title: Wound management with compression therapy and topical hemoglobin solution in a patient with Budd-Chiari Syndrome.
abstract: BACKGROUND
  Although the underlying primary cause of chronic wounds may vary, a common etiology of this is a hypoxic or ischemic status of the affected tissue of the lower extremities. In particular, for rare diseases associated with disturbed blood flow a correlation between cause and effect is often diagnosed inappropriately. As a consequence, chronic wounds may develop and persist for years.
  
  
  METHODS
  We present a case of a patient with chronic venous insufficiency due to an occlusion of the inferior caval vein. Initially, a Budd-Chiari syndrome was diagnosed which is a thrombotic obstruction of the hepatic venous outflow. In addition, the patient developed an obstruction of the inferior caval vein and subsequently a chronic venous insufficiency. As a consequence, chronic leg ulcers developed with a history of more than 7 years. Various wound care approaches were performed without success in wound closure. Finally, a combination of compression therapy and topical application of a hemoglobin solution successfully led to fast and persistent wound closure.
  
  
  CONCLUSIONS
  Chronic ulcers of the lower limb such as venous leg ulcers, even for patients with rare disorders like Budd-Chiari syndrome, are associated with oxygen supply disturbances resulting in a hypoxic status of the affected tissue. Therefore, an adequate oxygen supply to chronic wounds plays a pivotal role in successful wound healing. Compression therapy in combination with enhancement of the local oxygen supply by topically applied hemoglobin showed marked improvement of wound healing in the presented patient.
authors.affiliation: die pflegezentrale GmbH, 47138 Duisburg, Bahnhofstr. 20-22, Germany;
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Babadagi-Hardt
authors.affiliation: EngelsConsult, Gartenstr. 25, 51429 Bergisch Gladbach, Germany;
authors.forename: Peter
authors.initials: P
authors.lastname: Engels
authors.affiliation: MVZ KfH Nierenzentrum Krefeld, Lutherplatz 56, 47805 Krefeld, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Kanya
keywords: Budd-Chiari syndrome; chronic wound; hemoglobin; oxygen; ulcer
references.citation: MMW Fortschr Med. 2012 Oct 4;154 Suppl 3:73-6
references.pmid: 23133882
references.citation: J Vasc Surg. 2010 Nov;52(5 Suppl):46S-49S
references.pmid: 21069933
references.citation: Br J Dermatol. 2010 Aug;163(2):257-68
references.pmid: 20394633
references.citation: Wound Repair Regen. 2009 Jan-Feb;17(1):1-18
references.pmid: 19152646
references.citation: World J Gastroenterol. 2007 May 21;13(19):2693-6
references.pmid: 17569137
references.citation: N Engl J Med. 2006 Aug 3;355(5):488-98
references.pmid: 16885552
references.citation: J Hepatol. 2009 Jan;50(1):195-203
references.pmid: 19012988
references.citation: Science. 1960 Feb 26;131(3400):585-90
references.pmid: 14443421
references.citation: Hautarzt. 2011 Jul;62(7):504-8
references.pmid: 21523520
references.citation: AJR Am J Roentgenol. 2012 Oct;199(4):737-45
references.pmid: 22997363
references.citation: J Thromb Thrombolysis. 2010 Aug;30(2):226-8
references.pmid: 19943085
references.citation: Curr Probl Dermatol. 1999;27:124-9
references.pmid: 10547736
references.citation: Cochrane Database Syst Rev. 2012 Nov 14;11:CD000265
references.pmid: 23152202
references.citation: Hautarzt. 2013 Mar;64(3):180-6
references.pmid: 23354657
references.citation: Lancet. 2004 Jun 5;363(9424):1854-9
references.pmid: 15183623
references.citation: Semin Liver Dis. 2008 Aug;28(3):259-69
references.pmid: 18814079
references.citation: Liver Int. 2008 Apr;28(4):455-66
references.pmid: 18339072