LOCAL TREATMENT OF VENOUS ULCERS WITH TISSUE-TYPE PLASMINOGEN-ACTIVATOR CONTAINING OINTMENT

Background: The pathogenesis of venous leg ulcers is still not known. One hypothesis states that pericapillary fibrin cuffs might play an im portant role. These fibrin cuffs might nor be broken down because of a n inadequate fibrinolytic activity. Patients and Methods: To stimulate fibrinolysis, tissue type plasminogen activator (t-PA) containing oin tment was applied over 12 weeks on chronic venous leg ulcers of six pa tients. Three of the six ulcers healed within this period. Biopsy spec imens for immunofluorescence studies were taken from the ulcer base an d margin before and at the end of treatment and if the ulcer had heale d, from the healed area. Results: Deposition of pericapillary fibrin w as seen around the capillaries of all investigated ulcers at the start of the study. Pericapillary fibrin was still present with nearly undi minished intensity at the end of the study even though 3 of the ulcers healed. Conclusion: It is most likely that the healing of these ulcer s was not improved by the fibrinolytic activity of t-PA, but caused by other wound healing properties of t-PA.