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2017 ; 5
(2
): 280-292
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Vasculitic and autoimmune wounds
#MMPMID28214498
Shanmugam VK
; Angra D
; Rahimi H
; McNish S
J Vasc Surg Venous Lymphat Disord
2017[Mar]; 5
(2
): 280-292
PMID28214498
show ga
OBJECTIVE: Chronic wounds are a major cause of morbidity and mortality.
Approximately 20% to 23% of nonhealing wounds that are refractory to vascular
intervention have other causes, including vasculitis, pyoderma gangrenosum, and
other autoimmune diseases. The purpose of this article was to review the
literature across medical and surgical specialties with regard to refractory
chronic wounds associated with vasculitis and autoimmune diseases and to
delineate clinical outcomes of these wounds in response to vascular and other
interventions. METHODS: An electronic search encompassing MEDLINE, PubMed,
Cochrane Library, and Scopus was completed using the following search terms:
rheumatoid arthritis; systemic sclerosis; systemic lupus erythematosus;
antineutrophil cytoplasmic antibody-associated vasculitis; mixed connective
tissue disease; antiphospholipid syndrome; pyoderma gangrenosum; thromboangiitis
obliterans; cryoglobulinemia; hydroxyurea; sickle cell; atrophie blanche;
livedoid vasculitis; cholesterol emboli; calciphylaxis; antiphospholipid
antibodies; prothrombotic; combined with the terms: chronic wound and leg ulcer.
Full-text articles published in English up to March 1, 2016, that investigated
the clinical outcomes of chronic wounds associated with autoimmune diseases were
included. Review articles and evaluations of management of chronic wounds were
also reviewed. Primary outcomes included in the review were amputation, ulcer
healing, reduction in wound size, overall survival, and freedom from
reintervention. Owing to the heterogeneity of data reporting among articles,
qualitative analysis is also reported. RESULTS: Vasculitis and autoimmune
diseases play a role in 20% to 23% of patients with chronic lower extremity
ulcers. Furthermore, patients with autoimmune disease have a significantly high
rate of split thickness skin graft failure (50% compared to 97% in patients
without autoimmune disease; P = .0002). The management of leg ulcers associated
with autoimmune diseases is discussed. CONCLUSIONS: Autoimmune and vasculitic
causes should be considered in patients with chronic wounds who do not respond to
appropriate vascular intervention and standard local wound care. A
multidisciplinary approach with the involvement of rheumatologists allows
investigation for underlying systemic disease and improves clinical outcomes for
many of these challenging patients.
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