The Efficacy of Multi-Layer Compression System and TIME-Concept for the Management of Leg Ulcers in Patients with Ambulatory Venous Hypertension – Truth and Myth
DOI:
https://doi.org/10.56294/saludcyt2024.1100Keywords:
leg ulcers, multi-layer compression system, TIME concept, ambulatory venous hypertension, efficacy, managementAbstract
Introduction: Venous leg ulcers are late manifestations of chronic venous insufficiency that can cause disability and serious complications. The elderly are more commonly affected. This study was designed to test the effectiveness, healing rates, quality of life and costs of multi-layer compression system and TIME-concept (tissue management, infection control, moisture balance and wound edge optimization) for the management of leg ulcers in patients with ambulatory venous hypertension.
Methods: A prospective clinical study on 50 outpatients with venous leg ulcers, treated three times weekly for 12 weeks or until healed, with all patients consenting and independently mobile associated with a multi-layer compression system along with the TIME-concept treatment.
Results: The study revealed that, the cohort was predominantly female (66%) with a mean age of 61.7 years. Universal presence of varicose veins and secondary lymphedema was noted. Specific conditions included postthrombotic syndrome (24%), calf pump dysfunction (8%), and venectomy history (32%). All patients achieved complete epithelialization, with an average healing time of 8.5±8.3 weeks and a median of 5.5 weeks (P=0.0064), with 88% healing within 12 weeks. No significant complications were reported. The median number of clinic visits was 16.5, and the median treatment cost was UAH 11,240.00. Patients’ satisfaction with the treatment was 100% according to completed wound healing.
Conclusions: The study demonstrates effective management of venous leg ulcers using a multi-layer compression system and the TIME concept, achieving high healing rates with minimal complications and manageable treatment costs.
References
1. Bodnar P. Structural features of the lower limb deep vein remodeling as a morphologic component in the pathogenesis of pulmonary thromboembolism in cancer patients. Rep. of Morph. [Internet]. 2019Dec.19 [cited 2024Jul.1];25(4):11-6. Available from: https://morphology-journal.com/index.php/journal/article/view/394
2. Sopilnyk L, Dotsenko V, Aleksandraviciute B. Preservation of labour potential in the Ukrainian healthcare sector: on the way to the third SDG fulfilment in pandemic conditions. LBSHerald [Internet]. 2021;1(3):17–24. Available from: http://dx.doi.org/10.46489/lbsh.2021-1-3-3
3. Robles-Tenorio A, Lev-Tov H, Ocampo-Candiani J. Venous Leg Ulcer. Phlebology, Vein Surgery and Ultrasonography: Diagnosis and Management of Venous Disease. 2022:341-53.
4. Gai L, Hruzevskyi O, Koltsova I, Dubina A, Tabulina A. The use of immunological drugs for the treatment of wound infections in military personnel during hostilities. FM [Internet]. 2024 Mar. 15 [cited 2024 Jun. 29];3(1):59-70. Available from: https://futurity-medicine.com/index.php/fm/article/view/121
5. Millan SB, Gan R, Townsend PE. Venous ulcers: diagnosis and treatment. Am Fam Physician. 2019 Sep 1;100(5):298-305.
6. Ortega MA, Fraile-Martínez O, García-Montero C, Álvarez-Mon MA, Chaowen C, Ruiz-Grande F, et al. Understanding chronic venous disease: A critical overview of its pathophysiology and medical management. J Clin Med [Internet]. 2021;10(15):3239. Available from: http://dx.doi.org/10.3390/jcm10153239
7. Bavaresco T, Lucena A de F. Low-laser light therapy in venous ulcer healing: a randomized clinical trial. Rev Bras Enferm [Internet]. 2022;75(3). Available from: http://dx.doi.org/10.1590/0034-7167-2021-0396
8. Odynets O. Philosophy of Health Within the Metamodern Worldview Paradigm. FPH [Internet]. 2024 Jun. 19 [cited 2024 Jun. 29];3(3):42-59. Available from: https://futurity-philosophy.com/index.php/FPH/article/view/89
9. Burnet M, Metcalf DG, Milo S, Gamerith C, Heinzle A, Sigl E, et al. A host-directed approach to the detection of infection in hard-to-heal wounds. Diagnostics (Basel) [Internet]. 2022;12(10):2408. Available from: http://dx.doi.org/10.3390/diagnostics12102408
10. Farah MH, Nayfeh T, Urtecho M, Hasan B, Amin M, Sen I, et al. A systematic review supporting the Society for Vascular Surgery, the American Venous Forum, and the American Vein and Lymphatic Society guidelines on the management of varicose veins. J Vasc Surg Venous Lymphat Disord [Internet]. 2022;10(5):1155–71. Available from: http://dx.doi.org/10.1016/j.jvsv.2021.08.011
11. Todd M. Assessment and management of older people with venous leg ulcers. Nurs Older People [Internet]. 2018;30(5):39–48. Available from: http://dx.doi.org/10.7748/nop.2018.e1004
12. Raffetto JD, Ligi D, Maniscalco R, Khalil RA, Mannello F. Why venous leg ulcers have difficulty healing: Overview on pathophysiology, clinical consequences, and treatment. J Clin Med [Internet]. 2020;10(1):29. Available from: http://dx.doi.org/10.3390/jcm10010029
13. Ren S-Y, Liu Y-S, Zhu G-J, Liu M, Shi S-H, Ren X-D, et al. Strategies and challenges in the treatment of chronic venous leg ulcers. World J Clin Cases [Internet]. 2020;8(21):5070–85. Available from: http://dx.doi.org/10.12998/wjcc.v8.i21.5070
14. Lazarus G, Valle MF, Malas M, Qazi U, Maruthur NM, Doggett D, et al. Chronic venous leg ulcer treatment: future research needs: Future research needs for venous ulcers. Wound Repair Regen [Internet]. 2014;22(1):34–42. Available from: http://dx.doi.org/10.1111/wrr.12102
15. Mahlapuu M, Sidorowicz A, Mikosinski J, Krzyżanowski M, Orleanski J, Twardowska‐Saucha K, et al. Evaluation of LL‐37 in healing of hard‐to‐heal venous leg ulcers: A multicentric prospective randomized placebo‐controlled clinical trial. Wound Repair and Regeneration. 2021;29(6):938-50.
16. Tiwary SK, Choubey KK, Nath G, Kumar P, Khanna AK. Effect of four-layer dressing on the microbiological profile of venous leg ulcer. J Wound Care [Internet]. 2023;32(Sup3):S22–30. Available from: http://dx.doi.org/10.12968/jowc.2023.32.sup3.s22
17. Mabeba M. The Effect of Military Expenditure on Economic Prosperity in Croatia. FSocS [Internet]. 2024 May 7 [cited 2024 Jun. 29];2(2):4-20. Available from: https://futurity-social.com/index.php/journal/article/view/34
18. Derwin R, Patton D, Strapp H, Moore Z. The effect of inflammation management on pH, temperature, and bacterial burden. Int Wound J [Internet]. 2023;20(4):1118–29. Available from: http://dx.doi.org/10.1111/iwj.13970
19. Raju S, Knight A, Lamanilao L, Pace N, Jones T. Peripheral venous hypertension in chronic venous disease. J Vasc Surg Venous Lymphat Disord [Internet]. 2019;7(5):706–14. Available from: http://dx.doi.org/10.1016/j.jvsv.2019.03.006
20. Fife CE, Horn SD. The Wound Healing Index for predicting venous leg ulcer outcome. Adv Wound Care (New Rochelle) [Internet]. 2020;9(2):68–77. Available from: http://dx.doi.org/10.1089/wound.2019.1038
21. Velozo BC, Colenci R, Abbade LPF. Multilayer elastic compression for the treatment of a 30-year venous ulcer. An Bras Dermatol [Internet]. 2020;95(2):263–4. Available from: http://dx.doi.org/10.1016/j.abd.2019.08.025
22. Xu Q, Li Z. Effects of pneumatic compression therapy on wound healing in patients with venous ulcers: A meta-analysis. Int Wound J [Internet]. 2023;21(3):e14438. Available from: http://dx.doi.org/10.1111/iwj.14438
23. Bernatchez SF, Eysaman-Walker J, Weir D. Venous leg ulcers: A review of published assessment and treatment algorithms. Adv Wound Care (New Rochelle) [Internet]. 2022;11(1):28–41. Available from: http://dx.doi.org/10.1089/wound.2020.1381
24. Bossert J, Vey JA, Piskorski L, Fleischhauer T, Awounvo S, Szecsenyi J, et al. Effect of educational interventions on wound healing in patients with venous leg ulceration: A systematic review and meta-analysis. Int Wound J [Internet]. 2023;20(5):1784–95. Available from: http://dx.doi.org/10.1111/iwj.14021
25. Jacinto MAG, Oliveira AC de S, Martínez CSG, Schlosser TCM, Dantas BA da S, Torres G de V. Healing of venous Leg Ulcers influenced by individual aspects: Cluster analysis in a Specialist Wound Management Clinic. J Prim Care Community Health [Internet]. 2024;15:21501319231223458. Available from: http://dx.doi.org/10.1177/21501319231223458
26. Aloweni F, Mei CS, Lixuan NL, Fook-Chong S, Yobas P, Yuh AS, et al. Healing outcomes and predictors among patients with venous leg ulcers treated with compression therapy. J Wound Care [Internet]. 2022;31(Sup3):S39–50. Available from: http://dx.doi.org/10.12968/jowc.2022.31.Sup3.S39
27. Yousefian F, Hesari R, Jensen T, Obagi S, Rgeai A, Damiani G, et al. Antimicrobial wound dressings: A concise review for clinicians. Antibiotics (Basel) [Internet]. 2023;12(9):1434. Available from: http://dx.doi.org/10.3390/antibiotics12091434
28. Lee SY, Lee MJ, Byun SB. Analysis of the factors of wound healing problems after transtibial amputation in diabetic patients. Int J Low Extrem Wounds [Internet]. 2023; Available from: http://dx.doi.org/10.1177/15347346231198940
29. Scotton MF, Miot HA, Abbade LPF. Factors that influence healing of chronic venous leg ulcers: a retrospective cohort. An Bras Dermatol [Internet]. 2014;89(3):414–22. Available from: http://dx.doi.org/10.1590/abd1806-4841.20142687
30. Urwin S, Dumville JC, Sutton M, Cullum N. Health service costs of treating venous leg ulcers in the UK: evidence from a cross-sectional survey based in the north west of England. BMJ Open [Internet]. 2022;12(1):e056790. Available from: http://dx.doi.org/10.1136/bmjopen-2021-056790
31. Barnsbee L, Cheng Q, Tulleners R, Lee X, Brain D, Pacella R. Measuring costs and quality of life for venous leg ulcers. Int Wound J [Internet]. 2019;16(1):112–21. Available from: http://dx.doi.org/10.1111/iwj.13000
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