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A venous ulcer tends to occur on the medial side of the leg, typically around the medial malleolus in the 'gaiter area' whereas arterial ulcer tends to occur on lateral side of the leg and over bony prominences. A venous ulcer is typically shallow with irregular sloping edges whereas an arterial ulcer can be deep and has a 'punched out' appearance.
For venous stasis ulcers, the paste-impregnated wrap is covered by an elastic layer, generally an elastic wrap ("ACE" bandage) or self-adherent elastic bandage such as Coban; this is referred to as a 2-layer compression bandage. An alternative treatment is a 4-layer, graduated compression wrap (Pro-Fore is an example).
Potential complications of venous stasis are: Venous ulcers; Blood clot formation in veins (venous thrombosis), that can occur in the deep veins of the legs (deep vein thrombosis, DVT) or in the superficial veins; Id reactions [1]
Venous ulcers are common and very difficult to treat. Chronic venous ulcers are painful and debilitating. Even with treatment, recurrences are common if venous hypertension persists. Nearly 60% develop phlebitis which often progresses to deep vein thrombosis in more than 50% of patients. The venous insufficiency can also lead to severe hemorrhage.
The treatments to prevent the formation of blood clots is balanced against the risk of bleeding. [5] One of the goals of blood clot prevention is to limit venous stasis as this is a significant risk factor for forming blood clots in the deep veins of the legs. [6] Venous stasis can occur during the long periods of not moving.
If this happens for prolonged periods of time, it progresses to what we call chronic venous insufficiency or CVI. With CVI the stagnant blood in the lower extremities starts to cause an inflammatory reaction in the vessels and the surrounding tissue, which leads to fibrosis, and potentially even ulcers, called venous stasis ulcers.
Maggots in medical packaging. Maggot therapy improves healing in chronic ulcers. [1] In diabetic foot ulcers there is tentative evidence of benefit. [3] A Cochrane review of methods for the debridement of venous leg ulcers found maggot therapy to be broadly as effective as most other methods, but the study also noted that the quality of data was poor.
It is recommended that healthcare providers handle the pain related to chronic wounds as one of the main priorities in chronic wound management (together with addressing the cause). Six out of ten venous leg ulcer patients experience pain with their ulcer, [10] and similar trends are observed for other chronic wounds.
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