Healing rate and bacterial necrotizing vasculitis in venous leg ulcers

Morbidity associated with venous leg ulcers is important in the elderly. The biological processes involved during attempts at healing are much more complex than in most models of experimental wounds. In addition, there is still controversy on deleterious effects elicited by both microorganisms and antiseptics on cells involved in the healing process. Using histology, immunohistochemistry and iterative computerized planimetry, we evaluated the bacterial load, the inflammatory aspects and the healing rate of leg ulcers present in 15 eligible women aged from 57 to 73 years. Each patient had at least 2 chronic ulcers treated with hydrocolloid dressing alone or in combination with daily applications of povidone-iodine solution (PVP-I). The weekly reduction in wound area was superior for hydrocolloid+PVP-I treatment than in hydrocolloid-treated ulcers. After a 4-week treatment, hydrocolloid-treated ulcers contained clumps of microorganisms and showed massive infiltration by phagocytes including Mac 387+ and factor XIIIa+ cells. Leukocytoclastic vasculitis was present as well. These features were less pronounced in ulcers treated with hydrocolloid+PVP-I. In sum, a broad-spectrum antimicrobial such as PVP-I may be beneficial in reducing deleterious bacteria-related inflammation. As a result, the healing rate leg ulcers is enhanced.