Venous Ulcers

INTRODUCTION

The area typically affected by varicose eczema and ulceration is the ‘gaiter’ area of the leg. Firm compression is the single most important factor in the healing of venous ulcers.

Treatment method

1. Clean the ulcer with N saline. If slough, apply IntraSite gel.

2. Ideally, apply a foam dressing. A lightweight bandage can hold a non-adherent dressing in place.

3. Apply an elastic compression bandage, applied with 30% stretch from base of toes to just below the knee. Other options include elastic stockings, zinc paste bandages (Unna boots) and legging orthoses.

4. Lifestyle modification, e.g. weight loss, smoking cessation.

5. Encourage early ambulation and exercise.

6. Leg elevation (if severe, 45–60 min bd and at night): ensure legs are higher than the heart.

Note: Dressings should be changed when they become loose or fall off, or when discharge seeps through. Remove dressings under the shower if necessary.

WOUND DRESSING

There are five main types of modern wound dressings: films, hydrogels, hydrocolloids, alginates and foams—all expensive. Films, hydrogels and hydrocolloids increase the wound moisture whereas alginates and foams absorb exudate. The more traditional dressings such as tulle grass, non-adherent pad dressings and saline soaks can be useful.

General rules:

• Allow 2–3 cm of dressing greater than the wound

• Place ⅓ above and ⅔ below the wound

• Remove when ‘strike-through’ occurs

• Remove with care in older patients

• Remove under the shower if necessary

• When in doubt, DO NOT HARM: use foam and gel combinations