title: Insufficient and incomplete shaving in chronic venous leg ulcers leads to a poor prognosis of the skin graft: a histomorphological analysis.
abstract: BACKGROUND
  The surgical treatment for therapy-resistant venous leg ulcers is shave therapy with mesh graft transplantation.
  
  
  OBJECTIVE
  To demonstrate the need of complete shaving with help of histomorphological criteria.
  
  
  METHODS
  Biopsies were taken from the bottom and the border of the 28 ulcers and from nonulcer skin nearby. Specimens were analyzed in correlation to the clinical course 6 months after the treatment (healed/nonhealed/recurrent).
  
  
  RESULTS
  10 ulcers healed, 10 were recurrent and 8 nonhealed. Nonhealed ulcers had an increased broadening of collagen fibers and rete ridges and reduced elastic fibers at the border of the ulcer. Significantly more obliterated vessels were in the upper dermis at the border of the nonhealed ulcers. Recurrent ulcers showed more signs of dermatoliposclerosis.
  
  
  CONCLUSIONS
  In nonhealed and recurrent ulcers histomorphological aspects of dermatoliposclerosis are still detectable. Thus, a more extensive fibrosis seems to be associated with a poorer outcome. The hypothesis that possibly a more aggressive shave therapy can increase the healing rate should be verified in a prospective study.
authors: Department of Dermatology, Ruhr University Bochum, Bochum, Germany. s.reich-schupke@klinikum-bochum.de
authors: Stefanie
authors: S
authors: Reich-Schupke
authors: Irina
authors: I
authors: Schmeil
authors: Alexander
authors: A
authors: Kreuter
authors: Falk
authors: F
authors: Bechara
authors: Klaus
authors: K
authors: Hoffmann
authors: Peter
authors: P
authors: Altmeyer
authors: Markus
authors: M
authors: Stücker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003094:Collagen / Q000032:analysis; D003646:Debridement / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016038:Skin Transplantation; D016896:Treatment Outcome; D014647:Varicose Ulcer / Q000473:pathology / Q000601:surgery*
chemical_list: D003094:Collagen