Novel Surgical Approach for Wound Closure of Large Livedoid Vasculopathy Wounds: A Case Series

Livedoid vasculopathy (LV) is a rare, thrombotic disorder of the dermal capillaries characterized by recurrent, painful ulcerations in the lower extremities. Diagnosis is challenging and typically based on clinical presentation and distinct histopathologic features. Although systemic anticoagulation often leads to ulcer resolution, large, nonhealing wounds may require surgical intervention. In such cases, split-thickness skin grafting (STSG) may be considered. However, LV's prothrombotic pathogenesis can threaten graft viability in the immediate postoperative period. Thus, perioperative anticoagulation may play a critical role in graft success.

The authors describe a case series involving 3 patients with LV who underwent inpatient surgical debridement, initiation of an intravenous heparin protocol, and negative pressure wound therapy (NPWT) for 72 hours. Following reassessment of the wound bed, intravenous heparin was temporarily discontinued to allow for STSG. NPWT was resumed postoperatively, and intravenouseparin was reinitiated for an additional 72 hours to support graft take.

In 2 patients, prior STSG attempts failed in the absence of perioperative anticoagulation. Following implementation of the standardized protocol, all 3 patients achieved successful graft take and complete closure at 6 months. No anticoagulation-related complications were observed.

This case series demonstrates that a standardized perioperative heparin protocol may improve STSG outcomes in patients with LV by mitigating microvascular thrombosis during a critical window of graft adherence. Larger prospective studies are warranted to examine the relationship between perioperative intravenous anticoagulation and STSG success in patients with LV.