Clinical Characteristics, Wound Culture Results and Ulcer-Related Dermatological Findings in Patients with Active Venous Ulcers

Abstract

Background: The aim of this study was to determine clinical characteristics, wound culture results and ulcer-related dermatological findings in patients with active venous ulcers.
Materials and Methods: 28 patients with active venous ulcers were included in the study. Patient’s data were analyzed retrospectively.
Results: 89.2% of the patients were male and 75% were over 40 years old. Mean age was 53.89 ± 14.46. Secondary etiologic causes (71.5%) were in the first place. Anatomically, deep venous involvement (78.6%) was the most common. Postthrombotic syndrome was in 64.3% and isolated venous insufficiency in 35.7% of the patients. While 42.8% of the patients had ulcers for the first time, others (57.2%) had recurrent ulcers. The average ulcer duration was 3.08 ± 3.35 years. The average ulcer size was 6.3 x 8,4 cm2. Venous ulcer was on the left in 50%, on the right in 42.8% and on both extremities in 7.2% of the patients. Ulcer was frequently sole (89.2%). Ulcer was mostly located above medial malleolus (71.5%). The most common microorganisms grown in wound culture were pseudomonas aeruginosa (32.1%), proteus mirabilis (28.5%), escherchia coli (28.5%) and staphylococcus aureus (21.3%), respectively. Ulcer-related dermatological find-ings were lipodermatosclerosis (92.8%), hyperpigmentation (92.8%), edema (75%), eczematous stasis dermatitis (32.1%), corona phlebectatica (28.5%), lichenification (25%), phlebolymphedema (17.8%), celluli-tis (17.8%), atrophie blanche (10.8%), autosensitization dermatitis (7.1%) and onychomycosis (21.3%).
Conclusions: Active venous ulcer is clinically the last stage of chronic venous insufficiency. Venous ulcer treatment is difficult and recurrence is frequent. A multidisciplinary approach is required to achieve success in the treatment of venous ulcers.

Keywords: Venous ulcer, Etiology, Clinic, Skin findings, Culture, Microorganism

Aktif Venöz Ülseri Olan Hastalarda Klinik Özellikler, Yara Kültürü Sonuçları ve Ülserle İlişkili Dermatolojik Bulgular

Abstract

Amaç: Bu çalışmanın amacı, aktif venöz ülseri olan hastalarda klinik özellikleri, yara kültürü sonuçları ve ülserle ilişkili dermatolojik bulguları belirlemekti. Materyal ve Metod: Çalışmamıza aktif venöz ülseri olan 28 hasta dahil edildi. Veriler hasta dosyalarından geriye dönük olarak analiz edildi. Bulgular: Hastaların %89,2'si erkek,% 75'i 40 yaşın üzerindeydi. Ortalama yaş 53,89 ± 14,46 idi. Hastaların %42,8'inde ilk kez ülser görülürken, diğerlerinde (%57,2) tekrarlayan ülser vardı. Ortalama ülser süresi 3,08 ± 3,35 yıldı. Ortalama ülser boyutu 6,3 x 8,4 cm2 idi. Venöz ülser hastaların %50'sinde solda, %42.8'inde sağda ve %7.2'sinde her iki ekstremitede idi. Ülser sıklıkla tekti (%89.2). Ülser en çok medial malleolün (%71,5) üzerinde yerleşmişti. Etiyolojide ikincil nedenler (%71,5) ilk sırada yer aldı. Anatomik olarak derin venöz tutulum (%78.6) en sıktı. Hastaların %64.3'ünde posttrombotik sendrom ve %35.7'sinde izole venöz yetmezlik vardı. Yara kültüründe en sık üreyen mikroorganizmalar sırasıyla pseudomonas aeruginosa (%32,1), proteus mirabilis (%28,5), escherchia coli (%28,5) ve staphylococcus aureus (%21,3) idi. Ülserle ilişkili dermatolojik bulgular; lipodermatoskleroz (%92,8), hiperpigmentasyon (%92,8), ödem (%75), ekzematöz staz dermatiti (%32,1), korona flebektatika (%28,5), likenifikasyon (%25), flebolenfödem (%17,8), selülit (%17,8), atrofi blanche (%10,8), otosensitizasyon dermatiti (%7.1) ve onikomikoz (%21,3) idi. Sonuç: Aktif venöz ülser klinik olarak kronik venöz yetmezliğin son aşamasıdır. Venöz ülser tedavisi zordur ve nüksü sıktır. Venöz ülser tedavisinde başarıya ulaşmak için multidisipliner bir yaklaşım gereklidir.

Keywords

• venous
• ulcer
• etiology
• clinic
• dermatological finding
• microbiological culture

References

1. 1. Eklof B, Perrin M, Delis KT, Rutherford RB, Gloviczki P. Updated terminology of chronic venous disorders: the VEIN-TERM transatlantic interdisciplinary consensus document. J Vasc Surg. 2009;49:498-501.
2. 2. Aykut K, Çetinkol Y, Albayrak G, Güzeloğlu M. Venöz ülserlerde bakteri kolonizasyonu ve antibiyoterapinin yara iyileşmesine etkisi. Tepecik Eğitim Hastanesi Dergisi 2012; 22 (2): 107-10.
3. 3. Evans CJ, Fowkes FG, Ruckley CV, Lee AJ. Prevalence of varicose veins and chronic venous insufficiency in men and women in the general population: Edinburgh Vein Study. J Epidemiol Community Health. 1999;53:149.
4. 4. Lee AJ, Evans CJ, Allan PL, Ruckley CV, Fowkes FG. Lifestyle factors and the risk of varicose veins: Edinburgh Vein Study. J Clin Epidemiol. 2003;56:171.
5. 5. Dean SM. Cutaneous manifestations of chronic vascular disease. Prog Cardiovasc Dis. 2018;60(6):567-79.
6. 6. Nelson EA, Jones J. Venous leg ulcers. BMJ Clin Evid. 2008 Sep 15;2008:1902. PMID: 19445798; PMCID: PMC2908003.
7. 7. Sermsathanasawadi N, Jieamprasertbun J, Pruekprasert K, Chinsakchai K, Wongwanit C, Ruangsetakit C, et al. Factors that influence venous leg ulcer healing and recurrence rate after endovenous radiofrequency ablation of incompetent saphenous vein. J Vasc Surg Venous Lymphat Disord. 2020;8(3):452-57.
8. 8. Binaghi F, Cannas F, Fronteddu PF, Pitzus F. Relation between changes in the microcirculation in the capillaries supplying the toenails and the degree of chronic venous insufficiency. Minerva Cardioangiol 1994; 42: 163-68.

9. 9. Phillips TJ, Dover JS. Leg ulcers. J Am Acad Dermatol 1991; 25: 965-87.
10. 10. Fisher DA. Activated protein C resistance and anticardiolipin antibodies in patients with venous leg ulcers. J Am Acad Dermatol 1998;39:299-300.
11. 11. Lynch TG, Dalsing MC, Ouriel K, Ricotta JJ, Wakefield TW. Developments in diagnosis and classification of venous disorders: noninvasive diagnosis. Cardiovasc Surg 1999; 7: 160-78.
12. 12. Bollinger A, Leu AJ, Hoffmann U, Franzceck UK. Microvascular changes in venous disease: an update. Angiology 1997; 48: 27-32.
13. 13. Ibrahim S, MacPherson DR, Goldhaber SZ. Chronic venous insufficiency: mechanisms and management. Am Heart J 1996; 132: 856-60.
14. 14. Dormandy A. Pathophysiology of venous leg ulceration. Int J Microcirc Clin Exp 1997; 17 (Suppl. 1): 2-5.
15. 15. Melikian R, O'Donnell TF Jr, Suarez L, Iafrati MD. Risk factors associated with the venous leg ulcer that fails to heal after 1 year of treatment. J Vasc Surg Venous Lymphat Disord. 2019;7(1):98-105.
16. 16. Gohel MS, Taylor M, Earnshaw JJ, Heather BP, Poskitt KR, Whyman MR. Risk factors for delayed healing and recurrence of chronic venous leg ulcersdan analysis of 1324 legs. Eur J Vasc Endovasc Surg 2005;29:74-7.
17. 17. Karanikolic V, Karanikolic A, Petrovic D, Stanojevic M. Prognostic factors related to delayed healing of venous leg ulcer treated with compression therapy. Dermatologica Sinica 2015;33:206-9.
18. 18. Dos Santos SLV, Martins MA, do Prado MA, Soriano JV, Bachion MM. Are there clinical signs and symptoms of infection to indicate the presence of multidrug-resistant bacteria in venous ulcers? J Vasc Nurs. 2017;35(4):178-86.
19. 19. Franks PJ, Barker J, Collier M, Gethin G, Haesler E, Jawien A, et al. Management of Patients with Venous Leg Ulcer: Challenges and Current Best Practice. J Wound Care 2016;25(Suppl 6):S1-67.
20. 20. Aguiar FJ, Ferreira-Júnior M, Sales MM, Cruz-Neto LM, Fonseca LA, Sumita NM, et al. Proteina C reativa: aplicac¸~oes clinicas e propostas para utilizac¸~ao racional. Rev Assoc Med Bras 2013;59(1):85-92.
21. 21. Villegas MV, Blanco MG, Sifuentes-Osornio J, Rossi F. Increasing prevalence of extended-spectrum-betalactamase among gram-negative bacilli in Latin America - 2008 update from the Study for Monitoring Antimicrobial Resistance Trends (SMART). Braz J Infect Dis 2011;15(1):34-9.
22. 22. Gottrup F, Apelqvist J, Bjarnsholt T, Cooper R, Moore Z, Peters EJ, et al. EWMA Document: Antimicrobials and Non-healing Wounds—Evidence, Controversies and Suggestions. J Wound Care 2013;22(5 Suppl):S1-92.
23. 23. Martins MA, Tipple AFV, Reis C. Ulcera cronica deperna de pacientes em tratamento ambulatorial: annalise microbiologica e de suscetibilidade antimicrobiana. Cienc Cuid Saude 2010;9(3):464-70.
24. 24. Cooper RA, Ameen H, Price P, McCulloch DA, Harding KG. A clinical investigation into the microbiological status of “locally infected” leg ulcers. Int Wound J 2009;6(6):453-62.
25. 25. Landis SJ. Chronic wound infection and antimicrobial use. Adv Skin Wound Care 2008;21:531-40.
26. 26. Alhede M, Alhede M. The biofilm challenge. EWMA 2014;14(1):54-8.
27. 27. Sáez de Ocariz MM, Arenas R, Ranero-Juárez GA, Farrera-Esponda F, Monroy-Ramos E. Frequency of toenail onychomycosis in patients with cutaneous manifestations of chronic venous insufficiency. Int J Dermatol. 2001;40(1):18-25.
28. 28. Belsito DV. Autosensitization dermatitis. Fitzpatric’s Dermatology in General Medicine. Ed. Fredberg IM, Eisen AZ, Wolf K. Newyork, McGraw-Hill, 2003; 1177-80.