide</xref>, and <xref ref-type="sub-article" rid="BMJ_1902_I5">mesoglycan</xref> may also be effective.
<list list-type="bullet"><list-item><p>We don't know whether <xref ref-type="sub-article" rid="BMJ_1902_I4">therapeutic ultrasound</xref>, <xref ref-type="sub-article" rid="BMJ_1902_I34">oral aspirin</xref>, <xref ref-type="sub-article" rid="BMJ_1902_I35">rutosides</xref>, <xref ref-type="sub-article" rid="BMJ_1902_I36">thromboxane alpha<sub>2</sub> antagonists</xref>, <xref ref-type="sub-article" rid="BMJ_1902_I38">zinc</xref>, <xref ref-type="sub-article" rid="BMJ_1902_I22">debriding agents</xref>, <xref ref-type="sub-article" rid="BMJ_1902_I37">intravenous prostaglandin E1</xref>, <xref ref-type="sub-article" rid="BMJ_1902_I6">superficial vein surgery</xref>, <xref ref-type="sub-article" rid="BMJ_1902_I10">skin grafting</xref>, <xref ref-type="sub-article" rid="BMJ_1902_I23">topical antimicrobial agents</xref>, <xref ref-type="sub-article" rid="BMJ_1902_I42">leg ulcer clinics</xref>, <xref ref-type="sub-article" rid="BMJ_1902_I11">laser treatment</xref>, or advice to elevate legs, increase activity, lose weight, change diet, or give up smoking increase healing of ulcers in people treated with compression.</p></list-item><list-item><p><xref ref-type="sub-article" rid="BMJ_1902_I41">Larval therapy</xref> is not likely to be beneficial as it has no impact on healing and is painful.</p></list-item></list></p><p><xref ref-type="sub-article" rid="BMJ_1902_I7">Compression bandages and stockings</xref> reduce recurrence of ulcers compared with no compression, and should ideally be worn for life.
<list list-type="bullet"><list-item><p><xref ref-type="sub-article" rid="BMJ_1902_I9">Superficial vein surgery</xref> may also reduce recurrence, but we don't know whether <xref ref-type="sub-article" rid="BMJ_1902_I8">systemic drug treatment</xref> is effective.</p></list-item></list></p></abstract><counts><table-count count="1"></table-count><ref-count count="111"></ref-count></counts></article-meta><notes notes-type="disclaimer"><sec><title>Disclaimer</title><p>The information contained in this publication is intended for medical professionals. Categories presented in Clinical Evidence indicate a judgement about the strength of the evidence available to our contributors prior to publication and the relevant importance of benefit and harms. We rely on our contributors to confirm the accuracy of the information presented and to adhere to describe accepted practices. Readers should be aware that professionals in the field may have different opinions. Because of this and regular advances in medical research we strongly recommend that readers' independently verify specified treatments and drugs including manufacturers' guidance. Also, the categories do not indicate whether a particular treatment is generally appropriate or whether it is suitable for a particular individual. Ultimately it is the readers' responsibility to make their own professional judgements, so to appropriately advise and treat their patients.
To the fullest extent permitted by law, BMJ Publishing Group Limited and its editors are not responsible for any losses, injury or damage caused to any person or property (including under contract, by negligence, products liability or otherwise) whether they be direct or indirect, special, incidental or consequential, resulting from the application of the information in this publication.</p></sec></notes></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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