Unna Boot in Venous Ulcer Treatment: Evaluation of 30 patients

Yıl 2013, Cilt: 20 Sayı: 2, 124 - 128, 01.04.2013

Mehmet Acıpayam M. Hakan Zor Levent Altınay Hasan Uncu Ümit Halıcı

Öz

Aim: We aim to evaluate the results of the Unna boot practice with this prospective study. Material and Methods: This study included a total of 30 patients (1 female, 29 male; ages 23–56, mean 33.5) admitted to outpatient clinic with chronic venous leg ulcers. All patients were treated with Unna's boot. This treatment combined with oral calcium dobesilat 500 mg tabletorally twice a day. As the ulcer was healing, the treatment continued with calcium dobesilate tablets and compression stockings. Results: Ulcer placement was as follows: around medial malleol 23 (76%); widespread below knee 2 (0.06%); mid-tibial region 2 (0,06%); tibia 1/3 distal region plus medial malleol 2 (0,06%), around lateral malleol 1 (0,03%) patient. Ulcer duration was between 1.5–168 months (mean 25,2). Unna boot was applied between 1–6 times (mean 2.13). Seven (24%) patients had dermatitis manifested with skin dryness and pruritis at Unna boot applied skin region. Four patients had ulcer recurrence and treated with Unna boot. Conclusion: We think that Unna bandage usage in chronic venous ulcus treatment must be taken into consideration because this treatment method is easy to supply and be applied, low cost of treatment, minimal complication rate and it can be performed effectively and more safely than other treatment modalities in patients with arterial disease. Key words: Venous Ulcer; Unna Boot; Venous Insufficiency.

Anahtar Kelimeler

Venous Ulcer; Unna Boot; Venous Insufficiency.

Venöz Ülser Tedavisinde Unna Bandajı Uygulaması: Otuz Hastanın Değerlendirmesi

Öz

Amaç: Bu prospektif çalışma ile kliniğimizdeki Unna bandajı uygulamalarımızda elde ettiğimiz verileri değerlendirmeyi amaçladık. Gereç ve Yöntemler: Nisan 2007 - Ağustos 2011 arasında venöz ülser şikayeti ile başvuran 1'i kadın, 29'u erkek toplam 30 hasta (23-56 yaşları arasında, ortalama 33,5) çalışmaya alındı. Tüm hastalara Unna bandajı uygulandı. Unna bandajı ile birlikte günde iki kez kalsiyum dobesilat 500 mg tablet verildi. Yara iyileşmesini takiben tedaviye diz altı orta basınçlı varis çorabı, kalsiyum dobesilat ile devam edildi. Bulgular: Ülserler 23 (%76) hastada medial malleol çevresinde, 2 (%0.06) hastada diz altında yaygın, 2 (%0.06) hastada tibia orta bölgesinde, 2 (%0.06) hastada tibia 1/3 distal ve medial malleol çevresine yayılmış ve 1 (%0.03) hastada lateral malleol proksimalindeydi. Hastaların ülserli geçirdiği süre 1,5 ile 168 (ortalama 25,2) aydı. Olgulara 1 ile 6 kür (ortalama 2,13) Unna bandajı uygulandı. Yedi olguda (%24) Unna bandajı uygulanan bölgede ciltte kuruluk ve kaşıntı ile seyreden dermatit görüldü. Ülser nüksü gözlenen 4 (%13) olgu Unna bandajı ile tedavi edildi. Hastaların takibi sırasında Unna bandajının erken dönemde çıkarılmasının gerektiği hasta olmadı. Sonuç: Kronik venöz ülser tedavisinde Unna bandajının, uygulanması ve temininin kolay, tedavi maliyetlerinin düşük, minimal komplikasyona sahip olması, arteriyel hastalığın da bulunduğu olgularda diğer kompresyon yöntemlerine göre daha güvenli olması ve diğer yöntemlerden etkinlik açısından bir farkının bulunmaması dolayısıyla akılda bulunması gereken bir yöntem olduğunu düşünmekteyiz. Anahtar kelimeler: Venöz Ülser; Unna Bandajı; Venöz Yetmezlik.

Anahtar Kelimeler

Venöz Ülser; Unna Bandajı; Venöz Yetmezlik.

Kaynakça

• 'l— Sharp B, Davies A.H. Ouality of life in patients with venous ulcers. In: A.H. Davies, T.A. Lees, |.F. Lane, eds, Venous disease simplified, vol. 3tfm Publishing Ltd, Shropshire 2006. p.33—44.
• — Baker SR, Stacey MC. Epidemiology of chronic leg ulcers in Australia. Aust NZ J Surg 1994;64:258-61.
• — Nelzen O, Bergqvist D, Lindhagen A. Venous and non—ve- nous leg ulcers: clinical history and appearance in a popula— tion study. BrJ Surg 1994;81:182—7.
• Üstünsoy H, Çine N. Venöz ülser kliniği. Turkiye Klinikleri J Cardiovasc Surg—Special Topics 2008;1:11—6.
• — Sandeman D, Shearman CP. Clinical aspects of lower limb ulceration. In: Mani R, Falanga V, Shearman CP, Sandeman D, eds. Chronic wound healing, 1st edn. London: W. B. Saunders 1999.p.4-25.
• Bradbury A.W, Brittenden J, Allan P.L, Ruckley C.V. Comparison of venous reflux in the affected and non— affected leg in patients with unilateral venous ulceration. Br J Surg1996;83:513-5.
• Welkie J.F, Comeraota A.J, Kerr R.P, Katz M.L, Jayheimer E.C, Brigham R.A. The haemodynamics of venous ulceration Ann Vasc Surg 1992;6z1-4.
• McEnroe C.S, O'Donnell T.F.J, Mackey W.C. Correlation of clinical findings with venous haemodynamics in 386 patients with chronic venous insufficiency. AJS 1988;156:148—52.
• Browse NL, Burnand KG. The cause of venous ulceration. Lancet 1982;2z243—5.
• Coleridge SP, Thomas P, Scurr JH, Dormandy JA. Causes of venous ulceration: a new hypothesis. Br Med J 1988;296:1726—7.
• I Claudy AL, Mirshahi M, Soria C, Soria J. Detection of
• undegraded fibrin and tumor necrosis factor alpha in
• venous leg ulcers. J Am Acad Derm 1991;25:623-7.
• — Falanga V, Eaglstein WH. The "trap" hypothesis of venous ulceration. Lancet 1993;341:1006-8. with increased platelet and monocyte activation and
• Michelson AD. Chronic venous insufficiency is associated 13 Powell CC, Rohrer MJ, Barnard MR, Peyton BD, Furman Ml, aggregation. J Vasc Surg 1999;30:844-51. telangiectasias.Paris. Elsevier 2004.
• Coleridge-Smith P, Lok C, Ramelet AA. Venous leg ulcer: a meta-analysis of adjunctive therapy with micro-nized purified flavonoid fraction. Eur J Vasc Endovasc Surg 2005;30:198-208. Compression. Dermatol Surg 2001;27:611—21.
• — Lansdown A., Mirastschijski U, Stubbs N. Zinc in wound hea ling: Theoretical, experimental, and clinical aspects. Wound Rep Reg 2007;15:2—16.
• Keefer KA, locono JA, Ehrlich HP. Zinc-containing wound
• dressings encourage autolytic debridement of dermal
• Eklof B, Rutherford RB, Bergan JJ, Carpentier PH, Gloviczki
• P, Kistner RL, et al. Revision of the CEAP classification for
• O Carr SC. Diagnosis and management of venous ulcers.
• Perspect Vasc Surg Endovasc Ther 2008;20:82—5.
• Bouza C, Munoz A, Amate JM. Efficacy of modern dressings
• in the treatment of leg ulcers: a systematic review. Wound
• van Gent W.B, Hop W.C, van Praag MC, Mackaay A.J, de
• Boer EM, Wittens C.H. Conservative versus surgical
• Barwell JR, Davies CE, Deacon J, et al. Comparison of
• surgery and compression with compression alone in chronic
• — Harrison MB, VanDenKerkhof EG, Hopman WM, Graham ID,
• Carley ME, Nelson EA, The Canadian Bandaging Trial
• Sackheim K, De Araujo T.S, Kirsner R.S. Compression
• modalities and dressings: their use in venous ulcers.
• Rasmussen L.H, Lawaetz M, Bjoern L. Randomized clinical
• trial comparing endovenous laser ablation, radiofrequency
• Cordts PR, Hanrahan LM, Rodriques AA, Woodson J, La
• Marte WW, Menzaion JO. A prospective randomized trial of
• Kikta MJ, Schuler JJ, Meyer JP, et al. A prospective,
• randomized trial of Unna’s boots versus hydroactive
• Alvares OM, Mertz PM, Eaglstein WH. The effect of occlusive dressings on collagen synthesis and re— epithelization in super—ficial wounds. J Surg Res 1983;35:142-8.