Venous Ulcer – Present View on Aetiology, Diagnostics and Therapy
Authors:
T. Toporcer; L. Lakyová; J. Radoňak
Authors place of work:
II. chirurgická klinika LF UPJŠ, Košice
Published in the journal:
Čas. Lék. čes. 2008; 147: 199-205
Category:
Review Article
Summary
The common aetiology of chronic wounds is chronic venous insufficiency. The prevalence of chronic venous insufficiency ranges from 5 to 8% and the prevalence of venous ulcers is about 1%. Venous ulcer is caused by induction of chronic inflammation. Chronic inflammation leads to deregulations of wound healing mechanisms. Senescent phenotype of wound healing cells is recorded as outcome of chronic inflammation. Diagnosis is based on classical clinical presentation of venous ulcer and on supporting examinations. Supporting examinations include duplex ultrasound, photoplethysmography, ankle brachial index investigation and examination of hemocoagulation status. Malignant transformation is a possible complication of venous ulcers. The relative risk of malignancy in chronic venous ulcers is 5.8%. The first step in venous ulcer treatment is debridement. There is no consensus in speculations about wound colonization treatment. However the signs of infection are indication for general antibiotics treatment. Local antiseptic therapy is increasingly used. On the other side local antibiotics therapy is not recommended. Compression is used as the mainstay of therapy. It is important to rule out arterial disease before initiating compression therapy. Dressings are used as an adjuvant therapy to compression. Venous ulcers treatment is an interdisciplinary problem. Large diagnostic and therapeutic methods are needed for its management.
Key words:
chronic venous insufficiency, venous ulcer, chronic wound.
Zdroje
1. White, R. J., Cutting, K., Kingsley, A.: Topical antimicrobials in the control of wound bioburden. Ostomy. Wound.Manage., 2006, 52, s. 26–58.
2. Lim, T., Mwipatayi, B., Murray, R. et al.: Microbiological profile of chronic ulcers of the lower limb: a prospective observational cohort study. ANZ. J. Surg., 2006, 76, s. 688–692.
3. Bergqvist, D., Lindholm, C., Nelzen, O.: Chronic leg ulcers: the impact of venous disease. J. Vasc. Surg., 1999, 29, s. 752–755.
4. Ruckley, C. V.: Socioeconomic impact of chronic venous insufficiency and leg ulcers. Angiology, 1997, 48, s. 67–69.
5. Abbade, L. P., Lastoria, S.: Venous ulcer: epidemiology, physiopathology, diagnosis and treatment. Int. J. Dermatol., 2005, 44, s. 449–456.
6. Nicolaides, A. N., Hussein, M. K., Szendro, G. et al.: The relation of venous ulceration with ambulatory venous pressure measurements. J. Vasc. Surg., 1993, 17, s. 414–419.
7. Falanga, V., Eaglstein, W. H.: The “trap” hypothesis of venous ulceration. Lancet, 1993, 341, s. 1006–1008.
8. Coleridge Smith, P. D., Thomas, P. et al.: Causes of venous ulceration: a new hypothesis. Br. Med. J. (Clin. Res. Ed), 1988, 296, s. 1726–1727.
9. Claudy, A. L., Mirshahi, M., Soria, C. et al.: Detection of undegraded fibrin and tumor necrosis factor–alpha in venous leg ulcers. J. Am. Acad. Dermatol., 1991, 25, s. 623–627.
10. Bergan, J. J., Schmid-Schonbein, G. W., Smith, P. D. et al.: Chronic venous disease. N. Engl. J. Med., 2006, 355, s. 488–498.
11. Wong, T., McGrath, J. A., Navsaria, H.: The role of fibroblasts in tissue engineering and regeneration. Br. J. Dermatol., 2007, 156, s. 1149–1155.
12. Raffetto, J. D., Mendez, M. V., Marien, B. J. et al.: Changes in cellular motility and cytoskeletal actin in fibroblasts from patients with chronic venous insufficiency and in neonatal fibroblasts in the presence of chronic wound fluid. J. Vasc. Surg., 2001, 33, s. 1233–1241.
13. Scott, T. E., LaMorte, W. W., Gorin et al.: Risk factors for chronic venous insufficiency: a dual case-control study. J. Vasc. Surg., 1995, 22, s. 622–628.
14. Etufugh, C. N., Phillips, T. J.: Venous ulcers. Clin. Dermatol., 2007, 25, s. 121–130.
15. Humphreys, M. L., Stewart, A. H., Gohel, M. S. et al.: Management of mixed arterial and venous leg ulcers. Br. J. Surg., 2007, 94, s. 1104–1107.
16. Reich, A., Cisło, M., Szepietowski, J. C.: Squamous Cell Carcinoma Arising in Long Lasting Leg Ulceration. Čes.-slov. Derm., 2006, 81, s. 290–292.
17. Impola, U., Jeskanen, L., Ravanti, L. et al.: Expression of matrix metalloproteinase (MMP)-7 and MMP-13 and loss of MMP-19 and p16 are associated with malignant progression in chronic wounds. Br. J. Dermatol., 2005, 152, s. 720–726.
18. Eklof, B., Rutherford, R. B., Bergan, J. J. et al.: Revision of the CEAP classification for chronic venous disorders: consensus statement. J. Vasc. Surg., 2004, 40, s. 1248–1252.
19. Golian, D., Mazuch, J., Mištuna, D. et al.: Klinické hodnotenie varikóznej choroby DK z pohľadu CEAP, pooperačné sledovanie významných etiopatogenetických faktorov v našom súbore. Praktická flebologie, 2004, 13, s. 72–75.
20. Radoňak, J., Vajó, J., Brandebur, O. et al.: Liečba chronických žilových vredov. Praktická flebologie, 2007, 16, s. 22.
21. Marston, W.: Evaluation and treatment of leg ulcers associated with chronic venous insufficiency. Clin. Plast. Surg., 2007, 34, s. 717–730.
22. Granick, M. S., Posnett, J., Jacoby, M. et al.: Efficacy and cost-effectiveness of a high–powered parallel waterjet for wound debridement. Wound.Repair Regen., 2006, 14, s. 394–397.
23. Gurunluoglu, R.: Experiences with waterjet hydrosurgery system in wound debridement. World J. Emerg. Surg., 2007, 2, s. 10.
24. Steed, D. L.: Debridement. Am. J. Surg., 2004, 187, s. 71S–74S.
25. Blake, F. A., Abromeit, N., Bubenheim, M. et al.: The biosurgical wound debridement: experimental investigation of efficiency and practicability. Wound. Repair Regen., 2007, 15, s. 756–761.
26. Ebright, J. R.: Microbiology of chronic leg and pressure ulcers: clinical significance and implications for treatment. Nurs. Clin. North Am., 2005, 40, s. 207–216.
27. Reichenberg, J., Davis, M.: Venous ulcers. Semin.Cutan.Med.Surg., 2005, 24, s. 216–226.
28. Tammelin, A., Lindholm, C., Hambraeus, A.: Chronic ulcers and antibiotic treatment. J. Wound. Care, 1998, 7, s. 435–437.
29. Wilson, J. R., Mills, J. G., Prather, I. D. et al.: A toxicity index of skin and wound cleansers used on in vitro fibroblasts and keratinocytes. Adv. Skin Wound. Care, 2005, 18, s. 373–378.
30. Vermeulen, H., van Hattem, J. M., Storm-Versloot, M. N. et al.: Topical silver for treating infected wounds. Cochrane. Database. Syst. Rev., 2007, CD005486.
31. Milic, D. J., Zivic, S. S., Bogdanovic, D. C. et al.: A randomized trial of the Tubulcus multilayer bandaging system in the treatment of extensive venous ulcers. J. Vasc. Surg., 2007, 46, s. 750–755.
32. Lorimer, K. R., Harrison, M. B., Graham, I. D. et al.: Venous leg ulcer care: how evidence-based is nursing practice? J. Wound. Ostomy. Continence. Nurs., 2003, 30, s. 132–142.
33. Bello, Y. M., Phillips, T. J.: Chronic leg ulcers: types and treatment. Hosp. Pract. (Minneap.), 2000, 35, s. 101–107.
34. Toporcer, T., Radoňák, J.: Podtlakové uzatváranie rán – nové poznatky a možnosti aplikácie, 2006, 145, s. 702–707.
35. Kilík, R., Bober, J., Gál, P. et al.: Vplyv laserového žiarenia rôznych intenzít na hojenie incíznych rán u zdravých a diabetických potkanov. Rozhl. Chir, 2007, 86, s. 384–387.
36. Kopera, D., Kokol, R., Berger, C. et al.: Does the use of low–level laser influence wound healing in chronic venous leg ulcers? J. Wound. Care, 2005, 14, s. 391–394.
37. Baron, H. C., Wayne, M. G., Santiago, C. et al.: Treatment of severe chronic venous insufficiency using the subfascial endoscopic perforator vein procedure. Surg. Endosc., 2005, 19, s. 126–129.
38. Barwell, J. R., Davies, C. E., Deacon, J. et al.: Comparison of surgery and compression with compression alone in chronic venous ulceration (ESCHAR study): randomised controlled trial. Lancet, 2004, 363, s. 1854–1859.
39. Gohel, M. S., Barwell, J. R., Taylor, M. et al.: Long term results of compression therapy alone versus compression plus surgery in chronic venous ulceration (ESCHAR): randomised controlled trial. BMJ, 2007, 335, s. 83.
40. Glinski, W., Chodynicka, B., Roszkiewicz, J. et al.: Effectiveness of a micronized purified flavonoid fraction (MPFF) in the healing process of lower limb ulcers. An open multicentre study, controlled and randomized. Minerva Cardioangiol., 2001, 49, s. 107–114.
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Addictology Allergology and clinical immunology Angiology Audiology Clinical biochemistry Dermatology & STDs Paediatric gastroenterology Paediatric surgery Paediatric cardiology Paediatric neurology Paediatric ENT Paediatric psychiatry Paediatric rheumatology Diabetology Pharmacy Vascular surgery Pain management Dental HygienistČlánok vyšiel v časopise
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