Background: Venous ulcers have a prevalence of approximately 2 million people in the United States, with approximately 50% of the patients having an ulcer history of 10 years (Steed, Hill, Woodske, Payne, & Robson, 2006). Venous stasis ulcers have a high recurrence rate, up to 70% in extreme cases. This recurrence is ultimately what is detrimental to overall quality of life. The cause of a venous ulcer is not clear, with many suggesting that symptoms are a result of ambulatory venous hypertension associated with chronic venous insufficiency (Kahle, Hermanns, & Gallenkemper, 2011) and or venous incompetence (Collins & Seraj, 2010) along with contributing factors such as decreased calf muscle pump, decreased ankle range of motion and changes in gait (Shiman et al., 2009) . Purpose: Objective is to provide a summary of new treatments and their impact on ulcer recurrence, healing rate, and prevention of new ulcer formation. Methods: Thorough review conducted in Pub Med, PEDro, C!NaHL, and Cochrane databases search with the following combination of search terms: "venous ulcer," "venous stasis," "leg ulcer," "venous hypertension," "wound care," "wound healing," "exercise," "calf muscle pump," "tissue perfusion," "venous insufficiency," "venous incompetence," "ankle range of motion," "venous incompetence." No restrictions placed on dates of article publications. English was the only language searched and article reference lists were cross referenced to identify additional articles not detected in the original database search. Abstracts of articles were then reviewed for topic relevance in wound healing of venous ulcers. If an article fit inclusion criteria it was read thoroughly and reviewed for exclusion criteria. Primary outcome for data analysis is increased venous ulcer healing rate and decreasing recurrence therefore pre-intervention to post- intervention analysis was focus of this article. Each article was read in detail, with relevant information regarding purpose, methods, results and recommendations summarized. Studies were then assessed for quality using Pedro scale, oxford scale for level of evidence and reliability. Results: Seven articles recommend compression therapy as primary method of treating. With compression venous ulcer healing rate was 12-31 weeks. Multilayer compression dressings have more benefit when compared to single layer. Nelson et al. refute that compression stocking have no reduction on recurrence (20% reduction, not statistically significant). Introduction of compression when there is no specialized intervention has been shown to have significant impact. Ghauri et al., showed 12 week healing rate increase from 12-22% to 47% and 12 month recurrence rate decreased form 50-41% to 12%. Exercise and range of motion intervention were inconclusive. One random control trial was done with resistive exercise, although 3 months out of 6 months patients had independent treatment, and another controlled trial had a 6 week exercise intervention both showed improved hymodynamics. There is evidence showing exercise improves lower extremity hemodynamics and hypothesizes that this will ultimately increase venous ulcer healing. More research needs to be done in this area. Combination of therapies has shown to have the greatest impact on healing and recurrence. Compression and medication reduces healing rate from 21 weeks to 16 weeks (Coleridge-Smith, 2009). Lymphedema, compression, and exercise show increase in healing, decrease in pain and increase in overall quality oflife (Azoubel, Torres Gde, da Silva, Gomes, & dos Reis, 2010). Compression and exercise showed no difference, although note intervention was done in patient's home and nursing service was leading exercise (Juli et al., 2009). Again further research is needed in combination therapies, especially in exercise as one of the interventions. Conclusion: The successful treatment of venous ulcers requires consideration of many factors. Evidence recommends compression therapy as initial treatment and first line of defense. Compression alone has shown to increase healing and decrease recurrence for non-complicated ulcers. Using compression alone with topical dressing is not effective when treating complicated venous ulcers. Compression used in conjunction with medication, exercise, and range of motion interventions should be implemented to enhance healing. There is limited evidence with combination therapies to address exercise and range of motion. Evidence requires more statistical significance, although it is important to note that experts in the field have suggested that clinically this would be significant for patients. A new technique utilizing lymphatic drainage, exercise and compression have shown to have great effects on increasing healing rate, decreasing edema and pain, which improved overall quality of life (Azoubel et al., 2010). With chronic venous ulcers there is an indication of the importance of multi- professional health team to provide a variety of interventions, and encourage not only patients but families in the healing process.
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venous stasis ulcers, traditional treatment, ambulatory venous hypertension
Violante, Laura. "Evidence Analysis: Does exercises in combination with traditional treatment accelerate the healing of venous stasis ulcers and decrease their recurrence?." (2014). http://digitalrepository.unm.edu/dpt/58