You CAN Heal Venous Ulcers!

Ulcers
The word brings to mind an ugly image for most of us. It is a breakdown of tissue in the stomach lining or on the leg. For venous leg ulcers, the most common cause is venous stasis disease. The good news is that most venous ulcers can be healed with compression and good wound care.

What Causes Ulcers?
Your feet and legs need good blood circulation to stay healthy. This circulation is a system of vessels within your body that carries blood to your legs and feet and then carries it back up to the heart, which pumps it back out again. Arteries are the blood vessels that carry the blood to, and veins carry it away from, your feet and legs. Blood must flow from the feet and legs uphill against gravity by two primary means. The calf muscle in your leg contracts and squeezes blood out of the foot and lower leg. Additionally, veins have one-way valves to prevent the blood from flowing backwards. Sometimes these one-way valves no longer work properly or the vein becomes narrowed causing the blood to collect or pool in the lower legs. When the valves fail to work properly, pressure builds up from the pooled blood, small vessels stretch and leak fluid, causing swelling. After a while, the skin may break down and an ulcer may form. The ulcer often occurs on the inside surface of your leg just above the ankle. The shape is usually irregular and it can have a red or yellow color to it. There is usually swelling in the lower leg area and often brown stains, which occur when the blood leaks into the tissue. If you have a leg ulcer, lie down and position your feet so they are elevated six inches above the level of your heart. Use pillows or the arm of the couch to elevate your feet. If the pain stops, it is probably a venous ulcer.

Venous disease usually occurs as a person gets older. Women have been found to get the disease more often than men. Venous ulcers may cause a lot of pain. Your life may change because of decreased mobility and sometimes you may not be able to work. Ulcers can be difficult to treat and this is not a time for home remedies. It is very important to see a vascular specialist or wound care specialist if you have pain or swelling in your legs and feet and if you have an ulcer. Do not wait and see if the problem goes away on its own. The earlier treatment is started, the earlier it can be healed, which keeps the ulcer smaller and lessens the pain.

How Are Ulcers treated?
A venous leg ulcer is a symptom of underlying venous disease, so treatment must be directed at improving venous blood flow. If you understand what is going on and become active in prevention or treatment, you may heal the ulcer(s) and have some control over your condition.

Compression to the legs is the standard treatment. It is used to increase healing of venous stasis ulcers by improving the blood supply and reducing swelling. There are numerous types of compression wraps available. Some are elastic, others are not. Some are applied in a single layer; others are applied in multiple layers. The manner of application depends on the type of wrap used. Different amounts of compression are provided by different compression wraps. Once healed, you must continue to use compression to keep the ulcer from returning.

Non-elastic compression bandages. Unna's boot has been around for over 100 years. It is applied moist and usually contains a zinc oxide base (sometimes with calamine) to moisturize and reduce itching to the leg. It is covered with another bandage for pressure, usually an Ace wrap or Coban. The Unna's boot forms a rigid tube that causes enough pressure to push blood up the leg as the leg muscles pump when you walk. The pressure also helps reduce swelling. It is usually applied once or twice a week. Non-elastic compression also comes in a device with straps that wrap around the leg and fasten with Velcro.

Elastic bandages are stretched when applied and cause constant pressure, whether walking or at rest. The bandages come in moderate and high compression. Some provide compression with one layer; others have multiple layers to wrap around your foot and lower leg. To help you know how much to stretch the bandage, some of them come with easy-to-follow markings. High-compression elastic bandages have heavier elasticity. They may be applied by themselves or over another bandage used for padding. You may be instructed to wear the bandage for a whole week or you may be permitted to take it off at bedtime and reapply it first thing in the morning.

Moderate-compression elastic bandages aren't as strong when stretched, but they apply compression even after the swelling has gone down. They are usually part of a compression system with other layers. There are a number of different moderate-compression bandages on the market. If you aren't able to apply and remove your own bandage every day and you need 24-hour compression, this might be the best bandage for you.

The compression bandage should be applied from toes to knee. The greatest amount of pressure is at the foot and ankle. The best time to apply the compression bandage is when there is little or no swelling present in your foot and leg. That may be when you wake up in the morning or after a nap when you haven't been up and about on your feet.

It is important that you see a medical professional for proper examination and testing. There are differences in blood flow to and from the lower legs. Sometimes you may have an arterial flow problem, in addition to poor venous flow, which may prevent you from wearing compression. Since wraps come in many different degrees of compression, your vascular physician or nurse will know which will be better for you.

The pressure to your legs from these bandages may reduce your pain and provide comfort. It has been found that individuals with venous stasis disease take fewer pain pills when they wear good compression bandages. The compression from the bandages helps the blood flow, which assists in healing the venous leg ulcer, but you also need to take care of the wound.

Wound Care
When changing the compression wrap, good wound care is a must. To cleanse the wound, use a product recommended by your vascular doctor or nurse. There are a number of wound cleansers on the market, as well as normal saline. Cleansing will remove bacteria, extra moisture, dirt, or pieces of the bandage that may have been left behind when it was removed. A healing ulcer should become red and shiny. Your doctor or nurse may remove yellow or brown tissue from the wound to help it heal faster. This is called debridement. Sometimes a medication can be applied to the wound to debride it. You may be told to use hydrotherapy, which works like a whirlpool to rinse and clean the wound with rushing water. Visible signs that the wound is infected include redness around the ulcer, warmth to the touch over the ulcer, and more swelling and pain to the skin around the wound. An antibiotic taken by mouth may be prescribed if the wound is infected.

The wound should NOT be left open to air or dry out, but should be slightly moist at all times. If your wound drains a lot, you need to use a dressing that will absorb the excess drainage. Too much drainage is a good breeding ground for bacteria. You may be told to use a foam, an alginate (made from seaweed), or some other dressing that will absorb all the extra fluids. This is important so that the skin in and around the ulcer does not get too wet and cause more problems. You may also be instructed to use a medicated dressing to help decrease the bacteria and infection in wounds and, in turn, encourage faster healing. Some companies that make wound dressings also use an "antibacterial" silver dressing. The silver ions in the dressings are released over a period of several days and will keep the wound moist. Sometimes the wound may not have a lot of drainage. A hydrogel or thin hydrocolloid may be used to provide moisture.

Your vascular specialist will be familiar with dressings and wraps commercially available and will assist you in selecting the products that will work best for you. You may need to change the dressings and wraps twice a week in the beginning, but you can usually go to a weekly change once therapy begins. If your wound changes, the type of dressings being used on your ulcer may need to change.

Prevention
After the ulcer heals, compression stockings should be worn to prevent swelling and to keep another ulcer from occurring. It is important for you to see your health care provider regularly during treatment to provide you with necessary changes in your therapy. The key to healing and preventing venous leg ulcers is to reduce swelling in the legs and keep generally healthy. Good nutrition and drinking fluids, especially water, are helpful in staying healthy. Your activity level will also be discussed and recommendations made to properly exercise and rest your legs. You should avoid standing for long periods and when sitting, don't cross your legs. When resting, keep legs up when possible (six inches above your heart). Don't scratch your legs. If you are overweight, try to lose some of those pounds. If you smoke, quit. This is the most positive thing you can do for your health.

The most important part of compression wraps, dressings, nutrition, fluids, proper exercise, and rest is that you listen to all medical instructions and follow them. Lots of research has been done proving this is what will heal your venous ulcers. It only works if you take charge in following your treatment regimen.

About the Author: Sheila A. Kramer, RN, BSN, CWCN, COCN, is a Nurse Clinician with Wound/Ostomy Specialties at St. John's Mercy Medical Center in St. Louis. She has treated many patients with venous ulcers and other wounds over the many years she has been in practice.