Diagnosis and treatment of venous leg ulcers: S2k Guideline of the German Society of Phlebology and Lymphology (DGPL) e.V.
chronic venous insufficiency
chronic wounds
compression therapy
leg ulcers
pain
Journal
Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG
ISSN: 1610-0387
Titre abrégé: J Dtsch Dermatol Ges
Pays: Germany
ID NLM: 101164708
Informations de publication
Date de publication:
28 Jun 2024
28 Jun 2024
Historique:
received:
13
02
2024
accepted:
27
02
2024
medline:
28
6
2024
pubmed:
28
6
2024
entrez:
28
6
2024
Statut:
aheadofprint
Résumé
This S2k guideline on venous leg ulcers was created on the initiative and under the leadership of the German Society of Phlebology and Lymphology (DGPL). The guideline group also consisted of representatives from the German Society for Phlebology and Lymphology, German Dermatological Society, German Society for General Medicine, German Society for Angiology, German Society for Vascular Surgery and Vascular Medicine, German Society for Surgery, German Society for Dermatosurgery, German Society for Wound Healing and Wound Treatment, Professional Association of Phlebologists and Lymphologists and Initiative Chronische Wunden. The aim of this guideline is to combine the different approaches and levels of knowledge of the respective professional groups on the basis of consensus, so that a basic concept for the best possible treatment of patients with venous leg ulcers can be provided. A total of 70 specific recommendations were formulated and agreed upon, divided into the subject areas of diagnostics, therapy, prevention of recurrences, and everyday challenges. The guideline thus reflects the current state of scientific knowledge and is intended to be widely used as the best available document for the treatment of patients with venous leg ulcers in everyday clinical practice.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 The Author(s). Journal der Deutschen Dermatologischen Gesellschaft published by Wiley‐VCH GmbH on behalf of Deutsche Dermatologische Gesellschaft.
Références
Eklöf B, Rutherford RB, Bergan JJ, et al. Revision of the CEAP classification for chronic venous disorders: consensus statement. J Vasc Surg. 2004;40(6):1248‐1252.
Heyer K, Herberger K, Protz K, et al. Epidemiology of chronic wounds in Germany: analysis of statutory health insurance data. Wound Repair Regen. 2016;24(2):434‐442.
Nelson EA, Adderley U. Venous leg ulcers. Am Fam Physician. 2017; 95(10):662‐663.
Raffetto JD, Ligi D, Maniscalco R, et al. Why venous leg ulcers have difficulty healing: overview on pathophysiology, clinical consequences, and treatment. J Clin Med. 2020;10(1):29.
Vivas A, Lev‐Tov H, Kirsner RS. Venous leg ulcers. Ann Intern Med. 2016;165(3):17‐32.
Padberg F, Cerveira JJ, Lal BK, et al. Does severe venous insufficiency have a different etiology in the morbidly obese? Is it venous? J Vasc Surg. 2003;37(1):79‐85.
Scholl L, Dörler M, Stücker M. Ulkus bei Adipositas‐assoziierter chronischer Veneninsuffizienz. Hautarzt. 2017;68(7):560‐565.
Purwins S, Herberger K, Debus ES, et al. Cost‐of‐illness of chronic leg ulcers in Germany. Int Wound J. 2010;7(2):97‐102.
Phillips P, Lumley E, Duncan R, et al. A systematic review of qualitative research into people's experiences of living with venous leg ulcers. J Adv Nurs. 2018;74(3):550‐563.
Dantas DV, Torres GV, Salvetti MG, et al. Clinic validation protocol for venous ulcers in high complexity. Rev Gaucha Enferm. 2017;37(4):e59502.
Liu S, Team V, Qiu Y, et al. Investigating quality of life instrument measurement properties for adults with active venous leg ulcers: a systematic review. Wound Repair Regen. 2022;30(4):468‐486.
Finlayson K, Miaskowski C, Alexander K, et al. Distinct wound healing and quality‐of‐life outcomes in subgroups of patients with venous leg ulcers with different symptom cluster experiences. J Pain Symptom Manage. 2017;53(5):871‐879.
Hunter M. Assessing the effect of chronic oedema with associated ulceration. Br J Community Nurs. 2015;(Suppl.):8‐13.
Dissemond J. Chronisches Ulcus cruris. Hautarzt. 2017;68(8):614‐620.
Lurie F, Passman M, Meisner M, et al. The 2020 update of the CEAP classification system and reporting standards. J Vasc Surg Venous Lymphat Disord. 2020;8(3):342‐352.
Dissemond J, Bültemann A, Gerber V, et al. Definitionen für die Wundbehandlung. Hautarzt. 2016;67(3):265‐266.
Robertson L, Lee AJ, Gallagher K, et al. Risk factors for chronic ulceration in patients with varicose veins: a case control study. J Vasc Surg. 2009;49(6):1490‐1498.
Lee AJ, Robertson LA, Boghossian SM, et al. Progression of varicose veins and chronic venous insufficiency in the general population in the Edinburgh Vein Study. J Vasc Surg Venous Lymphat Disord. 2015;3(1):18‐26.
Blomgren L, Johansson G, Emanuelsson L, et al. Late follow‐up of a randomized trial of routine duplex imaging before varicose vein surgery. Br J Surg. 2011;98(8):1112‐1116.
Metzger PB, Rossi FH, Kambara AM, et al. Criteria for detecting significant chronic iliac venous obstructions with duplex ultrasound. J Vasc Surg. 2016;4(1):18‐27.
Coelho A, O'Sullivan G. Usefulness of direct computed tomography venography in predicting inflow for venous reconstruction in chronic post‐thrombotic syndrome. Cardiovasc Intervent Radiol. 2019;42(5):677‐684.
Xu D, Zou L, Xing Y, et al. Diagnostic value of ankle‐brachial index in peripheral arterial disease: a meta‐analysis. Can J Cardiol. 2013;29(4):492‐498.
Levine NS, Lindberg RB, Mason AD, et al. The quantitative swab culture and smear: a quick, simple method for determining the number of viable aerobic bacteria on open wounds. J Trauma. 1976;16(2):89‐94.
Schwarzkopf A, Dissemond J. Indikation und praktische Durchführung mikrobiologischer Diagnostik bei Patienten mit chronischen Wunden. J Dtsch Dermatol Ges. 2015;13(3):203‐210.
Heyer K, Protz K, Glaeske G, Augustin M. Epidemiology and use of compression treatment in venous leg ulcers: nationwide claims data analysis in Germany. Int Wound J. 2017;14(2):338‐343.
Körber A, Klode J, Al‐Benna S, et al. Genese des chronischen Ulcus cruris bei 31.619 Patienten im Rahmen einer Expertenbefragung in Deutschland. J Dtsch Dermatol Ges. 2011;9(2):116‐122.
Schimpf H, Rass K, Tilgen W. Differenzialdiagnosen des Ulcus cruris. Aktuelle Derm. 2009;35:231‐236.
Erfurt‐Berge C, Bültemann A, Gerber V, et al. Stellenwert der Biopsie in der Diagnostik chronischer Wunden – ein Positionspapier der Initiative Chronische Wunden (ICW) e. V. Dermatologie. 2024;75(2):163‐169.
Senet P, Combemale P, Debure C, et al. Malignancy and chronic leg ulcers: the value of systematic wound biopsies: a prospective, multicenter, cross‐sectional study. Arch Dermatol. 2012;148(6):704‐708.
Toussaint F, Erdmann M, Berking C, et al. Malignant tumours presenting as chronic leg or foot ulcers. J Clin Med. 2021;10(11):2251.
Rabe E, Partsch H, Morrison N, et al. Risks and contraindications of medical compression treatment ‐ a critical reappraisal. An international consensus statement. Phlebology. 2020;35(7):447‐460.
Rabe E, Földi E, Gerlach H, et al. Medical compression therapy of the extremities with medical compression stockings (MCS), phlebological compression bandages (PCB), and medical adaptive compression systems (MAC): S2k guideline of the German Phlebology Society (DGP). Hautarzt. 2021;72(Suppl. 2):37‐50.
Protz K, Reich‐Schupke S, Müller K, et al. Kompressionsverbände mit und ohne Unterpolsterung. Hautarzt. 2018;69(8):653‐661.
Dissemond J, Assenheimer B, Bültemann A, et al. Kompressionstherapie bei Patienten mit Ulcus cruris venosum. J Dtsch Dermatol Ges. 2016;14(11):1073‐1089.
Protz K, Eder S, Läuchli S, et al. Einteilung und Nomenklatur der aktuellen Materialien zur Kompressionstherapie. Dermatologie. 2023;74(4):270‐281.
Obermayer A, Göstl K, Roßmann H, et al. Aktive Bettruhe als Begleitmaßnahme für die erfolgreiche Chirurgie des Ulcus cruris venosum. Phlebologie. 2007;36(6):303‐308.
Anekar AA, Cascella M. WHO analgesic ladder. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023.
Van Hecke A, Grypdonck M, Beele H, et al. Adherence to leg ulcer lifestyle advice: qualitative and quantitative outcomes associated with a nurse‐led intervention. J Clin Nurs. 2011;20(3‐4):429‐443.
Qiu Y, Osadnik CR, Team V, et al. Effects of physical activity as an adjunct treatment on healing outcomes and recurrence of venous leg ulcers: a scoping review. Wound Repair Regen. 2022;30(2):172‐185.
Hach W. Das arthrogene Stauungssyndrom. Gefässchirurgie. 2003;8(3):227‐233.
S2k‐Leitlinie Diagnostik und Therapie der Lymphödeme. Gesellschaft Deutschsprachiger Lymphologen e.V. Published 2017. Available from: https://register.awmf.org/de/leitlinien/detail/058‐001 [Last accessed August 6, 2023].
Gohel MS, Heatley F, Liu X, et al. A randomized trial of early endovenous ablation in venous ulceration. N Engl J Med. 2018;378(22):2105‐2114.
Gohel MS, Jocelyn Mora M, Szigeti M, et al. Long‐term clinical and cost‐effectiveness of early endovenous ablation in venous ulceration: a randomized clinical trial. JAMA Surg. 2020;155(12):1113‐1121.
Barwell JR, Davies CE, Deacon J, et al. Comparison of surgery and compression with compression alone in chronic venous ulceration (ESCHAR study): randomised controlled trial. Lancet. 2004;363(9424):1854‐1859.
Gohel MS, Barwell JR, Taylor M, et al. Long term results of compression therapy alone versus compression plus surgery in chronic venous ulceration (ESCHAR): randomised controlled trial. Br Med J. 2007;335(7610):83‐87.
De Maeseneer MG, Kakkos SK, Aherne T, et al. European Society for Vascular Surgery (ESVS) 2022 clinical practice guidelines on the management of chronic venous disease of the lower limbs. Eur J Vasc Endovasc Surg. 2022;63(2):184‐267.
Dissemond J, Bültemann A, Gerber V, et al. Der Begriff Ulcus cruris mixtum sollte heute nicht mehr verwendet werden. Dermatologie. 2023;74(7):555‐559.
S3‐Leitlinie Periphere arterielle Verschlusskrankheit (PAVK), Diagnostik, Therapie und Nachsorge. Deutsche Gesellschaft für Angiologie – Gesellschaft für Gefäßmedizin e.V. Published 2015. Available from: https://register.awmf.org/de/leitlinien/detail/065‐003. [Last accessed August 6, 2023].
Jalaie H, Schleimer K, Barbati ME, et al. Interventional treatment of postthrombotic syndrome. Gefässchirurgie. 2016;21(Suppl. 2):37‐44.
Dissemond J, Bültemann A, Gerber V, et al. Positionspapier der Initiative Chronische Wunden (ICW) e. V. zur Nomenklatur des Débridements chronischer Wunden. Hautarzt. 2022;73(5):369‐375.
Strohal R, Dissemond J, O'Brien J, et al. EWMA Dokument 2013: Débridement. Stand der Entwicklung und Rolle des Débridements: aktuelle Übersicht und Begriffserklärungen. WUNDmanagement. 2013;7(Suppl. 3):4‐39.
Bianchi C, Cazzell S, Vayser D, et al. A multicentre randomised controlled trial evaluating the efficacy of dehydrated human amnion/chorion membrane (EpiFix®) allograft for the treatment of venous leg ulcers. Int Wound J. 2018;15(1):114‐122.
Hayes PD, Harding KG, Johnson SM, et al. A pilot multi‐centre prospective randomised controlled trial of RECELL for the treatment of venous leg ulcers. Int Wound J. 2020;17(3):742‐752.
Dearman BL, Boyce ST, Greenwood JE. Advances in skin tissue bioengineering and the challenges of clinical translation. Front Surg. 2021;8:640879.
Kerstan A, Dieter K, Niebergall‐Roth E, et al. Allogeneic ABCB5+ mesenchymal stem cells for treatment‐refractory chronic venous ulcers: a phase I/IIa clinical trial. JID Innov. 2022;2(1):100067.
Schmeller W, Roszinski S. Shave‐Therapie zur operativen Behandlung persistierender venöser Ulzera mit großflächiger Dermatoliposklerose. Hautarzt. 1996;47(9):676‐681.
Kleinhans M, Stoffels I, Dissemond J. Langfristige Abheilung eines therapierefraktären Ulcus cruris venosum nach kruraler Fasziektomie und Spalthauttransplantation. Hautarzt. 2021;72(2):157‐162.
Hach W, Hach‐Wunderle V. New aspects of chronic venous compartment syndrome. Gefässchirurgie. 2001;6(3):164‐169.
O'Brien J, Finlayson K, Kerr G, et al. Evaluating the effectiveness of a self‐management exercise intervention on wound healing, functional ability and health‐related quality of life outcomes in adults with venous leg ulcers: a randomised controlled trial. Int Wound J. 2017;14(1):130‐137.
Bar L, Brandis S, Marks D. Improving adherence to wearing compression stockings for chronic venous insufficiency and venous leg ulcers: a scoping review. Patient Prefer Adherence. 2021;15:2085‐2102.
Kulprachakarn K, Nantakool S, Rojawat C, et al. Effectiveness of combined conventional treatment with a tailored exercise training program on wound healing in patients with venous leg ulcer: a randomized controlled trial. J Tissue Viability. 2022;31(1):190‐196.
Shaalan W, El Emam A, Lotfy H, et al. Clinical and hemodynamic outcome of morbidly obese patients with severe chronic venous insufficiency with and without bariatric surgery. J Vasc Surg Venous Lymphat Disord. 2021;9(5):1248‐1256.
Veličković VM, Prieto PA, Krga M, et al. Superabsorbent wound dressings versus foams dressings for the management of moderate‐to‐highly exuding venous leg ulcers in French settings: an early stage model‐based economic evaluation. J Tissue Viability. 2022;31(3):523‐530.
Dissemond J. Modernes Wundmanagement chronischer Wunden. Hautarzt. 2021;72:733‐744.
S3‐Leitlinie Lokaltherapie chronischer Wunden bei Patienten mit den Risiken periphere arterielle Verschlusskrankheit, Diabetes mellitus, chronisch venöse Insuffizienz. Deutsche Gesellschaft für Wundheilung und Wundbehandlung e.V. Published 2023. Available from: https://register.awmf.org/de/leitlinien/detail/091‐001 [Last accessed October 2, 2023].
Dissemond J, Assadian O, Gerber V, et al. Classification of wounds at risk and their antimicrobial treatment with polihexanide: a practice‐oriented expert recommendation. Skin Pharmacol Physiol. 2011;24(5):245‐255.
Dissemond J, Gerber V, Lobmann R, et al. Therapeutischer Index für Lokale Infektionen: TILI‐Score Version 2.0. WUNDmanagement. 2021;15:123‐126.
O'Meara S, Al‐Kurdi D, Ologun Y, et al. Antibiotics and antiseptics for venous leg ulcers. Cochrane Database Syst Rev. 2014;(1):CD003557.
Kramer A, Dissemond J, Kim S, et al. Consensus on wound antisepsis: update 2018. Skin Pharmacol Physiol. 2018;31(1):28‐58.
Quirke M, Ayoub F, McCabe A, et al. Risk factors for nonpurulent leg cellulitis: a systematic review and meta‐analysis. Br J Dermatol. 2017;177(2):382‐394.
Wohlrab J. Topical preparations and their use in dermatology. J Dtsch Dermatol Ges. 2016;14(11):1061‐1070.
Jockenhöfer F, Zaremba A, Wehrmann C, et al. Pruritus in patients with chronic leg ulcers: A frequent and often neglected problem. Int Wound J. 2019;16(6):1464‐1470.
Kılınç F, Akbaş A, Şener S, et al. Cutaneous findings in patients with chronic venous insufficiency. J Cosmet Dermatol. 2022;21(5):2106‐2112.
Dissemond J. Allergietestung mittels repetitivem offenen Applikationstest (ROAT). WUNDmanagement. 2021;15:89‐90.
Erfurt‐Berge C, Geier J, Mahler V. The current spectrum of contact sensitization in patients with chronic leg ulcers or stasis dermatitis – new data from the Information Network of Departments of Dermatology (IVDK). Contact Dermatitis. 2017;77(3):151‐158.
Protz K, Verheyen‐Cronau I, Heyer K. Broschüren zur Unterstützung der Patientenedukation in den Themenbereichen MRSA, Kompression und Wundwissen – Eine Untersuchung anhand der Veröffentlichungen des Wundzentrum Hamburg e. V. Pflegewissenschaft. 2013;15:658‐678.
Mościcka P, Szewczyk MT, Jawień A, et al. Subjective and objective assessment of patients’ compression therapy skills as a predicator of ulcer recurrence. J Clin Nurs. 2016;25(13‐14):1969‐1976.
Weller CD, Buchbinder R, Johnston RV. Interventions for helping people adhere to compression treatments for venous leg ulceration. Cochrane Database Syst Rev. 2016;3(3):CD008378.
Protz K, Dissemond J, Seifert M, et al. Education in people with venous leg ulcers based on a brochure about compression therapy: a quasi‐randomised controlled trial. Int Wound J. 2019;16(6):1252‐1262.
Brown A. Implications of patient shared decision‐making on wound care. Br J Community Nurs. 2013;(Suppl.):26‐32.
Expertenstandard Pflege von Menschen mit chronischen Wunden. Deutsches Netzwerk für Qualitätsentwicklung in der Pflege (DNQP). 1st ed.; 2015.
Sippel K, Seifert B, Hafner J. Donning devices (foot slips and frames) enable elderly people with severe chronic venous insufficiency to put on compression stockings. Eur J Vasc Endovasc Surg. 2015;49(2):221‐229.
Ringwald K, Arnold A, Haase H, et al. Telemedizinische Nachsorge von Patient*innen mit Hauterkrankungen. Dermatologie. 2022;73:853‐858.
Huang Z, Wu S, Yu T, et al. Efficacy of telemedicine for patients with chronic wounds: a meta‐analysis of randomized controlled trials. Adv Wound Care. 2021;10(2):103‐112.
Chen L, Cheng L, Gao W, et al. Telemedicine in chronic wound management: systematic review and meta‐analysis. JMIR Mhealth Uhealth. 2020;8(6):15574.