[Ulcus cruris venosum: surgical debridement, antibiotic therapy and stimulation with thrombocytic growth factors].
Despite the availability of various topical agents and of new technics for surgical correction, venous stasis ulcers are still characterized by high recurrent rates. Experimental data from wound healing studies demonstrate stimulation of wound healing after topical application of various growth factors (TGF beta, PDGF, EGF). The results of clinical studies suggest that topical use of an autologous platelet releasate (PDWHF) containing various growth factors accelerates healing. In this prospective study the stimulating effect of autologous PDWHF on epithelialization of small ulcers (group A, < 5000 mm2) and granulation of large ulcers before mesh grafting (> 5000 mm2) will be demonstrated. Inclusion criteria were the venous aetiology of the ulcer and the failure of conventional therapy for 6 month. Exclusion criteria were arterial occlusive disease, diabetes mellitus, acute wound infection, thrombocytopenia and pregnancy. There were 24 patients with 36 ulcers, caused by postthrombotic syndrome in one-third of cases and in two-thirds by severe insufficiency of the perforating veins. The ulcer had been present for more than in 10 years in 38% of cases, while there were 6 circumferential ulcers. The overall ulcer healing rate was 77% after a mean of 14 weeks. In group A 78% of the patients were healed after a mean of 16 weeks. In group B the mesh graft procedure was successful in 90% of the patients after a mean of 13 weeks. Compared with other conventional therapy studies, we achieved a higher healing rate. PDWHF seems to create ideal granulation tissue for mesh graft, indicated by a high uptake of the skin grafts.(ABSTRACT TRUNCATED AT 250 WORDS)