3. Venous leg ulcer
Retrospective study assessing the efficacy of electrical stimulation on leg ulcer pain.
P. Leloup, P. Toussaint, J. P. Lembelembe et al
The authors presented the results of the first study on the efficacy of electrostimulation in leg ulcer pain, demonstrating that this method may improve pain control as assessed by the evolution of a subjective criterion (visual numeric scale) and a target (reduced consumption of analgesics).
Several clinical studies have demonstrated the efficacy of electrostimulation in chronic wound healing by applying an electric current directly to the ulcer. Electrostimulation increases angiogenesis as well as migration and proliferation of macrophages, fibroblasts, and keratinocytes in ulcers.
This retrospective study included 73 patients (43 women and 30 men) with leg ulcers, mean age of 75.2 years, assessed between 2011 and 2013. The etiology of leg ulcers varied: 31 venous ulcers, 21 mixed arteriovenous ulcers, 2 arterial ulcers, 17 necrotic angiodermatites, 1 amputation stump ulcer, and 1 ulcer due to Hydrea. Patients were assessed by conventional or home follow-up. Pain medication administered to each patient was closely monitored.
The results were interpreted using, as tools, the visual numeric pain scale (VNS) and the Student test for the statistical interpretation of data (significant P<0.05). Patients were treated with electrostimulation, and pain was assessed on days 0, 3, and 7.
The study showed a statistically significant decrease in pain between day 0 (VNS 5.3) and day 7 (VNS 2.2), accompanied by reduced consumption of pain medication. In necrotic angiodermatitis, a hyperalgesic condition, VNS decreased from 6.88 on day 0 to 2.82 on day 7 (P=0.001). The consumption of pain medication and the number of morphine derivatives used for pain relief also decreased.
Leg ulcer pain is difficult to control. The study showed that electrostimulation is an easy treatment that does not require hospitalization, favors leg ulcer closure, and significantly reduces pain.
Contact sensitivity to modern wound dressings: study in 345 patients with chronic leg ulcer.
A. Valois, M. Avenel-Audran, F. Truchetet et al.
Modern wound dressings for leg ulcers are effective, but failed to solve the problem of contact sensitivity. The authors started by presenting the results of a recent study in 423 patients with chronic leg ulcers, which showed that a high number of cases (73%) developed contact sensitivity to the components of topical treatments. After, the authors presented the results of a new French multicenter study conducted in 354 patients with chronic leg ulcers that evaluated contact sensitivity to modern wound dressings. The study was conducted over a period of 4 years (2009-2013) in patients with at least a one-month-old chronic leg ulcer of well-documented cause and course.
Patients were subjected to epicutaneous tests with the European standard battery (containing 27 molecules) and a “special” leg ulcer battery. The latter contained 26 allergens present in modern wound dressings, antiseptics, dermatocorticosteroids, and 11 different types of modern wound dressings. Of the total number of patients included in the study, 59.6% (211 patients) had at least 1 positive epicutaneous test and 32.8% (116 patients; 32.8%) had positive epicutaneous tests to modern wound dressings.
Modern wound dressings that caused contact sensitization were: Ialuset cream in 45 patients (12.5%), hydrocellular dressings in 28 patients (7.9%), hydrocolloid dressings in 17 patients (4.8%), hydrogels in 7 patients (2%), alginate (Algosteril) in 6 patients (1.6%), hydrofibers in 5 patients (1.4%), and interface dressings in 8 patients (2.2%). The constituents of modern wound dressings responsible for contact sensitivity were colophane (4.2%), amerchol L 101 (6.8%), sodium metabisulfite (4.8%), propylene glycol (1.4%), carboxymethyl cellulose (0.8%), and ibuprofen (0.3%).
There is a direct association between the ulcer’s age and an increasing rate of contact sensitivity to modern dressings. There is no direct correlation between the occurrence and intensity of contact sensitivity and association of chronic leg ulcers with periulcerous eczema, erythema, or chronic ulcer etiology, contrary to some literature data.
The authors suggested that the packages of modern dressings should specify the presence of the allergenic components detected in this study (eg, colophane derivatives, perfume, etc).
