An Analysis of the Effectiveness of Skin Grafting to Treat Chronic Venous Leg Ulcers
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The pathology of chronic venous leg ulcers (CVLUs) often presents itself and greatly influences the everyday life of the patient. Nearly 150,000 Lithuanian patients suffer from chronic venous insufficiency of the legs—almost 30,000 of which are attributed to venous leg ulcers.1 The literature states that the frequency of CVLU varies from 0.18% to 1.9% of the entire population.2–4 It should be noted that the frequency of CVLU depends on the age of the patient. In the group of patients who are older than 65 years, CVLU appear in 36 people of 100,000 and accounts for 3.6% of the population.2–4 In almost 80% of all leg ulcer cases, the origination of ulcers is due to chronic venous insufficiency.
In Western countries leg ulceration increases among elderly people because of risk factors, such as smoking, obesity, and increases in diabetes.5 The gender of a patient is also significant. According to various studies, the proportion of men and women with leg ulceration fluctuates from 1:1.5 to 1:3.6–8 These studies all note that the most common cause of CVLU is insufficient venous blood circulation. In this case, a CVLU opens due to the increased leg vein pressure. The main reason for that is the insufficiency of surface and deep veins and perforating vein valves. These veins and their valves must function well and are necessary so that blood can be pumped back to the heart during contraction of calf muscles (muscle pump). Valve leakage emerges as a result of post-thrombosis syndrome or it may be as congenital disease of valves or veins.
The primary clinical symptoms of chronic venous insufficiency of the legs are:
• edema
• lipodermatosclerosis
• hyperpigmentation
• hyperkeratosis
• atrophie blanche.9,10
According to International Wounds Treatment Committee data from 2001, the cost for treatment of trophic ulcers is the highest among all surgical treatments for wounds. Therefore, it is often discussed which treatment is most effective, costs less, and heals chronic leg ulcers the fastest. Two possible treatment methods are conservative and surgical—there are many ways to perform them. The treatment of the disease that caused the ulcer and the local treatment of the ulcer must be noted. However, it is often impossible to eliminate the cause of disease with conservative or surgical treatment, especially when the vein deficiency and leg ulcers have existed for a long time, or if the patient was operated on only after the ulcer had epithelized. Conservative CVLU treatment may be concentrated solely on the treatment of an ulcer (bandaging with various bandages), on the etiologic factor (compressive therapy, medicaments, and exercises) or both.
The full epithelization of an ulcer may take several months or even years. Sometimes an ulcer does not fully heal for several years with conservative treatment.
In most countries ulcers are treated by partial-thickness skin autografting (ADP).11,12
This study was undertaken to assess the effectiveness of skin autografting at 6 months post treatment. The tasks of the study were to 1) evaluate risk factors of ulcer origination on patients with large chronic venous leg ulcers; 2) identify the difference of epithelization speed between large chronic venous ulcers with conservative treatment versus skin autografting; 3) evaluate the cosmetic results of large CVLUs after skin autografting and conservative treatment.
Materials and Methods
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