How Venous Leg Ulcers Develop - And How To Treat Them
Updated: Mar 30, 2021
As the most common lower extremity wound type (80% of cases), venous leg ulcers (VLU) are skin wounds typically located on the medial aspect of the leg between the ankle and calf, the malleolus. Also known as Lower Extremity Venous Disorder (LEVD), these ulcers are slow to heal and often recur if proper prevention measures are not taken. The following statistics illustrate the impact of venous ulcers in the US.
The Prevalence and Costs of Venous Ulcers
2.5 million people suffer from venous ulcers in the US
1 in 4 Americans over the age of 65 will develop a leg ulcer in their lifetimes.
More common in women than in men
Venous ulcers costs over $3.5B annually in the US
3 year month recurrence rate is 70%*
*Thomas Miller, MD, Scott A. Clark, DPM, and Barry Stults, MD. Managing and Preventing Diabetic Foot Ulcers. Emerg Med 36(8):14-23, 2004
Venous ulcers are caused by impaired venous circulation in the legs most commonly due to LEVD. With normal venous function, blood is drained from the superficial vessels of the skin and subcutaneous fat by three major vascular pathways: the superficial veins, the deep veins, and the perforating veins. LEVD occurs when there is an abnormality of any part of the system, which results in impaired venous return and venous hypertension. An ineffective calf muscle pumping mechanism can also affect the onset of LEVD, as the calf muscle is key to moving venous blood up the system for re-oxygenation. The veins in the leg have one-way valves that prevent blood moving up the leg to the heart from flowing backwards. If the valves are damaged, they allow blood to flow back towards the ankles, which in turn causes swelling and edema of the leg, and possible formation of a venous ulcer.
Multiple factors increase the risk of developing a venous ulcer including family history, obesity, smoking, varicose veins, previous Deep Vein Thrombosis, and lack of physical activity. Individuals with multiple chronic diseases – hypertension, chronic heart failure, diabetes, etc. – often suffer from venous ulcers.
To accurately identify the etiology (type) of a leg wound, clinicians evaluate the arterial circulation using the ankle-brachial pressure index (ABI). Sufficient arterial blood flow to leg must be evaluated prior to wound debridement or compression therapy. ABI results may indicate referral to a vascular surgeon for revascularization of the leg if needed.
Evidence-based best practice indicates that compression therapy is the “gold standard” for venous wounds. It aims to promote the normal flow of venous blood up the leg and back to the heart. Compression has been shown to improve the rate of ulcer healing and reduce the incidence of recurrence. Efforts to heal venous leg ulcers are often focused on the use of advanced wound dressings and other therapies, while compression therapy to address the basic edema issue is underused.
There are several types of compression therapy options – compression bandages and wraps are commercially available as kits, as well as compression hosiery, garments and removable pumps. Compression bandages or wraps are long rolls of various types of fabric wrapped around the leg; some of the fabric is stretchy and some is not. The compression wrap is applied in a particular pattern, which has been demonstrated in commercial studies to deliver a specific amount of compression pressure. Compression bandages and wraps may consist of multiple layers. Compression hosiery are knitted garments that are donned like socks and can apply differing pressures to the leg. It is important to point out that TED or antiembolism hose are not an appropriate option for compression therapy.
Challenges in Treating Venous Ulcers
Inconsistent metrics and outcomes of healing across providers
Care provided and managed by different medical specialties – vascular surgeons, family practice, podiatrists, wound care specialists, etc.
Inconsistent use of evidence-based best practice regarding compression therapy
Lack of knowledge of the treating clinician: Incorrect identification of the wound’s etiology, or lack of skill in the application of compression therapy resulting in suboptimal or harmful compression
Board-certified wound care clinicians are trained to properly identify the wound etiology, recommend an evidence-based treatment plan, apply the proper dressings and adjunct therapies, and assist the patient with a long-term self-management plan to prevent recurrence.
Corstrata employs only board certified clinicians. Call us today and tap our knowledge!