University of Florida Health Wound Care and Hyperbaric Center, Gainesville, FL, USA.
University of Florida Health Wound Care and Hyperbaric Center, Gainesville, Fl, USA.
Am Fam Physician. 2019 Sep 1;100(5):298-305.
Venous ulcers are the most common type of chronic lower extremity ulcers, affecting 1% to 3% of the U.S. population. Venous hypertension as a result of venous reflux (incompetence) or obstruction is thought to be the primary underlying mechanism for venous ulcer formation. Risk factors for the development of venous ulcers include age 55 years or older, family history of chronic venous insufficiency, higher body mass index, history of pulmonary embolism or superficial/deep venous thrombosis, lower extremity skeletal or joint disease, higher number of pregnancies, parental history of ankle ulcers, physical inactivity, history of ulcers, severe lipodermatosclerosis, and venous reflux in deep veins. Poor prognostic signs for healing include ulcer duration longer than three months, initial ulcer length of 10 cm or more, presence of lower limb arterial disease, advanced age, and elevated body mass index. On physical examination, venous ulcers are generally irregular and shallow with well-defined borders and are often located over bony prominences. Signs of venous disease, such as varicose veins, edema, or venous dermatitis, may be present. Other associated findings include telangiectasias, corona phlebectatica, atrophie blanche, lipodermatosclerosis, and inverted champagne-bottle deformity of the lower leg. Chronic venous ulcers significantly impact quality of life. Severe complications include infection and malignant change. Current evidence supports treatment of venous ulcers with compression therapy, exercise, dressings, pentoxifylline, and tissue products. Referral to a wound subspecialist should be considered for ulcers that are large, of prolonged duration, or refractory to conservative measures. Early venous ablation and surgical intervention to correct superficial venous reflux can improve healing and decrease recurrence rates.
静脉溃疡是最常见的慢性下肢溃疡，在美国人群中发病率为 1%至 3%。静脉高压由于静脉反流（功能不全）或阻塞被认为是静脉溃疡形成的主要潜在机制。静脉溃疡形成的危险因素包括年龄 55 岁或以上、慢性静脉功能不全的家族史、较高的体重指数、肺栓塞或浅深静脉血栓形成史、下肢骨骼或关节疾病、妊娠次数较多、父母有踝部溃疡史、缺乏体力活动、溃疡史、严重的皮肤硬化和深静脉内的静脉反流。愈合不良的预后迹象包括溃疡持续时间超过三个月、初始溃疡长度 10 厘米或更长、存在下肢动脉疾病、高龄和体重指数升高。体格检查时，静脉溃疡通常不规则且较浅，边界清晰，常位于骨突出部位。可能存在静脉疾病的迹象，如静脉曲张、水肿或静脉性皮炎。其他相关发现包括毛细血管扩张、静脉曲张、萎缩性白瘢、皮肤硬化和小腿倒置香槟瓶畸形。慢性静脉溃疡显著影响生活质量。严重并发症包括感染和恶性变化。目前的证据支持采用压迫疗法、运动、敷料、己酮可可碱和组织产品治疗静脉溃疡。对于大、持续时间长或对保守治疗有抵抗的溃疡，应考虑转介给创面专家。早期静脉消融和手术干预以纠正浅静脉反流可以改善愈合并降低复发率。
