Venous Stasis Ulcers: Causes, Symptoms and Treatment

Venous stasis ulcers
By C Settley 7/17/2018Compiled by C Settley
1

Terms to know
• Dilate
▫ To widen or enlarge an opening or hollow structure
beyond its usual size, such as the pupil of the eye or a
blood vessel.
• Leg Varicose Veins
▫ Varicose veins are swollen, twisted veins that you can
see just under the surface of the skin. These veins
usually occur in the legs.
• Systemic Circulation (Blood Circulation)
▫ Systemic circulation is the part of the cardiovascular
system which carries oxygenated blood away from the
heart to the body, and returns deoxygenated blood
back to the heart.
7/17/2018Compiled by C Settley
2

Terms to know
• Varicose Veins
▫ Varicose veins are veins that have become
enlarged and twisted.
• Veins
▫ Blood vessels that carry blood to the heart.
3

What are venous stasis ulcers?
Pg. 667
• Venous ulcers, also referred to as stasis,
insufficiency or varicose ulcers, are the result of
malfunctioning venous valves causing pressure
in the veins to increase.
• These typically occur along the medial or lateral
distal (lower) leg.
4

Pg. 667
• Results in oedema, swelling, hyperpigmentation,
dermatitis and ulceration
• Superficial and deep veins may be involved
• Cellulitis may be a recurring problem in these
patients
• Venous ulcers are located in the lower third of
the lower-leg and generally are superficial
5

Pg. 667
6

What is a leg ulcer?
Pg. 667
• A leg ulcer is a long-lasting (chronic) sore that takes more
than four to six weeks to heal.
• They usually develop on the inside of the leg, just above the
ankle.
• A leg ulcer is a full thickness skin loss on the leg or foot due to
any cause.
• Leg ulcer occurs in association with a range of disease
processes, most commonly with arterial, vascular or
neuropathic diseases.
• A leg ulcer may be acute or chronic.
7

What is a leg ulcer?
Pg. 667
8

About Valves in the Vein
• Normal veins and valves (A), and varicose veins (B)
National Institutes of Health
9

Leg ulcers
• *video: Leg ulcers - Diagnosis and treatment of
leg ulcers
10

Pathophysiology – pg. 668
• Poor exchange of oxygen and other nutrients in
the tissue
• Causes necrosis of the tissues
• Alterations of the blood vessels at the arterial,
capillary & venous level may affect cellular
processes and lead to formation of ulcers
11

Clinical manifestations- pg. 668
• Related to the cause of the ulcer
• Most have more than one cause, particularly in
the elderly
• The ulcer appears open, inflamed and sore
which may be draining or covered by a dark
crust
12

Clinical manifestations
13

Arterial ulcers- pg.668
• Arterial insufficiency ulcers (also known as
Ischemic ulcers or Ischemic wounds) are mostly
located on the lateral surface of the ankle or the
distal digits.
• They are commonly caused by peripheral artery
disease (PAD).
• PAD- A circulatory condition in which narrowed
blood vessels reduce blood flow to the limbs.
14

Arterial ulcers
15

Venous ulcers & Arterial ulcers
• Let’s start with the venous ulcer, typically found on the
medial lower leg, medial malleolus and superior to the
medial malleolus.
• Seldom will you see them on the foot or above the knee.
• They tend to be irregular in shape, are superficial, have a
red wound bed, have moderate to heavy amount of
exudate and the patient may have no pain or a moderate
level of pain.
• Surrounding skin can be warm to the touch, edematous,
scaly, weepy (clear infection present) and you may see hemosiderin
(a yellowish brown granular pigment formed by breakdown of hemoglobin, found in
phagocytes and in tissues especially in disturbances of iron metabolism) staining
present.
16

Venous ulcers & Arterial ulcers
• You will typically find an arterial ulcer on the lateral
malleolus, over the phalangeal heads, between the toes, tips
of toes or areas that are subject to trauma and rubbing.
• They tend to be regular in shape, round punched out in
appearance.
• Deep pale wound beds with necrotic tissue present are
common in the arterial patient.
• The wound will likely produce minimal exudate, and the
patient will complain of extreme pain.
• The pain typically starts out as intermittent claudication or
cramping in the lower extremities and then continues to
progress.
• Surrounding skin will be cool to the touch, pale, cyanotic,
hairless on ankle and foot with thickened toenails.
▫ https://study.com/academy/lesson/difference-between-arterial-
ulcers-venous-ulcers.html
17

Diagnosis- pg. 668
• The cause needs to be determined
• So that the correct therapy be commenced
• Cultures may be needed to determine if infection
is the primary cause
18

Management - pg. 668
• Pharmacological: oral antibiotics, according to
culture and sensitivity if ulcer is infected
19

Compression therapy- pg.668
• Compression therapy is a simple and effective
means of increasing blood flow activity in the
lower limbs through strengthening vein support.
• It's a form of wound care that aims to gently
apply pressure to the ankles and legs by wearing
specifically designed stockings.
• By providing more pressure at the foot and ankle
than the calf, compression increases calf
function and efficiency, and lessens swelling.
20

Debridement- pg.668
• Debridement is the medical removal of dead,
damaged, or infected tissue to improve the
healing potential of the remaining healthy tissue.
• Removal may be surgical, mechanical, chemical,
autolytic, and by maggot therapy.
21

Surgical debridement
• Surgery to remove dead tissue is common in
some chronic wound healing procedures or
wounds that are very large in size.
• Because the debridement occurs in one session,
the room for error is often much smaller –
surgeons can visibly see what is being removed,
and avoid the healthy or granulating tissues.
22

Mechanical debridement
• This type of debridement is one most chronic wound patients will
likely be familiar with. Contrary to its name, mechanical
debridement is done through the use of wet and dry dressings that
are regularly changed throughout the healing process. Dressings
most often used start off as wet, slowly drying with the tissue so
that, when the dressing is removed, the necrotic tissue is removed
along with it. However, as with enzymatic debridement, mechanical
removal can strip the healthy and dead tissue away, so this method
is most often effective for large areas of unhealthy tissue.
• Depending on the type of wet-to-dry dressing used, this type of
debridement can be one of the most inexpensive for the patient.
However, due to the constant removal and application of new
dressings, this type of debridement can be more painful for the
patient than other methods.
23

Chemical debridement
• The most common chemicals used for wound
debridement are enzymes that digest necrotic
tissue, referred to as enzymatic debridement
agents (EDAs).
• Collagenase dissolves undenatured collagen
fibers, which anchor necrotic tissue to the
surface of the wound, without damaging
granulation tissue.
24

Autolytic debridement
• Autolytic debridement. Autolysis uses the body's
own enzymes and moisture to re-hydrate, soften
and finally liquefy hard eschar and slough.
• Autolytic debridement is selective; only necrotic
tissue is liquefied. It is also virtually painless for
the patient.
25

Maggot therapy
• Using larvae to remove dead tissue may gross
some individuals out, but this method can be
extremely effective. Maggots selectively eat only
the necrotic tissue of a wound, and when placed
under a loose bandage, can be used to assist in
the healing process.
• Maggot debridement may not be the fastest
methods, and clinicians should find reliable
options for this.
26

Maggot therapy 7/17/2018Compiled by C Settley
27

Topical therapy- pg.668
• A topical medication is a medication that is
applied to a particular place on or in the body.
• Most often topical administration means
application to body surfaces such as the skin or
mucous membranes to treat ailments via a large
range of classes including creams, foams, gels,
lotions, and ointments.
28

Wound dressing- pg.668
• To promote a moist environment by preventing
water loss and retaining warmth.
29

Essential health information- pg.669
• Ulcers must be kept clean
• Protected from injury
• Rest
• Elevate limb to reduce oedema
• Diet rich in protein, vitamins and minerals
• No strenuous exercises
• Correct jogging shoes
• Chronic illnesses must be addressed promptly
30

Leg ulcers in the elderly- pg. 1060
• Reduced skin elasticity combined with poor
peripheral circulation and chronic hypoxia may lead
to its formation
• DM or CF with pedal oedema also affects the healing
• Treatment of leg ulcers varies according to policies
and products available
• Anaemia & diet should be revised
31

Reference list
• Mogotlane, S. Chauke, M. Matlakala, M,
Mokoena , J. & Young, A. (eds). 2013. Juta’s
complete Textbook of Medical Surgical Nursing.
Cape Town: Juta.
• https://howshealth.com/venous-stasis-ulcer-
symptoms-location-pictures-treatment/
• https://www.bestveintreatment.com/vein-
treatment/compression/
• https://www.advancedtissue.com/top-types-
wound-debridement/
32

Venous Stasis Ulcers: Causes, Symptoms and Treatment

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