Wound etiology - Vascular wounds Flashcards
What is the most common type of leg ulcer?
Venous insufficiency ulcer
T/F: Venous system is a high pressure system that returns blood to the heart, against gravity
False, low pressure
What are perforator veins?
- Veins that connect deep and superficial venous system
- Considered to cause most of the problems
How does the calf muscle pump work?
- When the muscle contracts, it squeezes the deep veins to increase pressure, the perforator vein then closes, and blood moves up
- Opposite is true to move blood from superficial to deep
What are the venous pressures?
- 90mmHg in quiet standing
- 25-30 mmHg during ambulation
What generates the pressure difference in the leg veins?
The calf muscle pump
Risk factors for venous insufficiency ulcers
- Failure of calf muscle pump
- Multiple pregnancies
- obesity
- History of trauma
- Prolonged standing
- Family history
- Diabetes
Clinical features of venous insufficiency ulcer
- Proximal to medial malleolus
- Minimal pain - relieed with elevation
- Sloped edges, dry scaling periwound
- Lipodermatosclerosis
- Pedal pulses difficult to palpate due to edema
- Shallow wounds
- Hemosiderin pigmentation
- Pitting edema
- Develop slowly
- Large amounts of exudate
What is the venous insufficiency ulcer classification system?
- C = clinical presentation (0-6)
- E = etiology (primary, secondary, congenital)
- A = anatomic distribution (superficial, perforator, deep)
- P = pathophysiology (reflux, obstruction, both)
Venous insufficiency ulcer prognosis
- Heals in 8-12 weeks with treatment
- 20-40% decrease in surface area with 2-3 weeks of treatment indicates good response
T/F: Venous insufficiency ulcers treated without compression heal better and faster than those without
False, with compression is better
PT intervention for venous insufficiency ulcer
- wound debridement
- cleansing
- proper dressing
- elevation and exercise
- compression
- education
How should venous insufficiency ulcer be cleansed?
PLWS
Topical wound care for venous insufficiency ulcer
- Debridement of necrotic tissue
- Moisturize dry scaling periwound
- Choose appropriate dressing
- Use skin sealant to protect periwound
What is the standard of care for venous insufficiency ulcer?
- Compression
- Increases efficiency of venous return and the calf muscle pump
- Decrease MMPs and chronic inflammation
- Increases tissue oxygen levels in standing
- May be accomplished through intermittent gradient pressure pumps, compression wraps or both
How do compression pumps work?
- Pump 60 to 120 minutes at pressure less than diastolic
- Compress/relax ratio at 90:30 seconds
Compression wrap types for venous insufficiency ulcer
- Standard elastic wrap (least effective)
- Custom compression garment
- Unna boot - pliable, non stretch wrap that maintains leg contour
- Multilayer short stretch bandaging
T/F: Arterial system is a high pressure system carrying oxygenated blood to body tissues
True
What is the leading cause of arterial insufficiency?
- Atherosclerosis
- Risk is increased by smoking, diabetes, HTN, high cholesterol, CAD, age
What is one of the first symptoms of atherosclerosis?
- Intermittent claudication
- Activity specific pain due to local ischemia which subsides within 1-5 minutes of rest
- Cramping, burning, fatigue
Pain grade scale for ischemic pain
- Pain, discomfort, cramping, weakness with minimal exercise
- Moderate pain, discomfort, cramping, or weakness with exercise
- Severe or intense pain, discomfort, cramping, or weakness with exercise
- Excruciating or unbearable pain, discomfort, cramping, or weakness without exercise
What is the progression of arterial insufficiency?
- Arterial insufficiency
- Intermittent claudication
- Ischemic rest pain
- Ischemic ulcer
- Dry gangrene
- Amputation
What is the 2nd most common cause of arterial insufficiency ulcer?
- Thromboangiitis obliterans - “Buerger’s disease”
- Primarily affects young men who smoke
Clinical features of arterial insufficiency ulcer
- Deeper wounds with distinct borders, pale wound bed, minimal drainage
- Usually near toes, dorsum of foot, or lateral malleolus
- Very painful
- Decreased pulses
- Intermittent claudication
- Pallor on elevation
- Decreased hair growth
- Edema is rare - indicates venous involvement if present
- Blach eschar is common, leading to gangrene
