Medical and Surgical Considerations
Medical and Surgical Considerations (Only FDA approved treatment can be listed here).
There are many ongoing studies evaluating pharmacological agents including skin substitutes, sulodexide (glycosaminoglycan fractions), growth factors and platelet rich plasma (Rafetto et al., 2020). The most used medical therapy is pentoxifylline (Trental) that has the greatest benefit with woody fibrosis (lipodermatosclerosis) and ulcers present for more than a year. This methylxanthine (caffeine derivative) does have evidence for healing when used with and even without compression (O’Donnell et al., 2014).
Surgical options in select patients are directed at removing the incompetent superficial vein and diverting venous flow to the deep system (Evans et al., 2019). It is important to obtain duplex venous studies to evaluate the location of the reflux. Most surgical procedures are limited to pathology in the superficial system. The procedures that are available for surgical management are superficial vein stripping and endovenous ablation techniques (laser and chemical). Currently the Canadian provincial health insurance will pay for saphenous vein ligation and stripping procedures for venous leg ulcer patients. Further research is underway to evaluate the evidence for perforator surgery (Rafetto et al., 2020).