Venous Insufficiency Wounds

Question 1

What is the typical location of Venous Insufficiency wounds?

What does the surrounding skin usually look like?

Answer 1

above the malleoli in the distal 3rd of the lower leg (medial or lateral) if it is outside of this area it may not be VI

• hyperpigmentation and hemosiderin staining
• lipodermatosclerosis (scarring of skin which results in hard, thickened immobile skin and can cause “champagne bottle leg”
• thick and scaly epidermis
• varicose veins are common

Question 2

What are the wound characteristics for VI wounds?

What does the peri-wound typically look like?

Answer 2

• uneven wounds edges that are shallow
• highly exudative and if there is little drainage then consider AI component
• usually not very painful but if it is then consider AI or vasculitis

Peri-wound

• maceration common
• diffuse edges
• irritation

Question 3

Should you compress VI wounds?

Answer 3

Yes but use common sense and consider patient ADLs and functional needs, be flexible

Question 4

What options are there for compression of a wound?

Answer 4

• tube-like (least amount of compression and stretches with use)
• long stretch (stretches a long way and delivers constant compression but can feel tight at rest)
• short stretch (stretches a short distance and delivers high compression with use but low at rest)
• in elastic (only enough tension to hold in place, needs a secondary wrap, can be worn for a long time)
• stockings (very long term and very versatile)

Question 5

What would indicate a compression level of 15-20 mmHg?

20-30 mmHg?

30-40?

40-50?

over 60?

Answer 5

Support- early signs of VI w/o ulcer

Therapuetic- mild VI w/o ulcer, lymphedema, prophylaxis for high risk patients

moderate VI w/ or w/o ulcer, post ulceration, pronounced varicose veins, burn scar management

severe VI, VI ulcers and no AI, severe lymphedema

Severe lymphedema, elephantiasis, severe post thrombotic disease

Question 6

What is a farrow wrap?

Answer 6

a foot piece with series of velcro bands

Question 7

What is LaPlace’s Law?

Answer 7

way to calculate adjustments for graded compression that is based off of girth of the limb and bandage width

compression=(tension)x(# of layers)x(4630)/(limb girth)x(bandage width)

Question 8

True or False: a figure 8 wrap is 2x the compression of a spiral wrap.

Answer 8

True

Question 9

True or False: Elevation alone is adequate to promote venous return.

Answer 9

False, needs compression and elevation above the head

Question 10

What is the goal of PT with VI wounds?

Answer 10

• prevention
• set stage for body to heal by relieving pressure and congestion
• compression
• help patient adjust their ADLs due to life long issue of wound