Venous Insufficiency and Leg Ulcers Flashcards
Etiology of venous ulcers
- acquired valvular dysfunction
- venous HTN leads to fibrin cuff formation
Regarding the etiology of venous ulcers, acquired valvular dysfunction, especially of the
communicating system
Regarding etiology of venous ulcers, venous HTN leads to fibrin cuff formation around _________________, potentially inducing _____________ and __________________.
small vessels; fibrosis; decreased nutrient diffusion
Risk factors for venous ulcers
- trauma
- DVT
- pregnancies
- obesity
- clotting disorders
- family hx of venous ulcers
Venous ulcer presentations
- Good pulses
- Usually on LE, not involving feet
- Shallow, partial to full-thickness loss with minimal necrotic tissue
- Little pain (increased with standing, relieved by elevation)
- Brawny edema, hemosiderin staining
- Moderate to heavy drainage
- With more advanced venous disease, wood-like tissue develops over gaiter area
- Pulses may be difficult to palpate due to edema, which can be considerable
- Inverted “champagne-bottle” deformities
Lipodermatosclerosis
brawny edema with hardening and induration, hyperpigmentation of skin, fibrosis of tissue, skin changes like eczema
Edema grades
1+ mild
2+ moderate
3+ severe
4+ very severe
3 parts of Doppler Ultrasound
- resting test
- augmentation test
- reflux test
Standard care and treatments
- debridement
- cleansing
- dressings
- compression
- antibiotics
- pressure redistribution
When managing chronic wounds, treat _____________________ and __________________.
underlying conditions; comorbidities
To treat underlying conditions and comorbidities of chronic wounds,
- optimize blood glucose control
- adequate nutritional status
- revascularization
- pain management
- infection control
When should pain be assessed?
first thing every visit
Evidence-based protocols for venous leg ulcers
- compression therapy
- bioengineered tissue
When considering compression therapy, consider
multilayer elastic vs. single and inelastic
Apligraf falls under what protocol for venous leg ulcers?
Bioengineered tissue
What is Apligraf?
- skin graft created in a dish
- made from baby foreskins
Barriers to healing VLU
- presence of unresponsive or senescent cells
- inflammatory or proteolytic environment
- deficient or unavailable growth factors
- presence of bacteria
VLU stands for
Venous Leg Ulcer
Before doing compression therapy, what should be checked?
ABI
Venous ulcer plan of care
- consider surgical interventions
- compression therapy
- exercise and walking program
- elevation
- debridement
- wound care (especially for drainage control and bacterial reduction)
How long should a pt with venous insufficiency elevate his/her legs?
30 min for every 2 hours legs were in a dependent position at a level higher than the heart
Patient and caregiver education
- elevation and compression
- application or maintenance of compression tx device
- usually lifelong vigilance is required
Medical/surgical options
- Ligation
- Vein stripping
- Sclerotherapy
- SEPS (Subfascial Endoscopic Perforator Surgery)
SEPS stands for
Subfascial Endoscopic Perforator Surgery
Ligation
tying off of perforating veins
Vein stripping
resection perforating veins and/or varicosities
Sclerotherapy
injection to fibrose dysfunctional veins
SEPS is
interruption of perforating veins
SEPS may also improve
lipodermatosclerosis
To treat venous edema, compression bandages require
30-40 mmHg
Compression bandages do what to edema?
reduce/control it
Compression bandages should go from _______________ to __________.
base of toes; knee
