Dr Parveen Jindal

Dehradun

Venous Leg Ulcers affect around 1% of the population

Costs can rise to € 10,800 per patient

Twelve-month recurrence rates of 26-69% have been reported

Accurate Assessment

• Medical History

• Ankle-Brachial (pressure) Index (AB(P)I)

• Varicose Veins-Doppler Exam • Color Duplex Ultrasound Exam

• Hand Held Continuous Wave Doppler

• Venous photoplethysmography (PPG)

• Venography

• Ulcer characteristics • Size, edge, base, position of the ulcer and its surrounding skin

Reduction of edema and/or swelling

Pain reduction

Improvement of lipodermatosclerosis

Ulcer healing

Preventing recurrence

(by reducing venous hypertension, increasing venous return, increasing fibrinolytic activity in the tissues and improving oxygenation)

Bacteriological swabbing Inflammation/redness/cellulitis

Purulent exudate

Pyrexia

Foul odour

Compression bandage most used and successful treatment

only limited effect on ulcer healing High/Low/Multilayer/Non-Elastomeric/

Intermittent Pneumatic

Pain Reduction Individualize pain relief program

Compression/Leg Elevation/Exercise/Analgesia

Cleansing of the ulcer Irrigation – Warm Tap water/Saline

Dressing technique – Clean/prevent cross infection

Debridement Removal of necrotic and devitalized tissue

mechanical, autolytic, chemical, biosurgical or enzymatic debridement

Dressings and Topical Agents simple, low adherent, low cost and acceptable

application of high compression using a bandage or stocking – most important

Topical Negative Pressure V.A.C.® Therapy

Drug Treatments

Surgery

Follow-up

[Negative-pressure wound therapy (NPWT)]

V.A.C.® Therapy

Therapeutic technique using a vacuum dressing to promote healing in acute or chronic wounds

Involves the controlled application of sub-atmospheric pressure to the local wound environment, using a sealed wound dressing connected to a vacuum pump

The continued vacuum draws out fluid from the wound and increases blood flow to the area.

The vacuum may be applied continuously or intermittently, depending on the type of wound being treated and the clinical objectives.

Typically, the dressing is changed two to three times per week.

The dressings used for the technique include open-cell foam dressings and gauze, sealed with an occlusive dressing intended to contain the vacuum at the wound site.

Vacuum Assisted Closure Therapy

a dressing or a filler material

overlying foam is then sealed with a transparent film

drainage tube is connected to the dressing through an opening

connected to a canister on the side of a vacuum pump

vacuum pump can be set to deliver continuous or intermittent pressures [−125 and −75 mm Hg] depending on the material used and patient tolerance

2007 Cochrane Review supported improved healing.

2010 systematic review found consistent evidence of the benefit of NPWT in the treatment of diabetic ulcers of the feet, that is safe, and will accelerate healing.

Vuerstaek JDD, Vainas T, Wuite J, Nelemans P, Neumann MHA, Veraart JCJM. State-of-art treatment of chronic leg ulcers: A randomized controlled trial comparing vacuum-assisted closure (V.A.C.) with modern wound dressings. J Vasc Surg, 2006; 44(5): 1029-1037.

Saxena V, Hwang CW, Huang S, Eichbaum Q, Ingber D, Orgill DP. Vacuum-assisted closure: microdeformations of wounds and cell proliferation. Plast Reconstr Surg, 2004; 114(5): 1086-1096.

D.C. Kieser, J.A. Roake, C. Hammond, D.R. Lewis. Negative pressure wound therapy as an adjunct to compression for healing chronic venous ulcers. J wound care, Jan 2011; 2 0 (1): 35-37.

V.A.C. Therapy - 35% Reduction of Complete Healing Time

V.A.C.® Therapy

Vuerstaek has clearly stated the benefits of V.A.C. Therapy: "V.A.C.® Therapy should be considered as the treatment of choice for chronic leg ulcers owing to its significant advantages in the time to complete healing and wound bed preparation time compared with conventional wound care."

Vacuum Assisted Closure Therapy

Fast and effective healing

Cost-effective healing

Offering a better quality of life

V.A.C. Therapy is helping to reach all the goals. It reduces edema and when the wound is in the healing phase it also reduces chronic pain. It helps formation of granulation tissue and epithelialisation.

V.A.C. Therapy delivers good healing results for Leg Ulcers 1) It stimulates cell proliferation via the process of micro-strain. 2) The negative pressure stimulates local blood perfusion. 3) As a consequence granulation tissue formation is promoted. 4) The suction removes exudate including wound healing

inhibiting molecules – as consequence, local edema is reduced.

V.A.C. Therapy can effectively be combined with compression therapy. The recent introduction of V.A.C. Granufoam Bridge™ Dressing makes

this even easier to apply. Where the wound bed improves and skin grafting is required, V.A.C.

Therapy can also provide support.

Recent publications show that the treatment of over 5 million Leg Ulcers per year costs more than 1 billion US dollar (equivalent to over 755.000.000 Euro).

Standard treatment will take at least 45 days before healing, which reduces to 29 days with V.A.C. Therapy.

Leg Ulcer patients very often also suffer additional symptoms. E.g. 65% of these patients also develop depression.

• Use of compression stockings • Other strategies

Clinical Venous investigation and surgery Lifetime compression therapy Regular follow up to monitor skin condition for recurrence Regular follow up to monitor ABPI

Patient education Concordance with compression hosiery Skin care Discourage self-treatment with over the counter preparations Avoidance of accidents or trauma to legs Early self-referral at signs of possible skin breakdown Encouragement of mobility and exercise Elevation of the affected limb when immobile

Education and training for leg ulcer care of health care professionals