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Acta Vulnologica 2003 April;1(0):25-9


language: Italian

Venous ulcer: the challenges

Guarnera G.

U.O. di Chirurgia Vascolare delle Lesioni Ulcerative, Dipartimento di Chirurgia e Patologia Vascolare, Istituto Dermopatico dell’Immacolata, Roma


Venous ulcer represents about 70% of the lower limbs ulcers. The treatment is based on a clinical, etiological, anatomical and pathophysiological classification (CEAP classification), a study of the relationship between the 3 venous systems and an assessment of the microcirculation and coagulation. Even if a venous ulcer presents a uniform clinical picture, a careful evaluation of the hemodynamic patterns of venous reflux is essential for a tailored therapeutic program. Duplex scanning examinations show a prevalence of superficial venous reflux and surgical stripping or ligation of long saphenous vein seems to be the first option in venous ulcers related to varicose veins. The role of incompetent perforating veins is controversial and their treatment, recently possible through video-endoscopic procedure, must be performed selectively. Venous ulcers related to primary deep venous insufficiency, require complex therapeutic problems and also the possibility to perform venous valve reconstructive surgery. In post-phlebitic syndrome and in deep venous thrombosis the therapy is essentially conservative and is based on elastic compression, that is the common therapy of every kind of venous ulcers, especially to prevent recurrences. A suitable wound bed preparation is mandatory: in the last few years research provided physicians with new dressings to reduce pain, to interact with exudate, to promote the action of growth factors. The therapeutic success is apparently related to a multidisciplinary approach and to evidence-based medicine.

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