Chronic venous ulcer

BMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7101.188a (Published 19 July 1997) Cite this as: BMJ 1997;315:188

Some references may be misleading

  1. R P Cole, Consultant plastic and reconstructive surgeona
  1. a Odstock Centre for Burns, Plastic and Maxillo-Facial Surgery, Salisbury District Hospital, Salisbury, Wiltshire SP2 8BJ
  2. b Department of Anaesthesia, Royal Lancaster Infirmary, Lancaster LA1 4RP
  3. c Vascular Surgery Office, Department of Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh EH3 9YW
  4. d North Coast Surgeons Medical Group, 9850 Genesee Avenue, Suite 560, La Jolla, CA 92037, USA
  5. e University of California, San Diego, UCSD Medical Center, 200 West Arbor Drive, San Diego, CA 92103

    Editor—Niren Angle and John J Bergan are to be congratulated in their stated pursuit of evidence based information in the treatment of chronic venous ulcer.1 However, in what is necessarily a brief summary of the topic, I must take issue with their choice of reference in the paragraph on excision and skin grafting.2 Their only reference illustrating the success in covering venous ulcers using split thickness skin grafting is a retrospective review of 26 patients treated over three years. In only 10 of these patients was the aetiology thought to be venous insufficiency. Despite the small number of patients, healing rates are given in percentages and a rate of only 20% was achieved for venous ulcers. This study neither fulfils the criteria described in the methods section of the review nor provides evidence to support the use of skin grafting in the treatment of chronic venous ulcer.

    The next paragraph talks about excision and free flap coverage. An unreferenced statement indicates that a free tissue transfer provides its own venous system containing “hundreds of competent valves.” In a free tissue transfer where the venae comitantes of the flap are used for the microvenous anastomosis, the ability of small valves in a vein of 2-3 mm diameter to withstand the pressure generated by a column of blood from the right atrium through the abdominal and pelvic veins down to the dysfunctional limb veins is questionable.

    Finally, with regard to maintaining the healing of chronic leg ulcers (whether achieved by conservative or surgical means), even in a study reporting one of the best healing rates in …

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