静脉性溃疡 讲解材料.ppt

What is the role of medication? To improve healing in combination with compression Aspirin (300 mg daily) Pentoxifylline (400-800 mg 3x/d) To reduce LDS inflammation, pain, induration Stanozolol Oxandrolone Horse chestnut seed extract (active ingredient: aescin) To reduce pain (based on neuropathic origin) Amitriptyline, gabapentin, pregabalin What is the role of growth factors? Granulocyte macrophage colony-stimulating factor Topical and perilesional injection increases ulcer healing Promotes wound healing through many mechanisms (homeostasis, inflammation, proliferation, maturation) Increases vascularization FDA-approved for neutropenia but not wound healing Phase 3 trials stopped due to bone pain associated with perilesional injections What is the role of physical therapy or exercise? Aim: to improve range of ankle movement and calf muscle pump function Might enhance ulcer healing But evidence conflicting and RCTs lacking RCT underway: comparing compression therapy with compression therapy + 12 weeks of supervised exercise What is the role of hyperbaric oxygen therapy? Adjunct to standard wound care Controversial because evidence for treating VLU extremely limited 100% oxygen at 2-2.5 atmosphere absolute for 60- to 120-minute periods over 15-30 sessions Goal: increase partial pressure of oxygen at the wound Role in pathogenesis and treatment unclear Fibrin cuff theory: fibrin cuffs formed around precapillary vessels may result in wound hypoxia, so increased oxygen might aid healing What is the role of surgical debridement or skin grafting? Debridement Removes nonviable tissue to achieve an appropriate wound bed with granulation tissue Standard care despite lack of controlled data on healing Skin grafting Enhances healing for large or slow-healing ulcers May rapidly decrease pain and aid functional status Pinch grafts, split-thickness skin grafts, and micro-skin grafts used successfully but RCTs lacking Skin equivalents (cellular, acellular) may aid heal