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

Abstract

BACKGROUND:Leg ulcers are a burden to patients, their families and society. The second most common cause of chronic leg ulcers is the mixed arterio-venous type. An 80-year-old female patient presented to our department due to painful enlarging chronic leg ulcer of mixed arteriovenous origin on her left lower leg. She suffered from peripheral arterial occlusive disease stage I and chronic venous insufficiency Widmer grade IIIa, and a number of comorbidities.AIM:The aim of our ulcer treatment was a complete and stable wound closure that was hampered by arterial occlusion, exposed tendon, and renal insiffuciency.CASE REPORT:To improve the prognosis for ulcer surgery, we performed percutaneous transluminal angioplasty, transcutaneous CO2 and deep ulcer shaving. The wound was closed by sandwich transplantation using elastin-collagen dermal template and meshed split skin graft. She had a 100% graft take with rapid reduction of severe wound pain.CONCLUSION:Complex approaches are necessary, to gain optimum results in leg ulcer therapy in mixed leg ulcers. Therapeutic nihilism should be abandonend.

The effect of transcutaneous application of gaseous CO2 on diabetic chronic wound healing—A double‐blind randomized clinical trial

“…[15][16][17][18][19] To our knowledge, one randomized control trial and one observational trial have been conducted investigating the effect of CO 2 -enriched water on chronic wound treatment in humans, one observational study using transcutaneous application of CO 2 in acute and chronic wounds, and one randomized controlled study using subcutaneous CO 2 injections in chronic wound treatment. 13,14,20 All mentioned studies confirmed a positive influence on the healing of chronic wounds. In our opinion, transcutaneous application of gaseous CO 2 has some advantages compared with the other two application methods: it is not invasive like subcutaneous injections of CO 2 and it does not moisturize the wound area like CO 2 -enriched water.…”

“…As noted by many authors, CO 2 therapy has a vasodilatory effect probably influenced by a NO-dependent pathway. 13,14,17,[23][24][25][26] Savin as well as Sato confirmed vasodilatation and increased blood flow after a single exposure to CO 2 therapy compared with a placebo in humans. 17,26 Minamiyama and Yamamoto used intravital microscopy to confirm subcutaneous vasodilatation after CO 2 therapy in rats.…”

“…Wollina et al presented the results of transcutaneous application of gaseous CO 2 in 86 patients with chronic wounds. 13 Similar to our research, these patients received the same transcutaneous CO 2 therapy once daily, but the exposure time is not specified. They performed the treatment for 6 to 14 days-until they observed granulation tissue formation and improved microcirculation.…”

“…Described uses of CO 2 include subcutaneous injections of CO 2 , bathing in CO 2 -enriched water, and transcutaneous application of CO 2. [9][10][11][12][13][14][15][16][17][18] Previous studies established a positive influence of CO 2 -enriched water or transcutaneous application of CO 2 for different indications, including an improvement of symptoms in Raynaud's phenomenon, intermittent claudication, stage II artheriopathy, and after surgical revascularization procedures. [15][16][17][18][19] To our knowledge, one randomized control trial and one observational trial have been conducted investigating the effect of CO 2 -enriched water on chronic wound treatment in humans, one observational study using transcutaneous application of CO 2 in acute and chronic wounds, and one randomized controlled study using subcutaneous CO 2 injections in chronic wound treatment.…”

Dosed tissue stretching in the preparation of the donor site for chronic wounds split-skin grafting

“…Лечение хронических ран остается одной из нерешенных проблем, которой занимаются специалисты в области пластической хирургии и хирургической инфекции во всем мире [1][2][3][4]. Мировая статистика свидетельствует о том, что частота встречаемости этого заболевания за последние годы не имеет тенденции к уменьшению [5,6,7].…”