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]
