Venous Leg Ulcer

https://ir.dut.ac.za/bitstream/10321/73/1/Hoffmann_2006

 

Vergleich: Siehe: Krankheiten + Beingruppe + Karbunkel

 

[Dr. E.B. Nash]

Bone pains: Aur-met. Kali-i. Asaf. Mercuries in periosteal affections.

[Matthew Wood]

Bone remedies are usually white and sometimes look like bones. Comfrey roots are coated black, but underneath they have a calcium-white like color. Another name for comfrey is knitbone.

I prefer boneset, which has a bone-white flower. True Solomon's seal has roots that look like vertebra, knuckles, joints, sockets, and bones of all kinds, while the leaves attach on the stalks

like muscles attaching to bones -- this is an excellent remedy for tendons, ligaments, joints, and probably for bones as well. It works well on bone spurs.

Inula helenium = elecampane: older roots look like rotted-out bones and are useful in infection of the jawbones from bad teeth.

 

It is always necessary to sedate heat and excitation and for this purpose no remedies surpass the rose family. Peach, a member of this clan, is particularly beneficial because

it is cooling and moistening, a therapeutic action often needed since heat often causes dryness

 

[Thomas, 1998]

Venous leg ulcers: Ulcers occurring due to chronic venous insufficiency, usually in the ankle area of the leg

[Mitchell and Kumar, 2003]

Auto-immune vasculitits: Inflammation of the small blood vessels ultimately leading to tissue damage and the possibility of ulceration

[Percival and Bowler, 2004]

Biofilm: A film over a wound produced by microorganisms on its surface

[Schoen and Cotran, 2003]

Deep vein thrombosis: Venous stasis leading to a clot completely or partially occluding a vein

 

[Delia Hoffmann]

The relative and combined efficacy of the homoeopathic similimum (taken orally) and the topical application of a lotion (prepared from the homeopathic tinctures of

Hypericum perforatum and Calendula officinalis) in the treatment of venous leg ulcer.

 

Medical treatments:

Hyperbaric oxygen therapy :

Another treatment modality aimed at correcting poor oxygenation of the tissues in chronic wounds is hyperbaric oxygen therapy. According to Wright

(1987), hyperbaric oxygen can assist in wound healing. It combats certain harmful micro-organisms in the wound, and enhances the effects of systemic antibiotics, as well as leukocyte and

macrophage activity locally. Hyperbaric oxygen therapy is very expensive.

Jet therapy:

The application of purified air under pressure to the skin, with the aim of stimulating the circulation. The jets provide a circulatory massage, without damaging skin tissue, according to the inventors.

The results claimed are enhanced wound healing as well as promoting a more stable circulation to the treated part. Clinical trials were run by Mars, Tufts, Naidu, Kleinfeldt and Robbs (2000), and showed an improvement in pain levels and shortened in hospital stay for patients with diabetic foot ulcers. This therapy is not fully tested and is expensive.

Skin grafting:

According to Jones and Nelson (2006), non-healing wounds, such as venous ulcers, can be treated with skin grafts to prevent infection and assist the wound to heal.

Skin may be taken from a suitable site on the patient and transferred to the ulcer site, or may be taken from cadavers (allografts), or animals, usually a pig (xenograft). The allografts and xenografts are considered to be only temporary, as tissue rejection occurs within seven days of grafting.

The problem with application of skin grafts to the ulcer site is that with poor blood flow to the area, compounded by oedema, infection is likely, and ultimately, rejection hence it

is of limited use in the treatment of leg ulcers. Skin grafting is also a relatively expensive treatment.

Bio-engineered tissue:

Substitutes closely resemble human skin.

Cultivation of the patient‟s own cells in the laboratory is possible (Badylak, 2004).

Bio-engineered products are very expensive and come with warnings about allergic reactions, and they have to be stored under special conditions (Hebra, 1998).

This would make them impractical for generalised use in a unit with a limited budget.

Wound modulating products:

Other substances have been created specifically to modulate the events of wound

healing, for example:

Promogran:

This is a Johnson and Johnson registered product. The dressing incorporates a matrix of freeze-dried collagen and oxidised regenerated cellulose, which modulates the wound

environment, by binding and inactivating excess proteases in the wound. These proteases prevent healing by breaking down protein. The Promogran matrix also protects growth factors, and

attracts fibroblasts to the wound. This product must be used on a clean wound, free of necrotic tissue, and is applied directly to the wound where it forms a gel (Cullen, Smith and Silcock,

2002).

There are many products that can be used on wounds where there are obstacles to healing, such as slough, infection and excess exudate. Patients in this study had to have clean wounds, with minimal slough, so that the unmedicated wound dressing appropriate to the level of exudate could be used.

 

Venous hypertension in the lower limb, occurring from a variety of causes, leads to microcirculatory abnormalities which may permit the formation of a chronic ulcer (Zimmet, 1998).

Venous leg ulcers are a cause of much debility, social isolation, depression, fears of loss of employment and income (Royal College of Nursing Institute, 1998).

The mainstay of treatment at present is compression bandaging to reduce the venous pressure in the lower limb. 80% of venous leg ulcers will heal within 8 - 12 weeks with compression bandaging (Thomas, 1997).

Homoeopathy is a system of medicine based on natural laws of healing, and recognizes the biophysical energy of an individual (also known as the vital force) as that which provides the normal protective defence mechanisms of the body, and is disturbed in disease, producing symptoms on the physical, mental and emotional levels (Vithoulkas, 1980).

Many plants are known to have wound-healing properties (Curtis and Fraser, 2003).

Calendula officinalis and Hypericum perforatum were considered the best plants in a homoeopathic lotion to be used on chronic venous leg ulcers, as they cover all the common problems associated with this type of wound, providing pain relief and anti-microbial activity (Lawless, 1995).

In this study, homoeopathic mother tinctures of the herbs were used to make the lotion for topical application to the wounds.

 

TREATMENT BY MEANS OF BANDAGING

The mainstay of treatment of venous leg ulcers at present is compression bandaging, and elevation of the limb to help drainage and reduce the venous hypertension, if this can be achieved,

seven out of ten venous leg ulcers will heal in three months (Thomas, 1998).

Following healing of the ulcer, the patient is advised to wear support stockings, exercise regularly, elevate the limb, and where necessary the patient is referred for stripping of varicose veins (Royal College of Nursing Institute, 1998).

 

Varicose Veins and Haemorrhoids

 

[Harald Gaier]

These conditions fall under the broader heading of chronic vascular insufficiency. In a minority of instances raised venous pressure (venous hypertension) may be associated, which can be determined

by a simple non-invasive Doppler screen. The GP usually prescribes hydroxyethylrutosides and/or the use of compression stockings for varicose veins, but these should not be used if the in-flow pressure ratio of the ankle or foot to that in the arm is low. An article in the BMJ gives reliable information on the symptoms and orthodox treatment of varicose veins [Br Med J, 2000, 320:1391-1394].

Varicose veins become more frequent with age. It is six times more frequent in the over-60s than in those aged 30. There is little difference between the sexes. Height and overweight do not play as important a role as is often assumed, but occupations requiring much standing do make people more disposed to the condition. Sophisticated studies have shown that haemorrhoids are not merely a matter of venous congestion, but that there are connexions with the arterial system.

Reading on the toilet can give you haemorrhoids, and there is a published study to prove it [Lancet, 1989, I; 8628:54]. Researchers at the John Radcliffe Hospital, Oxford, compared the habits of 100 people suffering from haemorrhoids with 100 unaffected individuals and found that a much larger proportion of the group suffering from piles reads on the loo. It’s not the reading that’s bad for you;  but sitting on the lavatory for extended periods causes undue pressure on your bottom, say the Oxford doctors.

Associated with such vascular insufficiency there may be nutritional defects, or food hypersensitivities, or hormonal imbalances (pregnancy can often trigger either varicosities or haemorrhoids, or both). There may be other causes which the clinician should investigate and, if possible, help correct.

Naturopathic medicine has long used hydrotherapy for varicose veins. The results of a placebo-controlled randomized clinical trial involving 122 patients in which applications of cold water (12 - 18° C) followed by warm (35 - 38° C) for 10 minutes daily during 24 consecutive days produced a decrease in foot volume, as well as ankle and calf circumference [Eur J Phys Med Rehabil, 1993, 3:123-124].

In another trial thermal mineral water containing carbon dioxide produced a marked improvement in venous function after 20 minutes of bathing compared with baseline [Phys Med Rehabil Kurortmedizin, 1993, 3:153-157]. Vaccinium myrtillus (= Bilberries) are added to the daily diet of pregnant women to prevent and treat varicose veins of pregnancy [Minerva Ginecol, 1981, 33:221-230].

Nutritional medicine prescribes bromelain obtained from the stem of the pineapple plant (= Ananas comosus) as an adjunct to treating thrombophlebitis [Angiology, 1969, 20:22-26] and to treat varicose veins [Praxis, 1972, 61:950-951]. For those patients known to deficient in vitamins C or E, supplementation with these vitamins has shown positive results in treating vascular and capillary fragility [for vit C: Am J Clin Nutr, 1981, 34(5):871-876; for vit E: J Vitaminology, 1972, 18:125-130]. 3 groups of flavonoids have a long history in the reliably successful treatment of varicose veins and varicose ulcers. They are rutin, hesperidin and the anthocyanosides (bilberries are a rich source for these last flavonoids) [for rutin: Am J Ophthalomol, 1948, 31:671-678; for hesperidin: Del State Med J, January 1959, pp 19-22; for anthocyanosides: Minerva Med, 1977, 68(52):3565-3581].

Botanical medicine has 3 popular remedies for the treatment of varicose veins, which have demonstrated their success. The Pennywort (= Hydrocotyle asiatica a.k.a Centella asiatica) in a clinical placebo-controlled randomized trial, involving 94 patients who received 120mg titrated extract of Pennywort daily for two months, produced significant beneficial effect in reducing oedema and symptoms of heaviness in the lower legs, compared with placebo [Angiology, 1987, 38:46-50]. These results are corroborated by another double-blind trial in which a daily dose of 60mg of titrated extract of Pennywort for 30 consecutive days significantly improved the itchy sensation, oedema, and night cramps, compared with placebo [Clin Ther, 1981, 99:507-513]. Treatment with red vine leaf extract (= Vitis vinifera) in a large double-blind study involving 260 patients with chronic venous insufficiency over a 12 week period reported a reduction in lower leg volume and calf circumference compared with placebo [Arzneimittelforschung, 2000, 50:109-117]. However, the favoured oral treatment is Horse-chestnut (= Aesculus hippocastanum). A systematic review of 13 randomized controlled trials, involving 1083 patients provides compelling placebo-controlled evidence for the effectiveness of this treatment in all forms of chronic venous insufficiency, even when it was compared with compression therapy and with hydroxyethylrutosides (derived from rutin), as it was in some of the 13 trials reviewed [Arch Dermatol, 1988, 134:1356-1360].

For persistent haemorrhoids I prescribe an ointment that is specially made up by an homoeopathic pharmacy. I find this to be a thoroughly reliable combination remedy.

Its formula is: Paeonia officinalis 1DH…12 g; Sedum acre 1DH… 0,56 g; Ratanhia 1DH… 0,56 g; Aesculus hippocastanum 1DH… 0,56 g; Vaseline q.s.p. 100g. This could be used up in suppository form.

 

 

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