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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.
 
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.
Authored by Dr. Allan Freedline and Dr. Tamara D. Fishman.
References: The Care of Wounds, A Guide for Nurses by Carol
Dealey Bsc (Hons), RGN, RCNT. Blackwell Scientific Publications
1994
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