Abstract and Introduction
Abstract
Introduction: Venous ulcers are often intractable.
Objective: The aim of this study was to retrospectively analyze the effectiveness of endovenous ablation, compression therapy, moist wound healing, and skin care in the management of venous ulcers.
Materials and Methods: Twenty-eight consecutive patients (10 male, 18 female; mean age, 70.1 years) with Clinical-Etiology-Anatomy-Pathophysiology (CEAP) class C6 venous ulcer underwent endovenous ablation between December 2014 and August 2020. The main treatment strategies were radiofrequency ablation and varicectomy (including stab avulsion of incompetent perforating veins), use of compression therapy until complete healing was achieved, moist wound healing (washing the ulcer site and covering it with dressings twice daily), and skin care, taking into consideration the balance of the microbiome.
Results: Active venous leg ulcers (CEAP class C6) were diagnosed in 36 patients at the first visit. In 7 of these patients, compression therapy and use of strategies to promote moist wound healing resulted in ulcer healing by the day of the planned surgery. One patient was unable to quit smoking and, therefore, could not undergo surgery. After excluding these 8 patients, the authors analyzed the data from 28 patients who underwent endovenous ablation. The mean surgical time was 38.9 minutes, and the mean number of stab avulsion incision sites was 9.7. All ulcers healed within a median of 55.5 days (range, 13–365 days). Ulcer healing was achieved by 1 year in all 28 patients (100%). No ulceration recurred as of the final follow-up (median, 24.5 months [range, 3–66 months]).
Conclusions: Endovenous ablation, adequate varicectomy (stab avulsion [maximum number of sites in 1 patient, 43]), compression therapy, moist wound healing, and skin care are effective in treating and preventing recurrence of venous ulcers.
Introduction
The optimal treatment strategy for lower extremity varicose veins with venous ulcers is currently under debate, despite the publication in 2014 of the Society for Vascular Surgery (SVS) guidelines for the optimal management of venous leg ulcers (VLUs).[1] According to the Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification system for chronic venous disorders, active ulcers are the most severe: class C6.[2] A combination of endovenous ablation and compression therapy has become the standard of care for the management of C6 chronic venous insufficiency, mainly in developed countries. A randomized clinical trial in the United Kingdom found that early treatment of saphenous vein reflux using endovenous ablation as an adjunct to compression therapy shortened the ulcer healing time and increased both the ulcer healing rate and the length of time free from ulcers.[3] Nevertheless, a survey by the Japanese Society of Phlebology found variations among institutions regarding the methods used for ulcer treatment. Although the SVS guidelines recommend using moist dressings for wound care, in 2016, the rate of dressing use excluding gauze was less than 10% in Japan. Additionally, previous research reported that the ulcer healing rate during the follow-up period of 3 months to 1 year and 3 months was 78.7% in Japan.[4]
At Okamura Memorial Hospital, treatment of venous ulcers consists of endovenous ablation and adequate varicectomy (including stab avulsion of incompetent perforating veins [IPVs]), compression therapy, moist wound healing, and skin care for stasis dermatitis. The aim of this retrospective study was to evaluate the effectiveness of such treatment. The hypothesis was that moist wound healing, which maximizes autologous tissue regeneration, has an important role in wound repair. Moist wound healing in the management of venous ulcers is controversial, however. Preliminary findings were previously reported.[5] In the current study, the authors expanded the investigation and confirmed the previously reported results by examining a larger study sample.
Wounds. 2022;34(4):99-105. © 2022 HMP Communications, LLC
