Surgical Removal of Ulcer and Lipodermatosclerosis Followed by Split-Skin Grafting (Shave Therapy) Yields Good Long-term Results in "Non-healing" Venous Leg Ulcers

Abstract

The purpose of this study was to evaluate the long-term effects of shave therapy in non-healing venous leg ulcers. Forty-one patients with 75 recalcitrant leg ulcers caused by primary deep vein incompetence or post-thrombotic syndrome were operated by shave therapy (removal of ulcer and surrounding lipodermatosclerosis with a Schink skin-grafting knife and covering of the wounds with meshed split-thickness skin grafts). After an average follow-up period of 2 years and 5 months all patients were evaluated for long-term results. The healing rate of ulcers classified as non-healing was 67% (50 of 75 ulcers). The healing rate was 76% for ulcers associated with primary deep vein incompetence and 58% for ulcers associated with post-thrombotic syndrome (p = 0.08). Even in cases with recurrence (33%) these ulcers were strikingly reduced by 80-90% of their original size. Hypaesthesia was noticed in 38% of the transplanted areas. In "non-healing" venous leg ulcers due to deep venous insufficiency shave therapy yields favourable long-term results. Because it is only a symptomatic treatment which does not reduce the pathological refluxes, continuous compression of the lower leg is important.

Success Rate of Split-Thickness Skin Grafting of Chronic Venous Leg Ulcers Depends on the Presence of Pseudomonas aeruginosa: A Retrospective Study

“…A wide range of things are believed to adversely influence skin graft take; haematoma or shearing movements[8], inadequate compliance, deficient blood supply, presence of microtrombi in the dermal blood vessels[22], local fibrin deficiency in the wound bed[23] and former thrombophlebitis in relation to primary deep vein incompetence[24] are examples. Skin graft loss due to infection make up only a minor part in the literature with very few publications on deterioration of skin grafts due to P. aeruginosa [8], [12]–[16], particularly in the field of chronic lower limb ulcerations.…”

Perioperative antibiotic prophylaxis in skin surgery – Position paper of the Antibiotic Stewardship working group of the German Society for Dermatologic Surgery (DGDC), Part 2: Special indications and situations

“…For healing and integration of the graft, the quality of the wound bed is just as important as it is for wound defect closure by skin grafts after tumor surgery. For this reason, extensive surgical debridement or fasciectomy is recommended for preparing the wound bed 19,20 …”

Perioperative Antibiotikaprophylaxe in der Dermatochirurgie – Positionspapier der Arbeitsgruppe Antibiotic Stewardship der Deutschen Gesellschaft für Dermatochirurgie (DGDC), Teil 2: Spezielle Indikationen und Situationen

“…Für die Einheilung des Transplantats ist die Qualität des Wundgrundes ebenso wichtig wie bei der Wunddefektdeckung mittels Hauttransplantation nach Tumorchirurgie. Aus diesem Grund wird zur Vorbereitung des Wundbettes ein umfangreiches chirurgisches Débridement oder Fasziektomie empfohlen 19,20 …”