Meulendijks AM, Franssen WMA, Schoonhoven L, Neumann HAM, et al.
Journal of tissue viability. Date of publication 2020 Aug 1;volume 29(3):190-196.
1. J Tissue Viability. 2020 Aug;29(3):190-196. doi: 10.1016/j.jtv.2019.10.002.
Epub 2019 Oct 9.
A scoping review on Chronic Venous Disease and the development of a Venous Leg
Ulcer: The role of obesity and mobility.
Meulendijks AM(1), Franssen WMA(2), Schoonhoven L(3), Neumann HAM(4).
Author information:
(1)University of Applied Sciences Utrecht, Research Group Healthy and
Sustainable Living, Utrecht, the Netherlands; University Medical Centre Utrecht,
Department Julius Centre for Health Sciences and Primary Care, Nursing Studies,
Utrecht, the Netherlands. Electronic address: Audrey.meulendijks@hu.nl.
(2)University of Hasselt, REVAL, Rehabilitation Research Center, Faculty of
Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium.
(3)University Medical Centre Utrecht, Department Julius Centre for Health
Sciences and Primary Care, Nursing Studies, Utrecht, the Netherlands.
(4)Erasmus University Medical Centre Rotterdam, Department of Dermatology,
Rotterdam, the Netherlands.
OBJECTIVE: The risk factors obesity and reduced mobility are not well known in
the development of a Venous Leg Ulcer (VLU). The aim of this scoping review is
to explore the mechanisms by which obesity and reduced mobility contribute the
development of a VLU in patients with Chronic Venous Disease (CVD).
METHODS: For this scoping review a search was performed in May 2019 in the
Cochrane Library and Pubmed to identify studies on the working mechanisms of
obesity and mobility in developing a VLU. Hand searches were performed to find
additional studies explaining the working mechanisms (indirectly related to the
VLU). Two reviewers independently reviewed the abstracts and full-text articles.
RESULTS: Twenty-eight studies met our eligibility criteria. Disturbed range of
ankle motion and gait can lead to a reduced Calf Muscle Pump (CMP) function
which leading to a venous outflow disorder. Increased abdominal pressure due to
obesity can lead to a venous outflow obstruction and increased adipose tissue
mass results in an increase in adipokine secretion. The venous outflow disorder,
outflow obstruction and increased adipokine secretion can all lead to chronic
systemic inflammation, increased endothelial permeability and hence
microcirculatory dysfunction. This alone can result in a VLU.
CONCLUSION: Obesity and reduced mobility can lead to a reduction of the CMP
function, an increase in abdominal pressure and an increase in adipose tissue
mass. This can simultaneously lead to haemodynamic changes in the macro- and
microcirculation of the lower extremities and eventually in a VLU. In patients
with obesity and reduced mobility the microcirculation alone can lead to skin
changes and eventually a VLU. Therefore, early recognition of CVD symptoms in
patients with obesity and reduced mobility is crucial to diagnose and treat CVD
to prevent a VLU.
Copyright © 2019 Tissue Viability Society. Published by Elsevier Ltd. All rights
reserved.
DOI: 10.1016/j.jtv.2019.10.002
PMID: 31668667 [Indexed for MEDLINE]
Conflict of interest statement: Declaration of competing interest The authors
have no competing interests.
