Shave therapy is a simple, effective treatment of persistent venous leg ulcers

Schmeller, W.; Gaber, Yvonne; Gehl, Hans-Björn

doi:10.1016/s0190-9622(98)70081-7

Cited by 63 publications

(39 citation statements)

References 14 publications

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“…Traditionally, wounds not responding to the best conservative standard of care either have to be accepted as intractable or to be repaired surgically, typically with a split-skin mesh graft [19,20,21,22]. EpiDex as a living epidermal equivalent seems to represent an intermediate solution.…”

Section: Discussionmentioning

confidence: 99%

“…But even when the more rigid scale of German DRGs (diagnosis-related groups) is used, EpiDex would still be 6–38% more cost-effective than an in-patient treatment. According to the G-DRG Version 2010 Definition Handbook [27], conservative in-patient treatment of a patient with a venous leg ulcer gets reimbursed with EUR 6,962.90 (DRG F21B), and surgical treatment of a patient with a venous ulcer of >4 cm 2 surface by tangential ablation and mesh grafting (shave therapy [19]) with EUR 8,621.70 (DRG F21A), calculated on an average base rate of EUR 2,900. The chapter for vascular diseases comprises the base DRG F21.…”

Section: Discussionmentioning

confidence: 99%

“…They considerably impair the quality of life [9,10,11] and usually require 3–6 months to heal in 60–80% of patients, with approximately 20% remaining refractory to all conservative medical measures [12,13,14,15,16,17]. Skin substitutes derived from cell culture systems [18] have, therefore, been developed and proposed for the use in the latter, difficult-to-heal leg ulcer patients, also with the goal to reduce the need for expensive in-patient skin grafts [19,20,21,22]. …”

Section: Introductionmentioning

confidence: 99%

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EpiDex® Swiss Field Trial 2004–2008

et al. 2010

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Background: Approximately 20% of leg ulcers remain unresponsive to the best conservative standard of care. So far, these patients could either receive conventional skin grafts or had to accept their intractable wound. Skin substitutes from cell culture may represent a promising alternative to heal a major part of these patients on a non-surgical, potentially more cost-effective basis. Objective: To systematically evaluate the first 68 patients treated in Switzerland (Swiss EpiDex® field trial 2004–2008). Methods: Retrospective study on EpiDex treatment of a complete consecutive series of 68 patients with chronic wounds (66 chronic leg ulcers, 2 sores) unresponsive to best conservative standard of care. The primary end point was complete wound closure within 9 months after transplantation, the secondary end points change of wound surface area, pain reduction and overall judgement by the patient. Adverse effects were infection, dermatitis and others. Calculation of treatment costs was made. Results: By the end of the study, 50/68 (74%) of patients had their wound completely healed [venous 29/37 (78%); mixed 7/9 (78%); others 14/22 (64%)]; 10/68 (15%) had the wound surface area reduced by >50%, and 8/68 (12%) did not respond to the EpiDex treatment. Wound pain disappeared completely in 78% and partially in 13%. Fifteen patients (22%) received antibiotics for wound infection, and 2 (3%) developed dermatitis (not related to the local therapy). Average treatment costs for venous ulcers amounted to EUR 5,357, compared to EUR 5,722–8,622 reimbursed according to the German DRG system (2010) for an in-patient skin graft. Conclusion: EpiDex may effectively heal up to three quarters of recalcitrant chronic leg ulcers. Thus, it represents an intermediate step to avoid costly in-patient split-skin mesh graft treatments. Patients remain mobilized, and a donor site is avoided. Large wound size or a necrotic wound bed limit the use of EpiDex. Otherwise, it offers the opportunity to avoid conventional skin grafts in a significant number of chronic leg ulcer patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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EpiDex® Swiss Field Trial 2004–2008

et al. 2010

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“…According to recent investigations, one promising therapeutic option [34] in patients with extensive dermatoliposclerosis is a combined shave operation, i.e. a surgical removal of the sclerotic tissue down to the fascia [35], of the perilesional sclerotic skin and a subsequent wound closure. It seems appropriate to complement the combined shave operation with a mesh graft transplantation and postoperative VAC therapy.…”

Section: Discussionmentioning

confidence: 99%

Vacuum Assisted Closure Device Improves the Take of Mesh Grafts in Chronic Leg Ulcer Patients

et al. 2008

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Background: Vacuum assisted closure (VAC) is established in the management of acute and chronic wounds. In recent years, few data have been published concerning VAC therapy after skin graft transplantation. Objectives: The aim of this study was to determine whether postoperative VAC helps assist closure of mesh grafts in chronic leg ulcer patients. Patients/Methods: We report a consecutive case series of 54 patients with chronic leg ulcers who received a total of 74 mesh grafts. A postoperative VAC therapy was performed in 28 mesh grafts, and 46 mesh grafts were treated with standard gauze therapy. Results: In the VAC group, 92.9% of grafts showed complete healing, compared to 67.4% in the control group without postoperative VAC therapy. Differential analysis revealed a negative correlation of the take rate in patients over 70 years of age or in patients suffering from diabetes mellitus or dermatoliposclerosis. Particularly patients with diabetes mellitus and of greater age exhibited improved take rates, both 100%, in the VAC group compared to 50 and 62%, respectively. Conclusion: The results of our retrospective study demonstrate for the first time the significant benefit of VAC therapy after skin grafting in chronic leg ulcer patients as evaluated in a clinical trial.

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“…The first choice of surgical method for the treatment of these therapy-resistant leg ulcers is shave therapy [2,3,4,5]. Here, suprafascial necrosis and indurate tissue surrounding the ulcer are ablated in thin layers.…”

Section: Introductionmentioning

confidence: 99%

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

Reich‐Schupke

Schmeil²,

Kreuter³

et al. 2011

Dermatology

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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.

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Shave therapy is a simple, effective treatment of persistent venous leg ulcers

Cited by 63 publications

References 14 publications

EpiDex® Swiss Field Trial 2004–2008

EpiDex® Swiss Field Trial 2004–2008

Vacuum Assisted Closure Device Improves the Take of Mesh Grafts in Chronic Leg Ulcer Patients

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

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