Current knowledge on venous and lymphatic ulcers. A systematic review on evidence-based medicine

INTRODUCTION: Venous leg ulcer (VLU) and lymphatic leg ulcer (LLU) are often encountered in clinical practice, especially in the elderly and they have many important negative consequences on the health status and on the quality of life. Both venous and lymphatic ulcers can be manifested similar aspects, as there is a close anatomical and functional relation between veins and superficial lymphatics that work together to maintain fluid balance in the body. Aim of this review is to explore the common pathophysiological and therapeutic implications in these conditions. EVIDENCE ACQUISITION: We planned to include all the studies dealing with CLUs and LLUs. We excluded all the studies, which did not properly fit our research question, and with insufficient data. EVIDENCE SYNTHESIS: Of the 330 records found, after removing of duplicates, and after records excluded in title and abstract, 54 matched our inclusion criteria. After reading the full-text articles, we decided to exclude 19 articles because of the following reasons: 1) not responding properly to our research questions; 2) insufficient data; the final set included 35 articles. CONCLUSIONS: The abnormalities in the venous and lymphatic system are strictly related, in fact, in advanced chronic venous insufficiency the skin becomes inelastic, stretched, and ischemic with the onset of skin ulceration. On the other side, in lymphedema patients, as long as venous function is preserved, skin ulceration does not occur. Interestingly, impaired lymphatic function is often associated with chronic venous hypertension in severe CVI and in VLU. Actually, compression therapy acting contemporarily on both systems represent the gold standard for the management of skin ulceration.