Chronic Venous Insufficiency

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. Of those with peripheral arterial disease, approximately 20-70% have chronic wounds, according to data up to 2018. Since arterial ulcers may be underdiagnosed, certain experts theorize that the number of chronic wounds developed due to arterial insufficiency is higher in reality.

Emily Greenstein, APRN, CNP, CWON-AP, FACCWS
Dr. Terry Treadwell, MD, FACS

We all know that compression therapy is the “gold standard” for the treatment of venous leg ulcers. However, how do we know if we should apply compression, how much compression, and what type of compression?

Christine Miller, DPM, PhD

Chronic venous leg ulcerations (CVLUs) are one of the most common lower extremity wounds with a recurrence rate of as high as 70%. Among the wound care community, there is a common understanding that optimal healing requires the management of tissue, infection/inflammation, and moisture balance within the wound bed, along with appropriate compression therapy. It is also vital for patients with CVLUs to be evaluated by a multidisciplinary team. This evaluation includes a comprehensive vascular evaluation from both a venous and arterial standpoint. While there has been tremendous progress in treating venous insufficiency from a surgical perspective along with advanced wound healing techniques, CVLUs are still a major hurdle to overcome.

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.

by Tia Gray, PTA, CLT, CWT and Donald Thomas, PT, DPT, CLT-LANA, CWT

As lymphedema and wound care therapists at Penn Therapy & Fitness, we often see scenarios like those in the cases described in our abstract presented as a poster at the recent Symposium on Advanced Wound Care. Conditions such as lymphedema, chronic venous insufficiency, and phlebolymphedema that manifest in patients with wounds can lead to catastrophic and life-threatening skin breakdown (degradation). Complications of infections associated with lymphedema include cellulitis, lymphangitis, lymphadenitis, and ulcerations where protein-rich fluid provides a perfect medium for microbial growth.