Venous stasis ulcer
In medicine, venous stasis ulcers are a form of venous insufficiency and are the result of the breakdown of the tissues usually in the lower legs as the result of diminished circulation. As the tissues lose their source of nutrition and waste removal, breakdown in the skin occurs resulting in ulcerated lesions that resist healing.
Etiology
The most likely cause is lost efficiency of the valves in the deep veins of the leg increasing the pressure in the veins and thus decreasing the exchange of blood from arteries through the capillaries. Any mechanism that might block or diminish flow through the deep veins can cause the condition. The most common cause is deep venous thrombosis.
Treatment
Venous ulcers are costly to treat, and there is a significant chance that they will reoccur after healing;[1][2] one study found that up to 48% of venous ulcers had recurred by the fifth year after healing.[2]
A review by Clinical Evidence concluded that several beneficial treatments exist.[3]
Compression therapy
Compression bandages improve healing.Cite error: Closing </ref> missing for <ref> tag Compression therapy is used for venous leg ulcers and can decrease blood vessel diameter and pressure, which increases their effectiveness, preventing blood from flowing backwards.[2] Compression is also used [2][4] to increase release of inflammatory cytokines, lower the amount of fluid leaking from capillaries and therefore prevent swelling, and prevent clotting by decreasing activation of thrombin and increasing that of plasmin.[1]
It is not clear whether non-elastic systems are better than a multilayer elastic system.[3] Compression is applied using elastic bandages or boots specifically designed for the purpose.[2] Patients should wear as much compression as is comfortable. [5]
Type of dressing
The type of dressing applied beneath the compression may or may not matter. A meta-analysis by the Cochrane Collaboration concluded the type of dressing does note matter, specially [hydocolloid]] is not better than simple low adherent dressings.[6][7] Another systematic review concluded that hydocolloid is better.[8]
Pentoxifylline
A meta-analysis of randomized controlled trials by the Cochrane Collaboration found that "Pentoxifylline is an effective adjunct to compression bandaging for treating venous ulcers and may be effective in the absence of compression".[9]
Artificial skin
Artificial skin, made of collagen and cultured skin cells, is also used to cover venous ulcers and excrete growth factors to help them heal.[10] A meta-analysis of randomized controlled trials by the Cochrane Collaboration concluded "Bilayer artificial skin, used in conjunction with compression bandaging, increases the chance of healing a venous ulcer compared with compression and a simple dressing".[11]
Surgical correction of superficial venous reflux
A randomized controlled trial found that surgery "reduces the recurrence of ulcers at four years and results in a greater proportion of ulcer free time".[12]
Other treatments
Iloprost, a synthetic analogue of prostacyclin PGI2 can improve healing according to a randomized controlled trial.[13] In this initial trial, healing rates at 90 days were 100% in the intervention group and 50% in the control group.
References
- ↑ 1.0 1.1 Snyder RJ (2005). "Treatment of nonhealing ulcers with allografts". Clin. Dermatol. 23 (4): 388–95. DOI:10.1016/j.clindermatol.2004.07.020. PMID 16023934. Research Blogging.
- ↑ 2.0 2.1 2.2 2.3 2.4 Brem H, Kirsner RS, Falanga V (2004). "Protocol for the successful treatment of venous ulcers". Am. J. Surg. 188 (1A Suppl): 1-8. DOI:10.1016/S0002-9610(03)00284-8. PMID 15223495. Research Blogging.
- ↑ 3.0 3.1 Nelson EA, Cullum N, Jones J (2006). "Venous leg ulcers". Clinical evidence (15): 2607-26. PMID 16973096. [e]
- ↑ Taylor JE, Laity PR, Hicks J, et al (2005). "Extent of iron pick-up in deforoxamine-coupled polyurethane materials for therapy of chronic wounds". Biomaterials 26 (30): 6024-33. DOI:10.1016/j.biomaterials.2005.03.015. PMID 15885771. Research Blogging.
- ↑ Nelson EA, Harper DR, Prescott RJ, Gibson B, Brown D, Ruckley CV (2006). "Prevention of recurrence of venous ulceration: randomized controlled trial of class 2 and class 3 elastic compression". J. Vasc. Surg. 44 (4): 803-8. DOI:10.1016/j.jvs.2006.05.051. PMID 17012004. Research Blogging.
- ↑ Palfreyman SJ, Nelson EA, Lochiel R, Michaels JA (2006). "Dressings for healing venous leg ulcers". Cochrane database of systematic reviews (Online) 3: CD001103. DOI:10.1002/14651858.CD001103.pub2. PMID 16855958. Research Blogging.
- ↑ Palfreyman S, Nelson EA, Michaels JA (2007). "Dressings for venous leg ulcers: systematic review and meta-analysis". BMJ 335 (7613): 244. DOI:10.1136/bmj.39248.634977.AE. PMID 17631512. Research Blogging.
- ↑ Chaby G, Senet P, Vaneau M, et al (2007). "Dressings for acute and chronic wounds: a systematic review". Archives of dermatology 143 (10): 1297–304. DOI:10.1001/archderm.143.10.1297. PMID 17938344. Research Blogging.
- ↑ Jull A, Arroll B, Parag V, Waters J (2007). "Pentoxifylline for treating venous leg ulcers". Cochrane database of systematic reviews (Online) (3): CD001733. DOI:10.1002/14651858.CD001733.pub2. PMID 17636683. Research Blogging.
- ↑ Mustoe T. 2005. Dermal ulcer healing: Advances in understanding. Presented at meeting: Tissue repair and ulcer/wound healing: molecular mechanisms, therapeutic targets and future directions. Paris, France, March 17-18, 2005. Available.
- ↑ Jones JE, Nelson EA (2007). "Skin grafting for venous leg ulcers". Cochrane database of systematic reviews (Online) (2): CD001737. DOI:10.1002/14651858.CD001737.pub3. PMID 17443510. Research Blogging.
- ↑ Gohel MS, Barwell JR, Taylor M, et al (2007). "Long term results of compression therapy alone versus compression plus surgery in chronic venous ulceration (ESCHAR): randomised controlled trial". BMJ 335 (7610): 83. DOI:10.1136/bmj.39216.542442.BE. PMID 17545185. Research Blogging.
- ↑ Ferrara F, Meli F, Raimondi F, et al (2007). "The treatment of venous leg ulcers: a new therapeutic use of iloprost". Ann. Surg. 246 (5): 860–5. DOI:10.1097/SLA.0b013e3180caa44c. PMID 17968180. Research Blogging.