How do we prevent and treat venous stasis ulcers in our facility?

Venous stasis ulcers are the most common wound found on the lower extremities and can be a challenge to prevent and treat. Risk factors include obesity, advanced age, diabetes mellitus, cardiovascular disease, a history of blood clots or varicose veins or lower-leg injuries. 

Prolonged lower extremity edema, particularly that found with congestive heart failure, leads to increased venous pressure in the legs, and failure of the venous valves that normally help return blood back to the core are compromised, leading to additional pressure in the lower legs. Lifestyle risk factors for these ulcers include smoking and jobs in which there are significant periods of standing or sitting. Venous ulcer symptoms include tightness or burning, but they are typically not painful.

They appear as an irregularly shaped shallow ulcer on the inner lower leg above the ankle. The ulcers usually have a reddish base and have some adherent yellowish fibrous tissue. There is often copious drainage or exudate. The tissue surrounding the ulcer is typically swollen, with the skin appearing reddish, brownish or shiny due to edema.

The goals of caring for venous stasis ulcers are to heal the ulcer, but also to control the causative factors, including swelling. These ulcers can be tenacious and take weeks or months to heal.

Wound care includes use of a pH-balanced wound cleanser, and application of a non-stick dressing that absorbs the right degree of wound discharge. Elevation of the legs and treatment of underlying CHF or other medical problems are mainstays of the healing process.

Your healthcare providers may recommend compression stockings to help control the leg edema, but care should be taken to ensure that the arterial supply to the legs is adequate before applying stockings.