Venous Ulcers

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By Samantha Kuplicki, MSN, APRN-CNS, AGCNS-BC, CWCN-AP, CWS, RNFA

Should pain management interventions be put in place before debriding a venous ulcer?

Without question, yes. Any comprehensive wound treatment plan must include a thorough pain assessment, accounting for cyclical and non-cyclical pain sources. This will best guide interventions based on patient’s unique history, which can potentially include complicating factors such as complex personal pain management secondary to chronic pain, inability to tolerate specific interventions because of existing comorbid conditions, limited financial or social resources, etc. Multimodal pain management is standard of care, using the least invasive options and beginning pharmacologic therapy with the lowest necessary dosage possible.

Temple University School of Podiatric Medicine's picture

By Temple University School of Podiatric Medicine Journal Review Club

Venous leg ulcerations (VLUs) are a common and often chronic pathology, and these wounds diminish the quality of life and increase the financial burden for affected patients. A recent article estimates that up to 3% of the U.S. population suffer from VLUs. A venous leg ulcer can be severely painful and may decrease a patient’s quality of life by affecting sleep, mobility, activities of daily living, and even result in social isolation. A 1994 paper proposed that approximately 65% of patients felt financially affected by a VLU, and this number is likely to have increased as a result of rising healthcare costs. The prevalence and chronic nature of the venous leg ulceration has motivated physicians to research novel techniques to heal ulcers successfully and in a timely manner.
Acellular dermal matrices have been utilized to treat diabetic foot ulcers with favorable outcomes.4 This study investigated the efficacy of a specific acellular dermal matrix for VLUs.

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By the WoundSource Editors

Collateral circulation: A collateral blood vessel circuit that may be adapted or remodeled to minimize the use of occluded arteries. Collateralization may offset some of the physiological signs of peripheral artery disease, such as maintaining a normal capillary refill.

Critical limb ischemia: A severe form of peripheral arterial disease in which a severe blockage of the arteries of the lower extremities reduces blood flow. It is a chronic condition that is often characterized by wounds of the lower extremity.

Dependent rubor: A light red to dusky-red coloration that is visible when the leg is in a dependent position (such as hanging off the edge of a table) but not when it is elevated above the heart. The presence of dependent rubor is often an indicator of underlying peripheral arterial disease. When the leg is raised above the level of the heart, its color will normalize.

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By the WoundSource Editors

Lower extremity wounds such as diabetic foot ulcers (DFUs), venous ulcers, and arterial ulcers have been linked to poor patient outcomes, such as patient mortality and recurrence of the wound. Although precise recurrence rates can be difficult to determine and can vary across different patient populations, we do know that the recurrence rates of lower extremity wounds are quite high.

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By the WoundSource Editors

Wounds of the lower extremity, such as chronic venous leg ulcers and diabetic foot ulcers, often have a severe impact on patients' quality of life. Symptoms may range from mild to debilitating, depending on the location of the injury and its severity. These types of wounds also affect a tremendous number of people because lower extremity wounds are estimated to occur in up to 13% of the United States population. The estimated annual cost of treating lower extremity wounds is at least $20 billion in the United States.

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By the WoundSource Editors

Chronic wounds pose an ongoing challenge for clinicians, and there needs to be a clearer understanding of the pathophysiology of wound chronicity and treatment modalities available.

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By the WoundSource Editors

Lower extremity ulcers, such as venous and arterial ulcers, can be complex and costly and can cause social distress. An estimated 1% of the adult population is affected by vascular wound types, and 3.6% of those affected are older than 65 years of age. Many factors contribute to lower extremity wound chronicity, including venous disease, arterial disease, neuropathy, and less common causes of metabolic disorders, hematological disorders, and infective diseases. A total of 15% to 20% of lower limb ulcers have a mixed etiology.

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By the WoundSource Editors

Before the mid-1990s, venous disorders and disease were classified almost solely on clinical appearance, which failed to achieve diagnostic precision or reproducible treatment results. In response to this, the American Venous Forum developed a classification system in 1994, which was revised in 2004. This classification system has gained widespread acceptance across the clinical and medical research communities, and most published papers now use all or part of the CEAP system (defined in the next section). This system was once again updated in 2020.

M. Mark Melin's picture
Phlebolymphedema

M. Mark Melin, MD, FACS, RPVI, FACCWS

Understanding that February is venous leg ulcer (VLU) month, we would be remiss to exclude a consideration of the critically important role played by the lymphatic system. As such, I want to highlight the work of Dr. Tom O'Donnell in a recent editorial written on this subject.

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By the WoundSource Editors

The venous leg ulcer (VLU) is the most common type of chronic leg wound, and it can be challenging to manage. VLUs account for up to 90% of all chronic leg ulcers. Proper diagnosis and treatment planning are key to wound healing outcomes. This fact is particularly true for older adults, who have an annual VLU prevalence of 1.7%.