Guidelines for the treatment of venous ulcers

1. Co-chaired this panel2. University of South Florida, Tampa, FL3. Healthpoint Ltd., Fort Worth, TX4. University of California, San Francisco, CA5. University of Texas Medical Branch, Galveston, TX6. University of Cardiff, Cardiff, Wales, UK7. University of Pennsylvania, Philadelphia, PA8. Private practice, Warren, PA9. Private practice, Tamarac, FL10. University of Pittsburgh, Pittsburgh, PA11. St. Louis University, St. Louis, MO, and12. Washington University, St. Louis, MO

[1]  P. Parpex [Treatment of leg ulcers]. , 1992, Soins; la revue de reference infirmiere.

[2]  C. Moffatt,et al.  Risk factors for leg ulcer recurrence: a randomized trial of two types of compression stocking. , 1995, Age and ageing.

[3]  P. Nyström THE MICROBIOLOGICAL SWAB SAMPLER ‐ A QUANTITATIVE EXPERIMENTAL INVESTIGATION , 1978, Acta pathologica et microbiologica Scandinavica. Section B, Microbiology.

[4]  W. Eaglstein,et al.  Topical use of human recombinant epidermal growth factor (h-EGF) in venous ulcers. , 1992, The Journal of dermatologic surgery and oncology.

[5]  D. Margolis,et al.  Management of chronic venous leg ulcers: a literature-guided approach. , 1994, Clinics in dermatology.

[6]  L. Ovington Hanging wet-to-dry dressings out to dry. , 2001, Home healthcare nurse.

[7]  A. Mason,et al.  The quantitative swab culture and smear: A quick, simple method for determining the number of viable aerobic bacteria on open wounds. , 1976, The Journal of trauma.

[8]  H. Tk,et al.  Oxygen 2002: wounds. , 2004 .

[9]  W. Hop,et al.  Endoscopic versus open subfascial division of incompetent perforating veins in the treatment of venous leg ulceration: a randomized trial. , 1997, Journal of vascular surgery.

[10]  W. Marston,et al.  Treatment of superficial and perforator venous incompetence without deep venous insufficiency: is routine perforator ligation necessary? , 2003, Journal of vascular surgery.

[11]  P. Carson,et al.  Topically Applied Recombinant Tissue Plasminogen Activator for the Treatment of Venous Ulcers: Preliminary Report , 1996, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[12]  W. Eaglstein,et al.  The effect of occlusive dressings on collagen synthesis and re-epithelialization in superficial wounds. , 1983, The Journal of surgical research.

[13]  E. A. Nelson,et al.  Systematic reviews of wound care management: (2). Dressings and topical agents used in the healing of chronic wounds. , 1999, Health technology assessment.

[14]  H. Brem,et al.  Healing of Venous Ulcers of Long Duration with a Bilayered Living Skin Substitute: Results from a General Surgery and Dermatology Department , 2001, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[15]  M. Stacey,et al.  Stanozolol and the Treatment of Venous Ulceration — An Interim Report , 1986 .

[16]  P. Jones,et al.  Oxpentifylline treatment of venous ulcers of the leg. , 1990, BMJ.

[17]  A. Layton,et al.  The effect of aspirin on haemostatic activity in the treatment of chronic venous leg ulceration , 1995, The British journal of dermatology.

[18]  M. Stacey,et al.  THE EFFECT OF BACTERIAL COLONIZATION ON VENOUS ULCER HEALING , 1992, Australasian Journal of Dermatology.

[19]  P. Robins,et al.  The effect of two new dressings on epidermal wound healing. , 1982, The Journal of dermatologic surgery and oncology.

[20]  R. Sibbald,et al.  High bacterial load in asymptomatic diabetic patients with neurotrophic ulcers retards wound healing after application of Dermagraft. , 2001, Ostomy/wound management.

[21]  R. White,et al.  Wound colonization and infection: the role of topical antimicrobials. , 2001, British journal of nursing.

[22]  A. Sassano,et al.  Comparison of surgery and compression with compression alone in chronic venous ulceration (ESCHAR study): randomised controlled trial , 2004, The Lancet.

[23]  Marco Romanelli,et al.  Wound bed preparation: a systematic approach to wound management , 2003, Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society.

[24]  T. K. Hunt,et al.  Wound tissue oxygen tension predicts the risk of wound infection in surgical patients. , 1997, Archives of surgery.

[25]  L. Vanrijswijk Full-thickness leg ulcers: patient demographics and predictors of healing. Multi-Center Leg Ulcer Study Group. , 1993 .

[26]  W. Su,et al.  Histopathologic and immunopathologic study of pyoderma gangrenosum , 1986, Journal of cutaneous pathology.

[27]  J. Stanley,et al.  Prospective, multicenter study of managing lower extremity venous ulcers , 1994, Annals of vascular surgery.

[28]  E. Ayello,et al.  Debridement: Controlling the Necrotic/Cellular Burden , 2004, Advances in skin & wound care.

[29]  C. Barbarino,et al.  Pentoxifylline in the treatment of venous leg ulcers. , 1992, Current medical research and opinion.

[30]  T. Helfman,et al.  Stanozolol as a novel therapeutic agent in dermatology. , 1995, Journal of the American Academy of Dermatology.

[31]  E. Joseph A new prospective randomized trial of Vacuum assisted closure versus standard therapy of chronic nonhealing wounds , 2000 .

[32]  K. Overall,et al.  Vacuum-assisted closure used for healing chronic wounds and skin grafts in the lower extremities. , 2004, Ostomy/wound management.

[33]  F. Gottrup,et al.  Effect of smoking and abstention on oxidative burst and reactivity of neutrophils and monocytes. , 2004, Surgery.

[34]  E. Eriksson,et al.  Healing of partial thickness porcine skin wounds in a liquid environment. , 1992, The Journal of surgical research.

[35]  N. Liedberg,et al.  The effect of bacteria on the take of split-thickness skin grafts in rabbits. , 1955 .

[36]  A. O'Connor The Cochrane Database of Systematic Reviews , 2004 .

[37]  A. Ramelet Clinical Benefits of Daflon 500 mg in the Most Severe Stages of Chronic Venous Insufficiency , 2001, Angiology.

[38]  W. Southwick,et al.  Quantitative bacterial analysis of comparative wound irrigations. , 1975, Annals of surgery.

[39]  T. Krizek,et al.  Bacterial growth and skin graft survival , 1967 .

[40]  J. Lachapelle,et al.  Allergic contact dermatitis from hydrocolloid dressings. , 1997, American journal of contact dermatitis : official journal of the American Contact Dermatitis Society.

[41]  A. Bozkurt,et al.  Combination of hydrocolloid dressing and medical compression stockings versus Unna's boot for the treatment of venous leg ulcers. , 2003, Swiss medical weekly.

[42]  M. Stacey,et al.  Randomised double-blind placebo controlled trial of topical autologous platelet lysate in venous ulcer healing. , 2000, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[43]  M. Greaves,et al.  Venous leg ulceration: evaluation of zinc treatment, serum zinc and rate of healing , 1977, Clinical and experimental dermatology.

[44]  T. Sheldon,et al.  The debridement of chronic wounds: a systematic review. , 1999, Health technology assessment.

[45]  E. Georgiev,et al.  Collagenase in the Treatment of Dermal and Decubitus Ulcers , 1975, Journal of the American Geriatrics Society.

[46]  I. Leigh,et al.  Treatment of chronic venous ulcers with sheets of cultured allogenic keratinocytes , 1987, The British journal of dermatology.

[47]  London,et al.  Variations on a Theme , 1938 .

[48]  D. Ilstrup,et al.  Mid-term results of endoscopic perforator vein interruption for chronic venous insufficiency: lessons learned from the North American subfascial endoscopic perforator surgery registry. The North American Study Group. , 1999, Journal of vascular surgery.

[49]  S. Werner,et al.  Glucocorticoid-regulated gene expression during cutaneous wound repair. , 2000, Vitamins and hormones.

[50]  H. Westh,et al.  Bacterial colonization and healing of venous leg ulcers , 1996, APMIS : acta pathologica, microbiologica, et immunologica Scandinavica.

[51]  M. Perrin,et al.  Results of Valvuloplasty in Patients Presenting Deep Venous Insufficiency and Recurring Ulceration , 1999, Annals of vascular surgery.

[52]  A. Gam,et al.  Ultrasound therapy in chronic leg ulceration: a meta‐analysis , 1998, Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society.

[53]  D. M. Cooper,et al.  Determination of Endogenous Cytokines in Chronic Wounds , 1994, Annals of surgery.

[54]  E. A. Nelson,et al.  Compression for venous leg ulcers. , 2001, The Cochrane database of systematic reviews.

[55]  W. Eaglstein,et al.  Inhibition of cell proliferation by chronic wound fluid , 1993, Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society.

[56]  S. Peterson,et al.  Rapid resolution of cellulitis in patients managed with combination antibiotic and anti-inflammatory therapy. , 2005, Cutis.

[57]  G. Moneta,et al.  Fifteen-year results of ambulatory compression therapy for chronic venous ulcers. , 1991, Surgery.

[58]  Schraibman Ig The significance of beta-haemolytic streptococci in chronic leg ulcers. , 1990 .

[59]  Gregory L. Moneta,et al.  Reporting standards in venous disease: An update , 1995 .

[60]  N. Weinzweig,et al.  Free tissue transfer provides durable treatment for large nonhealing venous ulcers. , 2000, Journal of vascular surgery.

[61]  H. Gehl,et al.  Shave therapy is a simple, effective treatment of persistent venous leg ulcers. , 1998, Journal of the American Academy of Dermatology.

[62]  G. Cherry,et al.  Zinc and the healing of chronic leg ulcers. , 1970, American journal of surgery.

[63]  L. Greenfield,et al.  Classification and grading of chronic venous disease in the lower limbs. A consensus statement. , 1995, International angiology : a journal of the International Union of Angiology.

[64]  N. Weinzweig,et al.  Free Tissue Transfer in Treatment of the Recalcitrant Chronic Venous Ulcer , 1997, Annals of plastic surgery.

[65]  K. Burnand,et al.  Venous lipodermatosclerosis: treatment by fibrinolytic enhancement and elastic compression. , 1980, British medical journal.

[66]  Finn Gottrup,et al.  Oxygen in Wound Healing and Infection , 2004, World journal of surgery.

[67]  M. Stiller,et al.  A portable pulsed electromagnetic field (PEMF) device to enhance healing of recalcitrant venous ulcers: a double‐blind, placebo‐controlled clinical trial , 1992, The British journal of dermatology.

[68]  V. Falanga,et al.  Debridement performance index and its correlation with complete closure of diabetic foot ulcers , 2002, Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society.

[69]  J. Reichrath,et al.  Treatment recommendations for pyoderma gangrenosum: an evidence-based review of the literature based on more than 350 patients. , 2005, Journal of the American Academy of Dermatology.

[70]  H. Becker,et al.  [Ulcus cruris venosum: surgical debridement, antibiotic therapy and stimulation with thrombocytic growth factors]. , 1995, Archiv fuer Klinische Chirurgie.

[71]  J. Maklebust,et al.  Debridement: choices and challenges. , 1997, Advances in wound care : the journal for prevention and healing.

[72]  C. T. Hess Identifying and managing venous dermatitis. , 2005, Advances in skin & wound care.

[73]  L. Baddour Cellulitis syndromes: an update. , 2000, International journal of antimicrobial agents.

[74]  P. Chiaravelli Variations on a theme. , 1990, Journal of the American Dental Association.

[75]  Andrew N. Nicolaides,et al.  Reporting standards in venous disease , 1988 .

[76]  B. Pomahac,et al.  Accelerated Healing of Full-Thickness Skin Wounds in a Wet Environment , 2000, Plastic and reconstructive surgery.

[77]  C. B. Kincaid,et al.  Effect of electrical stimulation on chronic leg ulcer size and appearance. , 2003, Physical therapy.

[78]  J. Hasty,et al.  Sequential gradient pneumatic compression enhances venous ulcer healing: a randomized trial. , 1990, Surgery.

[79]  F. Rosner,et al.  Sickle cell anemia — clinical manifestations in 100 patients and review of the literature , 1975, The American journal of the medical sciences.

[80]  C. McCollum,et al.  Oxerutins in the prevention of recurrence in chronic venous ulceration: Randomized controlled trial , 1991, The British journal of surgery.

[81]  R. Kirsner,et al.  Venous ulcers: pathophysiology and treatment options. , 2005, Ostomy/wound management.

[82]  D. Krasner,et al.  Wound Healing Scale, version 1.0: a proposal. , 1997, Advances in wound care : the journal for prevention and healing.

[83]  R. Kistner,et al.  Long-term results of venous valve reconstruction: a four- to twenty-one-year follow-up. , 1994, Journal of vascular surgery.

[84]  F. F. F. F. Aws S. Salim Ph.D. The role of oxygen-derived free radicals in the management of venous (varicose) ulceration: A new approach , 2005, World Journal of Surgery.

[85]  T. Phillips,et al.  Leg Ulcers of Unusual Causes , 2003, The international journal of lower extremity wounds.

[86]  K. Chiller,et al.  Skin microflora and bacterial infections of the skin. , 2001, The journal of investigative dermatology. Symposium proceedings.

[87]  D. M. Cooper,et al.  Safety and effect of transforming growth factor‐β2 for treatment of venous stasis ulcers , 1995, Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society.

[88]  R. Sibbald,et al.  Comparing a foam composite to a hydrocellular foam dressing in the management of venous leg ulcers: a controlled clinical study. , 2004, Ostomy/wound management.

[89]  F. J. Volenec,et al.  Burn wound biopsy bacterial quantitation: a statistical analysis. , 1979, American journal of surgery.

[90]  R. Samson,et al.  Stockings and the Prevention of Recurrent Venous Ulcers , 1996, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[91]  T. Krizek,et al.  SKIN ULCERATION IN SICKLE CELL ANEMIA , 1969, Plastic and reconstructive surgery.

[92]  G. Rodeheaver,et al.  Use of the PUSH tool to measure venous ulcer healing. , 2005, Ostomy/wound management.

[93]  C. M. Hill,et al.  Anaerobic cocci populating the deep tissues of chronic wounds impair cellular wound healing responses in vitro , 2003, The British journal of dermatology.

[94]  Thomas Mustoe,et al.  Understanding chronic wounds: a unifying hypothesis on their pathogenesis and implications for therapy. , 2004, American journal of surgery.

[95]  K. Harding,et al.  Cost and dressing evaluation of hydrofiber and alginate dressings in the mManagement of community-based patients with chronic leg ulceration , 2001 .

[96]  Sue Ann Sisto,et al.  Structured exercise improves calf muscle pump function in chronic venous insufficiency: a randomized trial. , 2004, Journal of vascular surgery.

[97]  D. Kopera,et al.  Does the use of low-level laser influence wound healing in chronic venous leg ulcers? , 2005, Journal of wound care.

[98]  P. Coleridge-Smith,et al.  Venous leg ulcer: a meta-analysis of adjunctive therapy with micronized purified flavonoid fraction. , 2005, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[99]  D. M. Cooper,et al.  Definitions and guidelines for assessment of wounds and evaluation of healing. , 1994, Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society.

[100]  W. Payne,et al.  Maintenance of wound bacterial balance. , 1999, American journal of surgery.

[101]  J. Guilhou,et al.  Benefit of a 2-month treatment with a micronized, purified flavonoidic fraction on venous ulcer healing. A randomized, double-blind, controlled versus placebo trial. , 1997, International journal of microcirculation, clinical and experimental.

[102]  M. Ponec,et al.  Randomized trial comparing cryopreserved cultured epidermal allografts with hydrocolloid dressings in healing chronic venous ulcers. , 1993, Journal of the American Academy of Dermatology.

[103]  A. Nicolaides,et al.  Treatment of venous ulcers with pentoxifylline: a 12-month, double-blind, placebo controlled trial. Microcirculation and healing. , 2002, Angiology.

[104]  M. Robson,et al.  Wound healing alterations caused by infection. , 1990, Clinics in plastic surgery.

[105]  C. Bouza,et al.  Efficacy of modern dressings in the treatment of leg ulcers: A systematic review , 2005, Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society.

[106]  A. Kaszuba,et al.  The Beneficial Augmentative Effect of Micronised Purified Flavonoid Fraction (MPFF) on the Healing of Leg Ulcers: An Open, Multicentre, Controlled, Randomised Study , 1999 .

[107]  E. Andersson,et al.  Malignant skin lesions on the legs and feet at a dermatological leg ulcer clinic during five years. , 1998, Acta dermato-venereologica.

[108]  M. Jünger,et al.  Fragliche Wirksamkeit autologer thrombozytärer Wachstumsfaktoren (PDWHF) in der Behandlung venöser Beinulzera , 1999, Der Hautarzt.

[109]  A. Deva,et al.  A Prospective, Blinded, Randomized, Controlled Clinical Trial of Topical Negative Pressure Use in Skin Grafting , 2004, Plastic and reconstructive surgery.

[110]  J. Barwell,et al.  Comparison of surgery and compression with compression alone in chronic venous ulceration (ESCHAR study): Randomized controlled trial☆ , 2004 .

[111]  R. Depalma,et al.  Comparison of Costs and Healing Rates of Two Forms of Compression in Treating Venous Ulcers , 1999 .

[112]  L. Parish,et al.  Debridement of cutaneous ulcers: medical and surgical aspects. , 1991, Clinics in dermatology.

[113]  H. Raaschou,et al.  Low anti-streptokinase IgG concentrations following streptokinase-streptodornase treatment of leg ulcer patients. , 1994, Acta Dermato-Venereologica.

[114]  S. Marks,et al.  Morphological and clinical aspects of scapular fasciocutaneous free flap transfer for treatment of venous insufficiency in the lower extremity , 1998, Clinical anatomy.

[115]  M. Ignjatović [Wet wound healing]. , 2001, Vojnosanitetski pregled.

[116]  T. K. Hunt,et al.  Cigarette smoking decreases tissue oxygen. , 1991, Archives of surgery.

[117]  R. L. Walton,et al.  Free flap valvular transplantation for refractory venous ulceration. , 1994, Journal of vascular surgery.

[118]  M. Velasco,et al.  A comparative study of some anti-inflammatory drugs in wound healing of the rat , 1973, Experientia.

[119]  A. S. Salim Role of sulphydryl‐containing agents in the management of venous (varicose) ulceration. A new approach , 1992, Clinical and experimental dermatology.

[120]  D. Ilstrup,et al.  Mid-term results of endoscopic perforator vein interruption for chronic venous insufficiency: Lessons learned from the North American Subfascial Endoscopic Perforator Surgery registry , 1999 .

[121]  C. Hansson,et al.  The effects of cadexomer iodine paste in the treatment of venous leg ulcers compared with hydrocolloid dressing and paraffin gauze dressing. Cadexomer Iodine Study Group. , 1998, International journal of dermatology.

[122]  K. Harding,et al.  Healing responses of skin and muscle in critical illness , 2003, Critical care medicine.

[123]  C. McCollum,et al.  Clinical trial of calcium alginate haemostatic swabs , 1990, The British journal of surgery.

[124]  E. Tarpila,et al.  Treatment of leg ulcers with split skin grafts: early and late results. , 1999, Scandinavian journal of plastic and reconstructive surgery and hand surgery.

[125]  R. Edlich,et al.  Bacterial diseases of the skin. , 2005, Journal of long-term effects of medical implants.

[126]  M. Kucharzewski,et al.  Modern application of high voltage stimulation for enhanced healing of venous crural ulceration. , 2000, Medical engineering & physics.

[127]  G. A. Holloway,et al.  Multicenter trial of cadexomer iodine to treat venous stasis ulcer. , 1989, The Western journal of medicine.

[128]  L C Parish,et al.  Randomized trial of topically applied repifermin (recombinant human keratinocyte growth factor‐2) to accelerate wound healing in venous ulcers , 2001, Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society.

[129]  G. Lazarus,et al.  PYODERMA GANGRENOSUM: A REAPPRAISAL OF ASSOCIATED SYSTEMIC DISEASES , 1980, The British journal of dermatology.

[130]  D. Margolis,et al.  Rapid healing of venous ulcers and lack of clinical rejection with an allogeneic cultured human skin equivalent. Human Skin Equivalent Investigators Group. , 1998, Archives of dermatology.

[131]  J. Dartigues,et al.  A multi-center trial of the effects of oral nutritional supplementation in critically ill older inpatients. GAGE Group. Groupe Aquitain Geriatrique d'Evaluation. , 2000, Nutrition.

[132]  I. Khan,et al.  Stenotrophomonas maltophilia Endocarditis: A Systematic Review , 2002, Angiology.

[133]  E. Morris,et al.  Early clinical experience with topical collagen in vascular wound care. , 1994, Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society.

[134]  K. Ballard,et al.  Randomised, comparative study of three primary dressings for the treatment of venous ulcers. , 2002, British journal of community nursing.

[135]  S. Powell,et al.  Contact sensitivity in community‐based leg ulcer patients , 1988, Clinical and experimental dermatology.

[136]  D. Margolis,et al.  A multicentre study of percentage change in venous leg ulcer area as a prognostic index of healing at 24 weeks , 2000, The British journal of dermatology.

[137]  E. Rabe,et al.  Contact sensitization in chronic venous insufficiency: modern wound dressings , 1998, Contact dermatitis.

[138]  T. K. Hunt,et al.  Direct measurement of wound and tissue oxygen tension in postoperative patients. , 1983, Annals of surgery.

[139]  P. Zamboni,et al.  Minimally invasive surgical management of primary venous ulcers vs. compression treatment: a randomized clinical trial. , 2003, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[140]  S. Homer-Vanniasinkam,et al.  Treatment of venous leg ulcers with Dermagraft. , 2004, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[141]  M. Límová,et al.  Treatment of leg ulcers with cultured epithelial autografts: clinical study and case reports. , 1995, Ostomy/wound management.

[142]  I. Fumal,et al.  The Beneficial Toxicity Paradox of Antimicrobials in Leg Ulcer Healing Impaired by a Polymicrobial Flora: A Proof-of-Concept Study , 2002, Dermatology.

[143]  C. McCollum,et al.  Pinch skin grafting or porcine dermis in venous ulcers: a randomised clinical trial. , 1987, British medical journal.

[144]  L. Simpson Pinch skin grafting or porcine dermis in venous ulcers , 1987, British medical journal.

[145]  G. Mulder Cost-effective managed care: gel versus wet-to-dry for debridement. , 1995, Ostomy/wound management.

[146]  J. Bolognia,et al.  Treatment of lipodermatosclerosis with oxandrolone in a patient with stanozolol-induced hepatotoxicity. , 2000, Journal of the American Academy of Dermatology.

[147]  S. McDonough,et al.  Low-intensity laser therapy/combined phototherapy in the management of chronic venous ulceration: a placebo-controlled study. , 2002, Journal of clinical laser medicine & surgery.

[148]  R. Murphy,et al.  The effect of microbial contamination on musculocutaneous and random flaps. , 1986, The Journal of surgical research.

[149]  G. Schultz,et al.  Analysis of the acute and chronic wound environments: the role of proteases and their inhibitors , 1999, Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society.

[150]  ToftgÅrd,et al.  Treatment of venous leg ulcers with cryopreserved cultured allogeneic keratinocytes: a prospective open controlled study , 1998, The British journal of dermatology.

[151]  C. Wittens,et al.  Endoscopic versus open subfascial division of incompetent perforating veins in the treatment of venous leg ulceration: long-term follow-up. , 2001, Journal of vascular surgery.

[152]  M. Límová Evaluation of two calcium alginate dressings in the management of venous ulcers. , 2003, Ostomy/wound management.

[153]  H. Degreef,et al.  A retrospective study of Patch test results from 163 patients with stasis dermatitis or leg ulcers. I. Discussion of the Patch test results and the sensitization indices and determination of the relevancy of positive reactions. , 1979, Dermatologica.

[154]  A. Fleischer,et al.  Pyoderma Gangrenosum A Comparison of Typical and Atypical Forms with an Emphasis on Time to Remission. Case Review of 86 Patients from 2 Institutions , 2000, Medicine.

[155]  G. Schmid-Schönbein,et al.  Therapeutic Approach to Chronic Venous Insufficiency and its Complications: Place of Daflon® 500 mg , 2001, Angiology.

[156]  G. Winter,et al.  Effect of Air Drying and Dressings on the Surface of a Wound , 1963, Nature.

[157]  D. Guay Treatment of bacterial skin and skin structure infections , 2003, Expert opinion on pharmacotherapy.

[158]  W. Ryman,et al.  Understanding pyoderma gangrenosum: a review. , 2001, MedGenMed : Medscape general medicine.

[159]  S. Bohbot,et al.  Healing properties of calcium alginate dressings. , 1996, Journal of wound care.

[160]  L. Phillips,et al.  A prospective randomized evaluator-blinded trial of two potential wound healing agents for the treatment of venous stasis ulcers. , 1992, Journal of vascular surgery.

[161]  J. Rowland,et al.  Intermittent pump versus compression bandages in the treatment of venous leg ulcers. , 2000, The Australian and New Zealand journal of surgery.

[162]  P. Smith Skin grafting of venous ulcers , 2005 .

[163]  S. Miller,et al.  Bacteriology of chronic leg ulcers. , 1978, Archives of dermatology.

[164]  G. Tobin Closure of contaminated wounds. Biologic and technical considerations. , 1984, The Surgical clinics of North America.

[165]  C. R. Ricketts,et al.  Human skin lipids with particular reference to the self-sterilising power of the skin. , 1951, Clinical science.

[166]  W. Westerhof,et al.  Prospective randomized study comparing the debriding effect of krill enzymes and a non-enzymatic treatment in venous leg ulcers. , 1990, Dermatologica.

[167]  L. Abenhaim,et al.  Chronic venous disorders of the leg: epidemiology, outcomes, diagnosis and management. Summary of an evidence-based report of the VEINES task force. Venous Insufficiency Epidemiologic and Economic Studies. , 1999, International angiology : a journal of the International Union of Angiology.

[168]  D. Himes Protein-calorie malnutrition and involuntary weight loss: the role of aggressive nutritional intervention in wound healing. , 1999, Ostomy/wound management.

[169]  D. Keast,et al.  Preparing the wound bed--debridement, bacterial balance, and moisture balance. , 2000, Ostomy/wound management.

[170]  R. Snyder,et al.  Cadaveric allograft as adjunct therapy for nonhealing ulcers. , 1999, The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons.

[171]  V. Hopsu-Havu,et al.  Allergy to various components of topical preparations in stasis dermatitis and leg ulcer , 1979, Contact dermatitis.

[172]  F. Gottrup,et al.  Reduced collagen accumulation after major surgery , 1996 .

[173]  T. K. Hunt,et al.  Wound healing and wound infection. What surgeons and anesthesiologists can do. , 1997, The Surgical clinics of North America.

[174]  A. Bailey,et al.  Prognostic value of markers of collagen remodeling in venous ulcers , 1999, Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society.

[175]  L. Queral,et al.  The role of sclerotherapy as an adjunct to Unna's boot for treating venous ulcers: a prospective study. , 1990, Journal of vascular surgery.

[176]  F. Gottrup,et al.  Clinical quality indicators of venous leg ulcers: development, feasibility, and reliability. , 2005, Ostomy/wound management.

[177]  H. Beitner,et al.  Prostaglandin E1 treatment of leg ulcers caused by venous or arterial incompetence. , 1980, Acta dermato-venereologica.

[178]  A. Nicolaides,et al.  Treatment of venous ulcers with pentoxifylline: a 6-month randomized, double-blind, placebo controlled trial. , 2002, Angiology.

[179]  M. Stacey,et al.  Effect of exercise on calf muscle pump function in patients with chronic venous disease , 1999, The British journal of surgery.

[180]  V. Falanga,et al.  An economic assessment of Apligraf® (Graftskin) for the treatment of hard‐to‐heal venous leg ulcers , 2000, Wound Repair and Regeneration.

[181]  D. M. Cooper,et al.  Healing of Chronic Venous Ulcers Is Not Enhanced by the Addition of Topical Repifermin (KGF-2) to Standardized Care , 2004 .

[182]  N. Cullum,et al.  A systematic review of laser therapy for venous leg ulcers. , 1999, Journal of wound care.

[183]  R. Edlich,et al.  Pluronic F-68: a promising new skin wound cleanser. , 1980, Annals of emergency medicine.

[184]  I. K. Cohen,et al.  Wound fluids from human pressure ulcers contain elevated matrix metalloproteinase levels and activity compared to surgical wound fluids. , 1996, The Journal of investigative dermatology.

[185]  M. Robson Wound Infection: A Failure of Wound Healing Caused by an Imbalance of Bacteria , 1997 .

[186]  A. C. van der Wal,et al.  Causes, investigation and treatment of leg ulceration , 2003, The British journal of dermatology.

[187]  Ricardo Marques Da Costa,et al.  Randomized, double‐blind, placebo‐controlled, dose‐ ranging study of granulocyte‐macrophage colony stimulating factor in patients with chronic venous leg ulcers , 1999, Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society.

[188]  G. Xakellis,et al.  Cost and Cost Effectiveness of Venous and Pressure Ulcer Protocols of Care , 2001 .

[189]  T. K. Hunt,et al.  Tissue oxygenation, anemia, and perfusion in relation to wound healing in surgical patients. , 1991, Annals of surgery.

[190]  M. Stacey,et al.  The influence of dressings on venous ulcer healing--a randomised trial. , 1997, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[191]  T. K. Hunt,et al.  Oxygen as an antibiotic. A comparison of the effects of inspired oxygen concentration and antibiotic administration on in vivo bacterial clearance. , 1986, Archives of surgery.

[192]  A. Zabernigg,et al.  Recombinant human granulocyte‐macrophage colony‐stimulating factor applied locally in low doses enhances healing and prevents recurrence of chronic venous ulcers , 1999, International journal of dermatology.

[193]  D. Boudreau,et al.  Outcomes of 4 methods of debridement using a decision analysis methodology. , 1999, Advances in wound care : the journal for prevention and healing.

[194]  D. Steed,et al.  Effect of extensive debridement and treatment on the healing of diabetic foot ulcers. Diabetic Ulcer Study Group. , 1996, Journal of the American College of Surgeons.

[195]  E. A. Nelson,et al.  Systematic reviews of wound care management: (5) beds; (6) compression; (7) laser therapy, therapeutic ultrasound, electrotherapy and electromagnetic therapy. , 2001, Health technology assessment.

[196]  Maxine Taylor,et al.  Exploring debridement options for chronic venous leg ulcers. , 2005, British journal of nursing.

[197]  W. Su,et al.  Management of leg ulcers with hydrocolloid occlusive dressing. , 1984, Archives of dermatology.

[198]  V. Parag,et al.  Oral pentoxifylline for treatment of venous leg ulcers. , 2000, The Cochrane database of systematic reviews.

[199]  R. Edlich,et al.  Management of soft tissue injury. , 1977, Clinics in plastic surgery.

[200]  A. Lansdown Nutrition 1: a vital consideration in the management of skin wounds. , 2004, British journal of nursing.

[201]  L. Argenta,et al.  Vacuum‐Assisted Closure: A New Method for Wound Control and Treatment: Animal Studies and Basic Foundation , 1997, Annals of plastic surgery.

[202]  G. A. Holloway,et al.  Systemic treatment of venous leg ulcers with high doses of pentoxifylline: efficacy in a randomized, placebo‐controlled trial , 1999, Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society.

[203]  P. Gloviczki,et al.  Surgical treatment of venous ulcers: role of subfascial endoscopic perforator vein ligation. , 2003, The Surgical clinics of North America.

[204]  M. Wayne,et al.  Endoscopic Subfascial Perforator Vein Surgery for Patients with Severe, Chronic Venous Insufficiency , 2004, Vascular and endovascular surgery.

[205]  R. Kirsner,et al.  The clinical spectrum of lipodermatosclerosis. , 1993, Journal of the American Academy of Dermatology.