Patient-Caregiver Venous Leg Ulcer Management

Introduction

Venous leg ulcers can be painful, distressing, and have a negative impact on one’s quality of life. From weekly visits to the wound center, multi-layer wraps, debridement, compression hose, and elevating legs above the heart, to the odor associated with excessive exudate. There is a high recurrence rate in patients with venous leg ulcers. The high likelihood of recurrence is caused in part by patients who do not adhere to compression therapy. 

Throughout the diagnostic workup and testing, these results will aid in determining the nature of the problem and the severity of the disease, guiding the physician toward the most appropriate plan of care. Doppler, duplex ultrasonography, phlebography, plethysmography, venous pressure measurement, magnetic resonance venography, and computed tomography venography are all diagnostic procedures. 

Venous leg ulcers can be extremely costly to treat due to their prolonged healing time. Chronic venous insufficiency weakens the vein wall, resulting in dysfunctional valves. Varicose veins are characterized by a high concentration of collagen and a deficiency of smooth muscle cells and elastin. This combination results in muscle disorganization, disruption of elastic fibers, and fibrosis. When the valves are unable to seal completely, a cascade of reflux and pooling occurs, eventually resulting in blood seeping through the vein wall creating an ulcer.

 

Treatment Interventions & Helpful Tips

 

There are several recommended treatment modalities for patients with chronic venous insufficiency. In the early phases of chronic venous insufficiency, it is more likely to be treated. These strategies are intended to prevent blood pooling and venous ulcers. A treatment plan will be determined by a number of factors, including the patient’s age, overall health, medical history, the severity of the disease, signs and symptoms, treatment tolerance, and patient preference. Compression therapy has remained a cornerstone of conservative treatment for decades. Compression therapy with consistency has been shown to increase ulcer healing rates, decrease recurrence rates, and lengthen the time to the first recurrence.

  • Compression therapy (bandages, stockings, intermittent pneumatic compression (ICP)
  • Keep a healthy weight
  • Elevate your legs above your heart and avoid crossing them.
  • Limit your salt consumption and increase your activity level. 
  • Avoid prolonged periods of standing or sitting.
  • Avoid wearing constricting apparel and high heels.
  • Hydrate the skin
  • Cessation of smoking
  • Maintain proper skin hygiene
  • Debridement methods
  • Medications – Aspirin, Pentoxifylline, Diuretics, Anticoagulation therapy
  • Ultrasound therapy

Conclusion

Venous ulcer management is intended to heal the majority of ulcers, however, education and compliance gaps impede this goal. Patients must not only be informed but also checked often in order to ensure consistent venous ulcer management. This is not always achievable, however. The wound healing regimen for venous ulcer management includes compression therapy, debridement, topical medications, absorbent dressings, cellular therapies, and surgery.

 

Disclaimer

The views and opinions stated in this blog are exclusively those of the author and do not reflect iWound, its affiliates, or partner companies.

Future Reading and References

Scottsdale Wound Management Guide: A Comprehensive Guide for the Wound Care Clinician 2nd Edition by Matthew Livingston, RN, BSN, CWS and Tom Wolvos, MS, MD, FACS

Nelzen O, et al. Venous and non-venous leg ulcers: Clinical history and appearance in a population study. Br J Surg. 1994;81:182.

Lifestyle Changes for Venous Insufficiency. https://nyulangone.org/conditions/chronic-venous-insufficiency-in-adults/treatments/lifestyle-changes-for-chronic-venous-insufficiency

5 Things You Should Know About: Compression Therapy. Goldman, Robert J. MD Section Editor(s): Hess, Cathy Thomas BSN, RN, CWOCN Advances in Skin & Wound Care: July-August 2003 – Volume 16 – Issue 4 – p 172

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