Etiological classification of venous ulcer, a strategy for its management

The venous ulcer (VU) is a very frequent evolution and complication of the chronic venous disease (CVD). There are a lot of publications about its pathophysiology, treatments and diagnosis. In a database search about VU classification, we found the results around the CEAP system and no other. Based on the mechanism surrounding the genesis of VU and our clinical experience, we propose a classification or surname, which at the same time allows a description of the causes of VU and guides us to treatment. We propose the following “sure names” or types for the venous ulcers: 1) by reflux (superficial, deep or perforators); 2) by obstruction (intrinsic or extrinsic); 3) by pump malfunction (ankle, muscle, articular, etc.); 4) mixed (venous and not only arterial but vasculitis, neuropathic, autoimmune, etc.). Each point is attended on their causes and importance in the genesis of VU and some considerations and bibliographical references about the treatment. There is no doubt about the utility of compression therapy and is comment too. As examples of the utility of the proposed classification for the VU could be mentioned that a venous ulcer produced by great saphenous reflux and perforator could be named as “venous ulcer by reflux” and direct the treatment towards controlling the leak points with the technique preferred by the treating physician. Some authors include the VSSS score as complement of CEAP classification, but we need a physiopathology classification that allows the doctor and the patient to have a better understanding of the cause of the venous ulcer and its treatment. For this reason, we recommend this tool as classification or “surname” to organize and guide the treatment of venous ulcer.