Serra Raffaele, Buffone Gianluca, de Franciscis Andrea, Mastrangelo Diego, Vitagliano Tiziana, Greco Manfredi, de Franciscis Stefano
Unit of Vascular Surgery, University Magna Graecia of Catanzaro, Catanzaro, Italy.
Ann Vasc Surg. 2012 Feb;26(2):190-7. doi: 10.1016/j.avsg.2011.04.008. Epub 2011 Oct 21.
Venous leg ulcers are responsible for more than half of lower extremity ulcerations, with an overall prevalence ranging from 0.06 to 2% in the general population.
A total number of 120 patients with chronic venous leg ulcers (CEAP C6), secondary to primary chronic venous insufficiency, were recruited (81 F, 39 M, age range: 50-79, mean age: 64.6). All patients enrolled in this study had wounds that had failed to heal for more than 2 months and were refractory to conventional medical and physical therapy. Sixty patients (group A) underwent skin grafting followed by low-molecular-weight heparin long-term therapy. Sixty patients (group B) underwent skin grafting as sole procedure. The follow-up was of 5 years.
At hospital discharge, all patients had healed ulcers. In group A, at 5 years, about 90% of the ulcers remained healed. In group B, at 5 years, about 56% of the ulcers remained healed.
In our experience, long-term treatment with low-molecular-weight heparin seems to have improved early and late results of patients, who underwent reconstructive surgery for chronic venous ulcer; 90% of the ulcers remained healed at 5 years of follow-up. Probably, extracellular matrix-modulating treatments, such as heparin administration, may complete the management strategy for difficult-to-heal or chronic wounds.
下肢静脉溃疡占下肢溃疡的半数以上，在普通人群中的总体患病率为0.06%至2%。
招募了120例继发于原发性慢性静脉功能不全的慢性下肢静脉溃疡（CEAP C6）患者（81例女性，39例男性，年龄范围：50 - 79岁，平均年龄：64.6岁）。所有纳入本研究的患者伤口愈合时间均超过2个月，且对传统药物和物理治疗无效。60例患者（A组）接受皮肤移植，随后进行低分子量肝素长期治疗。60例患者（B组）仅接受皮肤移植手术。随访时间为5年。
出院时，所有患者的溃疡均已愈合。A组在5年时，约90%的溃疡仍保持愈合状态。B组在5年时，约56%的溃疡仍保持愈合状态。
根据我们的经验，低分子量肝素长期治疗似乎改善了接受慢性静脉溃疡重建手术患者的早期和晚期治疗效果；随访5年时约90%的溃疡仍保持愈合状态。可能，诸如给予肝素等细胞外基质调节治疗，可完善难愈合或慢性伤口的治疗策略。
