Ask the Treatment Expert about... lower extremity problems
Rosalyn Jordan, RN, BSN, MSc, CWOCN, WCC
What is the lower-extremity problem we're most likely to see?
The probability of a long-term care provider will coming across a resident who requires wound care associated with venous leg ulcers is very high. More than one-half million individuals are reported with venous leg ulcers across the U.S. annually. Developing an understanding of the etiology, risk factors, characteristics, and treatment are essential to successful treatment.
Venous blood flow is assisted by several physiological functions. Valves in the lower extremities direct blood forward and upward with the assistance of the muscles pump with during ambulation. If venous hypertension occurs, the valves become injured, resulting in a backward flow of the blood, and consequent edema.
Venous leg ulcers are usually located in the “gaiter area” of the leg or the mid-calf region to the medial malleolus. They present with red granular tissue in the base of the wound. The edge of the wound bed is usually irregular. Tissue surrounding the wound in the gaiter area may be a reddish, dark brown color.
Treatment principles for venous leg ulcers include protection of the surrounding skin, management of the drainage, debridement of non-viable tissue, protection of the wound and infection prevention.
The gold standard for venous ulcer treatment is compression therapy. The goal is to decrease edema and promote venous blood flow from the tissue into the venous vascular system. There are compression devices and dressings available.
Of course, compression treatment must be based on vascular testing and the resident's medical condition. Rehabilitation interventions include limb elevation and exercise.