Intended for healthcare professionals

Practice ABC of wound healing

Venous and arterial leg ulcers

BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7537.347 (Published 09 February 2006) Cite this as: BMJ 2006;332:347

Venous and arterial ulcers

EDITOR-The clinical review of Venous and arterial leg ulcers by Grey
et al is comprenhesive and clear, although some aspects deserve
comment(1). We are agree that venous hypertension is the underlying cause
of venous ulceration. Compression therapy is associated with a protracted
course of healing and multiple recurrences. Skin closure occurs rapidly
when venous hypertension is improved. The ablation of superficial and
perforator vein incompetence provides clinical and hemodynamic improvement
in patients with chronic venous ulcers(2). Subfascial endoscopic
perforator surgery has become the surgical technique of choice for
perforator ablation, although this approach cannot be adopted in all
cases. Small interconnected collaterals between the perforators and the
skin frequently convey the venous hypertension to the skin area, and
surgical procedures are inherently unable to close these vessels.

Surgical intervention has been successful but the advent of foam
sclerotherapy has proven to be an attractive alternative to surgery and
has added a new tool for the treatment of venous ulcers. Recently we have
published 116 patients with chronic venous ulcers treated with ultrasound-
guided injection of polidocanol microfoam (UIPM)(3). To reduce venous
hypertension UIPM was used to selectively sclerose sources of
incompetence. At 6-months`s follow-up, treatment with UIPM achieved
complete healing in 83% of patients with median time to healing of 2.7
months. In comparison with the patients treated with allogeneic cultured
human skin equivalent of a previously reported series, we obtained a
highly significant advantage for our overall results (X2 test, P<_.001. p="p"/>Foam sclerotherapy of superficial and perforating valveless veins is a
well-tolerated and effective outpatient procedure. Major advantages of
sclerosant in foam form with respect to classic liquid sclerosants include
selective effect on endothelium, visibility on ultrasound examination,
predictability of outcome, high sucess rate, and low frequency of
recurrence. Foam sclerotherapy may well prove to be the gold standard for
treatment of chonic venous ulcers in the future(4,5).

1.- Grey JE, Enoch S, Harding KG. Venous and arterial leg ulcers. BMJ
2006; 332:347-50.

2.- Pierik EG, van Urk H, Hop WC, Wittens CH. Endoscopic versus open
subfascial division of incompetent perforating veins in the treatment of
venous leg ulcerations: a randomized trial. J Vasc Surg 1997; 26: 1049-54.

3.- Cabrera J, Redondo P, Becerra A, et al. Ultrasound-guided
injection of polidocanol microfoam in the management of venous leg ulcers.
Arch Dermatol 2004; 140: 667-73.

4.- de Waard MM, der Kinderen DJ. Duplex ultrasonography-guided foam
sclerotherapy of incompetent perforator veins in a patient with bilateral
venous leg ulcers. Dermatol Surg 2005;31:580-3.

5.- Bergan J, Pascarella L, Mekenas L. Venous disorders: treatment
with sclerosant foam. J Cardiovasc Surg 2006; 47:9-18.

Competing interests:
None declared

Competing interests: No competing interests

22 February 2006
Pedro Redondo
Professor of Dermatology
Pedro Lloret and Juan Cabrera
University Clinic of Navarra, Pamplona, Spain