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Venous Ulcer Treatment

Chronic venous insufficiency is the main cause of venous ulcers.

The goals of treatment are to promote healing of ulcers, reduce leg swelling and prevent or reduce infection. Treatment is tailored to your specific needs. The majority of patients with venous ulcers are treated conservatively; however, surgical intervention may be indicated.

Diagnostic Tests
Certain tests are done to detect the cause and extent of venous insufficiency.

• Photoplethysmography (PPG)
  Measures valve function in the leg.
• Venous Flow Study
  Detects blockage in the deep veins and tells how well veins are returning blood to the heart.
• Duplex Scan
  Provides an image of the vein and measures blood flow in the veins.
• Venography
  This test is done in special cases. During this exam, dye is injected to check for blockages in the veins and looks at vein valve function.

Treatment
Your doctor or nurse may suggest one or more of the following treatment options:

Unna Boot
An Unna boot is a moist, gauze bandage made up of zinc oxide, calamine lotion and glycerine. It promotes healing, increases blood return to the heart and reduces infection. The boot is wrapped from the toes to just below the knee, covering the ulcer and the lower leg. The gauze then dries and hardens. An elastic bandage is wrapped snugly over the Unna boot. A new boot is applied every one to two weeks until the ulcer is healed. Initially, more frequent changes may be required for heavily draining ulcers. The larger the ulcer, the longer it will take to heal. Small ulcers heal in a few weeks; large ulcers sometimes take several months to heal. Keep the Unna boot dry. Do not take a tub bath or shower when wearing an Unna boot unless you cover the boot with a large plastic bag. In some cases, sponge bathing may be the only option. You should be able to wear a sock or stocking over an Unna boot as well as your regular shoes. If your foot is swollen, a wider shoe or slipper may be needed.

Multi-layer Compression Wrap
This dressing consists of three to four layers that are wrapped from the toes to just below the knees. The first layers are for padding and control of drainage and the outer layers provide compression. This dressing is similar to an Unna boot in its care, frequency of dressing changes, and its ability to heal ulcers.

Dressings
If the leg ulcers are large and/or infected, another type of dressing may be used. Depending upon the ulcer, these dressings may need to be changed more than once a day. An elastic bandage is applied over the dressing and wrapped from the toe to just below the knee. Remove the dressing before bathing and showering. After bathing, dry the leg well and re-apply the dressing and the elastic support. If an infection is present, oral or intravenous antibiotics may be needed.

Leg Elevation
Elevate your legs above the level of the heart for 30 minutes three to four times a day. This is helpful if the boot begins to feel tight or the ulcer hurts. A foam wedge or several large pillows may also be used to help raise the legs.

Elastic Support
Strong elastic support is needed.

• Wear an elastic bandage or special elastic stocking at all times.
• Apply the bandage or stocking before getting out of bed. The bandage may be removed at night.
• If you use an elastic bandage, wrap the bandage snugly from the toe to just below the knee. Overlap the edges. Do not use elastic bandages if they have lost their shape or become stretched out. Bandages can be purchased at most drug stores.
• Bandages may be washed with mild soap and water and reused.
• A compression pump may be used for severe swelling.

Surgery
The doctor can decide if surgery is an option by examining the skin around the ulcer while you are standing. Surgery may prevent venous ulcers by removing the superficial and/or perforating veins that cause blood to pool and block the supply of nutrients to the skin. The veins are removed by making small incisions over the area of the venous ulcer. The surgery is done under general anesthesia in the operating room. For more severe ulcers, a skin graft may be needed.

After the Ulcer Has Healed
After the ulcer has healed, you will be measured for a special elastic leg stocking. It will promote blood return and help prevent leg swelling and ulcers. You must wear this stocking whenever you are out of bed (except when bathing). It should be applied early in the morning to avoid leg swelling. These stockings must be replaced at regular time intervals as they become stretched and lose their level of compression. You must continue to elevate your legs three to four times per day.

Preventive Measures
To help prevent venous ulcers, follow these basic guidelines.

Foot/Body Care

• Inspect your skin on a daily basis. Look for cracking skin, breakdown and changes in skin color and/or temperature.
• Tell your doctor about any changes.
• Keep your skin in healthy condition.
• Wash your feet and legs daily; dry well.
• If your skin is dry, use a hand lotion, lanolin, or cocoa butter at bedtime.
• Wear clean stockings daily along with elastic support as suggested.

Activity
Exercise your legs regularly, even when you are lying in bed. Avoid standing or sitting in one position for a long period of time. It causes blood to pool in your legs.

If you must stand in one position for a long time, exercise your legs while standing. Raise up on your toes several times an hour. Shift your weight from one foot to another. While riding in the car, stop every two hours for brief walks to exercise your legs.

You cannot swim when wearing an Unna boot, but swimming is good exercise after the boot is removed. Walking and cycling are also good forms of exercise.

Avoid activities that may cause leg swelling, such as long periods of being on your feet.

Leg Elevation
Leg elevation is the best method of preventing skin breakdown.

• Elevate your legs several times a day for at least 10 to 15 minutes.
• Raise your legs higher than the level of your heart. You can do this by lying on the floor with your legs on a chair or against the wall. If you cannot elevate your legs this way, try a foam wedge or several large pillows.
• If you are working, plan rest periods for leg elevation. Elevate your legs every night, all night.

Clothing

• Do not wear constricting garters or other tight garments such as tight knee-high boots, girdles, or overly tight panty hose.
• Wear shoes that fit well to avoid skin breakdown on pressure points.
• Wear stockings or socks with your shoes at all times to avoid blistering.

Prevent Injury

• Avoid bumping, cutting, bruising, or scratching your legs.
• Do not go barefoot.
• Use an electric razor when shaving your legs.
• Avoid using pillows under the knees. Pressure may damage the blood vessel wall as well as obstruct blood flow.
• Protect your feet from excessive heat or cold.
• Avoid using heat lamps, hot water bottles, heating pads, cream hair removers, or any harsh chemicals on the legs or feet.
• Test bath water with your hands, not your toes. Water should be lukewarm (body temperature, 98.6 degrees F).

Nutrition

• Eat a well-balanced diet.
• Reduce your sodium intake. Too much salt in your diet causes fluid retention and leg swelling.
• Avoid overeating. Extra weight causes increased pressure in the veins.
• A diet high in fiber aids regular bowel movements and avoids straining. Straining during bowel movements puts pressure on leg veins. The main sources of fiber are raw fruits, especially those with skin and seeds, vegetables, such as celery, corn, lima beans, and whole grain breads and cereals.

Smoking
DO NOT SMOKE! Smoking has been known to contribute to blood clotting in the veins. Smoking causes narrowing of the arteries which decreases blood flow. Contact the Northwestern Memorial Wellness Institute's smoking cessation program at (312) 926-2069 for more information.

Follow-Up Care
Regular medical check-ups are needed. Keep all of your scheduled appointments. Notify your doctor if any of the following occur.

• Severe pain in the legs
• Sudden weight gain or swelling of feet, ankles, or legs
• Increase or decrease in temperature of the leg
• Increased or foul smelling drainage from the wound
• Increase in swelling, redness, tenderness or pain in the leg
• Cannot move your toes
• Color of your foot becomes pale
• Skin breakdown (new ulcer) or larger ulcer
• Fever over 101.5 degrees F

 

Review Date: 02/05