News on chronic vascular wounds
Seance of wednesday 24 september 2025 (Le traitement des plaies chroniques des membres inférieurs)
DOI number : 10.26299/ny3h-tz32/emem.2025.39.01
Abstract
Chronic lower limb wounds affect 1% to 3% of the general population and 5% to 6% of hospitalized patients, according to various studies.
The vast majority of these wounds are of vascular origin and should not be considered a simple dermatological lesion. In 70% to 80% of cases, they are of primary or post-thrombotic venous origin. In 15% of cases, there is arterial involvement: these are mixed ulcers. In other cases, the etiology is primarily arterial and, in rare cases, capillaritic: necrotic angiodermatitis. According to HAS recommendations, a vascular assessment is required to look for a venous origin, and an ABI should be performed to look for arterial involvement. These examinations will always be supplemented by arterial and venous Doppler ultrasound examinations. Chronic wounds affect 2.5 million patients in France and cause discomfort and a reduced quality of life.
According to CNAM data, with a cost in excess of €272 million, 200,000 hospital stays, and 6.4 million days of sick leave, chronic wounds represent a real economic challenge.
Although guidelines have been published, management regarding diagnosis, local care, and the type of medical compression is not always followed due to lack of training or negligence.
Moderate and uncomplicated chronic wounds can be managed on an outpatient basis by an experienced physician-nursing team. Very old and complicated chronic wounds should be managed in referral centers with expertise, training, and multidisciplinary logistics, with patient education on hygiene and dietary guidelines. With an average healing time of 210 days, a 30-day reduction would result in savings of €66 million just by following the recommendations for multi-type medical compression, as a recent study showed.
The vast majority of these wounds are of vascular origin and should not be considered a simple dermatological lesion. In 70% to 80% of cases, they are of primary or post-thrombotic venous origin. In 15% of cases, there is arterial involvement: these are mixed ulcers. In other cases, the etiology is primarily arterial and, in rare cases, capillaritic: necrotic angiodermatitis. According to HAS recommendations, a vascular assessment is required to look for a venous origin, and an ABI should be performed to look for arterial involvement. These examinations will always be supplemented by arterial and venous Doppler ultrasound examinations. Chronic wounds affect 2.5 million patients in France and cause discomfort and a reduced quality of life.
According to CNAM data, with a cost in excess of €272 million, 200,000 hospital stays, and 6.4 million days of sick leave, chronic wounds represent a real economic challenge.
Although guidelines have been published, management regarding diagnosis, local care, and the type of medical compression is not always followed due to lack of training or negligence.
Moderate and uncomplicated chronic wounds can be managed on an outpatient basis by an experienced physician-nursing team. Very old and complicated chronic wounds should be managed in referral centers with expertise, training, and multidisciplinary logistics, with patient education on hygiene and dietary guidelines. With an average healing time of 210 days, a 30-day reduction would result in savings of €66 million just by following the recommendations for multi-type medical compression, as a recent study showed.