Understanding a Venous Stasis Ulcer

What is it?

A venous stasis ulcer, also known as a venous insufficiency ulcer, means that there is an impairment or lack of venous blood flow to an area of the skin. These ulcers occur in the lower legs, between the knee and the ankle. The most common place for them to develop is around the ankle. In most cases, there is a change in the color of the skin before it actually opens (ulcerates), like a red spot or a black and blue bruising. Due to the lack of circulation, which provides the essential nutrients for the skin to survive, the skin begins to die in this spot and opens (ulcerates.) These wounds are typically shallow (do not get very deep.) They are often irregular in shape and tend to elongate (like a run in stockings.) Left untreated, they do not get better and will get worse.

How does it happen?

Gravity works well at getting the blood down to the feet, but when it comes to getting the blood back up the leg towards the knee and thigh, the ankle area usually suffers. The blood is pushed up the veins when your heart pumps and by your blood pressure. When it can’t make it upwards, it pools and collects in the veins, expanding them like a small balloon. The valves in the veins can’t open and close properly due to this distention. Tissues inside the skin depend upon the circulatory system to bring nutrients, (like oxygen) and to remove waste products from the cells. When this happens, the tissues discolor, devitalize and die. This causes an opening in the skin called ulceration.

How is it treated?

One treatment for these wounds is the Unna boot, but it may not be the only effective compression device. Another intervention is a compression stocking such as Jobst, Profore, etc. These are designed to compress the circulatory structures of the lower leg to help improve blood flow. Think of holding the end of a garden hose in your hand with water running through it. The water comes out at a certain pressure until you begin to squeeze or compress your hand around the end. When you squeeze it some, you will notice that the water begins to shoot out with more force, similar to a spray nozzle. You have done nothing to the pressure coming into the hose, but increased the pressure coming out. Other uses for compression are to control edema or swelling, and even to prevent blood clots from settling in the legs. Compression needs to be prescribed, however it may not be medically appropriate for use on some patients.

What about skin grafts?

You can put medications or skin graft on the wound, but it may not heal without the use of compression. Consider whether the graft will work or not. If you transplant a healthy plant into the ground and do not water or fertilize it, what will happen to the plant? Of course, it will die. If you have a circulation problem in a spot on your skin (like the hole in the ground), a graft (the healthy plant) will not survive unless it has proper blood flow (water and fertilizer.) That's why so many grafts do not work or take. Bypass surgery has been beneficial in some patients.

How do I care for the wound?

AmeriGel® Wound Dressing has been approved by the FDA for venous stasis ulcers and several other types of wounds. Apply AmeriGel® to your wound and do dressing changes twice a day for the first week and then once a day thereafter. Cover the wound with a gauze moistened with saline (saltwater.) Then place a dry piece of gauze over this and secure it in place. It will help clean out any necrotic (dead) or devitalized (dying) tissue, while combating infection. The wound will require moisture from time to time. When you take the dressing off, the gauze may be dried out and stiff because the wound required moisture and absorbed it from the gauze. Other times, the gauze will still be damp and may have a mucous deposit or drainage on it because the wound did not require additional moisture. The wound should always be covered 24 hours a day until healed. Once the wound heals, it will require 2-3 weeks for the skin to mature.

How can these ulcers be prevented?

Once an ulcer has developed, statistics show that another one will develop within 3-5 years. Preventing them is well worth the effort once you have experienced the pain and frustration associated with healing them. Many patients will continue to wear some type of compression stocking every day while they are on their feet to help the circulation. The wound may have healed, but the cause of the wound, poor circulation, has not been corrected. Use Amerigel® Care Lotion on your lower legs, particularly around the ankles every day. This helps the skin retain its natural moisture, promoting healthier skin that is less prone to problems.