Inflammatory and Genetic Mechanisms Underlying Chronic Venous Ulcer Healing: Translational Insights from a CEAP 6 Limb Salvage Case

Abstract

Background: Chronic venous disease, particularly in CEAP stage 6 (active venous ulcers), represents a significant therapeutic challenge with a high risk of amputation, especially in patients with comorbidities such as diabetes and a history of contralateral amputation. Objective: Analyze the comprehensive clinical and surgical approach applied for the successful salvage of a lower limb, which was initially considered non-viable, in a patient with a history of contralateral amputation due to chronic venous insufficiency with advanced ulceration, highlighting the importance of multidisciplinary management. Method: A descriptive, retrospective case study was conducted on a 67-year-old woman with type 2 diabetes and a bilateral venous ulcer classified as CEAP 6. Following initial right supracondylar amputation, a salvage strategy was chosen for the left limb. Management included surgical debridement, antibiotics targeted by culture to Staphylococcus aureus, radiofrequency ablation of the great saphenous vein, and a distal endovascular technique, followed by an advanced wound care regimen with bacteriostatic and hydrocolloid dressings. Results: Despite the initial indication for bilateral amputation, the left lower limb showed favorable progression. Surgical management and advanced wound therapy led to bone exposure coverage and complete re-epithelialization of the ulcer within three months of outpatient follow-up. Conclusions: The successful salvage of the lower limb in this case underscores that CEAP 6 chronic venous insufficiency, even in high-risk scenarios such as a history of contralateral amputation, can be effectively treated through early diagnosis with venous Doppler ultrasound and a combined therapeutic strategy that includes venous and arterial intervention, strict control of comorbidities, and a rigorous regimen of advanced wound care.