Treatment
of venous ulcers
 Leg
ulcers may be due to problems with
the arteries supplying blood to the leg or
other conditions, such as diabetes, which require
different treatments. But for those due to
problems with the veins (called venous ulcers),
treatment with a special form of bandaging
to improve the blood flow may be needed. Surgery
to remove incompetent veins may also be an
option.
Symptoms of Venous Leg Ulcers
The features of a leg ulcer include:
- Commonly found on the lower
leg and ankle
- Sunken, asymmetrically shaped
wound
- Edges of the ulcer are clearly
defined from the surrounding skin
- Surrounding skin is intact,
but inflamed
- Surrounding skin may be
pigmented, hardened or calloused
- Yellowish-white exudate
- Pain, particularly while
standing
- Varicose veins in the leg
The calf muscle and poor circulation
Generally, veins carry deoxygenated blood from the
body to the heart, where it can be sent to the lungs.
Veins have one-way valves to prevent blood from running
backwards. The contraction of muscles helps to massage
blood along the veins. The calf acts as a pump, using
muscular contraction in combination with deep veins
and chambers to help counteract gravity and push
the blood back up through the veins. This pumping
action can be hindered by a variety of problems,
including blockages in the deep veins, venous insufficiency
or venous disease. It is not known how poor vein
circulation triggers a leg ulcer. One current theory
proposes that white blood cells are trapped inside
the narrowed capillaries, the smallest blood vessels
of the circulatory system. These immune system cells
then attack and destroy the nearby skin tissue. Evidence
for this theory includes high numbers of white blood
cells and their by-products found in the pus of leg
ulcers.
Risk factors
A number of different
factors can increase a person's risk of chronic
venous leg ulceration, including:
- Age - peripheral circulation
becomes less efficient with old age.
- Varicose veins - the one-way
valves that stop blood from traveling backwards
in the vein stop working. The pooling of blood
stretches and distorts the vein.
- Cigarette smoking - tobacco
is known to constrict the vessels of the circulatory
system.
- Arterial disease - vein
problems are more likely if the person already
has other associated diseases of the arteries.
- Certain disorders - including
diabetes and arthritis.
- Pressure sores - bed-bound
people are at risk of pressure sores, which are
areas of damage to the skin caused by constant
pressure or friction.
- Medication - some cardiovascular
drugs can contribute to leg oedema and altered
circulation.
Treatment options
Treatment for chronic
venous leg ulceration includes:
- Cleaning the wound - using
wet and dry dressings and ointments, or surgery
to remove the dead tissue.
- Specialized dressings -
a whole range of products are available to
assist with the various stages of wound healing.
Dressings are changed less often these days,
because frequent dressing changes remove healthy
cells as well as debris.
- Occlusive dressings - ulcers
heal better when they are covered; dressings
should be changed weekly.
- Compression treatment
- to boost internal pressure, using either
elasticised bandages or stockings. This is
particularly effective if multiple layers are
used.
- Medications - such as
painkillers
- Supplements - there is
evidence to suggest that leg ulcers may heal
faster with mineral and vitamin supplements,
but only if the person suffers from a deficiency.
Zinc, iron and vitamin C may be used.
- Skin grafts - a surgical
procedure, where healthy skin is grafted onto
the prepared wound site.
- Hyperbaric oxygen - this
is now an accepted management option for ulcers
that resist other methods of healing for example,
diabetic ulcers.
Long term outlook
Unless the underlying conditions are addressed
and treated, the person is at risk of developing
subsequent ulcers. Options can include treatment
for varicose veins, quitting cigarettes, improving
the diet and taking regular exercise (such as 30
minutes of walking every day). The person should
avoid hot baths, and sitting still for too long.
Keeping the affected leg elevated above the level
of the heart, whenever practical, can help.
Things to remember
- The most common cause is
poor circulation.
- Treatment options include
compression bandages, dressings, surgery and,
pH-balanced wound cleansers.
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NOTE:
Microcyn® does not have U.S. FDA clearance
for claims other than to moisten, lubricate,
cleanse and debride wounds. |
