What is included in wound care of venous ulcers?

Updated: Apr 24, 2020
  • Author: Brian J Daley, MD, MBA, FACS, FCCP, CNSC; Chief Editor: Zubin J Panthaki, MD, CM, FACS, FRCSC  more...
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Answer

Treatment of venous ulcers includes compression therapy, providing a moist wound environment and debridement of necrotic tissue. [46, 47] Most venous ulcers heal with these measures alone. Some require split-thickness skin grafting or application of bioengineered skin (eg, Apligraf, Dermagraft). [48] Pentoxifylline (Trental) and horse chestnut seed (available in supermarkets and health food specialty stores) have been shown to expedite healing of venous stasis ulcers. In some cases, compression therapy is inadequate to maintain healing of venous ulcers, and surgical vein stripping or ligation of venous perforators may be helpful.

A study of 98 limbs with active chronic venous ulcers revealed that all but one had venous reflux; the study also suggested that most of these patients would benefit from surgical or endovascular intervention. [49] Other studies suggested a more modest level of benefit from corrective venous surgery. [50]

Table 4. Compression Bandages for Venous Ulcers* (Open Table in a new window)

Type

Description

Examples

Single layer

Single-layer simple tubular woven nylon/elastic bandages may be imprinted with rectangles that stretch to squares when appropriate wrapping tension (30-40 mm Hg) is applied.

ACE bandage, Comperm (Conco Medical), Setopress (Seton Healthcare Group)

Three layer

The layers include a padding absorption layer, a compression bandage layer, and a cohesive compression bandage. Bandages may be left in place for up to 1 week depending on wound exudate.

Dyna-Flex (Johnson & Johnson)

Four layer

The layers include a nonwoven wound contact layer that is permeable to wound exudate and 4 overlying bandages. Bandages may be left in place for up to 1 week depending on exudate volume.

Profore (Smith & Nephew)

Impregnated wrap

The porous flexible occlusive dressing is composed of stretchable gauze and a nonhardening zinc oxide paste.

Unna boot (ConvaTec)

*Compression wraps are contraindicated in severe arterial compromise. Some of these products are contraindicated in patients who are allergic to latex.


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