Treating Venous Stasis Ulcers In The Lower Extremity

Start Page: 68

Continuing Education Course #124 October 2004

I am very pleased to introduce the latest article, “Treating Venous Stasis Ulcers In The Lower Extremity,” in our CE series. This series, brought to you by the North American Center for Continuing Medical Education, consists of regular CE activities that qualify for one continuing education contact hour (.1 CEU). Readers will not be required to pay a processing fee for this course.

Approximately 25 percent of Americans can be affected by chronic venous insufficiency. If the disease goes untreated, it can lead to venous stais ulcers in the lower extremity. In this article, Mark Beylin, DPM, discusses the etiology of venous ulcers, what to look for in the diagnostic workup of these patients, and shares his insights on different treatment strategies one may employ to help achieve healing.

At the end of this article, you’ll find a 10-question exam. Please mark your responses on the postage-paid postcard and return it to HMP Communications. This course will be posted on Podiatry Today’s Web site (www.podiatrytoday.com) roughly one month after the publication date. I hope this CE series contributes to your clinical skills.

Sincerely,

Jeff A. Hall
Editor-In-Chief
Podiatry Today

INSTRUCTIONS: Physicians may receive one continuing education contact hour (.1 CEU) by reading the article on pg. 69 and successfully answering the questions on pg. 74. Use the postage-paid card provided to submit your answers or fax the form to NACCME at (610) 560-0502.
ACCREDITATION: The North American Center for Continuing Medical Education is approved by the Council on Podiatric Medical Education as a sponsor of continuing education in podiatric medicine.
DESIGNATION: This activity is approved for 1 continuing education contact hour or .1 CEU.
DISCLOSURE POLICY: All faculty participating in Continuing Education programs sponsored by the NACCME are expected to disclose to the audience any real or apparent conflicts of interest related to the content of their presentation.
DISCLOSURE STATEMENTS: Dr. Beylin has disclosed that he has no significant financial relationship with any organization that could be perceived as a real or apparent conflict of interest in the context of the subject of his presentation.
GRADING: Answers to the CE exam will be graded by the NACCME. Within 60 days, you will be advised that you have passed or failed the exam. A score of 70 percent or above will comprise a passing grade. A certificate will be awarded to participants who successfully complete the exam.
TARGET AUDIENCE: Podiatrists.
RELEASE DATE: October 2004.
EXPIRATION DATE: October 31, 2005.
LEARNING OBJECTIVES: At the conclusion of this activity, participants should be able to:
• demonstrate a knowledge of venous anatomy and the etiology of venous ulcers;
• discuss key clinical signs of venous stasis ulcers;
• contrast the various forms of compression therapy;
• discuss key steps to facilitating a clean wound bed with venous ulcers; and
• describe possible ancillary treatments for venous ulcers.

Sponsored by the North American Center for Continuing Medical Education.

This patient developed a large blister from chronic venous insufficiency, a condition that results in blood pooling in the venous system of the lower extremities.
Here one can see the same wound on the ankle one week after application of a Profore wrap. External compression is the hallmark of treatment for venous ulcers, according to the author.
Here is a venous stasis ulcer on the medial ankle. The ulcer developed as a result of chronic venous insufficiency and minor trauma.
As you can see, this ulceration on the medial ankle exhibits some signs of healing a week later after application of an Unna boot.
After another week, one can see the development of more granulation tissue as the treatment regimen continues for this patient.
74
Author(s): 
By Mark Beylin, DPM

Chronic venous insufficiency is a significant disease that affects as much as 25 percent of the population in the United States. It is also a condition commonly treated by podiatric physicians. The condition results in blood pooling in the venous system of the lower extremities (see “A Guide To Normal Venous Anatomy And Physiology below). Venous stasis ulcers are the end stage of chronic venous insufficiency.
In order to treat venous stasis ulceration, one must have a clear understanding of the pathophysiology of venous disease. Most of the vein problems that occur are due to increased pressure in the venous system. Venous insufficiency and subsequent hypertension are caused by valvular incompetence in the high-pressure deep venous system, low-pressure superficial venous system or both. Dilation of the veins is the primary problem. When the veins dilate, the valves are separated from each other. This causes a back flow of blood.

When veins lose their functional capacity, gravity works against the flow of venous blood in the lower extremity. When one is walking, the blood flow is generally normal even through the incompetent veins and muscle contracture circulates blood out of the leg. On the contrary, when one stands, there is a reverse flow in the incompetent vein and a back flow occurs. This gets in the way of venous drainage and eventually results in an elevation of venous pressure.
When valves of the perforating veins become incompetent, high-pressure blood from the deep venous system flows towards the skin, producing hypertension in the superficial veins.2 This process leads to the leaking of fluid from small veins makes into the surrounding tissues. This causes edema and characteristic discoloration. This is subsequently followed by an impaired exchange of nutrients and wastes between the arterial and venous systems.

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