Modalities to Treat Venous Ulcers: Compression, Surgery, and Bioengineered Tissue
Modalities to Treat Venous Ulcers: Compression, Surgery, and Bioengineered Tissue
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DOI：
10.1097/prs.0000000000002677
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发表时间：
2016-09-01
影响因子：
3.6
通讯作者：
Tomic-Canic, Marjana
中科院分区：
文献类型：
--
作者：
Gould, Lisa J.;Dosi, Garima;Tomic-Canic, Marjana
背景：静脉性小腿溃疡(VLU)是最常见的下肢溃疡。VLU以愈合延迟和延长而臭名昭著，复发率很高。大多数VLU患者也有严重的合并症，干扰了初级伤口的愈合。因此，护理VLU患者需要一种跨学科的方法来处理异常的静脉解剖和导致炎症、溃疡和敌对伤口微环境的下游影响。方法：回顾当前关于静脉溃疡治疗的文献，重点放在压迫、手术选择和生物工程组织的使用上。结合社会指南、Cochrane综述和80多篇具有高水平证据的主要文章，为治疗静脉性溃疡患者的综合方法开发了这一总结和算法。结果：慢性静脉功能不全(CVI)患者的综合治疗方法包括压迫、诊断、静脉疾病的微创外科治疗、创面准备以及生物工程皮肤和软组织替代物方面的进展。提出了一种将溃疡和静脉疾病的早期治疗与预防复发相结合的算法。结论：使用结合循证模式的指南将以最适当的资源利用获得最高质量的结果。积极主动地治疗静脉疾病将减轻痛苦，防止CVI的长期后遗症。
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 significant 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 insufficiency (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.