Wound Care Information Network (www.medicaledu.com) describes venous ulcers as the most common type of ulcer affecting the lower extremities.
Venous ulcers occur because of poor circulation in the legs. Caused by aging or a hereditary predisposition, valves in the vein that prevent black flow of blood become inefficient, causing Hemoglobin to leak into the tissue of the leg. The leaking results in discoloration.
Since the veins carry away carbon dioxide and wastes, these backups prevent the tissue from healing.
For this common wound, compression products are vital to the healing process. In addition to absorbing excess discharge and maintaining a most wound environment, compression, typically in the 40 mmHg range, should be applied. Compression can be applied with a multi-layer compression dressing, stockings or mechanical pumping devices.
Though compression therapy is effective, the Wound Care Information Network says that healing venous ulcers is lengthy.
Diabetes & Venous Ulcers
People with diabetes are sometimes prone to venous ulcers.
“Diabetics usually also have peripheral neuropathy,” says Dr. Joseph Caprini, MD, MS, FACS, RVT, professor of surgery at Northwestern University Medical School and professor of Biomedical Engineering at The Robert R. McCormick School of Engineering and Applied Science, and director of Surgical Research, Evanston Northwestern Healthcare, Evanston, Ill. “So they don’t have the normal sensation in their feet and their legs. For example, they would walk on a little pebble all day, whereas you and I would walk two steps and we’d pull it out of our shoe.”
Caprini warns that compression stockings must be applied with care for diabetic users, however.
“Sometimes with a diabetic ulcer, you will use a compression under certain circumstances to help heal that ulcer because the person doesn?t just have diabetes,” he says.
In fact, diabetics sometimes have combined disease, including arterial disease and venous stasis.
“So, they don’t get the right amount of blood to the tissues, but they also have venous stasis,” says Caprini. “And venous stasis is this broad category of what we call chronic venous insufficiency where the blood is not getting out of the legs normally. It can be due to being overweight; it can be due to bad valves in the veins on a genetic basis, it can be (because of) a blood clot. There are many causes for venous stasis, but venous stasis is common in diabetics. So, those diabetics that have venous stasis will need compression to treat their venous stasis.”
Caprini notes that those with failed arterial bypass may also be candidates for pneumatic compression, a sleeve filled with compressed air that pumps the leg. “Pumping of the leg to remove venous stasis as much as possible actually has caused the healing of some arterial ulcers,” he says.
Statistics from a 1994 survey, authored by T. Phillips, B. Stanton and A. Provan, showed of patients with venous ulcers:
- 81 percent found it hard to get around
- 56 percent reported spending up to eight hours per week on ulcer care
- 68 percent reported a negative emotional impact, including fear, social isolation, anger, depression and negative self-image
- Of the 20 percent employed, leg ulceration correlated with time lost from work, job loss and adverse effects on finances.
For more information on compression products, check out “A Chorus Line of Compression Products” in Home Health Products’ February issue. To see Caprini’s presentation on compression, visit the American Venous Forum at www.venous-info.com/education/compthervideos.html.