Monday, February 6, 2023

Topical Treatment For Venous Stasis Ulcers

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Can Vascular Ulcers Be Cured

Venous Stasis Ulcer Treatment

In many cases, it’s possible to heal a vascular ulcer. However, the likelihood of healing the ulcer depends on how severe it has become, so early treatment of vascular ulcers is critical to a good outcome.

It’s also essential to address the underlying problem that caused the ulcer. Your provider will likely recommend not just care for the ulcer but also for underlying health problems you have. Some of their recommendations will involve lifestyle changes that will help reduce your risk of another ulcer. The changes should also help improve your quality of life overall.

Causes Of Venous Ulcers

When the walls or valves of the veins are weak or dont work properly, blood in the veins can flow backwards and pool in your legs. Valve problems can result from vein disorders such as chronic venous insufficiency or deep vein thrombosis .

Veins have valves inside them that normally keep blood from flowing backwards. The valves are especially important in the legs, because gravity pulls the blood down toward the feet, making it more difficult for it to flow toward the heart.

CVI is an ongoing condition in which the walls or the valves of the veins dont work properly. DVT is when blood clots form in deep veins, which can damage the valves. A small number of people are also born without valves in their veins, which can also cause blood to flow backwards in the veins.

Pooling of the blood increases the pressure in the legs, which prevents oxygen and nutrients from getting to the tissue. This causes damage to the nearby tissue and forms a wound. Damage to the vein walls may also cause the release of compounds that damage the tissue even more.

Cleaning And Dressing The Ulcer

The first step is to remove any debris or dead tissue from the ulcer, wash and dry it, and apply an appropriate dressing. This provides the best conditions for the ulcer to heal.

A simple non-sticky dressing will be used to dress your ulcer. This usually needs to be changed 1 to 3 times a week.

Many people find they can manage cleaning and dressing their own ulcer under the supervision of a nurse.

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Compression Treatment Of Leg Ulcers: A Systematic Review

To estimate the clinical and cost effectiveness of compression systems for treating venous leg ulcers, 19 electronic databases including Medline, CINAHL, Embase, relevant journals, and conference proceedings included 24 randomised controlled trials which demonstrated that compression systems improve healing of venous leg ulcers and should be routinely used in uncomplicated venous ulcers. High compression is more effective than low compression, but should only be used in the absence of significant arterial disease. There are no clear differences in the effectiveness of different types of compression systems have been shown. Intermittent pneumatic compression appears to be a useful adjunct to bandaging. Rather than advocate one particular system, the increased use of any correctly applied high compression treatment should be performed. Compression bandages and stockings in the treatment of venous leg ulcers as reviewed by Cochrane Wounds Review Group, demonstrated that multilayer high compression bandages were significantly more effective than a single layer bandage. The direct comparisons of the healing rates were described in the two observational studies as 40% in 12 weeks and 42% of people attending a leg ulcer clinic. The limitations for use of four layer bandaging in a community clinic include the fact that some people are unable to leave their home due to immobility and cannot tolerate or do not like the treatment.

Swelling In The Legs And Ankles

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Venous leg ulcers are often accompanied by swelling of your feet and ankles , which is caused by fluid. This can be controlled by compression bandages.

Keeping your leg elevated whenever possible, ideally with your toes above your hips, will also help ease swelling.

You should put a suitcase, sofa cushion or foam wedge under the bottom of your mattress to help keep your legs raised while you sleep.

You should also keep as active as possible and aim to continue with your normal activities.

Regular exercise, such as a daily walk, will help reduce leg swelling.

But you should avoid sitting or standing still with your feet down. You should elevate your feet at least every hour.

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Enhancing Healthcare Team Outcomes

VLUs remain an unmet clinical need. Numerous guidelines showcase that a consensus between different specialties from various countries has not been reached. Despite this, there have been some attempts at analyzing the quality and consistency of the published literature. These efforts also demonstrate that an interprofessional team approach is fundamental for a thorough evaluation and treatment strategy. Primary prevention is one crucial strategy in which nurses and general practitioners should be actively participating.

Patients with limb-threatening disease, severe infections, who are unable to care for themselves should be immediately admitted to the hospital for advanced management and vascular surgery consultation. Mild to moderate cases can be treated in ambulatory wound care facilities. Physiotherapists should also participate in the treatment plan, as a systematic review and meta-analysis demonstrated improved healing with both aerobic and anaerobic activity .

Finally, nutrition specialists can help malnourished and overweight patients with specific guidance on how to improve their overall health, although weight management outcomes remain unclear for VLUs healing.

Contributed by Adriana del Carmen Rodriguez-Mena, MD

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How Can These Ulcers Be Prevented

Once an ulcer has developed, statistics show that another one will develop within 3-5 years. You know that preventing ulcers is well worth the effort if you have experienced the pain and frustration associated with healing wounds. Many patients will continue to wear some type of compression stocking every day while they are on their feet to help the circulation. While a Venous Stasis ulcer may have healed the poor circulation which caused the ulcer has not been corrected. Use AMERIGEL Care Lotion on your lower legs, particularly around the ankles daily. This helps the skin retain its natural moisture, promoting healthier skin that is less prone to problems.

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AMERX®, AMERIGEL®, HELIX3®, EXTREMIT-EASE®, Where Compression Meets Compliance®, Turn-Key DME®, and Oakin®, are registered trademarks of AMERX Health Care Corporation.

AMERX®, AMERIGEL®, HELIX3®, EXTREMIT-EASE®, Where Compression Meets Compliance®, Turn-Key DME®, and Oakin®, are registered trademarks of AMERX Health Care Corporation.

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What Are The Risk Factors For Venous Stasis Dermatitis

Several conditions may put you at higher risk for stasis dermatitis. One risk factor is getting older. Other risk factors include:

  • Not exercising enough.
  • Red, scaly or thick patches.
  • Tender or painful areas.

When you dont get treatment, venous stasis dermatitis can also cause leg and foot ulcers. Sometimes, an infection called cellulitis may develop.

Recognizing And Treating Venous Stasis Ulcers

Venous Stasis Ulcer Treatment | Wound Care OC

Yvette C. Terrie, BS Pharm, RPhClinical Pharmacist/Freelance Medical WriterHaymarket, Virginia

US Pharm. 2017 42:36-39.

ABSTRACT: Venous ulcers, also referred to as venous stasis ulcers , are the most common cause of ulcerations that affect the lower extremities. These types of ulcers are experienced by an estimated 1% of the U.S. population. The incidence of VSUs is most prevalent among the elderly population and is also ubiquitous in patients with a medical history of edema in the legs, long-standing varicose veins, or blood clots in either the superficial or the deep veins of the legs. VSUs generally occur in the lower extremities, especially along the medial distal ankle. In general, treatments for VSUs include compression therapy, local wound care and debridement, various types of wound dressings, antibiotics for infected wounds, the use of pharmacologic agents such as pentoxifylline, aspirin, calcium channel blockers, and topical corticosteroids when warranted, as well as surgery and other forms of adjunctive therapy.

Venous ulcers, also referred to as venous stasis ulcers , are perceived to be the most common cause of ulcerations affecting the lower extremities and can be severe and debilitating in nature.1-3 VSUs affect an estimated 1% of the U.S. population and are responsible for more than 80% of lower extremity ulcerations.1-3 Statistics also report that an estimated 2.5% of patients admitted to long-term care facilities have VSUs.4

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How Is A Vascular Ulcer Diagnosed

A healthcare provider can quickly diagnose a vascular ulcer by examining it. They will look closely at the ulcer and may feel the area around it, checking for specific symptoms.

However, your provider will also want to diagnose whatever caused the ulcer. Parts of their examination of the wound will help them do this, but they will also order certain tests to help them fully understand the cause, mainly because vascular ulcers can have multiple causes and many of those causes can be connected.

Elevation Of The Legs

The legs should be placed in an elevated position, ideally at 30 degrees to the heart, while lying down. This, again, helps in the movement of venous blood to the heart.This also prevents the build-up of liquid in the legs that leads to swelling. A cushion or any other object of comfort can be used to keep the toes above the level of the hip while sleeping.

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A Comparison Of The Efficacy And Cost Of Different Venous Leg Ulcer Dressings: A Retrospective Cohort Study

1North Cumbria University Hospitals NHS Trust, Cumberland Infirmary, Newtown Road, Carlisle, Cumbria CA2 7HY, UK

Abstract

Objective. To compare the efficacy and cost-effectiveness of simple nonadherent dressings with other more expensive dressing types in the treatment of venous leg ulcers. Study Design. Retrospective cohort study. Location. The leg ulcer clinic at the University Hospital of South Manchester. Subjects and Methods. The healing rates of twelve leg ulcer patients treated with simple nonadherent dressings were compared with an equal number of patients treated with modern dressings to determine differences in healing rates and cost. Main Outcome Measures. Rate of healing as determined by reduction in ulcer area over a specified period of time and total cost of dressing per patient. Results. Simple nonadherent dressings had a mean healing rate of 0.353cm2/week compared with a mean of 0.415cm2/week for more expensive dressings. This resulted in a one-tailed value of 0.251 and a two-tailed value of 0.508. Multiple regression analysis gave a significance of 0.8134. . The results indicate that the difference in healing rate between simple and modern dressings is not statistically significant. Therefore, the cost of dressing type should be an important factor influencing dressing selection.

1. Introduction

2.2. Alternative Hypothesis

What Causes A Stasis Ulcer

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Stasis ulcers are a complication of venous insufficiency, which is a health condition that affects the veins. Healthy vein valves normally help blood return to the heart, but the vein valves in people with venous insufficiency are damaged or weakened. This can lead to blood pooling in the legs instead of flowing back toward the heart. The resulting fluid buildup beneath the skin can damage the skin layer, causing a stasis ulcer to develop.

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What Causes Venous Ulcers

Your veins contain tiny valves that keep blood circulating throughout your body. These valves snap open and shut to move blood against the force of gravity back to your heart. In some people, venous diseases affect valve functioning. Other medical conditions, like diabetes, can also put you at risk for leg and foot ulcers.

F Grading The Evidence For Each Key Question

At the completion of our review, at least two reviewers will independently assign evidence grades. Conflicts will be resolved through consensus or third-party adjudication. We will grade the strength of evidence based on the quantity, quality, and consistency of the best available evidence, addressing KQs 1, 2, and 3 by adapting an evidence grading scheme recommended in the Methods Guide.13 We will apply evidence grades to the bodies of evidence about each intervention comparison for each outcome. We will assess the risk of bias of individual studies according to study design characteristics, such as confounding and selection and information biases. We will assess the strength of the best available evidence by assessing the limitations to individual study quality , consistency, directness, precision, publication bias, and the magnitude of the effect.

We will classify evidence pertaining to the KQs into four basic categories: 1) high grade 2) moderate grade 3) low grade and 4) insufficient grade .

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Treatment Of Arterial Ulcers

The most important aim in the treatment of arterial ulcers is to increase the blood supply to the affected area. The patient must stop smoking and diabetes or hypertension should be well controlled. Regular graded exercises should be encouraged to promote development of collateral circulation. Pressure areas may be protected by sheepskin or a special cushion with bony prominences, for example heel, malleoli, etc, being the vulnerable areas for leg ulcers. The head of the patient’s bed should be raised by 46 inches to encourage gravity dependent arterial flow and the limbs should be kept warm. Regular use of analgesics should be encouraged for the relief of pain, but if rest pain or acute infection is present, the patient should be referred to a vascular surgeon. Arterial reconstruction surgery may be performed to salvage the limb. After angiographic studies, endarterectomy to remove the clot or atheromatous plaques and/or reconstruction to bypass occluded artery may be performed. Balloon angioplasty may be the intervention of choice for ischaemic rest pain, ulceration, and gangrene of the leg. If angioplasty fails, femoropopliteal bypass graft may be tried. Cellulitis with or without lymphangitis needs to be treated with systemic antibiotics.

Stasis Dermatitis And Ulcers

Treating Venous Leg Ulcers

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What is stasis dermatitis?

Stasis dermatitis is skin inflammation that develops in people with poor circulation. It most often occurs in the lower legs because thats where blood typically collects.

When blood collects or pools in the veins of your lower legs, the pressure on the veins increases. The increased pressure damages your capillaries, which are very small blood vessels. This allows proteins to leak into your tissues. This leakage leads to a buildup of blood cells, fluid, and proteins, and that buildup causes your legs to swell. This swelling is called peripheral edema.

People with stasis dermatitis usually experience swollen legs and feet, open sores, or itchy and reddish skin.

One theory is that a protein called fibrinogen may be responsible for the changes you see in your skin. When fibrinogen leaks into your tissues, your body converts it to the active form of the protein, which is called fibrin. As it leaks out, the fibrin surrounds your capillaries, forming what are known as fibrin cuffs. These fibrin cuffs may prevent oxygen from entering your tissues. And when your cells dont receive enough oxygen, they can become damaged and die.

The symptoms of stasis dermatitis include:

  • skin discoloration

You may also experience symptoms of venous insufficiency, including:

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Treatment Of Varicose Ulcers

Varicose ulcers or venous ulcers are usually treated using compression therapy. Compression therapy in wound care usually includes using compression bandages to help increase venous return in decrease venous hypertension. Dressings can be used to manage the wound and provide symptom control.

  • Alginate Dressings Alginate dressings are a great option while treating venous ulcers as they provide a great moist wound healing environment and allow the wound to heal faster. Since they are made from natural seaweed, they can be easily used as packing material within the wound, which can then be covered by a bandage.
  • Compression Bandages Compression bandages are the cornerstone of any venous ulcer treatment. Once a dressing is applied to the wound, one can cover the wound with compression bandages that not only keep the dressing in place but act on the veins around the ulcer to expedite the healing process.

Prompt Proper Care Will Help Reduce Complications And Improve Quality Of Life

Venous ulcers are the most common lower extremity wounds in the United States. Patients experience poor quality of life as a result of pain and immobility, and they require advanced levels of wound care. Any delay in care increases the risk of infection, sepsis, amputation, skin cancers, and death. Patients who develop complications may require frequent care visits, dressing changes, and recurrent hospitalizations. In addition, they may experience loss of productivity, significant discomfort, or disability.

Many patients with venous ulcers struggle with adherence to rigorous treatment regimens, and the COVID-19 pandemic has added to that challenge because of treatment delays. For example, risk of complications increases when venous reflux goes undertreated or untreated, increasing the incidence of venous ulcers, which can be costly for the healthcare system and detrimental to patients lives.

Targeted nursing education is essential to improve the assessment and management of venous leg ulcers. In addition, empowering patients to care for themselves can help bridge care gaps.

Pandemic impact on wound care

A multidisciplinary approach in collaboration with a wound care center is the most beneficial for addressing wound care. However, during the height of the pandemic, the availability of expert care from a wound center was limited. The situation has eased in some geographic regions, but remains problematic in others.

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What Are Venous Stasis Ulcers

Affecting roughly 1 percent of the U.S. population, venous ulcers, also known as venous stasis ulcers, are open wounds usually found around the ankles and lower legs. This type of wound usually takes time to heal, sometimes taking weeks, months, or even longer in some occasions.

Venous ulcers are caused by poor blood circulation from the lower legs which leads to a backup of fluid. The veins have one-way valves that allow blood to flow toward the heart. For someone suffering from venous insufficiency, the valves get damaged causing blood to back up and pool in the vein. When this happens, fluid may leak out of the vein and into the surrounding tissue which can then lead to tissue breakdown and ulcer.

This type of ulcer is common in people who have varicose veins as well as those who have a history of leg swelling.

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