Comprehensive management for venous stasis ulcers.

Traditional treatment of venous stasis ulceration has focused on compression therapy, debridement, and topical wound management. Prospective randomized studies have shown that only two additional treatment modalities are effective in healing venous ulceration: pentoxyphylline and bilayered living-cell therapy. Although initial healing rates of up to 75% can be accomplished, there is an unacceptably high recurrence rate that is thought to be due to patient noncompliance. However, recurrence of venous stasis ulceration is more likely secondary to uncorrected venous hypertension, a disease whose causes have been largely ignored in wound treatment. Few previous studies show improved healing rates of ulcers after surgical correction of venous hypertension with saphenous stripping. Venous pathology responsible for venous hypertension can now be easily corrected with new minimally invasive techniques. The purpose of this chapter is to define venous hypertension in patients with ulceration, and provide evidence that surgical treatment to eliminate venous hypertension combined with evidence-based treatment strategies will not only improve short-term outcomes but will also prevent recurrent ulceration.