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What Is A Venous Ulcer

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Treatment Options For A Venous Ulcer

Arterial Ulcers vs. Venous Ulcers Nursing (Characteristics) for PVD (Peripheral Vascular Disease)

Treatment for a venous ulcer requires a combination of wound care and managing the underlying causes of the ulcer. Once you have an open venous ulcer, youll need to take steps to keep it from getting infected. This involves regularly cleaning and dressing the wound.

You should also try to keep the area around the venous ulcer dry wet skin is softer than dry skin, and the softness makes it easier for the ulcer to grow in size. Regularly wearing compression stockings can keep blood from continuing to pool in the leg. Some patients find that propping the leg up can hasten the healing process.

Your vein specialist may perform surgery on the vein leading to the venous ulcer if conventional treatment options arent working, if the ulcer continually reappears, or if the ulcer is large or infected. Surgery focuses on opening the vein so that it has better blood flow.

How Is Venous Insufficiency Treated

To reduce swelling and relieve pain caused by venous insufficiency, you can wear compression stockings. They are tighter at the ankles than at the top of the legs. They also can help venous skin ulcers heal. But there are different types of stockings, and they need to fit right. So your doctor will recommend what you need.

You also can try to:

  • Get more exercise, especially walking. It can increase blood flow.
  • Avoid standing still or sitting for a long time, which can make the fluid pool in your legs.
  • Try not to sit with your legs crossed at the knee.
  • Keep your legs raised above your heart when youâre lying down. This reduces swelling.

If these treatments donât work, you may need medicine or a procedure to help relieve symptoms. Procedures might be done to close the vein, to remove the vein, or to improve blood flow.

What Is A Venous Stasis Ulcer

Venous ulcers are open, non-healing wounds that occur on the legs or ankles. They often develop when blood is not circulating properly and begins to pool in these regions. This accumulation of blood accounts for over 80 percent of all ulcers.

Venous leg ulcers can lead to serious medical problems like infection and skin discoloration.

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Associated Changes In The Leg

  • Hemosiderin deposit
  • Lipodermatosclerosis
  • Dilated and tortuous superficial veins
  • Limb may be warm
  • Altered shape inverted champagne bottle
  • 4. Regular documentation to compare results before and after treatment and progression with time

    5. Assess comorbidities like obesity, malnutrition, intravenous drug use and coexisting medical conditions prior to surgery. Reduced calorie and protein intake hampers ulcer healing

    6. Rule out complications including severe infections, osteomyelitis and malignant changes .

    7. If no improvement after 12 weeks or in case of recurrence or no response to treatment after 6 weeks: Reassess

  • Risk factors for nonhealing – Increased wound size and duration, history of venous stripping or ligation, history of hip or knee replacement, ankle-brachial index < 0.8, > 50% of wound covered in fibrin and undermined wound margin
  • Accuracy of etiology
  • Rule out allergic contact dermatitis to medications and differentiate from venous eczema. Do a patch test in all cases of venous ulcers with eczema. The common sensitizers are lanolin, topical antibiotics , antiseptics, preservatives, emulsifiers, resins and latex. . Positive patch tests in these ulcers range from 40% to 82.5%.
  • Any new comorbidities?
  • Think of biopsy – to rule out malignancy, systemic disorders, collagen vascular disorders and vasculitis
  • Take bacterial, mycobacterial and fungal cultures
  • Is the treatment appropriate?
  • Is patient compliant with treatment?
  • What Are Venous Stasis Ulcers

    Venous Stasis Ulcer &  Chronic Lipodermatosclerosis

    Commonly located on the ankle or calf, venous stasis ulcers are painful and red in color but may be covered with a yellow, fibrous tissue and an irregular border.

    Drainage and discharge are possible with venous stasis ulcers. This type of ulcer is common in patients with a history of leg swelling or varicose veins.

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    What Types Of Venous Disease Cause Venous Stasis Ulcers

    Chronic venous insufficiency is a common cause of valve dysfunction. It occurs when your valves are damaged or too weak to do their job.

    Other venous ulcer causes include:

    • High blood pressure , which damages blood vessel walls.
    • Venous obstruction, a vein blockage thats sometimes due to blood clots.
    • Venous reflux, when blood flows backward through weak or damaged valves.

    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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    Skin Grafts And Artificial Skin

    Two layers of skin created from animal sources as a skin graft has been found to be useful in venous leg ulcers.

    Artificial skin, made of collagen and cultured skin cells, is also used to cover venous ulcers and excrete growth factors to help them heal. A systematic review found that bilayer artificial skin with compression bandaging is useful in the healing of venous ulcers when compared to simple dressings.

    Symptoms Of Leg Ulcers

    Venous Stasis Ulcer Treatment | Wound Care OC
    • that they are commonly found on the lower leg and ankle
    • a sunken, asymmetrically shaped wound
    • the edges of the ulcer are clearly defined from the surrounding skin
    • the surrounding skin is intact, but inflamed
    • the surrounding skin may be pigmented, hardened or calloused
    • yellowish-white exudate
    • varicose veins in the leg.

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    What Are Some Different Types Of Compression Therapy

    Compression therapy is the main treatment for venous skin ulcers. If you have a venous skin ulcer, your doctor may first want to reduce the buildup of fluid in your lower leg. After your lower-leg swelling has been reduced, compression is used to create more constant pressure on both the flexing and resting leg muscles. There are several types of medical devices for compression therapy. Your doctor will recommend the type that will work best for you. If you have an open wound, it will be covered with a dressing before the compression device is applied.

    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.

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    What Is Venous Ulcer Disease

    • Posted on: May 18 2020

    If you have venous insufficiency, you may be subject to venous ulcer disease a condition that causes open sores to form on your legs. Venous insufficiency occurs more in women than in men and may worsen with age. Its caused by the inability of veins in your legs to return blood to your heart. As a result, swelling occurs. If a vein swells too much, the skin may break, causing ulcers to form.

    What Type Of Dressing Is Best For Venous Leg Ulcers

    venous stasis ulcer picture

    Alginate dressings for venous leg ulcers. Venous leg ulcers are a common and recurring type of chronic or complex wound which can be distressing for patients and costly to healthcare providers. Compression therapy, in the form of bandages or stockings, is considered to be the cornerstone of venous leg ulcer management.

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    Cleaning And Dressing The Ulcer

    The first step is to remove any debris or dead tissue from the ulcer 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 once a week. Many people find they can manage cleaning and dressing their own ulcer under the supervision of a nurse.

    Controlling Pressure In The Leg Veins

    Controlling swelling is essential for patients with venous leg ulcers. Leg elevation, with the feet at or above the level of the heart, several times throughout the day and while sleeping, can help reduce swelling. Compression wraps or bandages are often applied to the legs. These can be changed as often as multiple times a day or as infrequently as once a week, depending on the amount of fluid draining from the ulcer. Once the leg ulcer is smaller or nearly healed, elastic compression stockings may be recommended. Compression stockings are sized to fit the legs and are typically put on in the morning and worn throughout the day. A venous pump may be prescribed for patients with severe swelling.

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    Diagnosis Of Leg Ulcers

    • examine the wound
    • perform some tests to measure the blood flow in your lower leg, such as the ankle-brachial index. This test compares blood pressure readings taken at the ankle and at the arm using a device called a Doppler machine
    • recommend an angiogram for an arterial ulcer, to find out if the artery needs surgery to clear the blockage.

    Preventive Compression After Healing

    Venous Stasis Ulcer Treatment

    After an ulcer has healed, lifelong maintenance of compression therapy may reduce the risk of recurrence. This is usually accomplished through compression stockings.

    There is also evidence that being active may help prevent venous ulcers from occurring. This is especially true when exercise is done in tandem with compression therapy.

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    What Are The Complications Of Stasis Ulcers

    The main complication of stasis ulcers is an infection. Wound infection can further impair the healing process. Bacteria colonise nearly all leg ulcers, but systemicantibiotics are not required unless clinical signs of infection are present. Signs that a stasis ulcer may require treatment with antibiotics include:

    • Redness and swelling of the skin surrounding the wound
    • Increasing warmth
    • Increasing purulentdischarge from the wound

    Topical antibiotics are not recommended because they slow the rate of wound healing, despite their bactericidal properties.

    Cellulitis and venous insufficiency

    Will I Need Any Tests

    Testing lets your healthcare provider know how severe the ulcer is. You may also undergo regular testing to determine whether venous ulcer treatments are working.

    Tests for venous ulcers include:

    • Ankle-brachial index, which takes blood pressure readings of your arms and legs.
    • Doppler study to listen to blood flowing through your veins.
    • Imaging studies, such as a CT scan to identify damaged or nonfunctioning valves.

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    How Do You Know When A Leg Ulcer Is Healing

    These wounds should be showing signs of healing within 2 weeks of injury. If a wound is taking longer than a couple of weeks to show signs of healing or the wound is weeping and getting larger, then this might be a sign of an underlying problem which needs looking into.

    Do leg ulcers ever heal?

    Most venous leg ulcers heal within 3 to 4 months if theyre treated by a healthcare professional trained in compression therapy for leg ulcers. But some ulcers may take longer to heal, and a very small number never heal. Treatment usually involves: cleaning and dressing the wound.

    Treatment For Leg Ulcers

    Case Study of Chronic Venous Stasis Ulcer
    • cleaning the wound using wet and dry dressings and ointments, or surgery to remove the dead tissue
    • specialised dressings a whole range of products are available to help the various stages of wound healing. Dressings are changed less often these days, because frequent dressing changes remove healthy cells as well
    • occlusive dressings ulcers heal better when they are covered. These dressings should be changed weekly
    • compression treatment boosts internal pressure, using either elasticised bandages or stockings. This is particularly effective if multiple layers are used
    • medication includes pain-relieving medication and oral antibiotics if infection is present
    • supplements there is evidence that leg ulcers may heal faster with mineral and vitamin supplements, but only if the person suffers from a deficiency. Zinc, iron and vitamin C may be used
    • skin graft is a surgical procedure, where healthy skin is grafted onto the prepared wound site
    • skin cancer and infection if ulcers fail to heal or if they increase in size, both these conditions will need to be ruled out
    • hyperbaric oxygen this is now an accepted treatment for ulcers that resist other methods of healing, such as diabetic ulcers.

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    Managing Venous Stasis Ulcers

    Venous disease, which encompasses all conditions caused by or related to diseased or abnormal veins, affects about 15% of adults. When mild, it rarely poses a problem, but as it worsens, it can become crippling and chronic.

    Chronic venous disease often is overlooked by primary and cardiovascular care providers, who underestimate its magnitude and impact. Chronic venous insufficiency causes hypertension in the venous system of the legs, leading to various pathologies that involve pain, swelling, edema, skin changes, stasis dermatitis, and ulcers. An estimated 1% of the U.S. population suffers from venous stasis ulcers . Causes of VSUs include inflammatory processes resulting in leukocyte activation, endothelial damage, platelet aggregation, and intracellular edema. Preventing VSUs is the most important aspect of CVI management.

    Treatments for VSUs include compression therapy, local wound care , dressings, topical or systemic antibiotics for infected wounds, other pharmacologic agents, surgery, and adjunctive therapy. Clinicians should be able to recognize early CVI manifestations and choose specific treatments based on disease severity and the patients anatomic and pathophysiologic features. Management starts with a full history, physical examination, and risk-factor identification. Wound care clinicians should individualize therapy as appropriate to manage signs and symptoms.

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    What Causes A Stasis Ulcer

    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 Are The Symptoms

    The first sign of a venous skin ulcer is skin that turns dark red or purple over the area where the blood is leaking out of the vein. The skin also may become thick, dry, and itchy.

    Without treatment, an ulcer may form. The ulcer may be painful. You also may have swollen and achy legs.

    If the wound becomes infected, the infection may cause an odor, and pus may drain from the wound. The area around the wound also may be more tender and red.

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

    Venous Leg Ulcer – Patient Assessment and Management

    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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