Venous Ulcers

Holly Hovan's picture

Holly Hovan MSN, APRN, RN-BC, CWOCN-AP

Identifying wound etiology before initiating topical treatment is important. Additionally, correctly documenting wound etiology is significant in health care settings for many reasons. Accurate documentation and appropriate topical treatment are two critical components of a strong wound treatment plan and program. Bedside staff members should be comfortable with describing wounds, tissue types, and differentiating wound etiologies. Training should be provided by the certified wound care clinician, along with follow-up (chart reviews and documentation checks, one-on-one education as needed, and routine competency or education days). Additionally, the wound care clinician should be able to develop an appropriate treatment plan based on wound etiology, by involving additional disciplines as needed to best treat the whole patient.

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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

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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WoundSource Practice Accelerator's picture

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%.

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By the WoundSource Editors

The most common type of chronic lower extremity wound is the venous ulcer, affecting 1% to 3% of the U.S. population. Chronic venous ulcers significantly impact quality of life and are a financial burden for both the patient and the health care system. In the United States, 10% to 35% of adults have chronic venous insufficiency, and 4% of adults 65 years old or older have venous ulcers. Identifying signs of venous disease early on while implementing surgical intervention, if warranted, can increase healing outcomes and decrease the recurrence of venous ulcers. Treatment of venous ulcers can include exercise, leg elevation, dressings, advanced wound care such as cellular and tissue-based products, compression therapy, medications, venous ablation, and surgical intervention.

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By the WoundSource Editors

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.

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