Insufficient and incomplete shaving in chronic venous leg ulcers leads to a poor prognosis of the skin graft: a histomorphological analysis.

BACKGROUND

The surgical treatment for therapy-resistant venous leg ulcers is shave therapy with mesh graft transplantation.

OBJECTIVE

To demonstrate the need of complete shaving with help of histomorphological criteria.

METHODS

Biopsies were taken from the bottom and the border of the 28 ulcers and from nonulcer skin nearby. Specimens were analyzed in correlation to the clinical course 6 months after the treatment (healed/nonhealed/recurrent).

RESULTS

10 ulcers healed, 10 were recurrent and 8 nonhealed. Nonhealed ulcers had an increased broadening of collagen fibers and rete ridges and reduced elastic fibers at the border of the ulcer. Significantly more obliterated vessels were in the upper dermis at the border of the nonhealed ulcers. Recurrent ulcers showed more signs of dermatoliposclerosis.

CONCLUSION

In nonhealed and recurrent ulcers histomorphological aspects of dermatoliposclerosis are still detectable. Thus, a more extensive fibrosis seems to be associated with a poorer outcome. The hypothesis that possibly a more aggressive shave therapy can increase the healing rate should be verified in a prospective study.