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
