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Skin grafts to improve leg ulcer healing

Approximately 1% of people in industrialised countries have a leg ulcer at some time, mainly caused by poor blood flow back from the legs towards the heart. Skin grafts, either using the patient's own skin, artificial skin or donor skin/cells, have been evaluated to see whether they improve the healing of ulcers. The review of trials found evidence that tissue‐engineered skin composed of two layers increases the chance of healing. There was not enough evidence to recommend any other type of graft, and further research is required.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Hydrocolloid dressings to promote foot ulcer healing in people with diabetes when compared with other dressing types

Diabetes, a condition which leads to high blood glucose concentrations, is a common condition with around 2.8 million people affected in the UK (approximately 4.3% of the population). Dressings are commonly used to treat foot ulcers in people with diabetes. There are many types of dressings that can be used, which also vary considerably in cost.This review (four studies involving a total of 511 participants) identified no research evidence to suggest that any type of hydrocolloid wound dressing is more effective in healing diabetic foot ulcers than other types of dressing.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Interventions for Mooren's ulcer

Mooren's ulcer is inflammation that occurs at the edge of the cornea (clear part of the front of the eye). Its cause is unknown. It is very painful and can or will lead to loss of vision if untreated. It occurs worldwide and affects all age groups. It is diagnosed by excluding other causes of ulcerations at the edge of the cornea such as chronic inflammation of the joints due to rheumatoid arthritis. Mooren's ulcer can be treated both medically and surgically. Medical treatment includes the use of drugs such as steroids and non‐steroidal anti‐inflammatories. Surgical methods include resection of the conjunctiva (the thin clear tissue that covers the surface of the eye) from the cornea, removal of dead cornea tissue and cornea transplant. We set out to determine the best available intervention for the treatment of Mooren’s ulcer by looking for randomised controlled trials (RCTs) comparing one form of treatment to another; and treatment versus no treatment. The electronic database searches did not find any RCTs on the treatment of Mooren’s ulcer. This review recommends the need for well conducted RCTs for both medical and surgical interventions for Mooren’s ulcer. These trials should look at outcomes such as number of participants that healed against those that did not, what percentage of area healed and the speed at which healing took place.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Hydrogel dressings to promote diabetic foot ulcer healing

Diabetes, a condition which leads to high blood glucose concentrations, is a common condition with around 2.8 million people affected in the UK (approximately 3% of the population). Dressings are a widely used treatment when caring for foot ulcers in people with diabetes. There are many types of dressings that can be used, which also vary considerably in cost. This review (five studies involving a total of 446 people) suggests that hydrogel dressings may be more effective than basic wound contact dressings in healing foot ulcers in people with diabetes although the original research may be biased. There is insufficient research comparing hydrogel with advanced dressing types to allow conclusions to be drawn regarding relative effectiveness in terms of ulcer healing.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Laparoscopic (minimally invasive) repair for perforated peptic ulcer disease

A perforated peptic ulcer can be repaired using either open surgery or laparoscopy, a minimally invasive surgical technique sometimes known as 'keyhole' surgery. Three randomized controlled trials were identified that compared the two methods. These trials included patients with clinical suspicion of perforated peptic ulcer that was confirmed at surgery. Both laparoscopic and open repairs were made with an omentum patch or fibrin sealant. The primary outcomes assessed were septic abdominal and extra‐abdominal complications. Secondary outcomes assessed were mortality, operation time and hospital length of stay. The quality of the trials was acceptable. There were no statistically significant differences in septic abdominal complications between laparoscopic and open repair of perforated peptic ulcer. More randomized controlled trials with a greater number of patients are needed to confirm such an assumption, guaranteeing a long learning curve for participating surgeons.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

This review assesses the usefulness surgery for anal fissure, a painful ulcer at the anal opening, by comparing the efficacy of various surgical procedures and how likely they are to result in complications.

Does surgery provide a long term cure for anal fissure? Yes, in better than 90% of patients having recommended operative procedures. Such operations include principally partial division of the anal sphincter, or controlled dilation of the narrowed anal opening. The technique for cutting the muscle has been refined in recent years and appears to improve cure and diminish the risk of bowel control problems. The method of achieving controlled anal dilation needs further investigation.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Genital ulcer disease treatment for reducing sexual acquisition of HIV

The presence of a genital ulcer would provide an entry point for the HIV virus if an HIV‐negative individual with an ulcer has unprotected sexual intercourse with an HIV‐infected person. Treatment of the condition causing the genital ulcer would allow the ulcer to heal and therefore reduce the chances of HIV acquisition. This review assessed whether giving treatment for diseases that present with ulcers in the genital region would reduce sexual acquisition of HIV. Three studies were identified involving 173 HIV‐negative patients with genital ulcers. These studies did not provide sufficient evidence that treatment of genital ulcer diseases reduces sexual acquisition of HIV infection. However, genital ulcer diseases are public health problems in their own right and patients with these conditions should be treated appropriately; whether the treatment reduces the risk of HIV infection or not.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Antibiotics vs. acid suppression therapy (with or without long‐term maintenance acid suppression therapy) for the prevention of recurrent bleeding from peptic ulcer

Peptic ulcers are caused by acidic stomach juices damaging the lining of the stomach (gastric ulcer) or upper small intestine (duodenal ulcer). This causes pain, indigestion and sometimes bleeding. Bleeding in the gut can be life‐threatening. Several treatments aim to heal the ulcer and prevent future bleeding. These include acid‐suppressing drugs and antibiotics to treat Helicobacter pylori, a bacterium that causes most peptic ulcers. The review found that, for people who have had a bleeding peptic ulcer caused by Helicobacter pylori, treatment with antibiotics more effectively prevents gastrointestinal re‐bleeding than acid‐suppressing drugs. Antibiotics when Helicobacter pylori infection is present are also cheaper and more convenient than long‐term acid‐suppressing drugs.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Comparing Proton Pump Inhibitors

How do proton pump inhibitors compare in gastroesophageal reflux disease (GERD)?

PubMed Clinical Q&A [Internet] - National Center for Biotechnology Information (US).

Version: October 1, 2010

Topical treatments for HIV‐related oral ulcers

Oral aphthous ulcers associated with HIV infection occur commonly and recur frequently with varying severity. They occur at different stages of the disease. Topical treatments aim at meeting the basic requirements of the management of these ulcers which include pain relief, healing and reduction in recurrence. Topical treatment reduces the incidence of toxicity and serious side effects associated with systemic treatments. This review was conducted to evaluate the efficacy of the various topical agents available for the treatment of HIV related oral aphthous ulcers. From all the abstracts and articles examined, only two studies appeared to meet the inclusion criteria but had no full text reports, which makes it impossible to make recommendations.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Pressure‐relieving devices for treating heel pressure ulcers

Pressure ulcers (also known as pressure sores, decubitus ulcers and bed sores) are areas of localised damage to the skin and underlying tissue, believed to be caused by pressure, shear or friction. Pressure‐relieving devices such as beds, mattresses, heel troughs, splints and pillows are used as part of the treatment to reduce or relieve the pressure on the ulcer. Heel ulcers were studied specifically as their structure is very different to the other body sites which are prone to pressure ulcers (such as the bottom) and they are more prone to diseases, such as poor circulation, which do not affect other pressure ulcer sites. We identified one study that was at moderate to high risk of bias. This study lost over half the participants to follow up. More high quality research is needed to inform the selection of pressure relieving devices to treat pressure ulcers of the heel.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Electromagnetic therapy (EMT) for treating venous leg ulcers

Venous leg ulcers (which appear as open sores) can be caused by a blockage or breakdown in the veins of the legs. Compression of the leg, using bandages or hosiery (stockings), can help heal most of these ulcers. Electromagnetic therapy is also sometimes offered. Electromagnetic therapy is not a form of radiation or heat, but uses an electromagnetic field to try to promote healing. This review of clinical trials concluded that there is no high quality evidence that electromagnetic therapy speeds the healing of venous leg ulcers.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Pentoxifylline for treating venous leg ulcers.

Venous leg ulcers are a common, recurring and disabling condition. The mainstay of treatment is the use of firm compression bandages or stockings to support the veins of the leg. Some leg ulcers take many months or years to heal and treatment is aimed at preventing infection and speeding up healing. Pentoxifylline is a tablet taken to improve blood circulation. The review of trials suggests that pentoxifylline, 400 mg tablet taken three times a day, increases the chance of healing.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

The effect of therapeutic ultrasound on pressure ulcers.

Pressure ulcers (also called pressure sores, bed sores or decubitus ulcers) are sores on the body caused by pressure or rubbing. They usually happen to immobile people, on bony parts of their bodies, such as hips, heels and elbows.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Electromagnetic therapy for treating pressure ulcers

Pressure ulcers (also called bed sores, decubitus ulcers or pressure sores) are sores on the skin caused by pressure or rubbing. They usually affect immobile people on the bony parts of their bodies such as hips, heels and elbows, and take a long time to heal. Electromagnetic therapy is not a form of radiation or heating, but uses an electromagnetic field with the aim of stimulating healing. However, the review of trials concluded that there is no strong evidence that electromagnetic therapy helps or hinders healing of pressure ulcers.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Intermittent pneumatic compression for treating venous leg ulcers.

Venous leg ulcers (open sores) can be caused by a blockage or breakdown in the veins of the leg. Compression, using bandages or hosiery (stockings), can help heal ulcers. However, they do not always work, and some people are not willing or able to wear them. Intermittent pneumatic compression (IPC) uses an air pump to inflate and deflate an airtight bag wrapped around the leg. This technique is also used to stop blood clots developing during surgery. However, the review of trials found conflicting evidence about whether or not IPC is better than compression bandages and hosiery. Intermittent pneumatic compression (IPC) is better for healing leg ulcers than no compression. . Some studies suggest IPC might be a beneficial addition to bandages for some ulcers, but these studies might be biased. Delivering the IPC therapy in a rapid manner by inflating and deflating the IPC device more quickly resulted in more ulcers being healed than with a slower deflation regime.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Oral zinc supplements for treating leg ulcers

Most leg ulcers (open sores, usually on the lower leg) usually heal with good wound care, including wound dressings. However even with good wound care leg ulcers may take weeks or months to heal. Leg ulcers often cause distress to patients and are costly for health services. Failure to heal may be due to poor nutrition which reduces the ability of the body to repair itself. Minerals such as zinc are necessary for good healing and so it has been thought that taking zinc sulphate tablets might aid healing of ulcers. We found six trials that used zinc to treat leg ulcers but all were too small to show a benefit even if one exists. Furthermore the methods used in the existing trials mean that their results were possibly biased.On the basis of the evidence we have so far it appears that taking zinc tablets does not improve leg ulcer healing, however better quality trials are needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Repositioning for treating pressure ulcers

Pressure ulcers (also known as bed sores, pressure sores and decubitus ulcers) are localised areas of tissue damage caused by excess pressure and shearing forces. Pressure ulcers mainly occur in people who have limited mobility, nerve damage or both. Pressure, from lying or sitting on a particular part of the body, results in oxygen and nutrient deprivation to the affected area. Repositioning involves moving the individual into a different position in order to remove or redistribute pressure from a part of the body. If a person with an existing pressure ulcer continues to lie or bear weight on the affected area, the tissues become depleted of blood flow and there is no oxygen or nutrient supply to the wound, and no removal of waste products from the wound, all of which are necessary for healing. People who cannot reposition themselves require assistance. International best practice advocates the use of repositioning as an integral component of a pressure ulcer management strategy. The authors of this review found no studies that were eligible for inclusion in the review. Therefore, we do not know whether repositioning people makes any difference to the healing rates of pressure ulcers.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Systemic interventions for recurrent aphthous stomatitis (mouth ulcers)

Mouth ulcers (sores) are one of the most common oral problems and many people suffer with them repeatedly. These can be painful and slow to heal. At its worst, this can cause significant difficulties in eating and drinking. This review found that many different treatments were used to manage this condition, although the evidence of their effectiveness remains inconclusive.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Ultrasound therapy used for healing venous (varicose) leg ulcers and to improve symptoms

Venous leg ulcers are common, especially in the elderly. They are caused by damage or blockages in the veins of the legs, which in turn lead to pooling of blood and increased pressure in these veins. Eventually, these changes can damage the skin and lead to ulcer formation.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

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