Ask the treatment expert: What are the key points of caring for venous stasis wounds?

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What's the best way to prevent skin tears?
What's the best way to prevent skin tears?
Q: What should we know about venous stasis ulcers?

A: Risk factors that may contribute to development of venous stasis ulcers include history of leg swelling, varicose veins, history of blood clots, deep vein thrombosis, obesity, sedentary lifestyle, prolonged sitting or standing, increasing age and associated immobility, multiple pregnancies, congestive heart failure and smoking. 

Characteristics of venous stasis ulcers are edema, irregular ulcer edges, located around medial malleolus (gaitor area), aching or pain (worse at the end of the day), dermatitis (may be intensely pruritic), crusting and scaling, hemosiderosis (grayish-brown hyperpigmentation), red ruddy color, yellow fibrous tissue, large volume exudate, shiny taut skin, pulses usually palpable, ABI >0.5-0.6 and pain that improves with elevation and worsens with dependency.

 In the management of these wounds, the first priority is to improve venous return. This may include surgical management of damaged veins, elevation of legs, compression therapy and/or pharmacologic agents, meticulous skin care with a nontoxic cleanser, removal of devitalized tissue, maintenance of a moist wound bed, absorption of exudate, and protection of periwound skin by use of dressings.

Promote exercise, such as ankle pumps, when appropriate. Compression and elevation remain cornerstones of venous ulcer management. Therapeutic compression levels are between 30 mm and 40 mm Hg. Compression treatments include compression stockings, multilayer compression wraps, and intermittent pneumatic compression devices. Contraindications to compression therapy: uncompensated congestive heart failure, coexisting venous thrombosis in the extremity with the ulcer, and ischemic disease (clinical S/S and /or ABI < 0.5 – 0.6).

Please send your wound treatment-related questions to Susan Wickard at ltcnews@mcknights.com.