Venous Ulcers/Lymphedema

Question 1

Describe the primary pathology and to outline assessment parameters and management principles

Answer 1

Valvular incompetence, venous insufficiency, high ambulatory venous hypertension
RISK Factors: Pregnancy, Obesity, Hypertension, thrombophilia, aging/sedentary lifestyle, decreased ROM, previous DVT, prolonged standing
Causes: RBC/molecules leak out, attracts WBC w/ increased inflammation & fibrotic changes

Question 2

Given a pt scenario, recognize a venous ulcer and make appropriate mgmt decisions

Answer 2

Venous Ulcer - lower extremity, aching pain, stasis dermatitis (edema, erythema, scaling, weeping, pruritus), malleolus, exudative/ruddy base, edema, improved at rest & elevation, hemosiderin staining, ankle flare, lipodermatosclerosis, valvular incompetence
Management:
1. surgical consult (perforator veins)
2. compression if possible (ABI) - compression wraps/therapeutic stockings
3. elevation
4. analgesia, meds

Question 3

Explain why ACE bandages are generally NOT a good option for compression therapy

Answer 3

use dependent
no applied correctly
long stretch bandages, not adequate compression (stretch with calf movement, tighten at rest

Question 4

List contraindications to compression therapy

Answer 4

uncompensated HF
active thrombosis
ABPI <0.5 need vascular consult

Question 5

Identify therapeutic level of compression

Answer 5

ABPI 0.9-1.3 compression 30-40mmHg

ABPI 0.5-0.8 modified compression 20-27mmHg d/t moderately severe arterial disease

Question 6

Lymphedema: Indications and guidelines for management, as opposed to venous edema

Answer 6

cobblestone, lymphatic vessels (protein rich)
can occur secondary to chronic venous insufficiency
Indications: non-pitting edema groin to toes, positive Stemmers sign, poor response to elevation & compression, skin & soft tissue changes cobblestone (papillomatosis), filarisis
Treatment: Lymphedema treatment centre (Complex Decongestive Physiotherapy) followed by compression for maintenance