PORTAL ILMU LUKA INDONESIA: Venous Ulcerations

Etiology: It has been reported that venous ulcerations are the most common type of ulcer affecting the lower extremities.
The normal vein has valves that prevent the backflow of blood. When these valves become incompetent, the backflow of venous blood causes venous congestion. Hemaglobin from the red blood cells escapes and leaks into the extravascular space, causing the brownish discoloration commonly noted.
It has been shown that the transcutaneous oxygen pressure of the skin surrounding a venous ulcer is decreased, suggesting that there are forces obstructing the normal vascularity of the area.
Lymphatic drainage and flow also plays a role in these ulcers.
The typical venous ulcer appears near the medial malleolus, is in combination with an edematous and indurated lower extremity, is shallow, is not too painful and may present with a weeping discharge from the leg.
Non-invasive vascular studies should be performed on both legs and for both the arterial and venous structures. Reason: 1) Assess venous return 2) You shouldn't apply compressive dressings or devices if the arterial circulation is impaired.
You want to rule out a possible deep venous thrombosis as the source of the venous congestion.
Treatment: Treatment of venous ulcers can be frustrating and lengthy. Goals should be directed at keeping the ulcer infection free, absorbing any excess discharge, maintaining a moist wound environment, supplying compression (typically in the range of 40 mmhg), promoting activity of the patient and the involved extremity and managing the patient's medical problems. Controlling the edema is a primary concern.
Compression can be achieved via multi-layer compression dressings, stockings or mechanical pumping devices.

Pictures of venous ulcers

The patient above presented with this stasis ulcer which had been present for one and one half year. Treatment consisted of debridement, Woundress, Allevyn and a dry sterile dressing.