What is a Stasis Ulcer?
Stasis ulcers, sometimes called venous skin ulcers, affect almost 1% of Americans. These wounds usually occur on the lower legs, especially around the ankles. They can be extremely painful and are very slow to heal, taking an average of six to 12 months to close completely. Worse still, for 70% of patients, ulcers will recur within five years of closure.
Causes
Stasis ulcers are caused when the valves in the veins of the leg are underperforming, meaning that blood pools in the end of the limb. This swelling can weaken the skin, making it harder for cuts to heal. A small tear in the skin over the ankle or lower shin can turn into a large wound, called an ulcer. The problem is exacerbated by blood protein leaking out of the stretched veins, making it harder for the natural healing processes to begin.
Risk Factors
According to WebMD, stasis ulcers are most common in older people, especially women. Other risk factors include:
- A history of varicose veins
- Smoking
- Obesity
- Circulation problems, blood clots, or phlebitis
- Reduced mobility, or sitting or standing for long periods of time
- A history of leg injuries, such as a fracture, burn or muscle damage
Symptoms
Patients who are beginning to experience venous insufficiency may develop a condition called stasis dermatitis, in which the skin on the lower legs becomes thin and itchy. If blood begins to pool in the legs, the skin may become dark red, purple, brown, or hardened.
Venous ulcers themselves are shallow, painful sores with uneven edges. They are usually red but might also appear yellow. If the wound becomes infected, it might also have a bad odor and draining pus. The surrounding skin may be shiny, tight and warm, and the patient may develop a fever.
How Should Stasis Ulcers Be Managed?
Challenges of Managing Stasis Ulcers
Stasis ulcers are a serious and chronic condition that can be difficult to treat. Infection is a frequent complication. If left unchecked, infection could progress to cellulitis or even septicemia, which in extreme cases could result in the need to amputate. There is also the risk of malignancy, most commonly squamous cell carcinomas.
It is essential that ulcers receive careful treatment and management, and that active steps are taken to prevent a recurrence. To reduce the risk of complications, patients are advised to seek treatment from a wound care specialist.
Initial Treatment
The first step to treating a venous ulcer is to treat any underlying infection. Depending on how severely infected the wound is, that might involve taking antibiotics orally, or via an intravenous drip. The treating physician will usually also debride the wound. Debridement refers to removing the damaged tissue around the ulcer. This helps reduce the amount of bacteria around the wound and also stimulates the healing process. Debridement should be done periodically as the ulcer begins to heal.
Once the wound has been thoroughly cleaned and debrided, it will be covered with a specialized dressing, designed to promote healing, protect the wound from touching the bandage, and to help the patient feel more comfortable. The patient may be given other topical or oral medications, such as a steroid cream, to reduce the inflammation of the skin around the wound and help with any stasis dermatitis or itching. For more severe venous ulcers, the doctor will also evaluate the option of surgery to repair the damaged valve or unblock the veins.
Wound Management and Recovery
Once the initial treatment has been completed, the focus will be on reducing the pressure on the veins to support the healing process, minimize the leg swelling (edema) and reduce the risk of recurring ulcers. Compression therapy is usually the recommended treatment for venous ulcers. This involves binding the wound with a thick, tight bandage or layers of bandage to apply a specific amount of pressure. These bandages should be applied by a wound care specialist who will be able to assess the appropriate pressure level, depending on the patient’s blood pressure and other factors. Compression reduces the fluid leakage from the capillaries and decreases the release of inflammatory proteins, which will slow the progression of the disease.
In addition to compression therapy, the wound care specialist will also advise patients on essential self-care techniques to manage their ulcer and promote a speedy recovery. These techniques include:
- Performing leg exercises to improve muscle function and blood flow
- Elevating the legs above heart level for 30 minutes, three or four times a day
- Avoiding standing still for long periods
- Using compression stockings
A wound care physician can also identify any risk factors which would affect recovery, such as smoking or obesity, and provide advice on how to address these.
Follow-Up Care and Prevention
It is essential that patients with venous ulcers follow a plan of care that includes regular check-ups, ideally with a wound care specialist. Venous ulcers can be a chronic and recurring condition, and patients will need to actively manage their recovery. The ulcer may need regular debridement until it has fully healed, and compression therapy may need to be repeated. The wound also should be checked frequently to make sure it has not become infected.
How Can a Wound Care Center Help?
Given the complexity of managing venous ulcer recovery, a wound care center is often the ideal place to seek treatment. A wound care center can provide specialized services to make sure that your wound heals, and also help with pain management, physical therapy, and other treatments. A dedicated wound care team can help make sure that you avoid the potentially devastating complications that can result from venous ulcers and promote a faster recovery.
Wound care specialists have received three years of training in the care of wounds, in addition to their medical training. Certification requires ongoing education and re-certification, meaning that wound care specialists are familiar with the most up-to-date care for all types of wounds. They will be extensively trained in procedures like debridement and compression. Wound care centers also offer access to the latest medical technologies to support the healing process, such as hyperbaric oxygen therapy, growth factor therapy, skin grafting, and ultrasound therapy. As a result, a wound care center may be the best place to begin the process of managing and recovering from a venous ulcer.
If you’re looking for a wound care center in Alabama, Rehab Select wound care clinics offer a high success rate, specialized treatments, and highly qualified medical staff. To find out more about our approach to wound care, or to schedule a visit, contact the facility online or over the phone today.
