Chronic cutaneous ulcerations and impaired healing in human skin

Chronic skin ulcers, which are frequently located on the lower legs, are a common cause of patient morbidity and incur significant direct and indirect costs in their treatment. The most important process for their development is probably impairment of blood flow to the capillaries and small vessels. Examples of such ulcers are illustrated and some of their causes discussed. The milieu in which chronic skin ulcers develop is usually very different from those conditions in which biosynthetic dressings have been more extensively tested; nonetheless, the use of these dressings to treat such lesions is currently being evaluated. The successful treatment of chronic skin ulcers rests on four basic principles: (1) treatment of pathogenetic mechanisms, (2) correction of physiologic alterations, (3) treatment of contributing factors, such as infection, and (4) additional treatment to promote healing. The use of biosynthetic dressings on chronic skin lesions appears to result in a more rapid epithelialization and a reduction of pain, thereby satisfying the fourth principle. The management of the other principles, as well, is necessary to achieve a maximal rate of healing with chronic skin ulcers.