Treatments
Conservative and Surgical Treatments
Venous ulcers can be very difficult to treat, and they often recur after healing. Treatments range from conservative to surgical.
Conservative Treatments
The idea behind conservative treatment of venous ulcers is to reduce leg swelling and reduce pressure in your veins. If this is accomplished, your venous ulcer may heal on its own.
Compression and Elevation
The key to conservative treatment is using compression stockings or specially designed bandages, as well as elevating your leg as much as possible, to reduce the swelling and the pressure in your veins.
In some cases, a dressing may be placed over the wound prior to putting on the compression stockings or bandage. The dressing may contain medicine to help heal the ulcer including hydrogels, alginate, debriding agents and antimicrobials.
Antiobiotics to Fight Infection
There are no medications for venous ulcers. Your doctor may prescribe antibiotics to fight infection, but they will not heal the ulcer.
Unna Boot
For deep or severe venous ulcers on the foot or lower part of the leg, a paste may be applied to the foot and leg. The paste hardens and is wrapped with a bandage, forming a soft, cast-like boot known as an Unna boot. With the extra protection provided by the boot, the ulcer can heal more quickly.
Surgical Treatments
Debridement
If there is any dead tissue on the wound, it will be removed in a procedure known as debridement. This is often used to help heal the ulcer. In debridement, dead tissue is removed so the remaining living tissue can adequately heal. The four major debridement techniques are surgical, mechanical, chemical, and autolytic.
Surgical Debridement
Surgical debridement (also known as sharp debridement) uses a scalpel, scissors, or other instrument to cut dead tissue from a wound. It is the quickest and most efficient method of debridement. The procedure can be performed at the patient’s bedside, and also may be done in an operating room, depending on the circumstances.
Mechanical Debridement
In mechanical debridement, a saline-moistened dressing is allowed to dry overnight and adhere to the dead tissue. When the dressing is removed, the dead tissue is pulled away, too.
This process is one of the oldest methods of debridement. It can be very painful because the dressing may adhere to living as well as to nonliving tissue. Because mechanical debridement cannot select between good and bad tissue, it is an unacceptable debridement method for clean wounds where a new layer of healing cells is already developing.
Chemical Debridement
Chemical debridement uses certain enzymes and other compounds to dissolve dead tissue. It is more selective than mechanical debridement.
The body makes its own enzyme, collagenase, to break down collagen, one of the major building blocks of skin. A pharmaceutical version of collagenase is available and is highly effective as a debridement agent.
Autolytic Debridement
Autolytic debridement allows the body's own ability to dissolve dead tissue. The key is keeping the wound moist, which can be done with a variety of dressings.
These dressings help to trap wound fluid that contains growth factors, enzymes, and immune cells that promote wound healing. Autolytic debridement is more selective than any other debridement method, but it also takes the longest to work. It is not appropriate for infected wounds.
Apligraf
A product called Apligraf can be applied in the office and monitored weekly. This is done without anesthesia or a hospital stay. Apligraf applies skin cells and growth factors directly to the ulcer, helping it to heal.
Skin Grafting
If a venous ulcer is very deep or does not heal, healthy skin from another part of the body may be applied (transplanted or grafted) over it. Skin grafting is done in the operating room.
Venous Closure
Venous ulcers will not heal if there is significant reflux of blood flow down the leg. This problem is similar to varicose veins. The abnormal vein in this case can also be treated with radiofrequency ablation (see VNUS closure).
