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Venous Leg Ulcer

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Venous insufficiency is the most common cause of lower leg ulcers. Venous leg ulceration is estimated to affect up to 1.3% of the adult population at any one time¹. The cost of care for a patient with venous disease and the rate of ulcer recurrence is very high. Quality of life issues including pain management and activities of daily living (e.g. working and bathing) impact significantly on the patient, family and society².

In the healthy venous system, blood is moved forward with the assistance of one way directional valves that close to prevent backflow and pooling. Contraction of the external calf muscle assists to pump the blood from the superficial system through the perforating veins into the deep veins, which eventually return the blood to the heart³. The forward flow of venous return can be impaired by a number of factors however:

  • Valve incompetence from genetic influences, previous injury, thrombophlebitis, cellulitis or obstruction of the deep system caused by obesity, pregnancy or pelvic tumour
  • Life style factors such as extensive sitting or standing
  • Congestive heart failure
  • Muscle weakness caused by paralysis or lack of use

Stasis of de-oxygenated blood within the deep veins increases venous hypertension and contributes to the symptoms of venous disease. The first sign of venous hypertension is the dilation of the long saphenous vein along the medial aspect of the calf. Eventually, without treatment, fluid accumulates in the dermis resulting in pitting lower limb or ankle oedema. Red blood cells break down as they leak through the walls of the venules resulting in hyperpigmentation with haemosiderin deposits in the tissue around the medial ankle. In longstanding venous disease, an accumulation of fibrin occurs in the dermis forming a cuff around blood vessels and resulting in hard wood like fibrotic changes to the skin of the limb. The fibrin cuff impedes the diffusion of oxygen and nutrients from the capillaries to the tissue. Stasis dermatitis with itching, scaling and erythema may develop and without treatment, eventually ulceration may occur.

A holistic interdisciplinary team approach ensures that patient assessment is comprehensive and that the complex issues involved in caring for the patient with a venous leg ulcer are appropriately managed5. Improved potential for healing can be achieved with effective high compression therapy (see Compression Bandages), infection control and moist interactive dressings (see 3M™ Tegaderm™ Film Dressing3M™ Tegaderm™ Foam Dressing3M Tegaderm™ Hydrocolloid Dressing and 3M™ Tegaderm™ Hydrocolloid Thin Dressing)6. To prevent recurrence, the patient requires ongoing education, encouragement and supportive follow up to ensure the continuous use of support stockings4.

For more information see:

1. Callam MJ (1987) Hazards of compression treatment of the leg: an estimate from Scottish surgeons. Br Med J 295: 1382
2. Charles, H (1996) Developing a leg ulcer management programme. Prof Nurse 11(7): 475-477
3. Johnson S (2002) Compression hosiery in the prevention and treatment of venous leg ulcer. J of Tissue Viability, 12 (2):67-74
4. Donnelly J, Shaw J (2000) Practice development. Developing a multidiciplinary complex wound care service. Br J Nurs 9 (19): Tissue Viability Supplement, S50-S55.
5. Blair SD, Wright DDI, Blackhouse CM, Riddle E, McCollum CN (1988) Sustained compression and healing of chronic venous ulcers. Br Med J 297: 1159-6
6. Rudolph D (2001) Standards of care for venous leg ulcers: compression therapy and moist wound healing. J Vacular Nursing 19(1):20-7

Information provided with support from the Wound Healing Research Unit, Cardiff.

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