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Venous Stasis Ulcer Treatment Dressings

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

Venous Stasis Ulcer Treatment

Syed M. Asim Hussain

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. Methods

2.1. Null Hypothesis
2.2. Alternative Hypothesis

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.

Can Venous Leg Ulcers Be Prevented

There are several ways to help prevent a venous leg ulcer in people at risk, such as:

  • wearing compression stockings
  • losing weight if you’re overweight
  • exercising regularly
  • elevating your leg when possible

This is particularly important if you’ve previously had a leg ulcer once a leg has suffered a venous ulcer, you’re at risk of further ulcers developing within months or years.

Read more about preventing venous leg ulcers.

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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.

Treatment Options For Venous Stasis Ulcers

PPT

At first, venous ulcers are generally shallow and irregularly shaped. As the deterioration of the affected tissue progresses, the ulcer can extend deeper into the underlying tissues, involving the tendons, ligaments, and bone. The goal of venous ulcer treatment is to minimize edema, control infection, heal the wound, and prevent reoccurrence. Many leg ulcer patients experience alternating periods of healed and open ulcerations. Those with venous stasis ulcer commonly find the skin lesions will return unless the underlying cause is corrected.

To effectively treat venous stasis ulcers, doctors commonly evaluate the venous and arterial circulation in the affected area to identify the underlying cause. Once the cause is determined, physicians are in a better position to develop a successful plan of action. Doctors treating venous ulcers may recommend one or more of the following options:

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Who Gets Stasis Ulcers

Stasis ulcers affect 1% of the population, so they are not uncommon. A variety of medical problems and lifestyle factors have been linked to their development. These include:

  • Increasing age
  • Standing upright for long periods
  • Multiple previous pregnancies

Stasis ulcers account for at least 4050% of chronic lower limb ulcers and contribute to a further 20% of mixed arterial and venous ulcers.

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What Is The Treatment For Venous Stasis

4.4/5treatment for venous insufficiency

Likewise, people ask, does venous stasis go away?

These venous stasis ulcers can be difficult to heal and can become infected. When the infection is not controlled, it can spread to surrounding tissue, a condition known as cellulitis. CVI is often associated with varicose veins, which are twisted, enlarged veins close to the surface of the skin.

Likewise, can exercise help venous insufficiency? Treatment for chronic venous insufficiencyExercise: Exercise helps pump blood through the legs and builds muscle that can promote better circulation. A doctor may also instruct a patient to elevate the legs above the heart three or four time a day for about 15 minutes at a time. This can help to reduce swelling.

Considering this, is walking good for venous insufficiency?

Your doctor may recommend that you walk, ride a stationary bicycle, or jog for 30 minutes several times a week. Being active helps improve circulation and tones muscles in your legs. This can help pump blood toward the heart. Stretching your calf and thigh muscles can also help improve blood flow.

Is venous insufficiency serious?

Vein disease is incredibly common â and manageable. However, if left untreated, venous insufficiency can cause far more serious complications like ulcers, bleeding, and a life-threatening condition called deep vein thrombosis .

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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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What Is A Stasis Ulcer

Treating Venous Leg Ulcers

Stasis ulcers, sometimes called venous skin ulcers, affect almost 1% of Americans. These wounds usually occur on the lower legs, especially around the ankles. They can be extremely painful and are very slow to heal, taking an average of six to 12 months to close completely. Worse still, for 70% of patients, ulcers will recur within five years of closure.

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What Is Daily Life Like With A Venous Ulcer

While youre undergoing treatment, there are steps you can take to promote healing. These include:

  • Eating a healthy diet, which supports your bodys natural healing abilities.
  • Keeping the ulcer and nearby skin clean.
  • Periodically raising your legs when seated to avoid blood pooling.
  • Staying active with gentle exercises, like walking.

A note from Cleveland Clinic

Venous stasis ulcers are wounds that are slow to heal. They typically occur in people with vein issues. Timely specialized care is necessary to prevent complications, like infections that can become life-threatening. Nonhealing ulcers also raise your risk of amputation. Venous ulcers can come back after treatment, which is why care often includes preventive therapies. Most people make a full recovery. But its essential to follow all care instructions.

Choosing More Effective Dressings And Medical Adhesives

Wound dressings are key components of effective venous leg ulcer treatment. Using the right dressing and using a secure, gentle medical adhesive can help the patient be more comfortable, promote rapid healing, and reduce costs.1 Important considerations when choosing a dressing and medical adhesive for a venous leg ulcer include:

With best practice wound management, it is possible to reduce the impact of venous leg ulcers, even in the most vulnerable populations. Secure wound dressings are essential in the management of exudate to support an optimal healing environment and contain exudate from moderately to heavily draining venous leg ulcers. Use of a strong, moisture-resistant medical tape plays a key role in the effective securement of wound dressings when managing venous leg ulcers. By choosing appropriate dressings based on the level of wound exudate, clinicians can support an optimal healing and can provide the best possible care while reducing costs and time spent changing dressings.

Industry Voices is brought to you by health care industry sponsors. All content is developed and paid for by the sponsoring company. Kestrel Health Information, Inc. is not involved in the creation of this content. The views and opinions expressed in this blog are solely those of the author and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

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Caring For Venous Ulcers

Venous ulcers need proper care and treatment to prevent infection and to heal. It’s important to have any venous ulcers checked right away by your healthcare provider.

Treatment may require focusing on the circulatory or vein problems that are causing the ulcers. Or it may mean removing some tissue around the wound. You may be asked to:

  • Clean the wound regularly

  • Apply a dressing to the ulcer

  • Avoid products that cause skin sensitivity

  • Wear compression stockings to prevent blood from pooling in the legs and to speed healing

  • Apply an antibacterial ointment or another topical medicine to prevent or treat an infection

  • Take oral antibiotic medicines to prevent or treat an infection

  • Have allergy testing done

Wearing a compression wrap to keep blood flowing back up to your heart can also help ulcers heal more quickly. In some cases, surgery or a skin graft is needed to close up the opening in the skin.

Review Of Key Questions

Venous Stasis

For all EPC reviews, key questions were reviewed and refined as needed by the EPC with input from Key Informants and the Technical Expert Panel to assure that the questions are specific and explicit about what information is being reviewed. In addition, for Comparative Effectiveness reviews, the key questions were posted for public comment and finalized by the EPC after review of the comments.

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Is A Venous Ulcer A Pressure Ulcer

Asked by: Marguerite Goyette

Yes. Venous skin ulcers are caused by poor circulation in the legs caused by damaged valves that prevent blood from flowing the wrong way, allowing blood to pool in the legs. Pressure ulcers, on the other hand, are caused by sustained pressure on an area of the body, which cuts off blood flow.

How Venous Leg Ulcers Are Treated

Most venous leg ulcers heal within 3 to 4 months if they’re treated by a healthcare professional trained in compression therapy for leg ulcers. However, some ulcers may take longer to heal, and a very small number never heal.

Treatment usually involves:

  • cleaning and dressing the wound
  • using compression, such as bandages or stockings, to improve the flow of blood in the legs

Antibiotics may also be used if the ulcer becomes infected, but they don’t help ulcers to heal.

However, unless the underlying cause of the ulcer is addressed, there’s a high risk of a venous leg ulcer recurring after treatment. Underlying causes could include immobility, obesity, previous DVT, or varicose veins.

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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.

Best Practices For Venous Leg Ulcer Treatment

Postphlebetic Syndrome – Venous Stasis Ulcers Diagnosis and Treatment (Ruth Bush, MD)

Venous leg ulcer treatment and management require frequent examination of at-risk patients and best practice wound care with a focus on prevention. Without effective treatment, venous leg ulcers can become extremely painful and result in cellulitis, osteomyelitis, and even death.1 To prevent these complications, health care professionals must actively work to identify venous leg ulcers, manage exudate, and choose wound dressings that enable an optimal healing environment. This can help promote rapid healing, reduce costs, and improve quality of life for patients.1

Identifying At-Risk Patients One of the most important components of venous leg ulcer management is prevention. Venous leg ulcers are caused by inflammatory processes that lead to endothelial damage, platelet aggregation, and intracellular edema. By taking steps to identify at-risk patients and regularly assessing them for signs of ulcers, health care professionals can reduce the incidence of the disease. Older adults, obese patients, those with mobility issues, and those who have previously had a venous leg ulcer are all significantly more likely to develop venous ulcers.1

Elevate Legs Leg elevation for 30 minutes three to four times a day can help reduce edema and thus may positively affect inflammation.1

Dress the Wound Dressings aid in the treatment of venous leg ulcers by protecting the wound, preventing adherence of compression bandages, and enabling an ideal healing environment.1,5

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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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Venous Stasis Ulcer Symptoms

The development of an venous stasis ulcer is a serious medical condition that is usually preceded by a series of symptoms, including:

  • The development of stasis dermatitis, a condition usually observed in the lower legs and characterized by itchy skin, fluid retention, and noticeable changes in skin color and texture.
  • Swelling
  • A general heaviness in the limbs of the affected area.

The venous stasis ulcer itself has several distinct characteristics, including:

  • Being a shallow sore with a red or purple base accompanied by the appearance of yellow, crust-like tissue around the perimeter of the sore
  • A brownish discoloration of the skin surrounding the venous stasis ulcer
  • The affected area being warm/hot to the touch
  • Localized pain
  • Oozing of pus

Unlike most wounds of the skin, which tend to heal quickly, a venous stasis ulcer lacks the proper oxygen and nutrients required to support the natural healing process this often results in prolonged or poor healing and a significant increase in the risk of infection.

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Data Collection And Analysis

Two review authors independently performed study selection, ‘Risk of bias’ assessment and data extraction. We conducted this NMA using frequentist metaregression methods for the efficacy outcome the probability of complete healing. We assumed that treatment effects were similar within dressings classes . We present estimates of effect with their 95% confidence intervals for individual treatments focusing on comparisons with widely used dressing classes, and we report ranking probabilities for each intervention . We assessed the certainty of the body of evidence using GRADE for each network comparison and for the network as whole.

Description Of The Intervention

PPT

The review includes all dressings and topical agents applied directly onto or into wounds and left in situ. This contrasts with products used to irrigate, wash or cleanse wounds and that are only in contact with wounds for a short period. Firstline treatment for venous leg ulcers is compression therapy in the form of bandages, stockings or mechanical devices . This application of external pressure around the lower leg assists venous return and reduces venous reflux . We therefore anticipated that wound dressings would commonly be used in combination with compression therapy.

Dressings are widely used in wound care with the aim of protecting the wound and promoting healing by influencing the local wound environment , typically by physical means, such as thermal insulation, absorption of exudate and physical protection. Dressings may also have pharmacological, immunological or metabolic actions. Topical agents include hydrogel gels, ointments and creams that are placed in contact with the wound and left in situ.

Dressings

The classification of dressings usually depends on the key material used in their construction, and whether additional substances are added to the dressing. Several attributes of an ideal wound dressing have been described , including the ability of the dressing to:

Capillaryaction dressings consist of an absorbent core of hydrophilic fibres held between two lowadherent contact layers. Examples include: Advadraw and Vacutex .

Topical agents

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