Venous Stasis Ulcers: an Update on Diagnosis and Management
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DERMATOLOGY AND WOUND CARE (C SAYED, SECTION EDITOR)
Venous Stasis Ulcers: an Update on Diagnosis and Management Amaris N. Geisler 1
&
Nicholas Taylor 2
Accepted: 29 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Venous leg ulceration (VLU) is a medically, financially, and psychologically debilitating disease for patients and a financial burden for the health care system. Of all dermatologic diseases, VLU generates the highest cost. The purpose of this manuscript is to review the current guidelines on the diagnosis and management of VLU with an emphasis on novel approaches. Recent Findings Two novel approaches to VLU diagnosis have been proposed in 2019 including voltammetric analysis to determine leg ulcer etiology, identify infection, and predict clinical course, and the use of dynamic optical coherence tomography to image blood capillaries of the peri-wound skin. Novel approaches to management include the use of trichloroacetic acid and low-frequency ultrasound debridement, growth factors harvested from human amniotic membrane or platelet-rich plasma, lowlevel laser therapy, and low-energy light therapy. Summary With shifting demographics toward an aging population, sedentary lifestyles, an increased prevalence of obesity, and the emergence of chronic diseases, VLU will likely continue to be a significant burden to patients and the health care system. Treatment should not purely be focused on healing, but should take a holistic approach, incorporating nutrition and well-being. The gold standard for the prevention and treatment of VLU is compression therapy and should be utilized with the TIME strategy which contributes to the stimulation of natural healing mechanisms and includes the following: Tissue debridement, Infection and inflammation control, Moisture balance, and Epidermization stimulation. Keywords Venous stasis ulcer . Venous leg ulceration . Venous stasis . Ulcer . Chronic venous insufficiency . Leg ulcer
Introduction Venous leg ulceration (VLU) is a debilitating disease for patients and a financial burden for the health care system [1]. VLU commonly presents as an irregularly shaped shallow ulcer base consisting of granulation tissue and fibrinous exudate in the gaiter area, extending from the midcalf to approximately 1 in. below the medial malleolus (Fig. 1) [2–8•]. The diagnostic and management strategies for VLU are constantly This article is part of the Topical Collection on Dermatology and Wound Care * Amaris N. Geisler [email protected] Nicholas Taylor [email protected] 1
CUNY School of Medicine, 160 Convent Ave, New York, NY 10031, USA
2
Department of Dermatology, NYU Langone Hospitals, New York, NY, USA
evolving. We herein report existing and novel approaches to evaluation and treatment of VLU.
Epidemiology The prevalence of VLU varies between 1.5 and 3% in the general population, increasing to 4–5% in individuals older than 80 years [2–4, 7–29]. VLU occurs 2–3 times more often in women of all ages [3, 10, 1
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