WOUND BLOG by Matthew Livingston RN

There are several more common types of wounds, other than surgical or pressure related wounds, that are common in the clinical setting. These include (but are not limited to) arterial, venous, and diabetic ulcers. The following will briefly discuss ideas related to the specific cause, diagnostics, appearance, and treatment of a venous wound etiology.

Venous ulcers form by a complex cascade of physiological events in the venous circulation related to venous hypertension. Diagnostics used to confirm venous hypertension include pneumoplethysmography (maximum venous outflow), venous photoplethysmography, and bi-directional color doppler.  Treatment for venous ulcers includes compression wrap bandages, intermittent pneumatic compression, and apligraf.   High compression bandaging is considered the gold standard of treatment of venous leg wounds, yet the majority of published clinical data indicate that only 65% of ulcers are likely to be healed within 24 weeks of appropriate compression therapy, with 20% of ulcers remaining unhealed after more than 50 weeks (1).

(1) Skene AI, Smith JM, Dore CJ, Charlett A, Lewis JD. Venous leg ulcers: a prognostic index to predict time to healing. BMJ 1992; 305(6862): 1119-21.

Common Terms include:

FIBRINOUS– Accumulation of fluids and fibrin (a stringy insoluble protein).

HEMOSIDERIN STAINING – Hemoglobin deposited in tissues. Appears as brownish patches. Symptomatic of venous disease.

LIPODERMATOSCLEROSIS – an induration and erythematous hyperpigmentationof the leg.

MALLEOLUS – A common location of venous wounds located at either of the two rounded protuberances on the side of the ankle, the inner formed by a projection of the tibia and outer projection of the fibula.

PERIPHERAL VASCULAR DISEASE (PVD) – Alterations in the arteries and veins of the extremities; those conditions which interfere with adequate flow of blood to or from the extremities. Peripheral vascular disease broadly describes the underlying pathology of venous stasis ulcers and arterial ulcers.

VARICOSITIES – swollen, twisted veins.

VAVULAR INCOMPETENCE – Refers to damaged valves in the perforator veins of the legs; results in poor venous return to the heart. Valvular incompetence is the underlying pathology of venous stasis ulcers.

VENOUS HYPERTENSION
Patients with varicose veins or nonfunctional venous valves after deep vein thrombosis develop ambulatory venous hypertension, that is, distal venous pressure remains elevated despite ambulation. This constant venous hypertension seems to cause white cell and fibrin buildup, which impairs capillary blood flow or traps growth factors. Macromolecules pass into the dermis and eventually cause the hemosiderin deposition and brawny induration in the distal leg (gaiter area) characteristic of chronic venous insufficiency.

VENOUS INSUFFICIENCY – Stagnation of the normal flow of blood from the lower extremities to the heart due to valvular incompetence; also called venous hypertension.

VENOUS STASIS – Stagnation of the normal flow of blood from the lower extremities to the heart due to valvular incompetence; also called venous hypertension.