Table of Contents  
LETTER TO EDITOR
Year : 2019  |  Volume : 6  |  Issue : 4  |  Page : 330

From compression to injections: Prostaglandins paving a new direction for venous leg ulcer treatment


Department of Surgery, NSCB Government Medical College, Jabalpur, Madhya Pradesh, India

Date of Submission01-Sep-2019
Date of Decision03-Sep-2019
Date of Acceptance20-Nov-2019
Date of Web Publication20-Dec-2019

Correspondence Address:
Dr. Pawan Agarwal
Department of Surgery, NSCB Government Medical College, Jabalpur, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijves.ijves_57_19

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How to cite this article:
Agarwal P, Sharma D. From compression to injections: Prostaglandins paving a new direction for venous leg ulcer treatment. Indian J Vasc Endovasc Surg 2019;6:330

How to cite this URL:
Agarwal P, Sharma D. From compression to injections: Prostaglandins paving a new direction for venous leg ulcer treatment. Indian J Vasc Endovasc Surg [serial online] 2019 [cited 2020 Jan 26];6:330. Available from: http://www.indjvascsurg.org/text.asp?2019/6/4/330/273599



Sir,

We read with interest the article from compression to injections: Prostaglandins paving a new direction for venous leg ulcer (VLU) treatment by Basavanthappa et al.[1] The authors should be commended for bringing out an idea of using old drug for a new indication. They rightly mentioned that no single procedure or product is adequate for the treatment of all patients with venous ulcers. Along with the treatment of varicose vein by surgery or laser, the compression dressings are the standard of care for the treatment of VLUs. The authors treated 47 patients with 50 ulcers by prostaglandin E1 (PGE1) administration, and 92% healed after 18 weeks of treatment. They concluded that intravenous administration of PGE1 is effective in reducing the healing time of VLUs, lesser hospitalization, quicker return to work, and overall improvement in the quality of life.

We beg to differ on certain aspects of this study. PGE1 is a costly drug (the cost of PGE1 is Rs 7500–9000 for 500 μg)[2] which may not be affordable by many patients. Apart from the cost issue, they have used PGE1 intravenously which has the potential for major side effects such as apnea, bleeding, cardiac rhythm disorders cardiac failure, disseminated intravascular coagulation, hypotension, and seizures, as mentioned by the authors in their own article.[1] Although they had minor side effects in their study, the likelihood of having major side effects is always possible which may not be acceptable for the treatment of benign condition such as VLU. The side effects are dose related and to further reduce the dose, the authors could have considered the technique of retrograde venous perfusion rather than intravenous injection.[3] This technique leads to the high concentration of drugs the at target site in lesser doses with minimal possibility of the systemic side effects.

In the pictures, all venous ulcers treated in their study looked clean and granulated. We wonder why authors have not considered the possibility of using thin split-thickness skin graft for ulcer healing.[4] In their study, 92% ulcers took 18 weeks to heal, which itself is a significant time period for patients. Skin grafting would have been a faster way of healing (in 3 weeks) without any side effects and no additional cost.

We would like authors to comment on these issues.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Basavanthappa RP, Gangadharan AN, Desai SC, Chandrashekar AR. From compression to injections: Prostaglandins paving a new direction for venous leg ulcer treatment. Indian J Vasc Endovasc Surg 2019;6:176-81.  Back to cited text no. 1
  [Full text]  
2.
Alprostadil – Prize list of three Brands Trade Names Medindia. Available from: https://www.medindia.net/drug-price/alprostadil.htm. [Last Accessed on 2019 Sep 01].  Back to cited text no. 2
    
3.
Agarwal P, Agrawal PK, Sharma D, Baghel KD. Intravenous infusion for the treatment of diabetic and ischaemic non-healing pedal ulcers. J Eur Acad Dermatol Venereol 2005;19:158-62.  Back to cited text no. 3
    
4.
Erratum: Borderud SP, Li Y, Burkhalter JE, Sheffer CE and Ostroff JS. Electronic cigarette use among patients with cancer: Characteristics of electronic cigarette users and their smoking cessation outcomes. Cancer 2015;121:800.  Back to cited text no. 4
    




 

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