In my last blog I started the discussion about the types of wounds we treat in our offices at Atlantic Foot & Ankle Associates with locations in Palm Coast, Daytona Beach, Port Orange, and Orange City, Florida. I initially spoke about diabetic wounds since they are the most common that we treat. They are however, not the only wounds that we see or treat of the lower extremity. There are two other very common ulcers, one being a venous stasis ulcer (ulcers of the lower legs) and the other being a decubitus ulcer (otherwise known as a pressure ulcer).
Venous stasis ulcers are very common in my practice. These are caused by a lack of venous return (the ability of your veins to return blood towards your heart) in the legs. Blood travels in two directions in the body, first being away from the heart and the second being towards the heart. When blood travels out towards our body it is pumped out by our heart. Unfortunately we do not have a heart in our legs to pump it back up so we rely on special valves in our veins to help promote blood return towards our heart. Over time these valves can fail or dilate thus causing a backflow of blood back down our legs. This presents initially as swelling and heaviness of the legs and ankles. As this condition progresses, other symptoms will occur such as a brown discoloration the legs, spider and varicose veins, and even small blisters. As these blisters progress they will turn into a full thickness wound of the lower leg. They are most commonly seen on the front of the leg or inside of the ankle.
These become very difficult to treat due to the chronic swelling of the legs. Fluid wants to flow through the area of least resistance. In this case the open wound. As long as the wound is draining due to the swelling it will never close. Compression therapy is the key to healing these and is performed in our office and also by home health care. These patients are seen weekly to debride (clean the wound of dead tissue) the wound/wounds and an unna boot or other form of compression is applied to the lower leg (from the foot up to the knee). This is performed until the wound or ulcer is completely healed which sometimes can take weeks or months. A wound graft may also be used to aid in healing of wounds that are not responding in a normal progression. Once a venous stasis ulcer is healed, it is important to treat the chronic swelling with leg elevation, compression stockings, pneumatic venous pumps and sometimes vein ligation to prevent reoccurrences.
Stay tuned for my next blog on decubitus ulcers.