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Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2020; 8(21): 5070-5085
Published online Nov 6, 2020. doi: 10.12998/wjcc.v8.i21.5070
Strategies and challenges in the treatment of chronic venous leg ulcers
Shi-Yan Ren, Yong-Sheng Liu, Guo-Jian Zhu, Meng Liu, Shao-Hui Shi, Xiao-Dong Ren, Ya-Guang Hao, Rong-Ding Gao
Shi-Yan Ren, Department of General Surgery and Vascular Surgery, Aviation General Hospital, China Medical University, Beijing 100012, China
Yong-Sheng Liu, Department of Dermatology, Aviation General Hospital, Beijing 100012, China
Guo-Jian Zhu, Department of General Surgery, Taian Communications Hospital, Taian 271000, Shandong Province, China
Meng Liu, Department of Surgery, Tianjin Hexi Hospital, Tianjin 300202, Tianjin, China
Shao-Hui Shi, Department of Orthopaedic Surgery, Aviation General Hospital, China Medical University, Beijing 100012, China
Xiao-Dong Ren, Department of Surgery, Wanquanqu Zhongyi Hospital, Zhangjiakou 076250, Hebei Province, China
Ya-Guang Hao, Department of Medical Administrative, Aviation General Hospital, China Medical University, Beijing 100012, China
Rong-Ding Gao, Department of General Surgery, Aviation General Hospital, China Medical University, Beijing 100012, China
Author contributions: Ren SY designed, drafted, revised, and submitted the manuscript and generated all the figures; Zhu GJ, Liu YS, Liu M, Shi SH, and Ren XD designed the outline and discussed and revised the article; Hao YG and Gao RD performed literature research, discussed the manuscript, and coordinated the writing of the paper; Ren SY, Liu YS, Zhu GJ, and Liu M contributed to the paper equally.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shi-Yan Ren, MD, PhD, Chief Doctor, Surgeon, Department of General Surgery and Vascular Surgery, Aviation General Hospital, China Medical University, No. 2 Beiyuan Road, Chaoyang District, Beijing 100012, China. rens66@126.com
Received: April 12, 2020
Peer-review started: April 12, 2020
First decision: July 25, 2020
Revised: August 6, 2020
Accepted: September 28, 2020
Article in press: September 28, 2020
Published online: November 6, 2020
Processing time: 208 Days and 0.6 Hours
Abstract

Evaluating patients with chronic venous leg ulcers (CVLUs) is essential to find the underlying etiology. The basic tenets in managing CVLUs are to remove the etiological causes, to address systemic and metabolic conditions, to examine the ulcers and artery pulses, and to control wound infection with debridement and eliminating excessive pressure on the wound. The first-line treatments of CVLUs remain wound care, debridement, bed rest with leg elevation, and compression. Evidence to support the efficacy of silver-based dressings in healing CVLUs is unavailable. Hydrogen peroxide is harmful to the growth of granulation tissue in the wound. Surgery options include a high ligation with or without stripping or ablation of the GSVs depending on venous reflux or insufficiency. Yet, not all CVLUs are candidates for surgical treatment because of comorbidities. When standard care of wound for 4 wk failed to heal CVLUs effectively, use of advanced wound care should be considered based on the available evidence. Negative pressure wound therapy facilitates granulation tissue development, thereby helping closure of CVLUs. Autologous split-thickness skin grafting is still the gold standard approach to close huge CVLUs. Hair punch graft appears to have a better result than traditional hairless punch graft for CVLUs. Application of adipose tissue or placenta-derived mesenchymal stem cells is a promising therapy for wound healing. Autologous platelet-rich plasma provides an alternative strategy for surgery for safe and natural healing of the ulcer. The confirmative efficacy of current advanced ulcer therapies needs more robust evidence.

Keywords: Chronic venous leg ulcers; Debridement; Compression; Negative pressure wound therapy; Autologous split-thickness skin grafting; Hair punch graft; Platelet-rich plasma; Advanced wound care therapies

Core Tip: Wound care, debridement, bed rest with leg elevation, and compression are basic therapies for chronic venous leg ulcers (CVLUs). Ablation of the great saphenous veins help heal some ulcers. Negative pressure wound therapy, autologous split-thickness skin grafting, autologous platelet-rich plasma, and administration of adipose tissue or placenta-derived mesenchymal stem cells are effective approaches for wound healing. Hair punch graft appears to have a better result than traditional hairless punch graft for CVLUs. There are little data to support the efficacy of silver-based dressings in the healing of CVLUs. Hydrogen peroxide is harmful to the growth of granulation tissue in CVLUs.