Insufficient and Incomplete Shaving in Chronic Venous Leg Ulcers Leads to a Poor Prognosis of the Skin Graft: A Histomorphological Analysis

Abstract

Background: The surgical treatment for therapy-resistant venous leg ulcers is shave therapy with mesh graft transplantation. Objective: To demonstrate the need of complete shaving with help of histomorphological criteria. Methods: Biopsies were taken from the bottom and the border of the 28 ulcers and from nonulcer skin nearby. Specimens were analyzed in correlation to the clinical course 6 months after the treatment (healed/nonhealed/recurrent). Results: 10 ulcers healed, 10 were recurrent and 8 nonhealed. Nonhealed ulcers had an increased broadening of collagen fibers and rete ridges and reduced elastic fibers at the border of the ulcer. Significantly more obliterated vessels were in the upper dermis at the border of the nonhealed ulcers. Recurrent ulcers showed more signs of dermatoliposclerosis. Conclusion: In nonhealed and recurrent ulcers histomorphological aspects of dermatoliposclerosis are still detectable. Thus, a more extensive fibrosis seems to be associated with a poorer outcome. The hypothesis that possibly a more aggressive shave therapy can increase the healing rate should be verified in a prospective study.

The Role of Complex Treatment in Mixed Leg Ulcers – A Case Report of Vascular, Surgical and Physical Therapy

“…Meta-analyses of infra-popliteal PTA show technical success rates of up to 90% [ 13 ][ 14 ]. Leg ulcer healing rates, however, are not improved by primary stent implantation [ 15 ][ 6 ].…”

“…The take rate after deep ulcer shaving and meshed grafts in venous and venous-arterial leg ulcers was 91% in our own department but decreased down to 80% in case of dystrophic calcifications [ 3 ]. Other negative factors for graft take are insufficient shaving, extensive fibrosis, clotting disorders, immunosuppression, and predominant arterial ulcers [ 6 ] while the ulcer size is not predictive for graft failure [ 7 ].…”

The role of radical surgery in the management of CEAP C5/6 and lipodermatosclerosis

“…All ulcers healed in the surgery group and no ulcer recurrence occurred. In the study conducted by Reich-Schupke et al 35 shave therapy achieved ulcer healing in 36%, ulcer recurrence in 36% and lack of ulcer healing in 28% of the cases. In their publication, the authors called for a more aggressive surgical treatment modality in order to achieve more successful and persistent results.…”

“…The theoretical basis of the various surgical interventions is the re-initiation of the healing process by transforming chronic wounds into acute. [33][34][35] The cornerstone of the surgical techniques of varying radicality is the removal of the contaminated, sclerotic, senescent and malfunctioning tissues. The debridement and the shave therapy cannot entirely eliminate the sclerotic, non-functioning tissues (lipodermatosclerosis); moreover, the insufficient superficial venous system of the leg and the IPVs remains present.…”

Review and Update on New Horizon in the Management of Venous Ulcers

“…31 In addition, ulcer debridement (shaving) is crucial to expedite wound healing. 38 Negative pressure wound therapy may play a role in stimulation of wound healing in the preparation of ulcers for subsequent skin grafting. 39 Others have related CVUs to increased compartment pressures.…”