[Linee guida flebo-linfologiche SIF-SICVE 2016 della Società Italiana di Flebologia e della Società Italiana di Chirurgia Vascolare ed Endovascolare].

Phlebology is not a specialty for its own in Italy. Phlebological patients are treated by vascular and general surgeons, dermatologists, phlebologists, angiologists, internists and even general practitioners. Even tough guidelines present a series of recommendations based on evidence-based medicine, guidelines may also be a tool to unify the diagnostic and therapeutic approach in a vast medical field like phlebology. Since vascular surgeons and phlebologists are particularly involved in phlebology-related pathologies the scientific societies of the Italian Society of Phlebology (SIF) and the Italian Society for Vascular and Endovascular Surgery (SICVE) decided to cooperate for the preparation of phlebo-lymphological guidelines. These guidelines comprehend also an important chapter dealing with the lymphology of the lower extremities; phlebological active physicians are often faced with lymphatic pathologies and a good differential diagnosis can be sometimes very helpful. Sclerotherapy and Surgery as the major therapeutical alternatives are extensively analyzed, but also the compression therapy, the medical and physical therapy are presented under the critical view of evidence based analyses. Separate chapters deal with the treatment alternatives for superficial and deep venous thromboses and the recommendations for the treatment of venous ulcers. The current scientific evidences were confronted with the experiences of Italian specialists and the particular practice and reality in Italy. They represent therefore the actual valid positions and recommendations in Italy which shall be updated regularly.

A nutritional formula enriched with arginine, zinc, and antioxidants for the healing of pressure ulcers: a randomized trial.

BACKGROUND: Trials on specific nutritional supplements for the treatment of pressure ulcers (PUs) have been small, inconsistent in their formulations, or unsuccessful in controlling for total supplement calorie or protein content. OBJECTIVE: To evaluate whether supplementation with arginine, zinc, and antioxidants within a high-calorie, high-protein formula improves PU healing. DESIGN: Multicenter, randomized, controlled, blinded trial. (ClinicalTrials.gov: NCT01107197). SETTING: Long-term care and home care services. PATIENTS: 200 adult malnourished patients with stage II, III, and IV PUs. INTERVENTIONS: An energy-dense, protein-rich oral formula enriched with arginine, zinc, and antioxidants (400 mL/d) or an equal volume of an isocaloric, isonitrogenous formula for 8 weeks. MEASUREMENTS: The primary end point was the percentage of change in PU area at 8 weeks. Secondary end points included complete healing, reduction in the PU area of 40% or greater, incidence of wound infections, the total number of dressings at 8 weeks, and the percentage of change in area at 4 weeks. RESULTS: Supplementation with the enriched formula (n = 101) resulted in a greater reduction in PU area (mean reduction, 60.9% [95% CI, 54.3% to 67.5%]) than with the control formula (n = 99) (45.2% [CI, 38.4% to 52.0%]) (adjusted mean difference, 18.7% [CI, 5.7% to 31.8%]; P = 0.017). A more frequent reduction in area of 40% or greater at 8 weeks was also seen (odds ratio, 1.98 [CI, 1.12 to 3.48]; P = 0.018). No difference was found in terms of the other secondary end points. LIMITATION: Participation was restricted to patients who were malnourished, were able to drink oral supplements, and were living in long-term care institutions or receiving home care services. CONCLUSION: Among malnourished patients with PU, 8 weeks of supplementation with an oral nutritional formula enriched with arginine, zinc, and antioxidants improved PU healing. PRIMARY FUNDING SOURCE: Azienda Ospedaliera Universitaria Maggiore della Carità.

Comparison Between a New, Two-component Compression System With Zinc Paste Bandages for Leg Ulcer Healing: A Prospective, Multicenter, Randomized, Controlled Trial Monitoring Sub-bandage Pressures.

UNLABELLED: Compression therapy is standard treatment for venous leg ulcers. The authors prefer multi-layer, multi-component, stiff, high-pressure bandages to treat venous leg ulcers. The Unna boot (UB) is an example of this type of bandage. The aim of this study was to compare the effectiveness and tolerability of UB to a new, two-component bandage. METHODS: One hundred (100) patients with venous ulcers were randomized into two groups: group A (n = 50) received UB and group B (n = 50) 3M™ Coban™ 2 Layer Compression System (C2L). All patients were followed weekly for 3 months and then monthly until complete healing was achieved. The primary outcomes were: ulcer healing or surface reduction; pain; and exudate control. The secondary outcomes were: ease of application and removal of the bandage, pressure exerted in the supine and standing position after application and before removal, and bandage comfort. RESULTS: C2L was associated with 100% ulcer healing; 47 out of 50 cases healed within the first 3 months after application of the bandage. Compared with the UB, there was no statistically significant difference. In both groups the effect of compression on pain and overall well being was excellent; pain decreased by 50% within 1-2 weeks and remained low throughout the duration of treatment and overall well being improved significantly. There was no significant difference between the two systems concerning level of comfort. CONCLUSION: C2L proved to be effective in treating venous ulcers due to its stiffness and pressure. Its effectiveness was similar to UB, which is often considered the gold-standard compression device for venous ulcers. This fact, in combination with high tolerability and ease of application and removal, make this new bandage particularly suitable for the treatment of venous leg ulcers. .