Venous Ulcers

Robin Lenz and Fahad Hussain's picture

By Dr. Lenz and Dr. Hussain

Heel pressure injuries and various forms of ulcers are easy to identify, but are you overlooking sleeping position as a cause for wounds in other locations? Do you have a wound you are sure is venous but has normal venous insufficiency testing results and fails to respond to compression? Can pressure while sleeping slow or stop healing in your patients with venous and arterial wounds? Do you ask patients about their sleeping position in your history taking and physical examination? After reading this article, you will be able to ask patients about their sleeping habits and heal more wounds with that knowledge

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By the WoundSource Editors

Moist wound healing is the current cost-effective, evidence-based modality to achieve faster wound healing rates and decreased pain and infection. As part of the wound healing process, acute wounds produce reparative exudates consisting of growth factors to support extracellular matrix production; in contrast, chronic wounds contain inflammatory-producing exudates studded with cytokines and proteases that may help maintain the inflammatory phase but can exert destructive effects on the fragile wound bed and may extend to the periwound surface.

Liping Tang's picture

By Liping Tang, PhD

Infection is the single most likely cause of delayed healing in chronic wounds. In most cases, identification of chronic wound infection (e.g., diabetic foot ulcers and venous leg ulcers) is not obvious because chronic wounds do not exhibit the same classic inflammatory signs of infection as those found in acute wounds. More arduously, those common signs of infection—pain, erythema, heat, and purulent exudate— vary as we age and occur differently in those with underlying diseases or weakened immune systems. Diagnosis is generally based on the doctors’ experience and could be confirmed with microbiological culture of tissue biopsy. However, culture could take a few days, and the results may not always be reliable because of sampling error. A fast and accurate diagnosis of wound infection would relieve the patient of significant discomfort and improve the treatment outcome.

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Holly Hovan MSN, GERO-BC, APRN, CWOCN-A

Predominant pain pattern, ulcer location, ulcer appearance, type and amount of wound exudate, and vascular and sensorimotor assessment are some key factors used to determine the primary etiology of lower extremity ulcers.

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By Holly Hovan MSN, GERO-BC, APRN, CWOCN-AP

Lower extremity wounds manifest in a multitude of ways, with numerous causative or trigger factors. These types of wounds are often costly to treat, are frequently refractory, and have a high risk for recurrence. A comprehensive assessment and an evidence-based treatment plan, along with ongoing patient education and routine follow-up, are essential components of an effective plan of care.

WoundSource Practice Accelerator's picture

Arteriography: Also called angiography, this technique is the medical imaging of blood vessels to look for aneurysm and stenosis.

Hemosiderin staining: Hemosiderin staining results in a red, ruddy appearance on the lower leg and ankle. This appearance is caused when red blood cells are broken down and not removed adequately as a result of venous insufficiency or another medical condition.

Phlebectomy: A minimally invasive procedure (usually outpatient) to remove varicose veins located near the surface of the skin.

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WoundSource Practice Accelerator's picture

Approximately 2.5 million Americans are diagnosed with chronic venous insufficiency, and approximately 20% will go on to develop venous leg ulcerations. Chronic venous leg ulcers (VLUs) account for 90% of all chronic ulcers of the lower limb region. Wound chronicity takes place in wounds that are stalled and/or remain unhealed after four to six weeks. Although evidence-based care has been established, it has been reported that 30% of patients still experience delayed healing, with wounds often failing to heal within a 24-week time frame. Identifying risk factors for VLUs is imperative in best outcomes.

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WoundSource Practice Accelerator's picture

Venous leg ulcers can be slow to heal; the longer a wound is present, the less likely it is to heal. To move a venous leg ulcer through the phases of wound healing may require more than just basic wound care.

Chronic venous leg ulcers can be prone to chronic inflammation. Changes in the microcirculation down to the capillary level can elevate levels of cytokines and proteases, thus leaving the wound stuck in the inflammatory cycle. Controlling, reducing, or eliminating inflammation is necessary to move the wound toward closure.

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WoundSource Practice Accelerator's picture

Of all the types of chronic wounds in lower extremities, venous leg ulcers are the most common, and they account for up to 70% of lower leg ulcers. Infection is a common complication in these wounds, however, and may contribute to chronicity. Biofilm is another common complicating factor. Preventing infection, removing unhealthy tissue from the wound, providing dressings that manage exudate, and using advanced modalities can help heal these chronic wound types and prevent a recurrence.

WoundSource Practice Accelerator's picture

Hard-to-heal venous leg ulcers (VLUs) comprise the most common type of leg ulcer and impose a major economic burden on the health care system. These wounds can be difficult to heal, and they often experience recurrence within three months of closure, thus further complicating treatment. When managing VLUs, it is important to select strategies that are evidence based and cost-effective. Early diagnosis and implementation of interventions can encourage best outcomes.

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