Management of hypertensive leg ulcers: A French national survey

Abstract

Background

Hypertensive leg ulcers (HLUs) are superficial, rapidly spreading, necrotic ulcers that are frequently resistant to standard local wound care. The available literature on HLU management is relatively poor. This survey-based study aimed to evaluate the management of HLUs in France.

Methods

A questionnaire was sent in December 2019 to all members of the Angiodermatology Group of the French Society of Dermatology. The questionnaire collected information about physicians and their department, and about their management of HLUs, including examinations and specific and non-specific topical and systemic treatments.

Results

Forty-four physicians responded. The most frequently performed examinations were lower-limb arterial Doppler (88.6%), ankle-brachial pressure index tests (83.7%) and venous Doppler (60.5%). Blood sampling for autoimmunity testing was requested by 27.3% of physicians and skin biopsy by 20.5%. The most frequently used first-line therapy was skin grafting (97.7%). Other treatments included topical steroids (58.1%), negative-pressure therapy (15.9%), electrostimulation (15.9%), auto-haemotherapy (14.0%), and iloprost (11.4%). The mechanism of action of electrostimulation is not very clear. Its main benefit lies in controlling the pain of HLU. Iloprost appears to be an interesting vasodilator although it has not been validated to date. An additional antiplatelet agent was proposed by 19.0% of the physicians and modification of anticoagulant treatment (use of a vitamin K antagonist in addition to direct oral anticoagulants) was proposed by 19.5% of physicians.

Discussion

The survey results showed that HLU evaluation involved searching for associated peripheral arterial disease and that HLU management in France was disparate. Skin grafting was the sole consensual treatment and was generally used as a first-line option. Other treatments require further evaluation. Management disparities could be reduced by the drafting and publication of a consensus guideline to harmonise HLU management.