Management of hypertensive leg ulcers: A French national survey

IF 3.1 4区医学 Q2 DERMATOLOGY

Annales De Dermatologie Et De Venereologie Pub Date : 2025-03-17 DOI:10.1016/j.annder.2025.103353

Y. Zerdani , H. Nguyen-Chi , J.-B. Monfort , P. Senet , E. Tella , E. Mahé , The Groupe Angiodermatologie (GAD) of the Société Française de Dermatologie

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引用次数: 0

Abstract

Background

Hypertensive leg ulcers (HLUs) are superficial, rapidly spreading, necrotic ulcers that are frequently resistant to standard local wound care. The available literature on HLU management is relatively poor. This survey-based study aimed to evaluate the management of HLUs in France.

Methods

A questionnaire was sent in December 2019 to all members of the Angiodermatology Group of the French Society of Dermatology. The questionnaire collected information about physicians and their department, and about their management of HLUs, including examinations and specific and non-specific topical and systemic treatments.

Results

Forty-four physicians responded. The most frequently performed examinations were lower-limb arterial Doppler (88.6%), ankle-brachial pressure index tests (83.7%) and venous Doppler (60.5%). Blood sampling for autoimmunity testing was requested by 27.3% of physicians and skin biopsy by 20.5%. The most frequently used first-line therapy was skin grafting (97.7%). Other treatments included topical steroids (58.1%), negative-pressure therapy (15.9%), electrostimulation (15.9%), auto-haemotherapy (14.0%), and iloprost (11.4%). The mechanism of action of electrostimulation is not very clear. Its main benefit lies in controlling the pain of HLU. Iloprost appears to be an interesting vasodilator although it has not been validated to date. An additional antiplatelet agent was proposed by 19.0% of the physicians and modification of anticoagulant treatment (use of a vitamin K antagonist in addition to direct oral anticoagulants) was proposed by 19.5% of physicians.

Discussion

The survey results showed that HLU evaluation involved searching for associated peripheral arterial disease and that HLU management in France was disparate. Skin grafting was the sole consensual treatment and was generally used as a first-line option. Other treatments require further evaluation. Management disparities could be reduced by the drafting and publication of a consensus guideline to harmonise HLU management.

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高血压腿溃疡的管理：一项法国全国调查

背景：高血压性腿部溃疡（hlu）是一种浅表、迅速扩散的坏死性溃疡，通常对标准的局部伤口护理无效。现有的关于HLU管理的文献相对较少。这项基于调查的研究旨在评估法国hlu的管理。方法于2019年12月向法国皮肤病学会血管皮肤病组所有成员发送问卷。问卷收集了医生及其科室的信息，以及他们对hlu的管理，包括检查、特异性和非特异性局部和全身治疗。结果44名医生回应。最常见的检查是下肢动脉多普勒（88.6%）、踝臂压指数（83.7%）和静脉多普勒（60.5%）。27.3%的医生要求采血进行自身免疫检测，20.5%的医生要求皮肤活检。最常用的一线治疗是植皮（97.7%）。其他治疗包括外用类固醇（58.1%）、负压治疗（15.9%）、电刺激（15.9%）、自体血液治疗（14.0%）和伊洛前列素（11.4%）。电刺激的作用机制尚不十分清楚。它的主要好处在于控制了HLU的痛苦。伊洛前列素似乎是一种有趣的血管扩张剂，尽管迄今尚未得到证实。19.0%的医生建议使用一种额外的抗血小板药物，19.5%的医生建议修改抗凝治疗（在直接口服抗凝药物的基础上使用维生素K拮抗剂）。调查结果显示，HLU评估涉及寻找相关的外周动脉疾病，法国的HLU管理存在差异。皮肤移植是唯一的双方同意的治疗方法，通常作为一线选择。其他治疗方法需要进一步评估。可以通过起草和出版协调卫生机构管理的协商一致准则来减少管理上的差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annales De Dermatologie Et De Venereologie 医学-皮肤病学

CiteScore

1.40

自引率

0.00%

发文量

审稿时长

81 days

期刊介绍： Les Annales de dermatologie sont le rendez-vous mensuel incontournable de toute la dermatologie francophone, grâce à leur comité de rédaction qui assure une sélection rigoureuse des articles selon les normes de l''édition scientifique internationale. Une revue didactique, véritable aide à la pratique médicale quotidienne Pour compléter et enrichir la partie scientifique, la rubrique Formation médicale continue propose aux lecteurs des textes didactiques et interactifs (Cas pour diagnostic, Notes de pharmacovigilance, la Question du praticien, Dermatologie chirurgicale, la Sélection bibliographique du mois...) qui les font bénéficier d''une formation post-universitaire diversifiée et de qualité. La revue consacre également un espace pour la publication de questions des lecteurs auxquelles des experts apportent une réponse.