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A Journal on Phlebology
Acta Phlebologica 2001 April;2(1):13-21
language: English, Italian
About prevention and treatment of venous ulcers of the limbs. Our experience
Riccioni C., Sarcinella R., Izzo A., Palermo G., Moschetti B., Martocchia R., Liguoru M. L.
U. O. di Angiologia, Ospedale Nuovo Regina Margherita - Roma (Italy)
BACKGROUND: We aim to verify how a condition of local asepsis might accelerate the healing.
METHODS: A randomized, comparative study prolonged for 12 weeks, with follow-up at 6 months was assess in 35 out-patients attending our day hospital for the care of venous leg ulcers. Patients selected had incompetence both of the safenic system and the perforator of the limbs, confirmed by clinics and Duplex Scan. Mean diameter of the ulcers was 5 cm placed on the 1/3 upper medialis of the leg. At the assessment, all the patients had a surgical courretage of the wound and a bacterial tampon which revealed: 16 Staphylococcus Aureus, 8 Pseudomonas Aeruginosa, 11 Staphylococcus Epidermidis. Patients were divided in 2 groups: during the first 2 weeks , 20 had sistemic and topic specific antibiotic therapy and elastocompression; 15 had only elastocompression. Dressing and bandages were provided by trainers and skilled nursing or by physicians, daily. The first group included 10 ulcers infected by Staphylococcus Aureus, 6 with Pseudomonas, 4 with Staphylococcus Epidermidis whereas the second group had 4 ulcers infected by Staphylococcus Aureus, 4 by Pseudomonas Aeruginosa and 7 by Staphilococcus Epidermidis. These microbia were sensitive to Vancocina, which we used topically, and to Ciclofloxacina which we used specifically per os at dose 500 mg/2 times/die as patients in Day Hospital regimen. Tampon was repeated once weekly. Clinically we consider as healing parameter the decreasing of the diameter of the ulcer and the decreasing of the pain during the first 2 weeks of treatment.
RESULTS: 27 patients healed during 12 weeks. The first group had a complete healing before than the second group (mean 6,8 weeks versus mean 10.6 weeks) with a decreasing both of the diameters of the ulcers from 5 to 1.8 cm and of the pain with a total tolerance of the bandages. Particularly, 16 patients healed after 8 weeks and all 20 reported the disappearance of the pain after 9 days. 11 Patients of the second group were healed in 12 weeks with a decreasing of the diameter from 5 cm to 3.4 cm reporting local pain for a mean of 3.8 weeks and leaving out often the bandages. The other 8 patients were healed after a mean of 14.6 weeks. After a follow-up at 6 months all the patients did not present ulcers.
CONCLUSIONS: Ulcers request continous clinical controls to block bacterial infection or corruption which can make worse the wound with pain and prevent the use of compressive bandages or elastic stockings. Infections are more frequents in patients which try to care the ulcers at home by some unsuitable ways.
For this reason, is to be recommended a daily control of the ulcer in a specialistic place and provide a once weekly bacterial tampon. It is possible by Day Hospital regimen which remain the more efficient and the less expensive way both socially and psicologically for the patient.