Bonkemeyer Millan S, Gan R, Townsend PE, et al.
American family physician. Date of publication 2019 Sep 1;volume 100(5):298-305.
1. Am Fam Physician. 2019 Sep 1;100(5):298-305.
Venous Ulcers: Diagnosis and Treatment.
Bonkemeyer Millan S(1), Gan R(2), Townsend PE(1).
Author information:
(1)University of Florida Health Wound Care and Hyperbaric Center, Gainesville,
FL, USA.
(2)University of Florida Health Wound Care and Hyperbaric Center, Gainesville,
Fl, USA.
Venous ulcers are the most common type of chronic lower extremity ulcers,
affecting 1% to 3% of the U.S. population. Venous hypertension as a result of
venous reflux (incompetence) or obstruction is thought to be the primary
underlying mechanism for venous ulcer formation. Risk factors for the
development of venous ulcers include age 55 years or older, family history of
chronic venous insufficiency, higher body mass index, history of pulmonary
embolism or superficial/deep venous thrombosis, lower extremity skeletal or
joint disease, higher number of pregnancies, parental history of ankle ulcers,
physical inactivity, history of ulcers, severe lipodermatosclerosis, and venous
reflux in deep veins. Poor prognostic signs for healing include ulcer duration
longer than three months, initial ulcer length of 10 cm or more, presence of
lower limb arterial disease, advanced age, and elevated body mass index. On
physical examination, venous ulcers are generally irregular and shallow with
well-defined borders and are often located over bony prominences. Signs of
venous disease, such as varicose veins, edema, or venous dermatitis, may be
present. Other associated findings include telangiectasias, corona
phlebectatica, atrophie blanche, lipodermatosclerosis, and inverted
champagne-bottle deformity of the lower leg. Chronic venous ulcers significantly
impact quality of life. Severe complications include infection and malignant
change. Current evidence supports treatment of venous ulcers with compression
therapy, exercise, dressings, pentoxifylline, and tissue products. Referral to a
wound subspecialist should be considered for ulcers that are large, of prolonged
duration, or refractory to conservative measures. Early venous ablation and
surgical intervention to correct superficial venous reflux can improve healing
and decrease recurrence rates.
PMID: 31478635 [Indexed for MEDLINE]
