Venous Ulcers

Question 1

What are venous ulcers?

Answer 1

Chronic skin and subcutaneous lesions usually found on the lower extremity in the gaiter region.

Question 2

What are risk factors of venous ulcers?

Answer 2

• Obesity
• Diabetes
• Sedentary lifestyle
• Family history
• Gestational diabetes
• Vascular disease
• Smoking
• Hypertension
• Hyperlipidemia
• Chronic kidney disease

Question 3

What issues are associated with venous ulcers?

Answer 3

• Valvular reflux
• Obstruction
• Failure of the calf-muscle pump

Question 4

What are associated causes of ulcers

Answer 4

• Accumulation of fibrin in tissue
• Accumulation of white blood cells in soft tissues, increased inflammation = increased breakdown of skin.
• Entrapment of growth factors and RBC: dark brown patches (hemosiderin)

Question 5

What is the gold treatment for venous leg ulcers?

Answer 5

Compression therapy

Question 6

What do prescription in compression therapy indicate?

Answer 6

They stipulate an amount of pressure to be applied, based on diagnosis, comorbid factors, and the patient’s willingness & ability to accept and adhere to treatment.

Question 7

What are the indications of compressive therapy?

Answer 7

• Venous hypertension
• Edema
• Exudative Venous Ulcers

Question 8

What are contraindications for compressive therapy?

Answer 8

• Arterial disease (ABPI < 0.5 - 0.8)

Question 9

What are variables affecting compression?

Answer 9

• Tension
• Number of layers
• Leg circumference
• Bandage width

Question 10

What are properties of compressive devices?

Answer 10

• Stiffness
• Elasticity / Stretch
• Re-usability (Adhesive/non-adhesive)
  -Number of layers

Question 11

In compressive devices, what does “stiffness” indicate?

Answer 11

• Ability of a textile to resist deformation under stress.
• Defined as the pressure increase produced by muscle contraction per centimeter of increase in leg circumference.
• Influences the amount of tension that can be exerted by the device.

Question 12

In compressive devices, what does “elasticity/stretch” indicate?

Answer 12

• The textile’s ability to return to its original size after the pressure has been reduced.
• Determines the deviced / textile’s effect on the pressure at standing in resting position as well as working pressure generated during walk, when muscle contraction and dynamic changes in leg circumference occur.
• Short-stretch VS long-stretch

Question 13

In compressive devices, what does “re-usability” indicate?

Answer 13

• Disposable products are used early in treatment when significant edema or an ulcer is present.
• Reusable compression products can be removed, cleaned, and then reused; primarily used for “maintenance compression” once the edema has resolved and the ulcer is significantly healed.
• Reusable products are non-adhesive wraps or garments.

Question 14

In compressive devices, what does “Number of Layers” indicate?

Answer 14

MULTILAYER
- 2 or more layers
- Disposable
- Elastic - provide sustained compression
- Absorb exudate, making them preferred choice for active venous ulcers

SINGLE LAYER / STOCKINGS / VELCRO WRAPS
- Ideal for lower-pressure compression applications (preventing recurrence)