Treatment of Venous Stasis Ulcers

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Venous Stasis Ulcers. PathophysiologyVenous ulcers result from damage to the valves in veins of the leg.This leads to increased venous pressureVenous hypertension, circulatory stasis and shear trauma in most superficial skin layers. Venous Stasis Ulcers. PathophysiologyThis stasis triggers an inflammatory reaction mediated by PMN'sRelease of cytokines, oxygen radicals and proteolytic enzymes results in fibrosclerotic remodelling of the skin and then ulceration.Swollen, edematous skin is p30341

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Treatment of Venous Stasis Ulcers

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1. Treatment of Venous Stasis Ulcers Charles Cornell, MD Geriatric Teaching Program May 28, 2008

2. Venous Stasis Ulcers Pathophysiology Venous ulcers result from damage to the valves in veins of the leg. This leads to increased venous pressure Venous hypertension, circulatory stasis and shear trauma in most superficial skin layers

3. Venous Stasis Ulcers Pathophysiology This stasis triggers an inflammatory reaction mediated by PMN’s Release of cytokines, oxygen radicals and proteolytic enzymes results in fibrosclerotic remodelling of the skin and then ulceration. Swollen, edematous skin is prone to recurrent infection: cellulitis

4. Venous Stasis Ulcers Differential Diagnosis Ischemic ulcers Neuropathic ulcers Erysipelas and cellulitis Immune mediated ulcers e.g. eczema N.B.: In spite of different etiology principles of treatment are very similiar

5. Venous Stasis Ulcers Clinical Presentation Chronic ulceration with necrosis and purulent exudate Surrounding edema Fibrotic skin Pain Surrounding cellulitis may be present

6. Venous Stasis Ulcers Clinical Management Most important aspect of treatment is reduction of edema achieved through the use of compression dressings

7. Venous Stasis Ulcers Clinical Management UNNA Boot Medicopaste bandage: gauze plus zinc oxide and glycerine Dries after application to form a compressive soft cast Soothing, relieves pain and protects the wound Extremely effective for edema reduction

8. Venous Stasis Ulcers Clinical Management Adjunctive Treatment Systemic antibiotics for cellulitis Surgical debridement to remove eschar Dressings applied beneath the compressive bandage to provide a moist environment, reduce bacterial burden and ease pain

9. Venous Stasis Ulcers Dressing Choices Currently: No evidence of superiority of any one dressing type but some evidence favoring hydrocolloids/microfibers Wet to Dry: don’t reduce bacterial burden Calcium Alginate ( Kaltostat ) and microfiber/silver( aquacell) VAC dressing: very effective Flap Coverage: not successful due to recurrence!!

10. Venous Stasis Ulcers Clinical Management Treatment Summary - Compression!!! - Debridement - Surface dressing Average time to healing is 31 weeks

11. Case Example 2 month old ulcer after iv antibiotics

12. Case Example 2 month old ulcer after iv antibiotics

13. 6 weeks after initiation of UNNA boot and calcium alginate

14. Ulcer at 12 weeks

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