Strategies and challenges in the treatment of chronic venous leg ulcers

Abstract

Evaluating patients with chronic venous leg ulcers (CVLUs) is essential to find the underlying etiology. The basic tenets in managing CVLUs are to remove the etiological causes, to address systemic and metabolic conditions, to examine the ulcers and artery pulses, and to control wound infection with debridement and eliminating excessive pressure on the wound. The first-line treatments of CVLUs remain wound care, debridement, bed rest with leg elevation, and compression. Evidence to support the efficacy of silver-based dressings in healing CVLUs is unavailable. Hydrogen peroxide is harmful to the growth of granulation tissue in the wound. Surgery options include a high ligation with or without stripping or ablation of the GSVs depending on venous reflux or insufficiency. Yet, not all CVLUs are candidates for surgical treatment because of comorbidities. When standard care of wound for 4 wk failed to heal CVLUs effectively, use of advanced wound care should be considered based on the available evidence. Negative pressure wound therapy facilitates granulation tissue development, thereby helping closure of CVLUs. Autologous split-thickness skin grafting is still the gold standard approach to close huge CVLUs. Hair punch graft appears to have a better result than traditional hairless punch graft for CVLUs. Application of adipose tissue or placenta-derived mesenchymal stem cells is a promising therapy for wound healing. Autologous platelet-rich plasma provides an alternative strategy for surgery for safe and natural healing of the ulcer. The confirmative efficacy of current advanced ulcer therapies needs more robust evidence.

A systematic review on clinical outcomes of human amniotic membrane preparations in the management of venous leg ulcers

“…Current literature indicates similar ulcer healing rates between superficial venous surgery and the use of compression. However, with a lesser recurrence rate [27]. Therefore, the effect of superficial venous surgery on ulcer healing cannot be disregarded in the current study.…”

Surgical outcomes of split-thickness skin grafts versus free flaps of the lateral thoracic region for incurable chronic venous ulcers

“…The risk of recurrence exists from a long-term perspective, and skin grafts are still widely used as surgical treatment for CVU [26,27]. On the other hand, surgical treatment using the free flap has the disadvantage of requiring microsurgery, although it offers the major advantage of fundamentally resolving venous insufficiency.…”

Venous Leg Ulcers: Advanced Therapies and New Technologies

“…A commonly known fact is that chronic wound tissues have a too low amount of oxygen, and the healing process of hypoxic tissues is disturbed, especially when a transcutaneous oxygen partial pressure (pO2) is lower than 40 mmHg [ 14 , 26 ]. It is suggested that oxygen therapy (OT) increases oxygen delivery to wounds, accelerates their healing, and does not reveal relevant cell damage risk [ 14 , 27 , 28 ].…”

“…Clinical implications under the influence of hyperbaric oxygen therapy, noted in trials, are reduction in the size of the venous leg ulcers, and acceleration of the healing process [ 14 , 27 , 28 , 29 ]. Nevertheless, there is still a need to conduct high-quality, large randomized, future trials to evidence whether HBOT as an adjunct treatment for non-healing venous leg ulcers improves a long-term disease state [ 14 ].…”

“…Clinical trials confirmed that TOT could influence venous leg ulcers area reduction, pain relief, or decrease ulcer recurrence rate [ 26 , 28 , 30 ]. On the other hand, the poor quality of current evidence requires clinical confirmation in the future.…”