Varicose Ulcer Clinical Trial
Official title:
Keratin4VLU: A Randomised Controlled Trial of Wool-derived Keratin Dressings for Venous Leg Ulcers
Venous leg ulcers (VLU) are the most common leg ulcer, can be painful, and limit work, lifestyles and activity, especially in older patients. Compression bandaging is the main treatment but there are few added treatments for patients with slow healing VLU. About 50% of patients with VLU may be slow healing. Research suggests using keratin dressings as well as using compression may help healing in patients with show healing VLU, but the current evidence is not enough to change clinical practice. The investigators will conduct a randomised controlled trial to test whether using keratin dressings is better than usual care for slow healing VLU.
A pragmatic, community based, single-blind, usual care-controlled, randomised trial to
determine whether keratin dressings increase the proportion of patients with venous leg
ulcers healed at 24 weeks when used in addition to compression in patients with slow healing
venous leg ulcers. Participants in have compression therapy (system of choice guided by
patient and/or clinical preference) as delivered through district nursing services at the
study centres as a background treatment. Keratin dressings will be applied when the
compression bandage is changed (approximately weekly). Usual care dressings will consist of
the usual formulary of moist wound dressings available at each study centre.
Participants will be district nursing service patients in five study centres in New Zealand
with prevalent or incident venous leg ulcers. A venous leg ulcer will be defined as a wound
on the lower leg that has remained unhealed for 4 or more weeks, appears to be primarily
venous in aetiology with other causative diseases ruled out. If the participant has two or
more venous leg ulcers, the largest ulcer will be the reference ulcer. A participant will be
considered to have a slow healing venous leg ulcer if the ulcer area is larger than 5 cm2
and/or the ulcer has been present for more than six months.
Participants will receive up to four visits from the research nurse - visit 1 to screen for
eligibility, visit 2 to consent and randomise the participant, visits 3 and 4 to collect
outcome data. District nurses will continue to visit the participant (about weekly or more
frequently if required) to provide routine care between research nurse visits.
Block randomisation will be used, stratified by study centre and prognostic index (ulcer size
greater than 5cm2 and/or ulcer duration greater than 6 months) to ensure a balance of
participants within study centres and for participants likely to be slow healers. Research
nurses will input information on inclusion criteria, exclusion criteria, and relevant
clinical history on consented participants via a tablet computer. The allocation will be
generated after this information has been entered. Randomised participants will receive the
allocated treatment until the reference ulcer heals or data collection is completed,
whichever occurs sooner.
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