Modalities to treat venous ulcers: Compression, surgery, and bioengineered tissue

Lisa J. Gould, Garima Dosi, Kara Couch, Gary W. Gibbons, Raelina S. Howell, Harold Brem, Marjana Tomic-Canic

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: Venous leg ulcers (VLUs) represent the most common ulcers of the lower extremity. VLUs are notorious for delayed and prolonged healing with high rates of recurrence. Most patients with VLUs also have signifcant comorbidities that interfere with primary wound healing. Thus, caring for patients with VLUs requires an interdisciplinary approach that addresses the abnormal venous anatomy and the downstream effects that lead to inflammation, ulceration, and a hostile wound microenvironment. Methods: The current literature regarding venous ulcer treatment with an emphasis on compression, surgical options, and use of bioengineered tissue was reviewed. A combination of society guidelines, Cochrane reviews, and over 80 primary articles with high-level evidence were utilized to develop this summary and algorithm for an integrated approach to treating patients with venous ulcers. Details regarding compression modalities and venous diagnostic imaging are presented to help the clinician understand the rationale for using these technologies. Results: The comprehensive approach to the patient with chronic venous insuffciency (CVI) includes advances in compression, diagnostics, minimally invasive surgical treatment of venous disease, wound bed preparation, and bioengineered skin and soft tissue substitutes. An algorithm that incorporates early treatment of the ulcer and the venous disease leading to healing with prevention of recurrence is presented. Conclusions: Utilizing guidelines that incorporate evidence-based modalities will lead to the highest quality outcomes with the most appropriate resource utilization. A proactive approach to treating venous disease will alleviate suffering and prevent the long-term sequelae of CVI.

Original languageEnglish (US)
Pages (from-to)199S-208S
JournalPlastic and Reconstructive Surgery
Volume138
Issue number3
DOIs
StatePublished - 2016

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Varicose Ulcer
Leg Ulcer
Guidelines
Recurrence
Wounds and Injuries
Diagnostic Imaging
Wound Healing
Ulcer
Comorbidity
Lower Extremity
Anatomy
Therapeutics
Inflammation
Technology
Skin

ASJC Scopus subject areas

  • Surgery

Cite this

Modalities to treat venous ulcers : Compression, surgery, and bioengineered tissue. / Gould, Lisa J.; Dosi, Garima; Couch, Kara; Gibbons, Gary W.; Howell, Raelina S.; Brem, Harold; Tomic-Canic, Marjana.

In: Plastic and Reconstructive Surgery, Vol. 138, No. 3, 2016, p. 199S-208S.

Research output: Contribution to journalArticle

Gould, Lisa J. ; Dosi, Garima ; Couch, Kara ; Gibbons, Gary W. ; Howell, Raelina S. ; Brem, Harold ; Tomic-Canic, Marjana. / Modalities to treat venous ulcers : Compression, surgery, and bioengineered tissue. In: Plastic and Reconstructive Surgery. 2016 ; Vol. 138, No. 3. pp. 199S-208S.
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