Essential Insights On Treating Chronic Venous Stasis Ulcers

Author(s): 
Nanjin J. Park, DPM, Latricia Allen, DPM, MPH, Guosheng Gu, MD, and Vickie R. Driver, DPM, MS, FACFAS

   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.

   The study demonstrated that patients who elevated the leg at least one hour per day for six days a week had less chance of ulcer recurrence.3 Study authors also found that 34 percent of patients were diagnosed with depression when they had ulcer recurrence. High body mass index and low nutritional value will delay the healing process. Overall, psychosocial issues will increase the chance of recurrence by impacting on self-care activities of patients.

Case Study: When A Patient Presents With Longstanding Venous Stasis Ulcers

A 45-year-old Caucasian male presented with a medical history of liver disease, tuberculosis, substance abuse and depression. The vascular clinic referred him for chronic, non-healing venous stasis ulcers of six years’ duration. The ulcerations began as trauma on both of his legs from broken glass while crawling through a window.

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