Venous Leg Ulcers (VLU)
Venous leg ulcers are the most common type of chronic recurring wounds. It has been estimated that 70% of leg ulcers are venous leg ulcers. Veins return blood to the heart. In lower limbs, valves in the veins prevent the blood to flowing down the legs. Venous occlusion and valve incompetency may cause venous insufficiency which leads to VLU. Trauma, surgery, deep vein thrombosis (DVT), and varicose veins may cause valves to work incompetently or stop them working completely. Other predisposing factors include family history of leg ulceration, history of varicose veins, sclerotherapy, history of phlebitis, sedentary life style, multiple pregnancy obesity, and being a female. In this condition, venous hypertension occurs. Greater volume of blood in lower extremities causes distention in veins and leads to leakage fluid into the tissue.
Venous leg ulcer assessment
A proper history and a holistic general assessment help to determine the immediate cause of the ulcer. A complete history, baseline measurements, blood pressure, general medical history, and body mass index (BMI) give us a good understanding of contributing factors. Also, a proper assessment of the wound determines the local wound care strategies.
Physical assessment of a leg with venous leg ulcer starts with observation. Haemosiderin staining is a common sign in the people with venous leg ulcers.
Leaking of red blood cells into the tissue causes a brownish color in lower legs which is called haemosiderin.
Ankle flare is another sign in VLUs which caused by dilation of vessels over medial aspect of foot.
Oedema and varicose / venous eczema are other characteristics we look for. PHOTO
Lipodermatosclerosis is fibrosis of the leg as fat is replaced by fibrosis tissue, becoming hard and woody to the touch.
Atrophic blanche is white patches of avascular tissue usually visible around the gaiter area.
Patient’s mobility, ability to exercise, use of the calf muscle pump, and ability to elevate the limb when at rest should be investigated.
Ankle Brachial Pressure Index (ABPI) should be performed to exclude any arterial disease.
Wound assessment should be done using photograph, or wound tracing. If no access to the camera, site, shape of the wound, size, depth, tissue type at the wound bed, level of exudate, odour, condition of the surrounding of the wound and any sign of infection have to be documented.
The CEAP classification system is a useful method of recording clinical severity.
Venous leg ulcer management
The mainstay of treatment for VLUs is compression therapy. The result of the ABPI test determines the amount of the pressure we can apply using compression therapy. However, we have to adjust the result of ABPI with the clinical symptoms. In diabetic patients we may get the false elevated result. If ABPI is 0.8 or greater the amount of the pressure we should apply is 40 mmhg. If between 0.5 and 0.8 is the result of ABPI we have to decrease the amount of the pressure.