Compression

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Leg Ulcer

Overview

According to an article in the American Journal of Surgery, venous leg ulcers account for 85% of all lower-extremity ulcers, with treatment costs of $3 billion and over 2 million workdays per year.¹ A venous leg ulcer is one of the most serious results of the progression of chronic venous insufficiency. This often-painful open wound affects the quality of life of patients and is slow to heal.

Ulcer patients interact directly with a wound clinic or physician and a certified fitter in the management of the wound. Compression plays an important role in the healing of a wound and certainly in the post-wound care. Once your wound is healed, you should wear graduated compression stockings for life.

What causes a venous ulcer?

When suffering from chronic venous insufficiency, the vein wall becomes stretched and weakens, the valves do not close. This starts the cascade of reflux and pooling which does not correct itself and only continues to worsen over time (another cause of valve incompetency is a blood clot). Once the blood seeps through the vein wall and into the tissue it can then go through the fragile skin and become an open leg ulcer.

Venous leg ulcers are often chronic and difficult to heal. They commonly appear on the inside of the leg (medial) above the ankle. They are shallow and can be painful. Swelling in the lower leg often occurs. There is often brownish discoloration of the skin due to the leakage of the iron-containing pigment in red blood cells (hemosiderin) into the tissue. The wound itself is often irregular and there may be weeping discharge as the tissue fluid seeps from the wound. There may also be indications of infection. Caution regarding arterial ulcers: approximately 10-20% of ulcers are arterial ulcers. Arterial ulcers typically appear on the outside of the leg, whereas venous ulcers usually appear on the inside of the leg.

Diagnosis

A visual assessment is done first and the wound size is recorded. Patients may also have a Doppler Ultrasound exam, a contrast venogram (X-ray test that takes pictures of the blood flow) or impedance plethysmography.

What is the treatment for a venous leg ulcer?

The primary treatment includes controlling the infection and healing the wound. A wound heals slowly and may take many months, depending of its size. Managing pain and minimizing the edema as well as protecting the healthy skin are also important during treatment. Steps to improve venous flow should be taken. Traditionally, short-stretch compression bandages are worn postoperatively until healing is nearly complete, after which the patient is fitted in a knee-length graduated compression stocking at 30-40 mmHg or higher. Only your physician will be able to assess your condition and prescribe the most effective treatment.

Nearly 80% of venous leg ulcers can be healed with good wound management. The recurrence rate of a venous ulcer after treatment approaches 70%.² Once the leg ulcer is healed, the patient should wear a minimum of 30-40 mmHg S medical graduated compression stocking for life to aid in non-recurrence of the ulcer.

Note: Graduated compression stockings are CONTRAINDICATED for severe arterial insufficiency.

¹ American Journal of Surgery (2002, vol. 183. n2, pp. 132-137 (14 ref.)
² Bryant RA, editor. Acute and Chronic Wounds. St Louis Mosby; 1992, p 164-204

Solutions

Medical graduated compression stockings play an important role in the healing and maintenance of wound care management. However, previously ulcerated skin is not stable and a wound can reoccur. Daily walks, a healthy diet and weight control are also key in patient caring for a venous leg ulcer.

SIGVARIS UlcerX Kit is a dual stocking system. It consists of a low-compression underliner and a 30-40 mmHg overstocking. The underliner is made with an inner layer of cotton and a smooth exterior that allows easy donning of the overstocking. The underliner keeps the wound dressing in place at night, helping the patient to rest comfortably. During daily activities, the overstocking provides the necessary compression needed to heal the venous ulcer. The 30-40 mmHg overstocking is recommended for removal at night, but the low-compression understocking should be worn during sleep or while recumbent.