Pathophysiology of Wound Healing in Venous Leg Ulcers

  • J. R. Mekkes
  • W. Westerhof
Conference paper


Venous ulceration is a common problem in clinical practice. Although it is quite clear that venous insufficiency is the underlying cause, the exact pathogenetic mechanism is still not fully understood and definitively very complex.


Venous Hypertension Venous Insufficiency Venous Ulceration Skin Equivalent Chronic Venous Insufficiency 
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  1. 1.
    Gay J (1868) On varicose disease of the lower extremities: the Lettsomian lectures of 1867. Churchill, London.Google Scholar
  2. 2.
    Homans J (1917) The aetiology and treatment of varicose ulcers of the leg. Surg Gynaecol Obstet 24:300–311.Google Scholar
  3. 3.
    Linton RR (1938) The communicating veins of the lower limb and the operating technique for their ligation. Ann Surg 107:582–593.PubMedCrossRefGoogle Scholar
  4. 4.
    Brewer AC (1950) Varicose ulceration. Br Med J 2:270.Google Scholar
  5. 5.
    Fearnley G (1965) Fibrinolysis. Arnold, London.Google Scholar
  6. 6.
    Browse NL, Gray L, Larret PM, Morland M (1977) Blood and vein-wall fibrinolytic activity in health and vascular disease. Br Med J 1:478–481.PubMedCrossRefGoogle Scholar
  7. 7.
    Browse NL (1983) Venous ulceration. Br Med J 286:1920–1922.CrossRefGoogle Scholar
  8. 8.
    Burnand KG, Whimster I, Naidoo A, Browse NL (1982) Pericapillary fibrin in the ulcer bearing skin of the lower leg: the cause of lipodermatosclerosis and venous ulceration. Br Med J 285:1071–1072.CrossRefGoogle Scholar
  9. 9.
    Browse NL, Burnand KG (1982) The cause of venous ulceration. Lancet 2:243–245.PubMedCrossRefGoogle Scholar
  10. 10.
    Fagrell B (1982) Microcirculatory disturbances — the final cause for venous leg ulcers?. Vasa 11:101–103.PubMedGoogle Scholar
  11. 11.
    Ernst E, Matrai A, Vinnemeier E, Marshall M (1986) Blood rheology in post-thrombotic syndrome — a pilot study. Phlebology 3:181–183.Google Scholar
  12. 12.
    Franzeck UK, Huch A, Huch R, Bollinger A (1982) Simultane transcutane PO2-Messung und Videomikroskopie bei Patienten mit chronisch-venöser Insuffizienz. Vasa 9:19.Google Scholar
  13. 13.
    Thomas PRS, Nash GB, Dormandy JA (1988) White cell accumulation in dependent legs of patients with venous hypertension: a possible mechanism for trophic changes in the skin. Br Med J 296:1693–1695.CrossRefGoogle Scholar
  14. 14.
    Coleridge Smith PD, Thomas P, Scurr JH, Dormandy JA (1988) Causes of venous ulceration: a new hypothesis. Br Med J 296:1726–1727.CrossRefGoogle Scholar
  15. 15.
    Ackerman Z, Seidenbaum M, Loewenthal E, Rubinow A (1988) Overload of iron in the skin of patients with varicose ulcers. Arch Dermatol 124:1376–1378.PubMedCrossRefGoogle Scholar
  16. 16.
    Arnoldi CC, Linderholm H (1968) On the pathogenesis of the venous leg ulcer. Acta Chir Scand 134:427.PubMedGoogle Scholar
  17. 17.
    Wenner A et al. (1980) Ultrastructural changes of capillaries in chronic venous insufficiency. Exp Cell Biol 48:1–14.Google Scholar
  18. 18.
    Leu HJ, Wenner A, Spycher MA, Brunner U (1980) Veränderungen der transendothelialen Permeabilität als Ursache des Oedems bei der chronisch-venösen Insuffizienz. Phlebol Proktol 9:67–73.Google Scholar
  19. 19.
    Shirley HH, Wolfram CG, Wasserman K, Mayerson HS (1967) Capillary permeability to macromolecules: stretched pore phenomen. Physiology 190:189–193.Google Scholar
  20. 20.
    Ryan TJ (1989) Structure and function of lymphatics. J Invest Dermatol 93(2):18–24.CrossRefGoogle Scholar
  21. 21.
    Zabel M, Hettwer H (1987) Zur Pathogenese der Atrophie blanche — histologische und elektronen-optische Untersuchungen. Phlebol Proktol 16:151.Google Scholar
  22. 22.
    Franzeck UK, Isenring G, Frey J, Jäger K, Mahler F, Bollinger A (1983) Eine Apparatur zur dynamischen intravitalen Videomikroskopie. Vasa 12:233–238.PubMedGoogle Scholar
  23. 23.
    Westerhof W, Mekkes JR (1990) Krill and other enzymes in enzymatic wound debridement. In: Wadstrom T, Eliasson I, Holder I, Ljungh A (eds) Pathogenesis of wound and biomaterial-associated infections. Springer, London.Google Scholar
  24. 24.
    Dutrieux RP, van Ginkel CJW, Westerhof W (1989) Groeifactoren en de wondgenezing: fictie of realiteit?. Ned Tijdschr Geneeskd 133:1870–1872.PubMedGoogle Scholar
  25. 25.
    Jansen FC, Westerhof W, Cormane RH (1986) Transplantatie van autologe huidbiopten: een doeltreffende Klinische behandeling van het ulcus cruris. Ned Tijdschr Geneeskd 130:1230–1233.PubMedGoogle Scholar
  26. 26.
    Leigh IM, Purkis PE, Navsaria HA et al. (1987) Treatment of chronic venous ulcers with sheets of cultured allogenic keratinocytes. Br J Dermatol 117:591–597.PubMedCrossRefGoogle Scholar
  27. 27.
    Mol MAE, Nanninga PB, van Eendenburg JP, Mekkes JR, Westerhof W, van Ginkel CJW (1991) Grafting of venous leg ulcers: an intra-individual comparison between cultured skin equivalents and full thickness skin punches. J Am Acad Dermatol 24:77–82.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1995

Authors and Affiliations

  • J. R. Mekkes
    • 1
  • W. Westerhof
    • 1
  1. 1.Department of DermatologyAcademic Medical CenterAmsterdamThe Netherlands

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