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DOI: 10.1055/s-0041-1727161
Wound Care for Venous Ulceration
Abstract
Venous leg ulcers (VLUs) affect as many as 20% of patients with advanced chronic venous insufficiency and are associated with significant morbidity and health care costs. VLUs are the most common cause of leg ulcers; however, other etiologies of lower extremity ulcerations should be investigated, most notably arterial insufficiency, to ensure appropriate therapy. Careful clinical examination, standardized documentation, and ultrasound evaluation are needed for diagnosis and treatment success. Reduction of edema and venous hypertension through compression therapy, local wound care, and treatment of venous reflux or obstruction is the foundation of therapy. As key providers in venous disease, interventional radiologists should be aware of current standardized disease classification and scoring systems as well as treatment and wound care guidelines for venous ulcers.
Publication History
Article published online:
03 June 2021
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References
- 1 Eberhardt RT, Raffetto JD. Chronic venous insufficiency. Circulation 2014; 130 (04) 333-346
- 2 Callam MJ, Harper DR, Dale JJ, Ruckley CV. Chronic ulcer of the leg: clinical history. Br Med J (Clin Res Ed) 1987; 294 (6584): 1389-1391
- 3 Gethin G, Cowman S, Kolbach DN. Debridement for venous leg ulcers. Cochrane Database Syst Rev 2015; (09) CD008599
- 4 Fife CE, Horn SD. The wound healing index for predicting venous leg ulcer outcome. Adv Wound Care (New Rochelle) 2020; 9 (02) 68-77
- 5 Hill DP, Poore S, Wilson J, Robson MC, Cherry GW. Initial healing rates of venous ulcers: Are they useful as predictors of healing?. Am J Surg 2004; 188 (1A, Suppl): 22-25
- 6 Nelzén O, Bergqvist D, Lindhagen A. Venous and non-venous leg ulcers: clinical history and appearance in a population study. Br J Surg 1994; 81 (02) 182-187
- 7 Adam DJ, Naik J, Hartshorne T, Bello M, London NJM. The diagnosis and management of 689 chronic leg ulcers in a single-visit assessment clinic. Eur J Vasc Endovasc Surg 2003; 25 (05) 462-468
- 8 Körber A, Klode J, Al-Benna S. et al. Etiology of chronic leg ulcers in 31,619 patients in Germany analyzed by an expert survey. J Dtsch Dermatol Ges 2011; 9 (02) 116-121
- 9 Labropoulos N, Mansour MA, Kang SS, Gloviczki P, Baker WH. New insights into perforator vein incompetence. Eur J Vasc Endovasc Surg 1999; 18 (03) 228-234
- 10 Sandri JL, Barros FS, Pontes S, Jacques C, Salles-Cunha SX. Diameter-reflux relationship in perforating veins of patients with varicose veins. J Vasc Surg 1999; 30 (05) 867-874
- 11 Jayaraj A, Meissner MH. A comparison of Villalta-Prandoni scale and venous clinical severity score in the assessment of post thrombotic syndrome. Ann Vasc Surg 2014; 28 (02) 313-317
- 12 Mackenzie RK, Ludlam CA, Ruckley CV, Allan PL, Burns P, Bradbury AW. The prevalence of thrombophilia in patients with chronic venous leg ulceration. J Vasc Surg 2002; 35 (04) 718-722
- 13 Mauck KF, Asi N, Elraiyah TA. et al. Comparative systematic review and meta-analysis of compression modalities for the promotion of venous ulcer healing and reducing ulcer recurrence. J Vasc Surg 2014; 60 (2 Suppl): 71S-90S.e1–2
- 14 Franks PJ, Barker J, Collier M. et al. Management of patients with venous leg ulcers: challenges and current best practice. J Wound Care 2016; 25 (Suppl. 06) S1-S67
- 15 Patel NP, Labropoulos N, Pappas PJ. Current management of venous ulceration. Plast Reconstr Surg 2006; 117 (7, Suppl): 254S-260S
- 16 Partsch H, Menzinger G, Mostbeck A. Inelastic leg compression is more effective to reduce deep venous refluxes than elastic bandages. Dermatol Surg 1999; 25 (09) 695-700
- 17 Lippmann HI, Fishman LM, Farrar RH, Bernstein RK, Zybert PA. Edema control in the management of disabling chronic venous insufficiency. Arch Phys Med Rehabil 1994; 75 (04) 436-441
- 18 Leaper DJ, Schultz G, Carville K, Fletcher J, Swanson T, Drake R. Extending the TIME concept: what have we learned in the past 10 years?(*). Int Wound J 2012; 9 (Suppl. 02) 1-19
- 19 O'Meara S, Al-Kurdi D, Ologun Y, Ovington LG, Martyn-St James M, Richardson R. Antibiotics and antiseptics for venous leg ulcers. Cochrane Database Syst Rev 2014; (01) CD003557
- 20 Bianchi T, Wolcott RD, Peghetti A. et al. Recommendations for the management of biofilm: a consensus document. J Wound Care 2016; 25 (06) 305-317
- 21 Jankunas V, Bagdonas R, Samsanavicius D, Rimdeika R. An analysis of the effectiveness of skin grafting to treat chronic venous leg ulcers. Wounds 2007; 19 (05) 128-137
- 22 Lok C, Paul C, Amblard P. et al. EMLA cream as a topical anesthetic for the repeated mechanical debridement of venous leg ulcers: a double-blind, placebo-controlled study. J Am Acad Dermatol 1999; 40 (2, Pt 1): 208-213
- 23 Briggs M, Nelson EA, Martyn-St James M. Topical agents or dressings for pain in venous leg ulcers. Cochrane Database Syst Rev 2012; 11 (11) CD001177
- 24 Caputo WJ, Beggs DJ, DeFede JL, Simm L, Dharma H. A prospective randomised controlled clinical trial comparing hydrosurgery debridement with conventional surgical debridement in lower extremity ulcers. Int Wound J 2008; 5 (02) 288-294
- 25 Dumville JC, Worthy G, Bland JM. et al; VenUS II Team. Larval therapy for leg ulcers (VenUS II): randomised controlled trial. BMJ 2009; 338: b773
- 26 Scottish Intercollegiate Guidelines Network. Management of Chronic Venous Leg Ulcers: A National Clinical Guideline. Scottish Intercollegiate Guidelines Network; 2010
- 27 Tate S, Price A, Harding K. Dressings for venous leg ulcers. BMJ 2018; 361: k1604
- 28 O'Meara S, Martyn-St James M. Foam dressings for venous leg ulcers. Cochrane Database Syst Rev 2013; (05) CD009907
- 29 O'Meara S, Martyn-St James M, Adderley UJ. Alginate dressings for venous leg ulcers. Cochrane Database Syst Rev 2015; (08) CD010182
- 30 Westby MJ, Norman G, Dumville JC, Stubbs N, Cullum N. Protease-modulating matrix treatments for healing venous leg ulcers. Cochrane Database Syst Rev 2016; 12 (12) CD011918
- 31 Norman G, Westby MJ, Rithalia AD, Stubbs N, Soares MO, Dumville JC. Dressings and topical agents for treating venous leg ulcers. Cochrane Database Syst Rev 2018; 6 (06) CD012583
- 32 Jull AB, Arroll B, Parag V, Waters J. Pentoxifylline for treating venous leg ulcers. Cochrane Database Syst Rev 2012; 12: CD001733
- 33 Kakkos SK, Nicolaides AN. Efficacy of micronized purified flavonoid fraction (Daflon®) on improving individual symptoms, signs and quality of life in patients with chronic venous disease: a systematic review and meta-analysis of randomized double-blind placebo-controlled trials. Int Angiol 2018; 37 (02) 143-154
- 34 Cowin AJ, Hatzirodos N, Rigden J, Fitridge R, Belford DA. Etanercept decreases tumor necrosis factor-alpha activity in chronic wound fluid. Wound Repair Regen 2006; 14 (04) 421-426
- 35 Dissemond J, Körber A, Grabbe S. [Differential diagnoses in leg ulcers]. J Dtsch Dermatol Ges 2006; 4 (08) 627-634
- 36 Michaels JA, Campbell B, King B, Palfreyman SJ, Shackley P, Stevenson M. Randomized controlled trial and cost-effectiveness analysis of silver-donating antimicrobial dressings for venous leg ulcers (VULCAN trial). Br J Surg 2009; 96 (10) 1147-1156
- 37 Jull A, Walker N, Parag V, Molan P, Rodgers A. Honey as Adjuvant Leg Ulcer Therapy Trial Collaborators. Randomized clinical trial of honey-impregnated dressings for venous leg ulcers. Br J Surg 2008; 95 (02) 175-182
- 38 Jull AB, Cullum N, Dumville JC, Westby MJ, Deshpande S, Walker N. Honey as a topical treatment for wounds. Cochrane Database Syst Rev 2015; (03) CD005083
- 39 Fumal I, Braham C, Paquet P, Piérard-Franchimont C, Piérard GE. The beneficial toxicity paradox of antimicrobials in leg ulcer healing impaired by a polymicrobial flora: a proof-of-concept study. Dermatology 2002; 204 (Suppl. 01) 70-74
- 40 Mosti G, Magliaro A, Mattaliano V, Picerni P, Angelotti N. Comparative study of two antimicrobial dressings in infected leg ulcers: a pilot study. J Wound Care 2015; 24 (03) 121-122 , 124–127
- 41 Cooper R, Jenkins L. Binding of two bacterial biofilms to dialkyl carbamoyl chloride (DACC)-coated dressings in vitro. J Wound Care 2016; 25 (02) 76 , 78–82
- 42 O'Donnell Jr TF, Passman MA, Marston WA. et al; Society for Vascular Surgery, American Venous Forum. Management of venous leg ulcers: clinical practice guidelines of the Society for Vascular Surgery ® and the American Venous Forum. J Vasc Surg 2014; 60 (2, Suppl): 3S-59S