A retrospective review of 20 hypertensive leg ulcers treated with mesh skin grafts

Dagrégorio, G.; Guillet, G.

doi:10.1111/j.1468-3083.2006.01399.x

Cited by 37 publications

(31 citation statements)

References 4 publications

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“…In 1946-1947, Farber and Hines stressed the link between the striking histopathology of the underlying arterioles showing distinctive wall thickening resulting in a narrow lumen and coined the term still in use today of 'hypertensive ischemic leg ulcer' [11,12] . It was Schnier et al [13] , who described the typical location on the laterodorsal leg, and several authors, among them Bertranou et al [14] , Lazareth and Priollet [15] and Dagregorio and Guillet [16] , recommended early debridement and skin grafting to enhance wound healing and effectively alleviate pain. In their comprehensive review from 2010, Vuerstaek et al [8] collected 889 cases published in 53 articles and theses.…”

Section: History Of Calciphylaxismentioning

confidence: 99%

“…Treatment of skin infarctions from ischemic arteriolosclerosis is essentially surgical [4,6,[14][15][16] . Numerous work groups have empirically determined and published that patients can be most rapidly and effectively helped when the necrotic tissue is excised and the wound covered early with a skin graft.…”

Section: The Common Treatment Concept Of Calciphylaxis Martorell Hytmentioning

confidence: 99%

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Calciphylaxis and Martorell Hypertensive Ischemic Leg Ulcer: Same Pattern - One Pathophysiology

Hafner¹

2016

Dermatology

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This review presents a closer look at four diseases which are probably closely related to one another pathophysiologically: (a) calciphylaxis (distal pattern); (b) calciphylaxis (proximal pattern); (c) Martorell hypertensive ischemic leg ulcer; (d) calciphylaxis with normal renal and parathyroid function (synonym: eutrophication). The four diseases have largely the same risk factors: (1) arterial hypertension, (2) diabetes mellitus (types 1 and 2), (3) secondary or tertiary hyperparathyroidism (in end-stage kidney disease) and (4) oral anticoagulation with vitamin K antagonists. They share the same clinical patterns: necrotizing livedo, skin infarctions at typical locations and acral gangrene in calciphylaxis. They also share the same histopathology: ischemic subcutaneous arteriolosclerosis and small-artery disease and ‘miniaturizing' Mönckeberg medial calcinosis. The treatment concept for the acute phase of the diseases is also broadly similar. In addition to an optimized control of the cardiovascular risk factors, a proactive wound approach (necrosectomy, negative pressure wound treatment with vacuum dressings, and early skin grafts supported by systemic antibiotic therapy) leads most rapidly and effectively to a reduction of the initially severe wound pain, and finally to complete healing of the wound. Oral anticoagulation with vitamin K antagonists should be stopped. In extensive cases, the use of intravenous sodium thiosulfate is recommended. All four diagnoses are little known in the medical schools of most countries. The need to improve familiarity with these four closely related disorders is therefore great. In particular, the risk of confusion with pyoderma gangrenosum is a major diagnostic problem which can lead to false and even damaging treatment.

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Section: History Of Calciphylaxismentioning

confidence: 99%

Section: The Common Treatment Concept Of Calciphylaxis Martorell Hytmentioning

confidence: 99%

Calciphylaxis and Martorell Hypertensive Ischemic Leg Ulcer: Same Pattern - One Pathophysiology

Hafner¹

2016

Dermatology

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“…Pain rapidly and significantly decreased. No recurrence or adverse event was ob-With classical wound dressings, ulcers usually heal after a mean period of 15 months [6,9] . Adequate therapeutic control of hypertension is mandatory but not sufficient to heal.…”

Section: Introductionmentioning

confidence: 99%

“…These "hard-to-heal ulcers" are secondary to local ischaemia due to the narrowed lumen of the arterioles and the reduced dermal capillary density in the lower leg [5] . In some specialized hospital departments, HLUs account for up to 15% of all the ulcers treated [6] . Treatment of HLU remains a therapeutic challenge [7,8] .…”

Section: Introductionmentioning

confidence: 99%

“…Adequate therapeutic control of hypertension is mandatory but not sufficient to heal. Skin grafting is the standard treatment but does not prevent recurrences [6,10] . Adipose tissue is known to be a rich source of mesenchymal stem cells (MSCs) with healing factors, and Lipostructure ® represents a new therapeutic approach for wound repair and tissue regeneration [11][12][13][14][15] .…”

Section: Introductionmentioning

confidence: 99%

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Autologous Adipose Tissue Graft to Treat Hypertensive Leg Ulcer: A Pilot Study

Chopinaud

Labbé

Creveuil³

et al. 2017

Dermatology

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Background: Adipose tissue is an abundant source of mesenchymal stem cells, called adipose-derived stem cells, which have anti-inflammatory and trophic effects to enhance overall tissue repair. Objective: To determine the healing effects of autologous adipose tissue graft on hypertensive leg ulcers. Methods: Prospective pilot study in 1 French dermatology department. Ten patients with a hypertensive leg ulcer were enrolled from April 2013 to June 2015. The primary end point was the wound closure rate at each follow-up visit. The secondary end points were wound characteristics, pain assessment and adverse events. Results: One patient, the only smoker, was lost to follow-up at month 5 (M5). For the 9 non-smokers, wound surfaces constantly and significantly decreased: the median wound closure rate was 73.2% at M3 and 93.1% at M6, p < 0.001. The median wound closure rate of the 10 patients was 63.2% at M3, p < 0.001. Percentages of fibrin and necrosis decreased, granulation tissue increased significantly. Pain rapidly and significantly decreased. No recurrence or adverse event was observed. Conclusion: Our data suggest that autologous adipose tissue grafting induces pain relief and promotes wound healing with a good skin quality. Large prospective controlled randomized studies are required to confirm these results.

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Topical Treatment of Hypertensive Leg Ulcers With Platelet-Derived Growth Factor-BB

Senet

Vicaut²,

Bénéton³

et al. 2011

Arch Dermatol

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Setting: Ambulatory or hospitalized patients from 17 dermatology departments. Patients: Among 64 consecutive randomized patients with 1 or more hypertensive leg ulcers who fulfilled all inclusion criteria, 59 received the allocated intervention, and findings were analyzed. Intervention: Becaplermin gel (human recombinant platelet-derived growth factor-BB, 0.1%, in hydrogel) or hydrogel dressing was applied, both in doses of 1 cm/ cm 2 , once daily for 8 weeks. Follow-up continued for 4 weeks beyond the final gel application. Main Outcome Measures: The primary end point was complete wound closure rate after 8 weeks of treatment. Secondary end points were percentages of patients with complete wound closure at week 12; changed ulcer area after treatment vs baseline; and changed ulcerrelated pain and health-related quality of life during the study. Results: Complete wound closure rates were comparable after 8 weeks for becaplermin (5 of 28 patients) and hydrogel (3 of 31 patients) (8 percentage-point difference; 95% confidence interval,-10% to 26%). No statistically significant differences were observed between the 2 groups for percentages of complete closure at week 12, changed ulcer area at week 8, or changed ulcer-related pain and quality of life during the study (PϾ.05 for all comparisons). Conclusions: Topical becaplermin gel is not superior to hydrogel dressing for hypertensive leg ulcer wound closure. Surgical management by grafting remains the most promising treatment strategy but requires further evaluation.

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A retrospective review of 20 hypertensive leg ulcers treated with mesh skin grafts

Abstract: The review of the present series shows that early mesh grafting of hypertensive leg ulcers is beneficial, because healing is very quick and the pain will disappear quasi-instantly.

Cited by 37 publications

References 4 publications

Calciphylaxis and Martorell Hypertensive Ischemic Leg Ulcer: Same Pattern - One Pathophysiology

Calciphylaxis and Martorell Hypertensive Ischemic Leg Ulcer: Same Pattern - One Pathophysiology

Autologous Adipose Tissue Graft to Treat Hypertensive Leg Ulcer: A Pilot Study

Topical Treatment of Hypertensive Leg Ulcers With Platelet-Derived Growth Factor-BB

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