A retrospective review of 20 hypertensive leg ulcers treated with mesh skin grafts.
BACKGROUND
Few articles have been published about hypertensive leg ulcers and their surgical treatment. Since mid of the year 2000, it has been our policy to treat all hypertensive leg ulcers very early with mesh split-thickness skin grafts. The present series consists of 15 patients whose hypertensive leg ulcers, including five bilateral cases, were treated with 20 mesh grafts from 2000 to 2002.


METHODS
All patients, nine women and six men, had a long history of hypertension. The same surgical procedure was applied to all 15 patients: a complete mechanical debridement of all necrotic tissues, immediately followed by mesh skin grafting.


RESULTS
Patients were discharged from the hospital after an average post-operative period of 16 days. Upon leaving the hospital, the patients had lesions completely healed in 14 of 20 cases. The graft take had been complete after an average period of 14 days. In six cases, one or two very small patches of skin graft had necrosed and complete healing required an additional period of 1 to 3 months. In all 20 cases, pain had disappeared within 1 week from surgery.


CONCLUSIONS
All patients were on opioid therapy before surgery. With medical treatment only, hypertensive leg ulcers used to heal after a mean period of 15 months. After surgery, the average healing period was 2 weeks and opioids were stopped within 1 month after surgery.


CONCLUSIONS
The review of the present series shows that early mesh grafting of hypertensive leg ulcers is beneficial, because healing is very quick and the pain will disappear quasi-instantly.
Dagregorio
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Federation of Dermatology and Plastic Surgery, Centre Hospitalo-Universitaire de Poitiers, Rue de la Milétrie, Poitiers Cedex, France. g.dagregorio@chu-poitiers.fr
Guillet
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D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D006973:Hypertension; D007871:Leg Ulcer / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016038:Skin Transplantation; D013526:Surgical Mesh; D016896:Treatment Outcome; D014945:Wound Healing