Combined conservative hemodynamic treatment for venous insufficiency strategy and negative-pressure wound therapy for the management of a refractory venous ulcer: a case report and review of the literature

BACKGROUND: Chronic venous ulcers (CVUs), affecting 1-5% of adults, present significant management challenges due to delayed healing and high recurrence rates. Negative pressure wound therapy (NPWT) has emerged as a beneficial adjunct to compression therapy for refractory cases. CASE PRESENTATION: A 78-year-old Chinese female with a 30-year history of symptomatic bilateral varicose veins CEAP C6 (CEAP classification stands for Clinical (C), Etiological (E), Anatomical (A), and Pathophysiological (P)) presented with two recalcitrant venous ulcers (5 cm × 8 cm and 1 cm × 2 cm) on the right lateral malleolus. The ulcers were characterized by necrotic tissue, seropurulent exudate, and peri-wound hyperpigmentation. Previous treatment, including a skin graft, had failed. She was diagnosed with varicose vein C6, chronic venous ulcers, skin infection and anemia. A multimodal management strategy was implemented, comprising surgical correction of venous insufficiency using the CHIVA strategy, radical debridement, systemic antibiotics, NPWT, and sustained compression therapy. Serial documentation showed progressive wound closure. Her ulcers were completely healed on day 75 after initial treatment, with no recurrence on 11-month follow-up. No recurrence was observed at the 11-month follow-up. CONCLUSION: This case demonstrates that combining the CHIVA strategy with NPWT within a multidisciplinary care framework can effectively overcome healing barriers in complex, refractory CVUs. This approach addresses the underlying etiology while optimizing the local wound environment, leading to accelerated healing and prevention of recurrence.