ORIGINAL ARTICLES   

Acta Phlebologica 2001 April;2(1):13-21

Copyright © 2001 EDIZIONI MINERVA MEDICA

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.