The venous ulcer continues to be a clinical challenge: an update

Oxford University Press (OUP) - 2018
Ting Xie1, Junna Ye2, Kittipan Rerkasem3, Raj Mani4,5,6
1Wound Healing Centre at Emergency Department, Shanghai Ninth People’s Hospital Shanghai Jiao Tong University School of Medicine Shanghai, China
2Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
3NCD Centre of Excellence, Research Institute of Health Sciences Chiang Mai University Chiang Mai, Thailand
4NCD Centre and Department of Surgery, Faculty of Medicine Chiang Mai University Chiang Mai, Thailand
5Shanghai Jiao Tong University, Shanghai Jiao Tong School of Medicine Shanghai, China
6Academic Division of Human Health and Development, Faculty of Medicine University of Southampton Southampton, UK

Tóm tắt

Abstract Venous ulcers are a common chronic problem in many countries especially in Northern Europe and USA. The overall prevalence of this condition is 1% rising to 3% in the over 65 years of age. Over the last 25 years, there have been many developments applicable to its diagnosis and treatment. These advances, notwithstanding healing response and recurrence, are variable, and the venous ulcer continues to be a clinical challenge. The pathogenesis of venous ulcers is unrelieved or ambulatory venous hypertension resulting mostly from deep venous thrombosis leading to venous incompetence, lipodermatosclerosis, leucocyte plugging of the capillaries, tissue hypoxia and microvascular dysfunction. It is not known what initiates venous ulcers. Triggers vary from trauma of the lower extremity to scratching to relieve itchy skin over the ankle region. Venous ulcers can be painful, and this condition presents an increasing burden of care. A systematic analysis of the role of technology used for diagnosis and management strongly supports the use of compression as a mainstay of standardised care. It further shows good evidence for the potential of some treatment procedures to accelerate healing. This article reviews the pathogenetic mechanisms, current diagnostic methods and standard care and its limitations.

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