Leg ulcers affect up to one percent of people at some time in their life. Leg ulceration is chronic in nature with ulcers being present for months and in some cases years without healing, and with a high risk of recurrence. Management approaches include dressings and the treatment of underlying medical problems such as malnutrition, lack of minerals and vitamins, poor blood supply or infection.
To assess the effectiveness of oral zinc in healing arterial or venous leg ulcers.
For this sixth update we searched The Cochrane Wounds Group Specialised Register (searched 17 May 2012); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 5); Ovid MEDLINE (2010 to May Week 2 2012); Ovid MEDLINE (In-Process & Other Non-Indexed Citations May 16, 2012); Ovid EMBASE (2010 to 2012 Week 19); and EBSCO CINAHL (2010 to May 2 2012). In the original version of the review a company manufacturing zinc sulphate tablets was asked for references to relevant trials.
Randomised controlled trials comparing oral zinc sulphate with placebo or no treatment in people with arterial or venous leg ulcers were eligible for inclusion. There were no restrictions on date or language of publication. The main outcome measure used was complete healing of the ulcers. Trials were eligible for inclusion if they measured ulcer healing objectively by documenting time to complete healing, proportion of ulcers healed during the study, or healing rates of ulcers.
All data extraction and assessment of trial quality were done by both authors independently.
Six small trials (183 participants) were eligible for inclusion. Four trials considered people with venous ulcers, one trial arterial ulcers and one people with mixed ulcers. In four trials, serum zinc was measured at baseline or during the trial. Pooling the four trials that compared oral zinc sulphate with placebo in people with venous ulcers showed no statistically significant difference between the two group (RR 1.22, 95%CI 0.88 to 1.68). Overall, there was no evidence of a beneficial effect of treatment with zinc sulphate on the number of ulcers healed.
Oral zinc sulphate does not appear to aid healing of arterial and venous leg ulcers, however all included studies were small and of mediocre quality.
"Zinc, both oral and topical, for its healing properties has been used for a long time for the management of ulcers and wounds of varied etiology. Although oral zinc sulphate was initially reported to enhance the healing of arterial/venous leg ulcers, recent systematic reviews and meta-analysis have found no statistically significant response . However, topical preparations containing zinc oxide have been used in the management of arterial and venous leg ulcers, pressure ulcers, and diabetic foot ulcers. "
[Show abstract][Hide abstract] ABSTRACT: Zinc, both in elemental or in its salt forms, has been used as a therapeutic modality for centuries. Topical preparations like zinc oxide, calamine, or zinc pyrithione have been in use as photoprotecting, soothing agents or as active ingredient of antidandruff shampoos. Its use has expanded manifold over the years for a number of dermatological conditions including infections (leishmaniasis, warts), inflammatory dermatoses (acne vulgaris, rosacea), pigmentary disorders (melasma), and neoplasias (basal cell carcinoma). Although the role of oral zinc is well-established in human zinc deficiency syndromes including acrodermatitis enteropathica, it is only in recent years that importance of zinc as a micronutrient essential for infant growth and development has been recognized. The paper reviews various dermatological uses of zinc.
Dermatology Research and Practice 07/2014; 2014. DOI:10.1155/2014/709152
[Show abstract][Hide abstract] ABSTRACT: Eine evidenzbasierte Datenlage zur Behandlung chronischer Wunden ist im Vergleich zur Flle an gelisteten Publikationen ber wound healing (1990 bis heute: 48.247 Verffentlichungen) nur in ausgesprochen geringem Umfang vorhanden und auch nur schwer zu finden. Zwar kann man in der Medline eine Anzahl von Treffern landen, doch muss dem Sucher bewusst sein, dass die Begrifflichkeit, nach der gesucht wird, in der Regel sehr willkrlich vom ursprnglichen Autor vergeben wurde. Schlielich sollen insbesondere die Keywords den Sucher auf eine Arbeit aufmerksam machen, die in den allermeisten Fllen nur ganz am Rande relevante Informationen in Bezug auf die eigentliche Thematik enthalten.Ein interner Filter im Hinblick auf den Entstehungsmechanismus der publizierten Daten, der die Gewichtung der Arbeiten sicherlich erleichtern wrde, ist nicht vorhanden, sodass z.B. unter den Begriffen evidence-based medicine and chronic wound eine Arbeit erscheint, die als Grundlage ihrer Bewertung ber die Anwendung von Honig bei chronischen Wunden Erwachsener case studies and serial case studies angibt. So besteht neben dem Problem einer eher dnnen Datenlage zustzlich die Schwierigkeit in einer angemessenen Zeit die tatschlich relevanten Arbeiten aufzufinden, was in der Regel berhaupt nur bei einer sehr eng begrenzten Suchspezifikation gelingt.Hier soll der Versuch gemacht werden, die unglaubliche Datenflle im Hinblick auf die Behandlung chronischer Wunden in eine gewisse Systematik zu bringen und schlielich in groben Schlaglichtern einzelne Schwerpunkte etwas zu erhellen.Very few evidence-based trials on the treatment of chronic wounds are available, in contrast to the total amount of listed papers on this topic (since 1990:48247). Using MEDLINE as a search tool for this topic one obtains some appropriate matches, but it is striking that the authors of the articles concerned have usually chosen a set of relatively idiosyncratic keywords. These words, used to narrow the search for publications, are meant to attract the readers attention, but in the majority of cases fail to do so because they only show a distant link, or are mentioned only in one short text passage. There is no existence of something like an internal filter showing the real character of an article or its genesis, which would make it easier to validate their significance. For instance, a search for the keywords evidence-based medicine and chronic wound turns up a paper that gives case study or serial case study as the foundation for its evaluation of the application of honey in treating chronic wounds in adults. Apart from the very sparse data, it appears to be a difficult task to efficiently find the appropriate relevant publications without an extremely narrow search strategy. In this article we attempt to systematize the incredible wealth of data on the treatment of chronic wounds and throw some light on particular major topics.
[Show abstract][Hide abstract] ABSTRACT: Chronic low-limb ulcers and pressure ulcers are a serious and costly issue. Malnutrition is a risk factor. Searching for intervention strategies in elderly patients referred for surgical closure of their ulcers, the trial aimed at investigating the micronutrient status, determining the food intake of such patients, and the role of oral liquid supplements.
Observational cohort study in 9 patients, starting 5 days prior to surgery until day 10 after surgery. Variables: body mass index (BMI), food intake assessed using standardized meals (energy target 25 kcal/kg/day). Oral liquid supplements were provided between meals. Laboratory: blood count, plasma proteins, antioxidant status, vitamins, Fe, Se, and Zn.
The patients were aged 71+/-10 y (mean+/-SD), with a BMI of 23.3+/-3.3. Baseline blood samples showed anemia and strong inflammation in 4 patients: albumin, retinol, and selenium were low; iron and zinc were very low. Food intake was largely variable and covered only about 76% (31-95%) of energy requirements. Breakfast provided 225+/-110, lunch 570+/-215, and dinner 405+/-150 kcal. Supplements were willingly consumed covering 35+/-12% of energy target. While vitamin supply was adequate, selenium and zinc requirements were not met.
Most patients with chronic skin ulcers suffered micronutrient status alterations, and borderline malnutrition. Meals did not cover energy requirements, while oral supplements covered basic micronutrient requirements and compensated for insufficient oral energy and protein intakes, justifying their use in hospitalized elderly patients.
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