Essential Insights On Treating Chronic Venous Stasis Ulcers

Start Page: 70
Nanjin J. Park, DPM, Latricia Allen, DPM, MPH, Guosheng Gu, MD, and Vickie R. Driver, DPM, MS, FACFAS

   Sometimes patients can wear Unna boots if their skin shows any type of dermatitis. Unna boots are rolled bandages that contain a combination of calamine lotion, glycerin, zinc oxide and gelatin. Calamine lotion can sometimes provide a soothing effect and it works well on the patient who has a burning sensation. However, the Unna boot itself does not provide any control of edema. Therefore, a compression wrap would still be required.

   It is important during treatment to consider the patient’s socioeconomic situation and possibly utilize a social worker to assist the patient in the frequent clinic visits that may be required. If a social worker is not available at the facility, arranging visits from the Visiting Nurse Associations of America may be another option. If nursing visits will be part of the treatment plan and follow-up, make sure dressing change orders are very clear and well communicated with the nurse. This plays an important role in treatment outcomes.

   Bolton and colleagues recommended that if the ulcer size does not reduce 40 percent within three weeks, the patient may require adjunctive therapies.5 These therapies may include IV or PO antibiotics to treat infection, additional drugs like anti-platelet or anti-clotting medication or vascular surgical options.

Selecting The Appropriate Compression Stockings

Once the ulcer has healed and edema is under control, then one needs to proceed to the recovery phase of treatment. This typically involves a patient centered self-care plan. One option is compression stockings to help keep blood from pooling in the feet and calf.

   Compression support hose have different pressure levels. Light compression socks will have 10 to 15 mmHg compression and are good for treating varicose veins, which fall under CEAP Category 2.8 Clinicians may employ medium compression hose, which have up to 20 to 30 mmHg compression, to treat severe varicose veins, chronic venous hypertension and to help prevent venous leg ulcers.

   High compression hose have a pressure range of 25 to 35 mmHg compression and are useful for those with severe edema, who require prevention of venous leg ulcers.

   Selecting correct compression hose often requires a degree of trial and error. However, it is safe to start the patient who shows hemosiderin changes and a history of venous ulceration with a 20 to 30 mmHg gradient compression hose and add more compression if the patient’s edema is not adequately controlled. For example, one can use compression pump treatment in conjunction with the stocking or utilize CircAid® products in combination with stockings.

   Patients with severe physical limitations may require additional accessory devices such as donning devices or stocking sleeves. It will be important to utilize either family members or other personal assistants to ensure timely and consistent implementation of the treatment plan.

   The table “What You Should Know About Elastic And Inelastic Compression Systems” (at left) provides an overview of some of the basic compression dressings.

What You Should Know About Psychosocial Factors And The Recurrence Of Venous Leg Ulcers

It is important to recognize the patient’s psychosocial factors during venous leg ulcer treatment. In a prospective study, Finlayson and colleagues collected data from 80 patients with a previous history of healed venous ulceration and identified the relationship among preventive activities, psychosocial factors and ulcer recurrence.3 They discovered that leg elevation, compression hosiery, high levels of self treatment efficacy and strong social support helped prevent recurrence. The study shows that median time to recurrence was 27 weeks.

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