Brenman S A
West Side Skin Clinic, Denver, CO 80210-5886.
J Am Osteopath Assoc. 1991 Jul;91(7):677-86.
Refractory or recurring leg ulcers typically signify the presence of impaired venous or arterial microcirculation (or both). A current hypothesis suggests that local oxygen and nutrient deficits occur because capillary lumens narrow and become permeable to fibrinogen and proteins by activated white blood cells and inadequate fibrinolysis. As a result, the deposition of a relatively impermeable perivascular fibrin sheath occurs, preventing adequate delivery of oxygen and nutrients. Therapy should therefore aim at reversing these deficits and improving wound healing. Pentoxifylline (Trental), used in combination with local wound care and appropriate antibiotic therapy, has been successful in significantly improving the healing of refractory leg ulcers. Pentoxifylline can reverse the abnormal function of white and red blood cells and platelets, as well as reduce blood viscosity and vascular permeability. The mechanisms of action of pentoxifylline are described in light of current hypotheses pertaining to leg ulcer development. Also discussed are nine cases in which pentoxifylline, when added to previously unsuccessful local wound care, either improved or healed the refractory ulcers.
难治性或复发性腿部溃疡通常表明存在静脉或动脉微循环受损（或两者皆有）。目前的一种假说认为，由于毛细血管腔变窄，并且被活化的白细胞以及纤溶不足导致对纤维蛋白原和蛋白质具有通透性，从而出现局部氧气和营养物质缺乏。结果，形成了相对不可渗透的血管周围纤维蛋白鞘，阻碍了氧气和营养物质的充分输送。因此，治疗应旨在扭转这些不足并促进伤口愈合。己酮可可碱（曲克芦丁）与局部伤口护理及适当的抗生素治疗联合使用，已成功显著改善难治性腿部溃疡的愈合。己酮可可碱可以逆转白细胞、红细胞和血小板的异常功能，以及降低血液粘度和血管通透性。根据目前有关腿部溃疡发生的假说描述了己酮可可碱的作用机制。还讨论了9例在先前局部伤口护理未成功的情况下添加己酮可可碱后难治性溃疡得到改善或愈合的病例。
