Chronic Venous Insufficiency

Christine Miller's picture

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.

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.

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.