701 - Complete wound closure in difficult to heal wounds following surgical excision and skin graft in the operating room: Evidence of effective limb salvage procedure in patients with chronic venous stasis ulcers

Case Diagnosis: Leg ulcers secondary to underlying venous insufficiency are a common cause of chronic non-healing ulcers. It has been estimated that venous ulcers cause the loss of 2 million working days per year in the US. We present 3 cases of chronic venous leg ulcers that healed successfully after surgical excision and skin grafting.

Case Description: Case 1 is a 71-year-old man with a chronic leg ulcer with underlying vein thrombosis (history of IV drug use) and venous reflux which failed standard treatments for 4 years. Case 2 is a 73-year-old man with a chronic venous leg ulcer which failed standard treatments for several months. Case 3 is a 52-year-old woman with a chronic venous ulcer which failed standard treatments for 10 years. Ulcer sizes on average were 250-300 square cm. Standard and advanced wound care that failed included diagnostics, infection control, vein ablations, compression therapy, serial wound debridements, and biologic therapies. Ultimately all three ulcers were treated with deep and wide surgical excision and split-thickness skin grafting (STSG) in the operating room. After this procedure, the ulcers healed progressively and achieved complete healing with standard wound care. Case 1 healed in 1 month, case 2 in 3 months, and case 3 in 18 months.



Discussions: Chronic venous ulcer beds develop chronic biofilms and hyperinflammatory milieu that is often resistant to standard wound care. Chronic venous ulcers cause prolonged morbidity with decline in function, quality of life and productivity.

Conclusions: In resistant cases of chronic venous ulcers deep and wide surgical excision with STSG with removal of inflammatory nonhealing tissue may be the key to changing the wound from a chronic nonhealing wound to an acute healing wound.