title: Modalities to Treat Venous Ulcers: Compression, Surgery, and Bioengineered Tissue.
abstract: BACKGROUND
  Venous leg ulcers (VLUs) represent the most common ulcers of the lower extremity. VLUs are notorious for delayed and prolonged healing with high rates of recurrence. Most patients with VLUs also have significant comorbidities that interfere with primary wound healing. Thus, caring for patients with VLUs requires an interdisciplinary approach that addresses the abnormal venous anatomy and the downstream effects that lead to inflammation, ulceration, and a hostile wound microenvironment.
  
  
  METHODS
  The current literature regarding venous ulcer treatment with an emphasis on compression, surgical options, and use of bioengineered tissue was reviewed. A combination of society guidelines, Cochrane reviews, and over 80 primary articles with high-level evidence were utilized to develop this summary and algorithm for an integrated approach to treating patients with venous ulcers. Details regarding compression modalities and venous diagnostic imaging are presented to help the clinician understand the rationale for using these technologies.
  
  
  RESULTS
  The comprehensive approach to the patient with chronic venous insufficiency (CVI) includes advances in compression, diagnostics, minimally invasive surgical treatment of venous disease, wound bed preparation, and bioengineered skin and soft tissue substitutes. An algorithm that incorporates early treatment of the ulcer and the venous disease leading to healing with prevention of recurrence is presented.
  
  
  CONCLUSIONS
  Utilizing guidelines that incorporate evidence-based modalities will lead to the highest quality outcomes with the most appropriate resource utilization. A proactive approach to treating venous disease will alleviate suffering and prevent the long-term sequelae of CVI.
authors.affiliation: Warwick, RI; Boston and South Weymouth, Mass.; Washington, D.C.; Mineola, N.Y.; and Miami, Fla.|From the Kent Hospital Wound Recovery and Hyperbaric Medicine Center; Department of Vascular Surgery, Brigham and Women's Hospital; George Washington University Hospital, Wound Healing and Limb Preservation Center; South Shore Hospital, Center for Wound Healing; Boston University School of Medicine; Division of Wound Healing and Regenerative Medicine, Department of Surgery, Winthrop University Hospital/Stony Brook University School of Medicine; and Wound Healing and Regenerative Medicine Research Program, Department of Dermatology, University of Miami Miller School of Medicine.
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Gould
authors.affiliation: Warwick, RI; Boston and South Weymouth, Mass.; Washington, D.C.; Mineola, N.Y.; and Miami, Fla.|From the Kent Hospital Wound Recovery and Hyperbaric Medicine Center; Department of Vascular Surgery, Brigham and Women's Hospital; George Washington University Hospital, Wound Healing and Limb Preservation Center; South Shore Hospital, Center for Wound Healing; Boston University School of Medicine; Division of Wound Healing and Regenerative Medicine, Department of Surgery, Winthrop University Hospital/Stony Brook University School of Medicine; and Wound Healing and Regenerative Medicine Research Program, Department of Dermatology, University of Miami Miller School of Medicine.
authors.forename: Garima
authors.initials: G
authors.lastname: Dosi
authors.affiliation: Warwick, RI; Boston and South Weymouth, Mass.; Washington, D.C.; Mineola, N.Y.; and Miami, Fla.|From the Kent Hospital Wound Recovery and Hyperbaric Medicine Center; Department of Vascular Surgery, Brigham and Women's Hospital; George Washington University Hospital, Wound Healing and Limb Preservation Center; South Shore Hospital, Center for Wound Healing; Boston University School of Medicine; Division of Wound Healing and Regenerative Medicine, Department of Surgery, Winthrop University Hospital/Stony Brook University School of Medicine; and Wound Healing and Regenerative Medicine Research Program, Department of Dermatology, University of Miami Miller School of Medicine.
authors.forename: Kara
authors.initials: K
authors.lastname: Couch
authors.affiliation: Warwick, RI; Boston and South Weymouth, Mass.; Washington, D.C.; Mineola, N.Y.; and Miami, Fla.|From the Kent Hospital Wound Recovery and Hyperbaric Medicine Center; Department of Vascular Surgery, Brigham and Women's Hospital; George Washington University Hospital, Wound Healing and Limb Preservation Center; South Shore Hospital, Center for Wound Healing; Boston University School of Medicine; Division of Wound Healing and Regenerative Medicine, Department of Surgery, Winthrop University Hospital/Stony Brook University School of Medicine; and Wound Healing and Regenerative Medicine Research Program, Department of Dermatology, University of Miami Miller School of Medicine.
authors.forename: Gary W
authors.initials: GW
authors.lastname: Gibbons
authors.affiliation: Warwick, RI; Boston and South Weymouth, Mass.; Washington, D.C.; Mineola, N.Y.; and Miami, Fla.|From the Kent Hospital Wound Recovery and Hyperbaric Medicine Center; Department of Vascular Surgery, Brigham and Women's Hospital; George Washington University Hospital, Wound Healing and Limb Preservation Center; South Shore Hospital, Center for Wound Healing; Boston University School of Medicine; Division of Wound Healing and Regenerative Medicine, Department of Surgery, Winthrop University Hospital/Stony Brook University School of Medicine; and Wound Healing and Regenerative Medicine Research Program, Department of Dermatology, University of Miami Miller School of Medicine.
authors.forename: Raelina S
authors.initials: RS
authors.lastname: Howell
authors.affiliation: Warwick, RI; Boston and South Weymouth, Mass.; Washington, D.C.; Mineola, N.Y.; and Miami, Fla.|From the Kent Hospital Wound Recovery and Hyperbaric Medicine Center; Department of Vascular Surgery, Brigham and Women's Hospital; George Washington University Hospital, Wound Healing and Limb Preservation Center; South Shore Hospital, Center for Wound Healing; Boston University School of Medicine; Division of Wound Healing and Regenerative Medicine, Department of Surgery, Winthrop University Hospital/Stony Brook University School of Medicine; and Wound Healing and Regenerative Medicine Research Program, Department of Dermatology, University of Miami Miller School of Medicine.
authors.forename: Harold
authors.initials: H
authors.lastname: Brem
authors.affiliation: Warwick, RI; Boston and South Weymouth, Mass.; Washington, D.C.; Mineola, N.Y.; and Miami, Fla.|From the Kent Hospital Wound Recovery and Hyperbaric Medicine Center; Department of Vascular Surgery, Brigham and Women's Hospital; George Washington University Hospital, Wound Healing and Limb Preservation Center; South Shore Hospital, Center for Wound Healing; Boston University School of Medicine; Division of Wound Healing and Regenerative Medicine, Department of Surgery, Winthrop University Hospital/Stony Brook University School of Medicine; and Wound Healing and Regenerative Medicine Research Program, Department of Dermatology, University of Miami Miller School of Medicine.
authors.forename: Marjana
authors.initials: M
authors.lastname: Tomic-Canic
mesh_terms: D058128:Compression Bandages; D006801:Humans; D019651:Plastic Surgery Procedures / Q000379:methods*; D023822:Tissue Engineering; D016896:Treatment Outcome; D014647:Varicose Ulcer / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D014656:Vascular Surgical Procedures / Q000379:methods; D014945:Wound Healing