Health service costs of treating venous leg ulcers in the UK: evidence from a cross-sectional survey based in the north west of England

ObjectivesTo estimate and examine the direct healthcare costs of treating people with open venous leg ulcers in the UK.DesignCost-of-illness study.SettingA cross-sectional survey of nine National Health Service community locales over 2-week periods in 2015/2016.MethodsWe examined the resource use and prevalence of venous leg ulcer treatment in the community. Examination of variation in these obtained costs was performed by ordinary least squares regression. We used additional resource use information from a randomised control trial and extrapolated costs to the UK for an annual period.ResultsThe average 2-week per person cost of treating patients where a venous leg ulceration was the primary (most severe) wound was estimated at £166.39 (95% CI £157.78 to £175.00) with community staff time making up over half of this amount. Costs were higher where antimicrobial dressings were used and where wound care was delivered in the home. Among those with any recorded venous leg ulcer (primary and non-primary), we derived a point prevalence of 3.2 per 10 000 population and estimated that the annual prevalence could be no greater than 82.4 per 10 000 population. We estimated that the national cost of treating a venous leg ulcer was £102 million with a per person annual cost at £4787.70.ConclusionOur point prevalence figures are in line with the literature. However, our annual prevalence estimations and costs are far lower than those reported in recent literature which suggests that the costs of treating venous leg ulcers are lower than previously thought. Movement towards routinely collected and useable community care activity would help provide a transparent and deeper understanding of the scale and cost of wound care in the UK.

Extracellular matrix and cellular senescence in venous leg ulcers

High prevalence of non-healing chronic wounds contributes to a huge healthcare burden across the world. Early treatment interventions for non-healing wounds are vital. It was previously shown that accumulation of 15% or more of senescent cells in a chronic wound edge is an indicator that the wound is unlikely to heal. However, determining the presence of senescent cells would require invasive procedures such as tissue biopsies to be taken. In this study, we found a strong correlation between decreased collagen area and presence of senescent cells in human chronic wounds i.e. venous leg ulcer (VLU), diabetic foot ulcer (DFU) and pressure ulcer (PRU). We also report that the lowest collagen levels were found in VLU patients less than 60 years of age, with a persistent wound of > 24 months. Elevated levels of senescent cells were also found in VLU of males. Second harmonic imaging of collagen at the edge of chronic wounds with a handheld multiphoton device could be used to predict the number of senescent cells, indicating if the wound is on a healing trajectory or not. Our data support the use of collagen imaging in cutaneous wound assessment for a faster and non-invasive method to predict cellular senescence and determining wound trajectory of healing.

Complete healing and short-term treatment by Argania honey dressing in a venous leg ulcer: case report

Background: Recent advances in care aware that inadequate management of the healing process in wounds and the development of bacterial infections leads to increase morbidity. Health professionals have progressively recognized the value of choosing suitable dressings to manage wounds particularly in developing countries. Honey has been used for thousands of years as a wound dressing and considered as biologic treatment due to its multiple bioactivities related to healing process. Objective: The aim of this case report is to demonstrate that Argania Honey dressing improve the healing process in a venous leg ulcer. Method: Pure raw Argania honey (Argania spinosa, endemic tree in southwestern of Morocco) with no additives, pasteurization, or manipulation was used and provided from local beekeepers. A mechanical debridement process was achieved previously to the application of honey dressings to a venous leg ulcer of a 67-year-old woman affected by type II diabetes for 11 years. Results : The Argania honey dressing accompanied by mechanical debridement process demonstrated a rapid recovery and complete healing of the wound for 12 weeks approximately (79 days). Conclusion: This Moroccan honey (Argania) experienced for the first time in venous leg ulcer management may represent a good alternative to treat other types of wounds. Further investigations by using Argania honey dressing are required to explain its effect and the mechanisms involved in the improvement of healing process.

Extracellular matrix and cellular senescence in venous leg ulcers

High prevalence of non-healing chronic wounds contributes to a huge health burden across the world. Early treatment interventions for non-healing wounds are vital. It was previously shown that accumulation of 15% or more senescent cells in a chronic wound edge is an indicator that the wound is unlikely to heal. However, determining the presence of senescent cells would require invasive procedures such as tissue biopsies to be taken. In this study, we found a strong correlation between decreased collagen area and presence of senescent cells in human chronic wounds i.e venous leg ulcer (VLU), diabetic foot ulcer (DFU) and pressure ulcer (PRU). We also reported that the lowest collagen levels were found in VLU patients less than 60 years of age, with a persistent wound of > 24 months. Elevated levels of senescent cells were also found in VLU of males. Second harmonic imaging of collagen at the edge of chronic wounds with a handheld multiphoton device could be used to predict the number of senescent cells, indicating if the wound is on a healing trajectory or not. Our data support the use of collagen imaging in cutaneous wound assessment for a faster and non-invasive method to predict cellular senescence and determining wound trajectory.

Patients’ Perspectives of Pain, Time, and Hope When Living with Venous Leg Ulcers and Using the geko™ Device: A Qualitative Descriptive Inquiry.

Introduction: Venous leg ulcers have an impact on individuals’ perspectives of pain, time, and hope. Community nurses seek to provide person-centred care to patients living with venous leg ulcers. There is a paucity of research exploring individuals’ experiences while living with leg ulcers, specifically their insights into the role of a neuromuscular electrostimulation medical device (geko™). Methods: Using a qualitative descriptive approach and telephone interviews, seven participants shared their experiences living with venous leg ulcers and when using a geko™ device. Research ethics was approved, and informed client consent obtained. Thematic analysis method was utilized to analyze the data. Interviews were typed verbatim and analysis focused on a data-driven approach, leading themes emerged. Results: Participants described regular use of pain medications. They described the concept of ‘time’ from the onset of the venous leg ulcer, through wound reoccurrences, and treatments. Participants described feeling hopeful the geko™ device would support wound healing and assist the wound to become smaller and heal faster. Conclusions: This small qualitative study adds to a growing body of literature focused on the role of the geko™ adjunctive therapy in venous leg ulcer healing. More research is needed to understand the role of adjunctive therapies as they may offer patients' hope and create optimism toward wound healing as part of multi-modal treatment approach. Keywords: geko™, individual perspectives, qualitative descriptive, pain, time, hope