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.

Keywords: Chronic venous leg ulcers; Debridement; Compression; Negative pressure wound therapy; Autologous split-thickness skin grafting; Hair punch graft; Platelet-rich plasma; Advanced wound care therapies

Core Tip: Wound care, debridement, bed rest with leg elevation, and compression are basic therapies for chronic venous leg ulcers (CVLUs). Ablation of the great saphenous veins help heal some ulcers. Negative pressure wound therapy, autologous split-thickness skin grafting, autologous platelet-rich plasma, and administration of adipose tissue or placenta-derived mesenchymal stem cells are effective approaches for wound healing. Hair punch graft appears to have a better result than traditional hairless punch graft for CVLUs. There are little data to support the efficacy of silver-based dressings in the healing of CVLUs. Hydrogen peroxide is harmful to the growth of granulation tissue in CVLUs.