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Optimal Treatment of Venous (Stasis) Ulcers in Elderly Patients

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Summary

In elderly patients, even those with a typical venous (stasis) ulcer, coexisting conditions like peripheral arterial insufficiency and diabetes are very common. Therefore, all elderly patients with leg ulcers should have a complete medical assessment. The mainstay of treatment for venous ulcers is compression therapy, exercise and leg elevation at rest. Long term treatment with double bandages (zinc paste bandages and elastic compression), changed once weekly, is the recommended standard treatment in the elderly. Hydrocolloid dressings are also suitable for long term treatment in clean ulcers, and should be changed once or twice weekly and combined with compression. Sloughy, exudating ulcers might need redressing daily with a desloughing agent for a short period of time. The risk of sensitising patients with chronic leg ulcers is high and few topical preparations, with low antigenicity, should be used.

Infection and ulcerated skin cancers should be ruled out in nonhealing ulcers if the patient complies with compression therapy. After healing, the patient should be advised to continue compression therapy with stockings to prevent recurrences. New noninvasive techniques for investigation of venous insufficiency can select patients suitable for venous surgery, but many elderly patients are not interested in surgery or have other ailments that prevent surgery.

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References

  1. Hume M. A venous renaissance? J Vasc Surg 1992; 15: 947–51

    PubMed  CAS  Google Scholar 

  2. Falanga V. Venous ulceration. J Dermatol Surg Oncol 1993; 19: 764–71

    PubMed  CAS  Google Scholar 

  3. Lindholm C, Bjellerup M, Christensen OB, et al. A demographic survey of leg and foot ulcer patients in a defined population. Acta Derm Venereol (Stockh) 1992; 72: 227–30

    CAS  Google Scholar 

  4. Callam MJ, Ruckley CV, Harper DR, et al. Chronic ulceration of the leg: extent of the problem and provision of care. BMJ 1985; 290: 1855–6

    PubMed  CAS  Google Scholar 

  5. Cornwall JV, Doré CJ, Lewis JD. Leg ulcers: epidemiology and aetiology. Br J Surg 1986; 73: 693–6

    PubMed  CAS  Google Scholar 

  6. Nelzén O, Bergqvist D, Lindhagen A, et al. Chronic leg ulcers: an underestimated problem in primary health care among elderly patients. J Epidemiol Community Health 1991; 45: 184–7

    PubMed  Google Scholar 

  7. Andersson E, Hansson C, Swanbeck G. Leg and foot ulcers: an epidemiological survey. Acta Derm Venereol (Stockh) 1984; 64: 227–32

    CAS  Google Scholar 

  8. Baker SR, Stacey MC. Epidemiology of chronic leg ulcers in Australia. Aust NZ J Surg 1994; 64: 258–61

    CAS  Google Scholar 

  9. Andersson E, Hansson C, Swanbeck G. Leg and foot ulcer prevalence and investigation of the peripheral arterial and venous circulation in a randomised elderly population: an epidemiological survey and clinical investigation. Acta Derm Venereol (Stockh) 1993; 73: 57–61

    CAS  Google Scholar 

  10. Callam MJ, Harper DR, Dale JJ, et al. Chronic ulcer of the leg: clinical history. BMJ 1987; 294: 1389–91

    PubMed  CAS  Google Scholar 

  11. Baker SR, Stacey MC, Jopp-McKay AG, et al. Epidemiology of chronic venous ulcers. Br J Surg 1991; 78: 864–7

    PubMed  CAS  Google Scholar 

  12. Boyd AM, Jepson RP, Hall Rahtcliffe A, et al. The logical management of chronic ulcers of the leg. Angiology 1952; 3: 207–15

    PubMed  CAS  Google Scholar 

  13. Haeger K. Leg ulcers. In: Carlsten A, Jacobson S, Johansson S, et al., editors. Venous and lymphatic disorders of the leg. Lund: Scandinavian University Books, 1966: 86–110

    Google Scholar 

  14. Nelzén O, Bergqvist D, Lindhagen A. Venous and nonvenous leg ulcers: clinical history and appearance in a population study. Br J Surg 1994; 81: 182–7

    PubMed  Google Scholar 

  15. Coon WW, Willis PW, Keller JB. Venous thromboembolism and other venous disease in the Tecumseh Community Health Study. Circulation 1973; 48: 839–46

    PubMed  CAS  Google Scholar 

  16. Bobek K, Cajzl L, Cepelak V, et al. Étude de la fréquence des maladies phlébologiques et de l’influence de quelques facteurs étiologiques. Phlébologie (Paris) 1966; 19: 217–30

    CAS  Google Scholar 

  17. Da Silva A, Widmer LK, Martin H, et al. Varicose veins and chronic venous insufficiency: prevalence and risk factors in 4376 subjects of the Basle study II. Vasa 1974; 3: 118–25

    PubMed  Google Scholar 

  18. Ryan TJ. The management of leg ulcers. 2nd ed. Oxford: Oxford University Press, 1987: 3

    Google Scholar 

  19. Ruckley CV, Dale JJ, Callam MJ, et al. Causes of chronic leg ulcer. Lancet 1982; 2: 615–6

    PubMed  CAS  Google Scholar 

  20. Levine JM. Leg ulcers: differential diagnosis in the elderly. Geriatrics 1990; 45: 32–4, 39–42

    PubMed  CAS  Google Scholar 

  21. Bliss MR, Schofield M. A pilot leg ulcer clinic in a geriatric day hospital. Age Ageing 1993; 22: 279–84

    PubMed  CAS  Google Scholar 

  22. Browse NL. The pathogenesis of venous ulcération: a hypothesis. J Vasc Surg 1988; 7: 468–72

    PubMed  CAS  Google Scholar 

  23. Nicolaides AN, Hussein MK, Szendro G, et al. The relation of venous ulcération with ambulatory venous pressure measure-ments. J Vasc Surg 1993; 17: 414–9

    PubMed  CAS  Google Scholar 

  24. Gaylarde PM, Dodd HJ, Sarkany I. Venous leg ulcers and arthropathy. Br J Rheumatol 1990; 29: 142–4

    PubMed  CAS  Google Scholar 

  25. Ardron ME, Helme RD, McKernan S. Microvascular responses in elderly people with varicose leg ulcers. Age Ageing 1991; 20: 124–8

    PubMed  CAS  Google Scholar 

  26. Shami SK, Shields DA, Farrah J, et al. Peripheral nerve function in chronic venous insufficiency. Eur J Vasc Surg 1993; 7: 195–200

    PubMed  CAS  Google Scholar 

  27. Meade JW, Mueller CB. Lymphatic and venous examination of the ulcerated leg: a preliminary report. Surgery 1992; 112: 872–5

    PubMed  CAS  Google Scholar 

  28. Bull RH, Gane JN, Evans JE, et al. Abnormal lymph drainage in patients with chronic venous leg ulcers. J Am Acad Dermatol 1993; 28: 585–90

    PubMed  CAS  Google Scholar 

  29. Fagrell B. Local microcirculation in chronic venous incompetence and leg ulcers. J Vasc Surg 1979; 13: 217–25

    Google Scholar 

  30. Fagrell B. Microcirculatory disturbances -the final cause for venous leg ulcers? Vasa 1982; 11: 101–3

    PubMed  CAS  Google Scholar 

  31. Pasyk KA, Thomas SV, Hassett CA, et al. Regional differences in capillary density of the normal human dermis. Plast Reconstr Surg 1989; 83: 939–47

    PubMed  CAS  Google Scholar 

  32. Homans J. The etiology and treatment of varicose ulcer of the leg. Surg Gynecol Obstet Invest 1917; 24: 300–11

    Google Scholar 

  33. Piulacks P, Vidal Barraquer F. Pathogenic study of varicose veins. Angiology 1953; 4: 59–100

    Google Scholar 

  34. Shami SK, Sarin S. Leg ulcers. J Am Acad Dermatol 1992; 27: 489–90

    PubMed  CAS  Google Scholar 

  35. Browse NL, Burnand KG. The cause of venous ulceration. Lancet 1982; 2: 243–5

    PubMed  CAS  Google Scholar 

  36. Falanga V, Moosa HH, Nemeth AJ, et al. Dermal pericapillary fibrin in venous disease and venous ulceration. Arch Dermatol 1987; 123: 620–3

    PubMed  CAS  Google Scholar 

  37. Vanscheidt W, Laaff H, Wokalek H, et al. Pericapillary fibrin cuff: a histological sign of venous leg ulceration. J Cutan Pathol 1990; 17: 266–8

    PubMed  CAS  Google Scholar 

  38. Claudy AL, Mirshahi M, Soria C, et al. Detection of undegraded fibrin and tumor necrosis factor-alpha in venous leg ulcers. J Am Acad Dermatol 1991; 25: 623–7

    PubMed  CAS  Google Scholar 

  39. Coleridge Smith PD, Thomas P, Scurr JH, et al. Causes of venous ulceration: a new hypothesis. BMJ 1988; 296: 1726–7

    PubMed  CAS  Google Scholar 

  40. Thomas PRS, Nash GB, Dormandy JA. White cell accumulation in dependent legs of patients with venous hypertension: a possible mechanism for trophic changes in the skin. BMJ 1988; 296: 1693–5

    PubMed  CAS  Google Scholar 

  41. Stibe E, Cheatle TR, Coleridge Smith PD, et al. Liposclerotic skin: a diffusion block or a perfusion problem? Phlébologie 1990; 5: 231–6

    Google Scholar 

  42. Veraart JCJM, Verhaegh MEJM, Neumann HAM, et al. Adhesion molecule expression in venous leg ulcers. Vasa 1993; 22: 213–8

    PubMed  CAS  Google Scholar 

  43. Ackerman Z, Seidenbaum M, Loewenthal E, et al. Overload of iron in the skin of patients with varicose ulcers: possible contributing role of iron accumulation in progression of the disease. Arch Dermatol 1988; 124: 1376–8

    PubMed  CAS  Google Scholar 

  44. Angel MF, Ramasastry SS, Swartz WM, et al. The causes of skin ulcérations associated with venous insufficiency: a unifying hypothesis. Plast Reconstr Surg 1987; 79: 289–97

    PubMed  CAS  Google Scholar 

  45. Cheatle T. Venous ulceration and free radicals. Br J Dermatol 1991; 124: 508

    PubMed  CAS  Google Scholar 

  46. Wysocki AB, Staiano-Coico LS, Grinnell F. Wound fluid from chronic leg ulcers contains elevated levels of metalloproteinases MMP-2 and MMP-9. J Invest Dermatol 1993; 101: 64–8

    PubMed  CAS  Google Scholar 

  47. Wilkinson LS, Bunker C, Edwards JC, et al. Leukocytes: their role in the ethiopathogenesis of skin damage in venous disease. J Vasc Surg 1993; 17: 669–75

    PubMed  CAS  Google Scholar 

  48. Falanga V, Eaglstein WH. The ‘trap’ hypothesis of venous ulceration. Lancet 1993; 341: 1006–8

    PubMed  CAS  Google Scholar 

  49. Falanga V, Kirsner R, Katz MH, et al. Pericapillary fibrin cuffs in venous ulceration: persistence with treatment and during ulcer healing. J Dermatol Surg Oncol 1992; 18: 409–14

    PubMed  CAS  Google Scholar 

  50. Falanga V, Bontempo FA, Eaglstein WH. Protein C and protein S plasma levels in patients with lipodermatosclerosis and venous ulceration. Arch Dermatol 1990; 126: 1195–7

    PubMed  CAS  Google Scholar 

  51. Vanscheidt W, Hasler K, Wokalek H, et al. Factor XIII-deficiency in the blood of venous leg ulcer patients. Acta Derm Venereol (Stockh) 1991; 71: 55–7

    CAS  Google Scholar 

  52. Gajraj H, Browse NL. Fibrinolytic activity of the arms and legs of patients with lower limb venous disease. Br J Surg 1991; 78: 853–6

    PubMed  CAS  Google Scholar 

  53. Stacey MC, Burnand KG, Mahmoud-Alexandroni M, et al. Tissue and urokinase plasminogen activators in the environs of venous and ischaemic leg ulcers. Br J Surg 1993; 80: 596–9

    PubMed  CAS  Google Scholar 

  54. Falanga V. Chronic wounds: pathophysiologic and experimental considerations. J Invest Dermatol 1993; 100: 721–5

    PubMed  CAS  Google Scholar 

  55. Winkler E, Levertowsky D, Shvoron A, et al. Familial leg ulcers of juvenile onset. Lancet 1991; 337: 15–6

    PubMed  CAS  Google Scholar 

  56. Serjeant GR. The clinical features of sickle cell disease. Baillieres Clin Haematol 1993; 6: 93–115

    PubMed  CAS  Google Scholar 

  57. Baker SR, Northeast AD, Berry AC, et al. Venous ulceration in males with sex chromosome abnormalitites. J R Soc Med 1993; 86: 24–5

    PubMed  CAS  Google Scholar 

  58. Burnand KG, Browse NL. The post-phlebitic leg and venous ulceration. In: Russel RCG, editor. Recent Advances in Surgery, II. Edinburgh: Churchill Livingstone, 1982: 225

    Google Scholar 

  59. Belcaro G, Marelli C. Treatment of venous lipodermatosclerosis and ulceration in venous hypertension by elastic compression and fibrinolytic enhancement with defibrotide. Phlebology 1989; 4: 91–106

    Google Scholar 

  60. Kirsner RS, Pardes JB, Eaglstein WH, et al. The clinical spectrum of lipodermatosclerosis. J Am Acad Dermatol 1993; 28: 623–7

    PubMed  CAS  Google Scholar 

  61. Frain-Bell W. Atrophie blanche. Trans St John’s Hosp Dermatol Soc 1959; 42: 59–65

    Google Scholar 

  62. Sindrup JH, Groth S, Avnstorp T, et al. Coexistence of obstructive arterial disease and chronic venous stasis in leg ulcer patients. Clin Exp Dermatol 1987; 12: 410–2

    PubMed  CAS  Google Scholar 

  63. Callam MJ, Harper DR, Dale JJ, et al. Arterial disease in chronic leg ulceration: an underestimated hazard? Lothian and Forth Valley leg ulcer study. BMJ 1987; 294: 1389–91

    PubMed  CAS  Google Scholar 

  64. Callam MJ, Ruckley CV, Dale JJ, et al. Hazards of compression treatment of the leg: an estimate from Scottish surgeons. BMJ 1987; 295: 1382

    PubMed  CAS  Google Scholar 

  65. Zax RH, Hodge EJ, Callen JP. Cutaneous leukocytoclastic vasculitis. Arch Dermatol 1990; 126: 69–72

    PubMed  CAS  Google Scholar 

  66. Phillips TJ, Salman SM, Rogers GS. Nonhealing leg ulcers: a manifestation of basal carcinoma. J Am Acad Dermatol 1991; 25: 47–9

    PubMed  CAS  Google Scholar 

  67. Swanbeck G, Hillström L. Analysis of etiological factors of squamous cell skin cancer of different locations. Acta Derm Venereol (Stockh) 1969; 49: 427–35

    CAS  Google Scholar 

  68. Cruickshank AH, McConnell EM, Miller DG. Malignancy in scars, chronic ulcers and sinuses. J Clin Pathol 1963; 16: 573–80

    PubMed  CAS  Google Scholar 

  69. Ackroyd JS, Young AE. Leg ulcers that do not heal. BMJ 1983; 286: 207–8

    PubMed  CAS  Google Scholar 

  70. Scott HJ, Coleridge Smith PD, McMullin GM, et al. Venous disease: investigation and treatment, fact or fiction? Ann R Coll Surg Engl 1990; 72: 188–92

    PubMed  CAS  Google Scholar 

  71. Weingarten MS, Branas CC, Czeredarczuk M, et al. Distribution and quantification of venous reflux in lower extremity chronic venous stasis disease with duplex scanning. J Vasc Surg 1993; 18: 753–9

    PubMed  CAS  Google Scholar 

  72. Fitzpatrick JE. Stasis ulcers: update on a common geriatric problem. Geriatrics 1989; 44: 19–21, 25–6, 31

    PubMed  CAS  Google Scholar 

  73. Rivlin S. Gravitational leg ulcers in the elderly. Lancet 1958; 1: 1363–7

    PubMed  CAS  Google Scholar 

  74. Jopp-McKay AG, Stacey MC, Rohr JB, et al. Outpatient treatment of chronic venous ulcers in a specialized clinic. Australas J Dermatol 1991; 32: 143–9

    PubMed  CAS  Google Scholar 

  75. Riordan CA. The management of venous ulcers of the leg. Australas J Dermatol 1991; 32: 111–6

    PubMed  CAS  Google Scholar 

  76. Burnand KG, Layer GT. Graduated elastic stockings. BMJ 1986; 293: 224–5

    PubMed  CAS  Google Scholar 

  77. Hendricks WM, Swallow RT. Management of stasis leg ulcers with Unna’s boots versus elastic support stockings. J Am Acad Dermatol 1985; 12: 90–8

    PubMed  CAS  Google Scholar 

  78. Blair SD, Wright DDI, Backhouse CM, et al. Sustained compression and healing of chronic venous ulcers. BMJ 1988; 297: 1159–61

    PubMed  CAS  Google Scholar 

  79. Partsch H. Compression therapy of the legs: a review. J Dermatol Surg Oncol 1991; 17: 799–805

    PubMed  CAS  Google Scholar 

  80. Dickey JW. A study of venous return from the leg during exercise. Phlebology 1989; 4: 185–9

    Google Scholar 

  81. Dickey JW. Stasis ulcers: the role of compliance in healing. South Med J 1991; 84: 557–61

    PubMed  Google Scholar 

  82. Van der Molen HR. Gummistrumpfprobleme. Ergebn Angiol 1970; 4: 169–80

    Google Scholar 

  83. Hansson C, Swanbeck G. Regulating the pressure under compression bandages for venous leg ulcers. Acta Derm Venereol (Stockh) 1988; 68: 245–9

    CAS  Google Scholar 

  84. Goldman MP, Fronek A. The Alexander House Group: consensus paper on venous leg ulcer. J Dermatol Surg Oncol 1992; 18: 592–602

    Google Scholar 

  85. Kikta MJ, Schuler JJ, Meyer JP, et al. A prospective, randomized trial of Unna’s boots versus hydroactive dressing in the treatment of venous stasis ulcers. J Vasc Surg 1988; 7: 478–83

    PubMed  CAS  Google Scholar 

  86. Cordts PR, Hanrahan LM, Rodriguez AA, et al. A prospective, randomized trial of Unna’s boot versus Duoderm CGF hydroactive dressing plus compression in the management of venous leg ulcers. J Vasc Surg 1992; 15: 480–6

    PubMed  CAS  Google Scholar 

  87. Ryan TJ. Wound healing and current dermatologie dressings. Clin Dermatol 1990; 8: 21–9

    PubMed  CAS  Google Scholar 

  88. Burton CS. Treatment of leg ulcers. Dermatol Clin 1993; 11: 315–23

    PubMed  Google Scholar 

  89. Bjellerup M, Lindholm C, Christensen OB, et al. Analysis of therapy-resistant venous leg ulcers: can triple layer treatment initiate healing? Wound Rep Reg 1993; 1: 54–62

    CAS  Google Scholar 

  90. Mostbeck A, Partsch H, Kahn P, et al. Nuklearmedizinische Untersuchungen zur Beurteilung von regionalem Blutvolumen und venöser Strömungsgeschwindigkeit. Z Phlebol Proktol 1984; 13: 111–5

    Google Scholar 

  91. Eriksson G, Eklund AE, Liden S, et al. Comparison of different treatments of venous leg ulcers: a controlled study using stereophotogrammetry. Curr Ther Res 1984; 35: 678–84

    Google Scholar 

  92. Ryan TJ. Current management of leg ulcers. Drugs 1985; 30: 461–8

    PubMed  CAS  Google Scholar 

  93. Holzegel K. The dry treatment of venous leg ulcers. In: Negus D, Jantet G, editors. Phlebology ’ 85. London: John Libbey, 1986: 609–12

    Google Scholar 

  94. Holm J, Andrén B, Grafford K. Pain control in the surgical debridement of leg ulcers by the use of a topical lidocaineprilocaine cream, EMLA®. Acta Derm Venereol (Stockh) 1990; 70: 132–6

    CAS  Google Scholar 

  95. Hansson C, Holm J, Lillieborg S, et al. Repeated treatment with lidocaine/prilocaine cream (EMLA) as a topical anaesthetic for the cleansing of venous leg ulcers: a controlled study. Acta Derm Venereol (Stockh) 1993; 73: 231–3

    CAS  Google Scholar 

  96. Forsling E. Comparison of saline and streptokinase-streptodornase in the treatment of leg ulcers. Eur J Clin Pharmacol 1988; 33: 637–8

    PubMed  CAS  Google Scholar 

  97. Westerhof W, Van Ginkel CJW, Cohen EB, et al. Prospective randomized study comparing the debriding effect of krill enzymes and a non-enzymatic treatment in venous leg ulcers. Dermatologica 1990; 181: 293–7

    PubMed  CAS  Google Scholar 

  98. Taussic SJ, Batkin S. Bromelain, the enzyme complex of pineapple (ananas comosus) and its clinical application, an update. J Ethnopharmacol 1988; 22: 191–203

    Google Scholar 

  99. Mangete EDO, West D, Blankson CD. Hypertonie saline solution for wound dressing. Lancet 1992; 340: 1351

    PubMed  CAS  Google Scholar 

  100. Gordon H, Middleton K, Seal D, et al. Sugar and wound healing. Lancet 1985; 2: 663–4

    Google Scholar 

  101. Quatraro A, Minei A, Donzella C, et al. Sugar and wound healing. Lancet 1985; 2: 664

    Google Scholar 

  102. Zumla A, Lulat A. Honey —a remedy rediscovered. J R Soc Med 1989; 82: 384–5

    PubMed  CAS  Google Scholar 

  103. Knighton DR, Halliday B, Hunt TK. Oxygen as an antibiotic: a comparison of inspired oxygen concentration and antibiotic administration on in-vivo bacterial clearance. Arch Surg 1986; 121: 191–5

    PubMed  CAS  Google Scholar 

  104. Brown CD, Zitelli JA. A review of topical agents for wounds and methods of wounding. J Dermatol Surg Oncol 1993; 19: 732–7

    PubMed  CAS  Google Scholar 

  105. Lineaweaver W, Howard R, Soucy D, et al. Topical antimicrobial toxicity. Arch Surg 1985; 120; 267–70

    PubMed  CAS  Google Scholar 

  106. Bergquist-Karlsson A. Delayed and immediate-type hypersensitivity to chlorhexidine. Contact Dermatitis 1988; 18: 84–8

    Google Scholar 

  107. Barrett SE, Varley SJ. The effects of calcium alginate on wound healing. Ann R Coll Surg Engl 1987; 69: 153–5

    Google Scholar 

  108. Jacobsson S, Jonsson L, Rank F, et al. Studies on healing of Debrisan-treated wounds. Scand J Plast Reconstr Surg 1976; 10: 97–101

    PubMed  CAS  Google Scholar 

  109. Ormiston MC, Seymour MTJ, Venn GE, et al. Controlled trial of Iodosorb in chronic venous ulcers. BMJ 1985; 291: 308–10

    PubMed  CAS  Google Scholar 

  110. Hollo way G A, Johansen KH, Barnes RW, et al. Multicenter trial of cadexomer iodine to treat venous stasis ulcer. West J Med 1989; 151: 35–8

    Google Scholar 

  111. Winter GD. Formation of scab and the rate of epithelialization of superficial wounds in the skin of the young domestic pig. Nature 1962; 193: 293–4

    PubMed  CAS  Google Scholar 

  112. Dyson M, Young S, Pendle CL. Comparison of the effects of moist and dry conditions on dermal repair. J Invest Dermatol 1988:91: 434–9

    PubMed  CAS  Google Scholar 

  113. Cherry GW, Ryan TJ. Enhanced wound angiogenesis with a new hydrocolloid dressing. In: Ryan TJ, editor. An environment for healing: the role of occlusion. Royal Society of Medicine International Congress and Symposium Series No 88. London: Royal Society of Medicine 1985: 61–8

    Google Scholar 

  114. Mulder G, Jones R, Cederholm-Williams S, et al. Fibrin cuff lysis in chronic venous ulcers treated with a hydrocolloid dressing. Int J Dermat 1993; 32: 304–6

    PubMed  CAS  Google Scholar 

  115. Gilchrist B, Reed C. The bacteriology of chronic venous ulcers treated with occlusive hydrocolloid dressings. Br J Dermatol 1989; 121: 337–44

    PubMed  CAS  Google Scholar 

  116. Mallon E, Powell SM. Allergic contact dermatitis from Granuflex hydrocolloid dressing 1994; 30: 110–1

  117. Kirsner RS, Falanga V. Techniques of split thickness skin grafting] for lower extremity ulcerations. J Dermatol Surg Oncol 1993; 19: 779–83

    PubMed  CAS  Google Scholar 

  118. Teepe RGC, Koebrugge EJ, Ponec M, et al. Fresh versus cryopreserved cultured allografts for the treatment of chronic skin ulcers. Br J Dermatol 1990; 122: 81–9

    PubMed  CAS  Google Scholar 

  119. Phillips TJ, Gilchrest BA. Cultured epidermal grafts in the treatment of leg ulcers. Adv Dermatol 1990; 5: 33–49

    PubMed  CAS  Google Scholar 

  120. Teepe RG, Roseeuw DI, Hermans J, et al. Randomized trial comparing cryopreserved epidermal allografts with hydrocolloid dressings in healing chronic venous ulcers. J Am Acad Dermatol 1993; 29: 982–8

    PubMed  CAS  Google Scholar 

  121. Harris IR, Bottomley W, Wood EJ, et al. Use of autografts for the treatment of leg ulcers in elderly patients. Clin Exp Dermatol 1993; 18: 417–20

    PubMed  CAS  Google Scholar 

  122. Reed BR, Clark RAF. Cutaneous tissue repair: practical implications of current knowledge, II. J Am Acad Dermatol 1985; 13: 919–41

    PubMed  CAS  Google Scholar 

  123. Hunt TK, Rabkin J, von Smitten K. Effects of edema and anemia on wound healing and infection. Curr Stud Hematol Blood Transfus 1986; 53: 101–11

    PubMed  Google Scholar 

  124. Levenson SM, Seifter E. Dysnutrition, wound healing and resistance to infection. Clin Plast Surg 1977; 4: 375–88

    PubMed  CAS  Google Scholar 

  125. Ruberg R. Role of nutrition in wound healing. Surg Clin North Am 1984; 64: 705–14

    PubMed  CAS  Google Scholar 

  126. Stegmann W, Huebner K, Deichmann B et al. Wirksamkeit der O-(beta-hydroxyethyl)-rutoside bei der Behandlung des venösen Ulcus Cruris. Therapiewoche 1986; 36: 1828–33

    Google Scholar 

  127. Colgan MP, Dormandy JA, Jones PW, et al. Oxpentifylline treatment of venous ulcers of the leg. BMJ 1990; 300: 972–4

    PubMed  CAS  Google Scholar 

  128. Rudofsky G. Intravenous prostaglandin Ei in the treatment of venous ulcers —a double-blind, placebo-controlled trial. Vasa Suppl. 1989; 28: 39–43

    PubMed  CAS  Google Scholar 

  129. Layer GT, Stacey MC, Burnand KG. Stanozolol and the treatment of venous ulceration —an interim report. Phlébologie 1986; 1: 197–203

    Google Scholar 

  130. Partsch H. Treatment of resistant leg ulcers by retrograde intravenous pressure infusions of urokinase. Phlebology 1991; 6: 13–21

    Google Scholar 

  131. Colgan MP, Moore DJ, Shanik DG. New approaches in the medical management of venous ulceration. Angiology 1993; 44: 138–42

    PubMed  CAS  Google Scholar 

  132. Falanga V. Growth factors and chronic wounds: the need to understand the microenvironment. J Dermatol 1992; 19: 667–72

    PubMed  CAS  Google Scholar 

  133. Falanga V. Growth factors and wound healing. J Dermatol Surg Oncol 1993; 19: 711–4

    PubMed  CAS  Google Scholar 

  134. Egan TJ, O’Driscoll J, Thakar DR. Human amnion in the management of chronic ulceration of the lower limb: a clinicopathologic study. Angiology 1983; 197–203

  135. Beaconsfield T, Genbacev O, Taylor RS. The treatment of longstanding venous ulcers with an extract of early placenta —a pilot study. Phlébologie 1991; 6: 153–8

    Google Scholar 

  136. Pekanmäki K, Kolari PJ, Kiistala U. Intermittent pneumatic compression treatment for post-thrombotic leg ulcers. Clin Exp Dermatol 1987; 12: 350–3

    PubMed  Google Scholar 

  137. Eriksson SV, Lundeberg T, Malm M. A placebo controlled trial of ultrasound therapy in chronic leg ulceration. Scand J Rehab Med 1991; 23: 211–3

    CAS  Google Scholar 

  138. Wheeland RG. Lasers for stimulation or inhibition of wound healing. J Dermatol Surg Oncol 1993; 19: 747–52

    PubMed  CAS  Google Scholar 

  139. Sugrue ME, Carolan J, Leen EJ, et al. The use of infrared laser therapy in the treatment of venous ulceration. Ann Vasc Surg 1990; 4: 179–81

    PubMed  CAS  Google Scholar 

  140. Malm M, Lundeberg T. Effect of low power gallium arsenide laser on healing of venous ulcers. Scand J Plast Reconstr Hand Surg 1991; 25: 249–51

    CAS  Google Scholar 

  141. Lundeberg T, Malm M. Low-power HeNe laser treatment of venous leg ulcers. Ann Plast Surg 1991; 27: 537–9

    PubMed  CAS  Google Scholar 

  142. Weiss DS, Kirsner R, Eaglstein WH. Electrical stimulation and wound healing. Arch Dermatol 1990; 126: 222–5

    PubMed  CAS  Google Scholar 

  143. Gentzkow GD. Electrical stimulation to heal dermal wounds. J Dermatol Surg Oncol 1993; 19: 753–8

    PubMed  CAS  Google Scholar 

  144. Stiller MJ, Pak GH, Shupak JL, et al. A portable pulsed electromagnetic field (PEMF) device to enhance healing of recalcitrant venous ulcers: a double-blind, placebo-controlled clinical trial. Br J Dermatol 1992; 127: 147–54

    PubMed  CAS  Google Scholar 

  145. Heng MCY. Local hyperbaric oxygen administration for leg ulcers. Br J Dermatol 1983; 109: 232–4

    PubMed  CAS  Google Scholar 

  146. Heng MCY, Kloss SG. Endothelial cell toxicity in leg ulcers treated with topical hyperbaric oxygen. Am J Dermatopathol 1986; 8: 403–10

    PubMed  CAS  Google Scholar 

  147. Heng MCY. Topical hyperbaric therapy for problem skin wounds. J Dermatol Surg Oncol 1993; 19: 784–93

    PubMed  CAS  Google Scholar 

  148. Eriksson G, Eklund AE, Kallings LO. The clinical significance of bacterial growth in venous leg ulcers. Scand J Infect Dis 1984; 16: 175–80

    PubMed  CAS  Google Scholar 

  149. Hansson C, Hoborn J, Möller Å, et al. The microbial flora in venous leg ulcers without clinical signs of infection: repeated culture using a validated standardised microbiological technique. Acta Derm Venereol (Stochh). In press

  150. Hansson C, Faergemann J, Swanbeck G. Fungal infections occurring under bandages in leg ulcer patients. Acta Derm Venereol (Stockh) 1987; 67: 341–5

    CAS  Google Scholar 

  151. Alinovi A, Bassissi P, Pini M. Systemic administration of antibiotics in the management of venous ulcers. J Am Acad Dermatol 1986; 15: 186–91

    PubMed  CAS  Google Scholar 

  152. Valtonen V, Karppinen L, Kariniemi AL. A comparative study of ciprofloxacin and conventional therapy in the treatment of patients with chronic lower leg ulcers infected with Pseudomonas aeruginosa or other Gram-negative rods. Scand J Infect Dis 1989; 60: 79–83

    CAS  Google Scholar 

  153. Hansson C, Jekler J, Swanbeck G. Candida albicans infections in leg ulcers and surrounding skin after the use of ointment impregnated stockings. Acta Derm Venereol (Stockh) 1985; 65: 424–7

    CAS  Google Scholar 

  154. Wilson CL, Cameron J, Powell SM, et al. High incidence of contact dermatitis in leg-ulcer patients —implications for management. Clin Exp Dermatol 1991; 16: 250–3

    PubMed  CAS  Google Scholar 

  155. Bojs G, Svensson Å. Contact allergy to garlic used for wound healing. Contact Dermatitis 1988; 18: 179–81

    PubMed  CAS  Google Scholar 

  156. Evans GA, Evans DMD, Seal RME, et al. Spontaneous fatal haemorrhage caused by varicose veins. Lancet 1973; 2: 1359–62

    PubMed  CAS  Google Scholar 

  157. Monk BE, Sarkany I. Outcome of treatment of venous stasis uclers. Clin Exp Dermatol 1982; 7: 397–400

    PubMed  CAS  Google Scholar 

  158. Andersson E, Hansson C, Swanbeck G. A follow-up study of leg and foot ulcer patients. Acta Derm Venereol (Stockh) 1987; 67: 496–500

    Google Scholar 

  159. Mayberry JC, Moneta GL, Taylor LM, et al. Fifteen-year results of ambulatory compression therapy for chronic venous ulcers. Surgery 1991; 109: 575–81

    PubMed  CAS  Google Scholar 

  160. Gaylarde PM, Sarkany I, Dodd HJ. The effect of compression on venous stasis. Br J Dermatol 1993; 128: 255–8

    PubMed  CAS  Google Scholar 

  161. Kitihama A, Elliott LF, Kerstein MD et al. Leg ulcer: conservative management or surgical treatment. JAMA 1982; 247: 197–9

    Google Scholar 

  162. Hoare MC, Nicolaides AN, Miles CR, et al. The role of primary varicose veins in venous ulceration. Surgery 1982; 92: 450–3

    PubMed  CAS  Google Scholar 

  163. Hanrahan LM, Araki CT, Rodrigues AA, et al. Distribution of valvular incompetence in patients with venous stasis ulceration. J Vasc Surg 1982; 13: 805–12

    Google Scholar 

  164. Sethia KK, Darke SG. Long saphenous incompetence as a cause of venous ulceration. Br J Surg 1984; 71: 754–5

    PubMed  CAS  Google Scholar 

  165. Zimmet SE. Leg ulcers. J Am Acad Dermatol 1992; 27: 487–8

    PubMed  CAS  Google Scholar 

  166. Wilson NM, Rutt DL, Browse NL. Repair and replacement of deep vein valves in the treatment of venous insufficiency. Br J Surg 1991; 78: 388–94

    PubMed  CAS  Google Scholar 

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  1. Dermatology Division, Sahlgrenska Hospital, University of Göteborg, Göteborg, Sweden

    Carita Hansson

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Hansson, C. Optimal Treatment of Venous (Stasis) Ulcers in Elderly Patients. Drugs & Aging 5, 323–334 (1994). https://doi.org/10.2165/00002512-199405050-00002

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