A Strategy to Enable Rapid Healing and Prevent Recurrence of Venous Ulcers

Abstract

Introduction. Venous ulcers are often intractable. Objective. The aim of this study was to retrospectively analyze the effectiveness of endovenous ablation, compression therapy, moist wound healing, and skin care in the management of venous ulcers. Materials and Methods. Twenty-eight consecutive patients (10 male, 18 female; mean age, 70.1 years) with Clinical-Etiology-Anatomy-Pathophysiology (CEAP) class C6 venous ulcer underwent endovenous ablation between December 2014 and August 2020. The main treatment strategies were radiofrequency ablation and varicectomy (including stab avulsion of incompetent perforating veins), use of compression therapy until complete healing was achieved, moist wound healing (washing the ulcer site and covering it with dressings twice daily), and skin care, taking into consideration the balance of the microbiome. Results. Active venous leg ulcers (CEAP class C6) were diagnosed in 36 patients at the first visit. In 7 of these patients, compression therapy and use of strategies to promote moist wound healing resulted in ulcer healing by the day of the planned surgery. One patient was unable to quit smoking and, therefore, could not undergo surgery. After excluding these 8 patients, the authors analyzed the data from 28 patients who underwent endovenous ablation. The mean surgical time was 38.9 minutes, and the mean number of stab avulsion incision sites was 9.7. All ulcers healed within a median of 55.5 days (range, 13–365 days). Ulcer healing was achieved by 1 year in all 28 patients (100%). No ulceration recurred as of the final follow-up (median, 24.5 months [range, 3–66 months]). Conclusions. Endovenous ablation, adequate varicectomy (stab avulsion [maximum number of sites in 1 patient, 43]), compression therapy, moist wound healing, and skin care are effective in treating and preventing recurrence of venous ulcers.

Major impact of moist wound healing on autologous tissue regeneration: A review of ulcer treatment

“…Moist wound healing results in almost complete epithelialization without necessitating reamputation. Figure 1A shows a complete regeneration of finger tears that would have been indicated for amputation using conventional methods 2,5 . Some deformities and shortening of the fingers are unavoidable in major amputation cases; however, no complications were observed in moving the treated finger in most cases.…”

“…Additionally, trafermin is not used because it causes localized pain. 2 Smoking and secondhand smoking are important risk factors for delayed wound healing and increased infection. 14 Nonsteroidal anti‐inflammatory drugs and acetaminophen use should be limited since they can decrease body temperature and immunity.…”

“…However, it may cause patients to apply soap to eliminate greasiness, which could lead to increased irritation. This phenomenon has been named the “petroleum jelly paradox.” After Mirai Kankyo Technology succeeded in emulsifying petroleum jelly using a 3‐phase emulsification process where water and oil are mixed without surfactants, 2 the authors began recommending a cosmetic moisturizer (Proud Blue Sensitive Moisture Cream™) developed using this technology. Meanwhile, ordinary cream formulations contain surfactants.…”

“…The development of irreversible membrane (IRM) dressings (Plus Moist™; Zuiko Medical Osaka) and composite absorbent pads (Zuikopad™; Zuiko Medical Osaka) in Japan have improved the moist wound healing technique. 2 Showering wounds twice daily, regardless of their possible infections, and covering them using these functional dressings could provide an optimal environment for tissue regeneration through excess exudate absorption and wet wound surface maintenance. Natsui reported ˃4000 cases where moist wound healing was used, 3 reflecting its increasing popularity.…”

“…Although clinical practice guidelines of the Society for Vascular Surgery recommend moist dressings for wound care, the rate of dressing usage, excluding gauze, in 2016 was <10% in Japan. Compared with conventional treatments such as disinfection and gauze, endovenous ablation of venous reflux; adequate varicose vein resection, including incompetent perforator veins 1 ; and compression therapy with moist wound healing 2 and appropriate skin care, yield more rapid epithelialization and prevent a recurrence. This study aimed to describe the widespread use of moist wound healing for venous ulcer treatment in Japan and its application to various wounds, particularly difficult‐to‐treat finger amputations and burns.…”