Dermal substitutes in the treatment of venous ulcers

Venous ulcers are the most common ulcerative lesions of the lower limbs and represent a major clinical challenge, particularly in the geriatric population. Chronic cutaneous ulcers are frequently associated with cardiovascular and metabolic comorbidities, which impair tissue repair and prolong healing. Pain is the predominant symptom, resulting from exposure of deeper epithelial layers to inflammatory and irritative processes. Diagnosis relies on clinical evaluation, venous colour Doppler ultrasonography, and laboratory investigations. Treatment is guided by ulcer aetiology and includes compression therapy, advanced wound dressings, surgical debridement, negative pressure wound therapy, and dermal substitutes.

Because the extracellular matrix plays a dynamic role in tissue regeneration, therapeutic strategies emphasise wound bed preparation and acellular dermal matrices. These biomaterials provide a non-immunogenic scaffold that supports cell migration while avoiding donor-site morbidity. In a retrospective observational study of 62 patients with chronic cutaneous ulcers, predominantly venous, an integrated therapeutic approach combining surgery, selective debridement, and regenerative biomaterials resulted in clinical improvement in 71.29% of patients. Dermal substitutes were associated with a marked reduction in postoperative pain, with NRS scores decreasing from 6-7 to 0-3 overall.