Management of Venous Ulceration: Excision, Skin Grafting and Microsurgical Flaps

Dunn, Raymond M.; Rohrer, Michael J.; Vernadakis, Adam J.

doi:10.1007/978-1-4471-0473-5_13

Cited by 3 publications

(11 citation statements)

References 75 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…14 Dunn and colleagues used a fasciocutaneous free flap instead of muscle that was successful in treating 23 venous stasis ulcers. 10,11 No ulcer recurrences in the territory of the flap were identified in these reports with follow-up periods of 2 to 8 years. Although these flaps are durable and no recurrent ulcers have been noted within the territory of the transferred flap, new ulceration elsewhere on the leg has been reported.…”

Section: Discussionmentioning

confidence: 73%

“…There are only a few reported clinical series of flap transfer for treatment of venous stasis ulcers. [6][7][8][9][10][11][12][13][14] Even scarcer are long-term outcomes among these reported patients. Therefore, several important questions still remain concerning the application of flap transfer to venous stasis ulcers: (1) How much tissue from the ulcer perimeter should be excised prior to transfer?…”

Section: Discussionmentioning

confidence: 99%

“…Although these flaps are durable and no recurrent ulcers have been noted within the territory of the transferred flap, new ulceration elsewhere on the leg has been reported. 9,[11][12][13][14] According to the report of 24 successful free flap transfers to venous stasis ulcers by Kumins and associates, no ulcers were identified in any flap after a mean of 58 months, but three patients (13%) had a separate new ulcer in the same leg after the free flap procedure at 6, 24, and 77 months. 14 Dunn and coworkers also noted this type of new ulcer in 18% of 23 fasciocutaneous flaps after a mean of 49 months, 11 and Steffe and Caffee noted this in all 12 muscle flaps after a mean of 17 months.…”

Section: Discussionmentioning

confidence: 99%

“…9,[11][12][13][14] According to the report of 24 successful free flap transfers to venous stasis ulcers by Kumins and associates, no ulcers were identified in any flap after a mean of 58 months, but three patients (13%) had a separate new ulcer in the same leg after the free flap procedure at 6, 24, and 77 months. 14 Dunn and coworkers also noted this type of new ulcer in 18% of 23 fasciocutaneous flaps after a mean of 49 months, 11 and Steffe and Caffee noted this in all 12 muscle flaps after a mean of 17 months. 9 In our study, ulcer recurrences in the territory of the flap were also never identified after a mean of 11 years, but 4 of 11 patients developed new ulcers in the same leg at 18 to 81 months after the flap transfer in spite of correcting venous hemodynamics with venous stripping and venous perforator ligation.…”

Section: Discussionmentioning

confidence: 99%

“…The recent application of free and pedicled flap transfer technique to these recalcitrant ulcers has lead to some promising results, including wound closure and limb salvage. [6][7][8][9][10][11][12][13][14] This technique can remove the surrounding lipodermatosclerotic tissue, which is a chronically scarred, poorly vascularized, fragile tissue bed that is likely to ulcerate, and it can close the resulting large soft tissue defect by healthy tissue transfer. Although some successful outcomes of flap transfer to intractable venous stasis ulcers have been reported, there is little information about long-term outcomes.…”

mentioning

confidence: 99%

See 4 more Smart Citations

Long-Term Outcomes of Flap Transfer for Treatment of Intractable Venous Stasis Ulcers in the Lower Extremity

Kawamura

Yajima

Kobata

et al. 2007

J reconstr Microsurg

View full text Add to dashboard Cite

There is little information about long-term outcomes of flap transfer for treatment of venous stasis ulcers in the lower extremity. Eleven patients who underwent free and pedicled flap transfer for treatment of intractable venous stasis ulcers were evaluated retrospectively. The operative procedures consisted of removal of the ulcer and surrounding lipodermatosclerotic tissue, venous stripping, and flap transfer. No ulcer recurrences in the territory of the transferred flap were identified for a mean of 11 years during the follow-up period. However, four patients developed new ulcers in the same leg after the flap transfer at 18, 24, 52, and 81 months. This was probably the result of incomplete excision of surrounding lipodermatosclerotic tissue. Three of four recurrent ulcers were healed with additional procedures. The results of this study indicated that flap transfer combined with venous stripping could lead to long-term healing of venous stasis ulcers. However, incomplete excision of surrounding lipodermatosclerotic tissue caused new ulceration around the transferred flap.

show abstract

Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Long-Term Outcomes of Flap Transfer for Treatment of Intractable Venous Stasis Ulcers in the Lower Extremity

Kawamura

Yajima

Kobata

et al. 2007

J reconstr Microsurg

View full text Add to dashboard Cite

show abstract

Free tissue transfer provides durable treatment for large nonhealing venous ulcers

Kumins¹,

Weinzweig²,

Schuler³

2000

Journal of Vascular Surgery

View full text Add to dashboard Cite

Free tissue transfer can provide rapid healing and long-term relief from severe VUs that are unable to be treated with conventional therapy. This technique improves venous hemodynamics, removes all liposclerotic tissue, provides an abundant blood supply, and resolves the tissue-related components of chronic ulceration. Although further work is needed to determine the optimal indications, this technique provides a durable treatment for especially recalcitrant ulcers.

show abstract

Circumferential Radical Debridement and Omental Free Flap in the Treatment of Severe Chronic Venous Ulcers

Cavadas

Padial²

2023

Ann Plast Surg

View full text Add to dashboard Cite

Background: Chronic venous leg ulcers are a significant health care burden with a difficult and unreliable treatment. Free flaps may be needed for wound coverage in severe cases. Incomplete removal of dermatoliposclerosis (DLS) area and/or not addressing the underlying venous dysfunction may contribute to the reported modest long-term results. Methods: A series of 5 patients with severe chronic venous ulcers of the leg, resistant to conservative treatment and superficial venous surgery, were treated with radical, circumferential, subfascial resection of the DLS skin and coverage with omental free flaps. Delayed arteriovenous (AV) loops were used as recipients. All patients had previous superficial venous surgery and multiple skin grafts. Mean follow-up was 8 years (4-15 years). Results: One hundred percent of flaps survived completely. No major complications occurred. One patient developed ulceration of the flap at 2 years and healed with basic wound care. At a mean follow-up of 8 years, all patients were ulcerfree. One patient died 15 years after the surgery for unrelated causes. Conclusions: Radical circumferential resection of DLS area in severe chronic venous leg ulcers and coverage with a free omental flap using staged AV loop provided durable coverage in a series of 5 patients. Complete resection of DLS area, addressing the underlying venous pathology, and draining the flap to a healthy competent vein graft (AV loop) may contribute to these favorable results.

show abstract

Management of Venous Ulceration: Excision, Skin Grafting and Microsurgical Flaps

Cited by 3 publications

References 75 publications

Long-Term Outcomes of Flap Transfer for Treatment of Intractable Venous Stasis Ulcers in the Lower Extremity

Long-Term Outcomes of Flap Transfer for Treatment of Intractable Venous Stasis Ulcers in the Lower Extremity

Free tissue transfer provides durable treatment for large nonhealing venous ulcers

Circumferential Radical Debridement and Omental Free Flap in the Treatment of Severe Chronic Venous Ulcers

Contact Info

Product

Resources

About