Lower extremity edema is a common comorbidity in wound patients with varying associated etiologies and contributing factors. Regardless of the etiology, edema is associated with delayed wound healing. The increased interstitial fluid volume that defines edema can contribute to the following depending on its extent1-4:
While compression is the gold standard for managing edema, optimizing treatment for patients with phlebolymphedema often involves more than just compression.5 Furthermore, other interventions are of additional utility in managing patients who cannot tolerate therapeutic compression due to peripheral arterial disease, claustrophobia, heat intolerance, and skin reactions. These interventions can include5:
Micronized purified flavonoid fraction (MPFF) is a venoactive drug (VAD) that is typically classified as a nutritional supplement in the US.5,6 It is a ratio, or fraction, of different flavonoids. Flavonoids are natural plant secondary metabolites that are known to exert anti-inflammatory and additional favorable effects.7 The flavonoids present in MPFF include7:
These flavonoids are naturally present in the rind of a certain orange type and undergo minimal processing (micronized, purified) before oral consumption.7
There has been significant research on the efficacy and effectiveness of MPFF, leading to its inclusion in many societal recommendations and guidelines.5,6 Its use is common in the treatment and management of many vascular diseases6:
In phlebolymphedema, vascular leakage and stasis are often present. MPFF decreases red blood cell viscosity and exerts an anti-inflammatory effect. Contents within blood vessels normally flow in a laminar fashion, meaning the contents stay in the center of the vessel. Conditions that increase contact between vascular contents and the vessel lining contribute to inflammation of the blood vessel wall. The associated increased blood viscosity of stasis irritates the vascular endothelium, creating a positive feedback loop of inflammation that can ultimately lead to ulceration.8 MPFF reduces the effects of stasis by decreasing bradykinin-induced microvascular leakage and inappropriate leucocyte activation. A systematic review and meta-analysis of 7 randomized double-blind placebo-controlled trials including 1,692 patients identified MPFF significantly improved 9 leg symptoms including9:
In addition, the researchers also found decreased functional discomfort, ankle circumference, leg redness, and skin changes, as well as increased quality of life.9 MPFF’s use in microcirculatory disorders includes the adjunctive treatment of venous leg ulcers, where its use is strongly associated with both the ability to heal and accelerated healing. A meta-analysis has shown a 32% raised chance of ulcer healing and a 5-week shorter healing process.10
MPFF has a favorable safety profile and a wealth of evidence supporting its use in phlebolymphedema and venous leg ulcer healing. The product is available as a pharmaceutical in Europe, and usually as an over-the-counter supplement in the United States.
About the Author
Dr. Laura Swoboda, DNP, APNP, FNP-BC, CWOCN-AP, is a Professor of Health Sciences, Family Nurse Practitioner, and certified wound specialist in Milwaukee Metro, Wisconsin. Dr. Swoboda is on the NPIAP’s Prophylactic Dressing Standards Initiative Task Force, a member of the editorial board for the Wound Care Learning Network and Wound Management and Prevention, and on the board of directors for the WOCNCB and the AAWC.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, HMP Global, its affiliates, or subsidiary companies.