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Skin Substitutes And Venous Leg Ulceration

In North America And Europe, venous leg ulceration is a frequently encountered problem. About 1% of the total population of people over 65 have been experiencing increased incidents with it. Venous ulcers often cause significant discomfort to patients. 

Several treatment strategies have emerged over the years, but the persistent nature of venous ulcers makes them difficult to treat. 

However, skin substitutes have recently emerged as a promising therapeutic option for venous ulceration. In this article, we will explore skin substitutes' role in managing venous leg ulcers. 

What Are Skin Substitutes?

The skin is the largest organ in the human body, although its role is often underappreciated. It serves as a protective barrier; if its integrity is compromised, it can adversely affect a person's overall health. Some situations that can compromise the skin are; wounds, ulcers, burns, and tissue injuries. 

Skin substitutes are used as replacements for normal skin. It is a group of biological and synthetic materials that mimic the function of the skin. They provide coverage to open wounds and can help stimulate wound healing. They can also be used for reconstruction following burn injuries. Examples of skin substitutes used in burn centers include xenografts, human skin allografts, and amniotic membrane products. Skin substitutes are gaining popularity for treating chronic, non-healing ulcers such as diabetic foot ulcers and venous ulcers. 

This can help clinicians provide appropriate care depending on the wound characteristics but keep in mind that each wound has its unique healing potential; therefore, the outcomes can vary. So, clinicians need to understand the material being used deeply. 

Types of Skin Substitutes

Different types of skin substitutes can be used for treating chronic wounds such as venous leg ulcers. The various skin substitutes available can be broadly categorized as follows:

  • Autografts: These are derived from the patient’s tissues. These can either be taken during a minor surgical procedure or could be cultured in the lab using the patient's cells.
  • Allografts: These come from another human donor. The major concern with the use of allogeneic skin grafts is the risk of transmitting infection.
  • Xenografts: These are taken from another species, the most common being pig as its skin bears structural similarities to human skin.
  • Tissue-engineered skin: Also known as “artificial skin”, these are manufactured using tissue engineering technology. The two major types include single-layered and bilayered skin substitutes.

Venous Ulcers And Skin Substitutes

Venous leg ulcers are a natural effect of chronic venous insufficiency. Venous insufficiency is chronic because fewer nutrients and oxygen get delivered to the tissues. Insufficient venous reflux or obstruction leading to "venous hypertension" is often the underlying cause. Without treatment, it can result in complications such as skin malignancy. Additionally, venous leg ulceration can negatively impact a person's quality of life due to pain, immobility, and wound odor.

The treatment of venous ulcers remains challenging, partly due to the high medical costs and the high recurrence rates despite treatment. It is estimated that about 60% to 70% of all healed venous ulcers recur within a year. 

Compression therapy is often considered the primary form of treatment for venous ulcers. It involves the application of sustained pressure to the affected limb using either multilayered bandages or pneumatic compression pumps. But the most commonly used method of applying compression therapy is the use of bandages. 

However, this method comes with challenges and limitations, such as the cooperation of patients. Additionally, even though compression therapy might be enough for some patients, it might not be the same for others. The education and training of staff are especially needed to ensure adequate pressure is sustained in the bandages applied. 

One therapeutic agent that can help treat difficult-to-heal chronic venous ulcers is skin substitutes. A study reported a significant improvement in wound healing rates using bilayered human skin substitutes and compression bandages. Improved healing rates were also reported with the use of allografts. 

It is beneficial and appropriate for specialists to consider using skin substitutes for patients with chronic and persistent venous ulcers.

Bottom Line

While compression therapy helps treat venous insufficiency, around 20% of venous ulcers exhibit no improvement in healing rates with bandaging alone. So, clinicians need to identify patients with chronic, difficult-to-treat venous ulcers for treatment with adjunct therapies such as skin substitutes. 

Venous ulcers can be challenging to treat effectively, but that doesn't mean it's impossible. Especially with the constant development of medical technology.

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