Adjuvant Therapies in Cutaneous Ulcers
摘要
Cutaneous ulcers include a wide spectrum of disorders, from leg ulcers due to chronic venous insufficiency to neoplastic processes. There are numerous options available regarding adjuvant therapies in cutaneous ulcers depending on the underlying pathology and may include a) pharmaceutical interventions, (b) surgical interventions, (c) topical agents, (d) the use of devices, and (e) other, such as physiotherapy and psychological treatments. Examples of pharmacological treatments used for treatment of cutaneous ulcers include pentoxifylline, iloprost, calcium antagonists, systemic corticosteroids, analgesics and other medications less often used such as NSAIDs, colchicine and antiplatelets. Surgical interventions are mainly used for the management of advanced cases of peripheral arterial disease, including open bypass and endovascular procedures, and closing with skin grafts or flaps hard-to-heal ulcers. Topical products in wound healing may be directed against the associated infections, such as use of antimicrobials. Other topical agents may be glyceryl trinitrate, zinc, phenytoin and retinoids. The use of specific devices in wound healing represents an ascending trend and include various procedures such as negative-pressure wound therapy, platelet-rich plasma (PRP) infiltrations of the cutaneous ulcer, hyperbaric oxygen therapy, radiant heat dressings, ultrasound therapy, laser therapy, hydrotherapy, electromagnetic therapy. Nonetheless, physiotherapy procedures may be required in cases of prolonged immobilization or after complex surgical interventions and impaired mobility and psychological treatments are used to alleviate stress to achieve a rapid and complete rehabilitation of the patient.