Venous Ulcers

By: Karen Bauer, NP-C, CWS How often should ankle-brachial indexes (ABIs) be repeated? If someone has a stage 3 pressure injury to the top of the foot, should compression be held on that extremity? The Wound, Ostomy and Continence Nursing Society guidelines suggest ABIs every 3 months routinely, while the Society for Vascular Surgery guidelines recommend that post endovascular repair, ABIs are done at 6 and 12 months (then yearly). For open revascularization, surveillance studies can be at 3, 6, and 12 months. Ultimately, many factors play into this. If the ulcer is closing and the limb remains stable, you might forgo frequent ABIs, but if the ulcer is not closing, or the patient has new or persistent ischemic symptoms, you should check ABIs more frequently. As far as compression with a dorsal foot pressure injury is concerned, as long as arterial status has been ascertained, compression can be utilized. The original source of pressure should be removed (shoe? ankle-foot orthotic?). If there is a venous component, cautious compression will aid in ulcer resolution.

By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS Lower extremity venous insufficiency ulcers represent approximately 80% of the leg ulcers typically seen in wound care facilities. The following statistics help to bring home the seriousness and chronicity of this common health problem:

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.

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.

by Bruce E. Ruben MD Chronic venous insufficiency (CVI) refers to a long-term condition where the veins inside the legs have lost their ability to move blood back up to the heart from the legs. This occurs because the vein walls have weakened to the point where the venous pumps are no longer sufficient enough to send blood back up, against gravity, to the heart. CVI also affects the tiny valves inside the leg veins. When these valves do not close sufficiently, blood seeps back down past the valves and pools in the lower legs.

Chronic wounds of the lower extremities impose an increasing burden on health care providers and systems, and they can have a devastating impact on patients and their families. These wounds include diabetic ulcers, venous ulcers, arterial ulcers, and pressure injuries. The estimated socioeconomic cost of chronic wounds is 2% to 4% of the health budget in Western countries. Moreover, patient mortality in individuals with chronic wounds has been estimated at 28% over a two-year period, significantly higher than the 4% mortality rate reported for 75 to 79 year-olds without chronic wounds.

Vascular ulcers are wounds on the skin that form as the result of abnormal blood circulation in the body, including arterial and venous etiologies. Estimates suggest 3-5% of those over 65 in the United States have a vascular ulcer.

Venous ulcers are known to be complex and costly. There is an array of evidence-based treatment options available to help formulate a comprehensive treatment plan toward wound closure. Health care professionals should utilize treatment options while encompassing a holistic approach to venous ulcer management. Involving the patient and/or caregiver in developing a treatment plan will increase the chances of successful wound healing outcomes. Wound closure is the primary goal of a treatment plan; however, preventing recurrence and infection should be considered just as important.

by the WoundSource Editors Venous leg ulcers (VLUs) are difficult to treat, and when they are present a variety of complications may arise. These complications can be challenging to treat and may often contribute to the prolonged healing times resulting from chronicity found with many VLUs. Further, if the condition of the ulcer deteriorates, it may worsen any complication already present or serve as the catalyst for the development of complications.