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Shanmugam VK, Angra D, Rahimi H, McNish S, et al.
Journal of vascular surgery. Venous and lymphatic disorders. Date of publication 2017 Mar 1;volume 5(2):280-292.
1. J Vasc Surg Venous Lymphat Disord. 2017 Mar;5(2):280-292. doi: 10.1016/j.jvsv.2016.09.006. Epub 2016 Dec 14. Vasculitic and autoimmune wounds. Shanmugam VK(1), Angra D(2), Rahimi H(2), McNish S(2). Author information: (1)Division of Rheumatology, The George Washington University, School of Medicine and Health Sciences, Washington, D.C.. Electronic address: vshanmugam@mfa.gwu.edu. (2)Division of Rheumatology, The George Washington University, School of Medicine and Health Sciences, Washington, D.C. OBJECTIVE: Chronic wounds are a major cause of morbidity and mortality. Approximately 20% to 23% of nonhealing wounds that are refractory to vascular intervention have other causes, including vasculitis, pyoderma gangrenosum, and other autoimmune diseases. The purpose of this article was to review the literature across medical and surgical specialties with regard to refractory chronic wounds associated with vasculitis and autoimmune diseases and to delineate clinical outcomes of these wounds in response to vascular and other interventions. METHODS: An electronic search encompassing MEDLINE, PubMed, Cochrane Library, and Scopus was completed using the following search terms: rheumatoid arthritis; systemic sclerosis; systemic lupus erythematosus; antineutrophil cytoplasmic antibody-associated vasculitis; mixed connective tissue disease; antiphospholipid syndrome; pyoderma gangrenosum; thromboangiitis obliterans; cryoglobulinemia; hydroxyurea; sickle cell; atrophie blanche; livedoid vasculitis; cholesterol emboli; calciphylaxis; antiphospholipid antibodies; prothrombotic; combined with the terms: chronic wound and leg ulcer. Full-text articles published in English up to March 1, 2016, that investigated the clinical outcomes of chronic wounds associated with autoimmune diseases were included. Review articles and evaluations of management of chronic wounds were also reviewed. Primary outcomes included in the review were amputation, ulcer healing, reduction in wound size, overall survival, and freedom from reintervention. Owing to the heterogeneity of data reporting among articles, qualitative analysis is also reported. RESULTS: Vasculitis and autoimmune diseases play a role in 20% to 23% of patients with chronic lower extremity ulcers. Furthermore, patients with autoimmune disease have a significantly high rate of split thickness skin graft failure (50% compared to 97% in patients without autoimmune disease; P = .0002). The management of leg ulcers associated with autoimmune diseases is discussed. CONCLUSIONS: Autoimmune and vasculitic causes should be considered in patients with chronic wounds who do not respond to appropriate vascular intervention and standard local wound care. A multidisciplinary approach with the involvement of rheumatologists allows investigation for underlying systemic disease and improves clinical outcomes for many of these challenging patients. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved. DOI: 10.1016/j.jvsv.2016.09.006 PMCID: PMC5319730 PMID: 28214498 [Indexed for MEDLINE]
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Atypical Ulcers
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