Venous Leg Ulcers: 6 Things To Know When Treating Venous Disease
Lower extremity venous disease affects millions of Americans and may ultimately lead to open, draining wounds that adversely affect quality of life. However, there are exciting developments in early diagnosis, prevention and treatment of venous leg ulcers . On the treatment side, there are more choices now than ever before in compression products, which is greatly improving the patient experience. But proper treatment also comes from a better understanding of venous leg ulcers, and better understanding comes from more education. Luckily, were here to help provide education and support for you and your team, so here are six things to know when treating VLUs.
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Unna Boot Plus Primary Dressing
An Unna boot is a paste system composed of a bandage impregnated with zinc oxide, calamine, glycerin, and gelatin. A primary dressing is applied to the ulcer. The impregnated bandage is then applied without tension in a circular fashion from the distal foot above the toes up to the tibial tubercle 2.5 centimeters below the knee. The patient should dorsiflex the foot so that it is at a 90 degree angle to the leg. The resultant UB is usually covered with an elastic wrap or support bandage and allowed to dry, forming a semirigid cast. It is changed once or twice weekly based on drainage and edema. A UB is extremely helpful when lower extremity edema is severe, but because it does not accommodate changes in the volume of the leg caused by edema, it needs frequent application. It is relatively contraindicated in patients with active infection. Reported adverse events included dermatitis, allergy, wound maceration, and poor fit.
Swetha Kandula, … Richard A. Clark, in, 2013
Unna Boot: Its Use And Direction
The Unna boot is a compressive bandage that is used to treat venous stasis ulcers. The gauze is applied wet and dries to form a semirigid mould against the skin, similar to a cast. It allows for unlimited ankle joint motion, unlike a cast. The Unna boot is more convenient for patients because it offers high-pressure compression during muscle contraction and low-pressure compression at rest. Its available in stores and needs to be updated every 3 to 7 days, depending on how much drainage is present. Since the Unna boot does not require continuous leg elevation to enable venous return, patients may resume their usual daily activities.
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How Does It Happen
Gravity works well at getting the blood down to the feet, but when it comes to getting the blood back up the leg towards the knee and thigh, the ankle area becomes most vulnerable. The blood is pushed up the veins when your heart pumps and by your blood pressure. When it cant make it upwards, it pools and collects in the veins, expanding them like a small balloon. The valves in the veins cant open and close properly due to this distention. Tissues inside the skin depend upon the circulatory system to bring nutrients, and to remove waste products from the cells. When the circulation reduces the tissues discolor, devitalize and die. This causes an opening in the skin called ulceration.
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Calamine And Zinc Oxide Layer Of The Unna Boot
This is the cast-like layer of the boot. It is applied from the foot to the knee. The foot should be in the neutral position:
The first layer of the Unna boot is applied with the foot at the neutral position
This is the layer with the calamine and zinc-oxide. It should be applied to the knee:
Notice the ulcer is covered
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What Patients Must Know About Venous Stasis Ulcer Treatment
Posted March 15, 2022
What is an ulcer?
An ulcer is a wound that has not healed in more than four weeks. There are 2 main types of vascular ulcers: Ischemic/arterial ulcers and venous ulcers. A venous stasis ulcer is a wound that is not healing due to the pooling of blood flow in the legs. This backup of blood flow in the veins causes an increased outward pressure applied to the skin. This then erodes away at the skin surface leading to the wound which then becomes an ulcer.
In a vascular practice, part of our mission is to help prevent ulcers from occurring. However, many patients come to us after an open ulcer has occurred. At times, patients have even had ulcers for years before seeking treatment. A patients medical conditions can also affect wound healing.
The most common conditions to slow wound healing are diabetes, tobacco use, obesity, cardiovascular disease, and lymphedema. Therefore, the best ulcer treatment is a team approach between the patient and their healthcare providers.
Venous stasis ulcer treatment
After the ulcer has healed, the skin is never as strong as it was prior to getting the wound. Therefore, it is important to continue to wear compression socks daily so that the wound does not return. It is also important to continue frequently scheduled check-ups with your vascular provider to help prevent an ulcer from reoccurring.
What to expect from CVM?
Call to schedule at 486-4690 or fill out a request to consult form.
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When To Use Unna Boots
Unna boots are used to treat non-healing wounds. Post-surgical lower extremity wounds and venous ulcers are the main indications. There are other options for each of these. For example, wet to dry dressing is often applied for venous ulcers. The Unna boot is a good option when it is thought that the patient should not tend to their own wound. The boot is applied in the clinic and replaced every several days in the clinic. Between sessions the patient does not need to tend to it.
Assessment Of Risk Of Bias Of Included Studies
Two reviewers will independently assess the quality of the included studies by using the standardised critical appraisal instruments from the JBI.14 15 The instruments require the following data: title, authors, year of publication, journal, methodology, method, data analysis employed, configuration, geographical and cultural context, participants, interventions, main results and conclusions of authors and reviewers. After extracting the data, a level of credibility will be assigned to each finding, and the results will be synthetised through groups of data from primary studies. Disagreements between reviewers over the quality checklist will be resolved through discussion.
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Dressings And Topical Agents For Treating Venous Leg Ulcers
What is the aim of this review?
The aim of this review is to find out which dressings and topical agents are most effective for treating a type of wound known as venous leg ulcers. These are longterm wounds in the lower leg caused by problems with blood flow back up the leg through the veins. Researchers from Cochrane found 78 relevant studies to answer this question. Randomised controlled trials are medical studies where patients are chosen at random to receive different treatments. This type of trial provides the most reliable evidence. We evaluated these studies using a method known as network metaanalysis , which allowed us to compare treatments across different studies and to rank them in terms of complete ulcer healing.
Key messages
We cannot be certain which dressings and topical agents are most effective for healing venous leg ulcers: over all studies there were not enough participants per treatment and there was high risk of bias this means that many of the studies were conducted or reported in a way that means we cannot be sure if the results are accurate. The main treatment for venous leg ulcers is compression bandages or stockings and the choice of additional dressings or topical treatments should take into account the review findings and their uncertainty, alongside factors such as patient preference and cost.
What was studied in the review?
What are the main results of the review?
How up to date is this review?
What Is An Unna Boot Bandage
Unna boot is a compression bandage that treats slow healing lower leg wounds and ulcers. Unna Boot for venous stasis ulcers offers pain relief and quicker healing of wounds that tend to heal slowly. The Unna Boot for lymphedema or other weeping leg wounds has two functions – it provides compression and prevents dryness. Compression helps decrease swelling, while the medicated cream helps prevent the wound from dryness. Unna wraps are gauze dressings soaked in a zinc oxide paste, which helps ease skin irritation and keep the area moist.
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Examples Of Compression Bandaging Systems
Zinc paste bandages are examples of completely nonstretch material with high stiffness that may remain on the leg for several days up to 2 weeks .
FIGURE 7-2. Unna boot bandage and wrapped over by an inelastic bandage . In order to avoid wrinkles and folds during application, the zinc paste bandage has to be cut and molded to the leg.
In contrast to many other institutions, we prefer to apply the unna boot layers with considerable tension and cover the zinc paste with an outer layer of an inelastic cotton wool bandage , thereby producing a multilayer, multicomponent inelastic bandage.
The force used during bandaging depends on the amount of edema, the walking ability of the patient, and the leg circumference. In contrast to bandages containing elastic fibers, the resulting interface pressure is solely produced by the strength during application of the bandage, which should be much higher when used with elastic material.
In a patient with severe edema, the inelastic bandage should be modeled with a pressure of about 60 mmHg to the distal portion of the lower leg. As with every compression treatment, it is mandatory to exclude arterial occlusive disease before such high pressure bandages are applied.
Velcro-band gaiters like Circ-Aid®,17,18 consisting of completely nonstretch material, can be applied by instructed patients themselves and can be readjusted when the bandages get loose due to edema reduction.
FRED F. FERRI M.D., … SEAN I. SAVITZ M.D., in, 2007
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.
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What Is The Best Treatment For Venous Ulcers
What is the recommended procedure for treating leg ulcers?
It depends on the cause. If the ulcers are due to varicose veins, then treatment of the varicosities can help significantly in conjunction with a wound care specialist. If due to deep venous reflux, compression stockings and wound care are the best choices.
It depends on the cause. If the ulcers are due to varicose veins, then treatment of the varicosities can help significantly in conjunction with a wound care specialist. If due to deep venous reflux, compression stockings and wound care are the best choices.
Correct any superficial venous reflux.
Correct any superficial venous reflux.
Venous stasis ulcers can be due to deep, superficial, and/ or perforatorvein incompetence deep vein thrombosis can also be involved in theetiology. Before recommending the best treatment, venous duplex scanning must be performed and acomprehensive history and physical must be taken by an expert in the field of complex venous disorders. Perforator vein surgery , superficial venous ablation, vein interruptions, or a combination of these treatments may be indicated.
The best treatment for venous ulcers consists of 2 parts, both applied assoon as possible. First, the underlying cause should be identified andtreated. Second, proper compression with edema reduction and specializedwound care is needed until the ulcer heals.
What Is Zinc Oxide
This is an incredibly useful compound that is frequently utilized in treating skin problems. Zinc does occur naturally in a mineral form called zincite, but most of the time, zinc oxide is created synthetically. Chances are that you’ve heard of this useful product before, even if you don’t realize it. For example, zinc is used in calamine lotion. Calamine lotion is commonly used to treat insect bites, insect stings, sunburn rashes, and chickenpox. Calamine lotion works to draw the itching out of common rashes and can reduce discomfort on the skin.
Similarly, zinc oxide is also used in many diaper rash ointment creams. Because zinc offers so many healing and anti-itch properties, it’s an incredibly useful ingredient when it comes to treating minor rashes for both children and adults. Some adults even use zinc-based medical tape during their workouts in order to prevent minor injuries from occurring, especially if they also play sports.
When it comes to Unna boot uses, zinc oxide paste is utilized for its anti-itch properties. Zinc can be used to minimize oozing and dry out wet rashes, which makes it the perfect choice for patients who struggle with these skin conditions.
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Para/medic: Unna Boot Compression Therapy For Wounds
Q. A friend of a friend who is a T6 para gets swelling in her lower legs. Somehow she developed a sore on the outside of her lower right calf, but she doesnt remember any pressure or trauma to the area. The sore wouldnt heal even though she spent months with it elevated. She finally went to a wound care clinic and they put something called an Unna Boot on her lower leg it looks sort of like a soft cast. This enabled her to spend time upright in her chair while still taking breaks to elevate her leg. Amazingly, the entire wound healed in about one and a half months! What exactly is an Unna Boot? And how does it help heal so fast? Stacy
A. Stacy, your friends story is a good reminder that when any type of skin breakdown or burn doesnt heal right away, its time to visit a doctor to get a referral to a wound care clinic. It is important to understand that different types of sores require different treatments. Also, different stages of healing require different treatments. Clinicians at a wound care clinic have the specialized training to address this and give you the best shot at healing as quickly as possible.
To explain how an Unna boot works, it is important to understand what it is used to treat. Dr. Bruce Ruben, founder of Encompass Healthcare, a state-of-the-art wound care clinic in West Bloomfield, Mich. explains that there are five main reasons why a wound doesnt heal:
Pressure
Poor nutrition
Edema
Resources
The Role Of The Pharmacist In Educating Patients About Vsus
Since pharmacists are often perceived as one of the most accessible healthcare professionals, they have a critical role in the treatment and care of patients at risk of, or with, VSUs. This includes effective patient counseling and education, especially with regard to therapy for VSUs, proper use of medications used to treat VSUs, and reminders about preventive measures to decrease reoccurrence of VSUs. Since the incidence of VSUs is common in elderly and diabetic patient populations, pharmacists play a key role in identifying those patients at greater risk of developing VSUs. Pharmacists should also seize every possible opportunity to remind patients about the critical importance of adhering to therapy to enhance therapeutic outcomes and prevent further complications.
Pharmacists can also reinforce patient education with regard to the preventive measures for VSUs such as staying vigilant about oneâs overall health and adhering to the goals of therapy. Patients should be reminded of the importance of routine wound care and follow-up with their primary healthcare provider, monitoring the ulcer for signs of infection, and immediately seeking medical attention if the wound shows signs of worsening or not healing. Patients at risk for VSUs should be aware that with early diagnosis and implementation of and adherence to therapy, the condition can be effectively treated and healed to avoid complications.
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Signs And Causes Of Venous Ulcers
Venous ulcers are non-healing or slow-healing wounds that form as a result of blood pooling in the legs and feet. This happens when the walls or valves in the veins of the lower extremities dont work effectively. This is called venous insufficiency.
Venous ulcers are more common in women and older people. Several factors increase your risk of developing venous ulcers, including:
- Long periods of immobility, such as bed rest
- Older age