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Retrograde Venous Perfusion in Chronic Ulcers of Lower Limb.
Article in English | IMSEAR | ID: sea-157554
ABSTRACT
Chronic foot ulcers are difficult to treat. These patients need prolong treatment which is costly and often associated with non-compliance. These patients are vulnerable to develop gangrene leading to amputation. Retrograde venous perfusion (RVP) is a new therapeutic approach which was recently introduced to the treatment of diabetic foot as an adjunctive line to systemic therapy and local therapy. It is based on principle of regional anesthesia. Recently, Latin American investigators, applied this approach to local therapy of pedal ischemia. Since then this approach was mainly employed for therapy of diabetic neuropathic pedal ulcers. In this work, the efficacy of this approach was explored in 5 group of chronic foot disorder – 1) Diabetic foot presenting as foot infection, 2) Dibetic neuropathic pedal ulcers, 3) Diabetic pedal ischemia and infection, 4) Nondiabetic post traumatic foot ulcers, 5) Non-diabetic ischemic ulcer and pre-gangrene or gangrene. The present study was conducted on 56 patients having non healing ulcer of lower limb. Regular dressing and debridment and retrograde venous perfusion therapy was done in all patients. Results were assessed after completion of therapy. The following conclusions are drawn from the present study. Out of all diabetic patients, 23.7% of cases presented as diabetic foot. The incidence of diabetic foot patients was 64.29% out of all studied patients with ulcer foot. Maximum number of patients, 28.57% were in 31-40 years age group. The mean age of the patients was 44.4 years. There was male predominance with male and female ratio being 1.551. Mean reduction of ulcer size after RVP therapy was 63.89%. Maximum improvement was found in patients with diabetic pedal ischemia and infection i.e. 70% where as patients with non diabetic post traumatic foot ulcers had minimum improvement i.e. 52.22%. Whole foot or more than 4 toe amputation was not required in any patient in therapy group. After RVP therapy gangrene or pre-gangrene was prevented in 72.73% of patients. Minimum days of stay was 11-15 days in 32.14% of patients. Average duration of hospital stay was 18 days. Patients with foot ulcer in whom RVP therapy was not done, average duration of hospital stay was 31 days. This denotes that RVP reduces the time of therapy an avoids prolonged treatment. The ratio of diabetic and non-diabetic patients with neuropathy was 2.51. In Doppler ultrasound study, patients with sign of ischemia, ankle-brachial pressure index was less than 0.6 in 22 patients, out of them 16 patients were diabetic. After RVP therapy 93.33% of diabetic foot patients and 80% of non-diabetic foot ulcer patients ankle-brachial ratio became more then 0.8 denoting that after RVP therapy the blood flow in lower limb was increased. The present study confirms the good result in respect to decrease in ulcer size, overcome critical complications which are threatening the foot, early healing of ulcer, increase blood flow in ischemic foot, check progression of gangrene and pre-gangrene and to conserve the foot to avoid amputation. This study entailed expansion of the application of RVP to intractable post-traumatic ulcers of the foot and lower leg, as well as, to critical pedal ischemia in diabetic and non-diabetic patients.
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Full text: Available Index: IMSEAR (South-East Asia) Main subject: Perfusion / Veins / Wound Healing / Infusions, Intravenous / Female / Humans / Male / Foot Ulcer / Diabetic Foot / Adult Type of study: Diagnostic study Language: English Year: 2013 Type: Article

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Full text: Available Index: IMSEAR (South-East Asia) Main subject: Perfusion / Veins / Wound Healing / Infusions, Intravenous / Female / Humans / Male / Foot Ulcer / Diabetic Foot / Adult Type of study: Diagnostic study Language: English Year: 2013 Type: Article