The recalcitrant venous leg ulcer – a never ending story?

S. W. I. Reeder; M. B. Maessen-Visch; S. I. Langendoen; K-P. de Roos; H. A. M. Neumann

doi:10.12687/phleb2145-6-2013

Phlebologie, Table of Contents

Phlebologie 2013; 42(06): 332-339
DOI: 10.12687/phleb2145-6-2013

Original article

Schattauer GmbH

The recalcitrant venous leg ulcer – a never ending story?

Die persistierende venöse Beinulzeration – eine unendliche Geschichte?

Authors

S. W. I. Reeder

¹Department of Dermatology, Erasmus MC, Rotterdam, The Netherlands
M. B. Maessen-Visch

²Department of Dermatology, Rijnstate, Velp, The Netherlands
S. I. Langendoen

¹Department of Dermatology, Erasmus MC, Rotterdam, The Netherlands
K-P. de Roos

³DermaPark, Uden, The Netherlands
H. A. M. Neumann

¹Department of Dermatology, Erasmus MC, Rotterdam, The Netherlands

Abstract

Summary

Introduction: In general, four particular causes of recalcitrant venous leg ulcers may be distinguished. These are foot pump insufficiency, chronic venous compartment syndrome and non-re-canalized popliteal vein thrombosis. The fourth cause of recalcitrant venous leg ulcers is lipodermatosclerosis as a symptom of severe chronic venous insufficiency.

Methods: We reviewed the literature and based on this we describe four main causes of recalcitrant venous leg ulcers and their specific treatment.

Results: Foot pump insufficiency arises when the plantar foot veins are not able to empty. Treatment should consist of physical therapy, a mechanical foot pump device and an insole. Lipodermatosclerosis may be treated by excision and split-thickness skin grafting (Vigoni procedure). Chronic venous compartment syndrome is usually caused by post-thrombotic syndrome and treatment consists of a fasciectomy, but is rarely used nowadays. Patients with non-re-canalized popliteal vein thrombosis may be supported by intermittent pneumatic compression, walking exercises, alternate standing and walking with lying down. All patients with recalcitrant venous leg ulcers must wear medical elastic compression stockings with high stiffness and high compression lifelong.

Conclusions: Patients with recalcitrant venous leg ulceration are challenging. More specific treatment will heal more of these ulcers.

Zusammenfassung

Einleitung: Chronische Venenerkrankungen kommen häufig vor und führt zu Ulzerationen in 1% der Westlichen Bevölkerung. Venöse Beinulzerationen können in drei Gruppen eingeteilt werden: unkompliziert, persistierend und rezidivierend. Es gibt vier Ursachen für persistierende Beinulzerationen: Insuffizienz der Muskel-Venen-Pumpe des Fußes, Lipodermatosklerose, chronisch-venöses Kompartment-Syndrom und nicht-rekanalisierte Throm bose der Vena poplitea.

Methode: Wir haben eine Literatursuche durchgeführt und beschreiben vier Hauptursachen von persistierenden Beinulzerationen und deren Behandlung.

Ergebnisse: Die Insuffizienz der Fußpumpe entsteht, wenn die Venen der Fußsohle sich nicht leeren können; die Therapie besteht in Physiotherapie, einer mechanische Fußpumpe und einer Einlegesohle. Lipodermatoskle-rose wird behandelt mit ambulanter Kompressionstherapie, Exzision des Ulkus und Spalthauttransplantation (Verfahren von Vigoni).

Das chronisch-venöse Kompartment-Syndrom wird meistens verursacht durch das postthrombotische Syndrom, das zur Erhö-hung des venösen Drucks führen kann. Die Behandlung besteht aus einer Fasziotomie. Patienten mit einer nicht-rekanalisierten Thrombose der Vena poplitea können unterstützt werden durch intermittierende pneumatische Kompression, Gehübungen und abwechselndes Stehen, Laufen und Liegen. Alle Patienten mit persistierende venöse Beingeschwüre sollten lebenslang medizinische Kompressionsstrümpfe mit einer hohen Steifigkeit tragen.

Schlussfolgerungen: Einsicht in die zugrunde liegende Pathologie persistierender venöser Beinulzerationen ist entscheidend, um die Behandlung dieser diagnostisch und therapeutisch anspruchsvollen Patienten zu optimieren. Die sorgfältige Analyse der Ursachen und der Behandlung wird die Ergebnisse verbessern und die Zahl erfolgreich behandelter Ulzerationen erhöhen.

Keywords

Recalcitrant venous leg ulcer - pathophysiology - therapy

Schlüsselwörter

Persistierende Beinulzerationen - Pathophysiologie - Behandlung

Full Text

References

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