Venous Ulcers
Venous leg ulcers are the most frequently occurring chronic wounds, accounting for 80% to 90% of all lower-extremity ulcerations and affected an estimated 2.5 million patients in the US at any given time. While rarely fatal, their chronic nature, frequency of recurrence, and associated complications can significantly diminish quality of life. Many patients with venous ulcers experience limited mobility, a loss of productivity, pain, and in some cases, depression. While we believe every wound can and will heal, taking early action will significantly improve the chances of complete closure.
If you believe you have a venous ulcer or are at risk of developing a venous ulcer, you can receive a professional consultation with a wound specialist by calling (212) 263-7187.
Click on the links below for more information:
What is a venous ulcer?
What causes venous ulcers?
Who is at risk for developing a venous ulcer?
What warning signs are associated with venous ulcers?
Can I expect my venous ulcer to heal?
What factors contribute to lower healing rates?
How severe is my venous ulcer?
What complications are associated with venous ulcers?
What will be done to address my pain?
What treatments are available for venous ulcers?
Why is my wound photographed during clinical visits?
What is debridement and how will it help my wound?
How does the surgeon determine what is good tissue vs. non-healing tissue?
What is Apligraf and how will it help me heal?
Q. What is a venous ulcer and where do they occur?
A. Venous ulcers are leg wounds that fail to heal due improper venous blood flow in the legs. They begin as minor ulcerations in the skin, but can grow to very large in size if left untreated. The typically occur in the lower leg, between the knee and ankle.
Q. What causes venous ulcers?
A. Most venous ulcers are caused by improper functioning of venous valves in the leg. In a healthy circulatory system, deoxygenated blood in the legs travels back to the heart against the pull of gravity. This is made possible through the action of venous valves, which systematically open and close to prevent back flow. Venous reflux occurs when these one-way valves lose their ability to function properly, allowing deoxygenated blood to flow backwards and accumulate in the legs. The discoloration often seen in the legs of persons who have venous reflux is a result of the breakdown of this accumulated blood. This can block blood flow, severely diminishes the ability of the surrounding tissue to heal and can act as a source for infection.
Q. Who is at risk for developing a venous ulcer?
Factors such as history of leg ulcers, recent edema, diabetes mellitus, congestive heart failure, or peripheral vascular disease are believed to be linking to venous ulcers. If you believe you have or have had any of these ailments, consult your doctor about the risk developing a venous ulcer.
Q. What warning signs are associated with venous ulcers?
A. Receiving early treatment is an essential factor affecting the healing rate of venous ulcers. Below are some very important warning signs that you may be developing a venous ulcer. If you are experiencing any of the following symptoms, consult a doctor immediately.
- Discoloration of the legs, typically dark red, purplish, or brown.
- Pain or aches in the legs, especially when standing or sitting.
- Swelling, typically around the ankles.
- Rashes, dryness, or any other noticeable changes in the skin around lower legs.
Q. Can I expect my venous ulcer to heal?
A. Venous ulcers are complex wounds that require significant amounts of professional intervention to fully heal. However, it is our philosophy that even the most serious venous ulcers can heal with, comprehensive, aggressive and persistent treatment.
Q. What factors contribute to lower healing rates?
A. A variety of factors have been demonstrated to impact the rate and degree of venous ulcer healing; for example the following factors are associated with poor healing rates:
- Duration of the wound
- Initial depth of the wound
- Degree of venous insufficiency
- Degree of fibrin/infection
Q. How severe is my venous ulcer?
Major variables have been identified in venous ulcer literature as predictors of wound healing. These include wound duration, location, area, and depth and the presence of fibrin. A wound severity scale was constructed using these factors to serve as a predictor of complete wound healing. Dr. Brem and others have developed a severity scale, which was shown to be a valuable tool for identifying hard-to-heal venous ulcers that may not have adequately responded to conventional compression therapy.
Q. What complications are associated with venous ulcers?
A. While rarely fatal, venous ulcers often contribute to patients experiencing a diminished quality of life. This frequently takes the shape in decreased mobility and productivity. Many patients also experience pain, infection, odor, and depression associated with their wound. In very rare cases, cancers can develop in association with venous ulcers.
Q. What will be done to address my pain?
A. Pain is too often undertreated in venous ulcers. It should be immediately addressed and treated, and it may require the assistance of persons with additional expertise, such as an anesthesiologist. We treat your pain by addressing the underlying problem. This requires an understanding of the mechanisms of pain and an understanding of all the different options available to correct it. At the NYU Wound Healing and Regenerative Medicine Division, your wound care specialist remains in constant communication with a pain management expert to decide on the best strategy for minimizing your discomfort. If any therapy is not working, you can expect our team to promptly address the issue and make the necessary changes to your pain management plan.
Q. What treatments are available for venous ulcers?
The first step in treatment is to correct the underlying circulation problem that may be preventing your wound from healing. This often entails a consultation with a vascular surgeon. Once the underlying problem is addressed, there are many therapies we employ to accelerate the healing process. This could include:
- Topical dressing - reduces infection and provides moist environment that promotes tissue growth.
- Antibiotics - the proper regiment of antibiotics fights harmful bacteria that inhibit healing.
- Debridement - removal of dead or infected tissue improves ability of healthy tissue to heal.
- Compression wrap - compression can improve the underlying problem of venous ulcers: improperly functioning venous valves.
- Cellular therapy - a topical drug that releases growth factors that promote healing.
In order to maintain an accurate idea regarding the effectiveness of your treatment plan, we also take a photograph of your wound upon each visit to measure its change in area.
Q. Why is my wound photographed during clinical visits?
Our clinical team has designed a Wound Electronic Medical Record (WEMR) to acquire and display the requisite data and provide the decision support necessary to improve the care of patients with chronic wounds. As part of this medical record, photographs are of the wounds are taken upon each clinical visit to record the progress of healing. Using these photographs and a computer program, our team calculates wound area as a method of tracking the healing rate. As part of each visit, you can view these photographs and a graph of your wound area to see improvement over time.
Q. What is debridement and how will it help my wound?
A. Debridement is the removal of dead, diseased or infected tissue from the wound bed to improve the potential for healthy tissue to heal. Dead, diseased, and infected tissue is a source of bacterial overgrowth, which can lead to pain, sepsis, and eventually, amputation. Thus, it must be removed to create the most ideal healing environment. Debridement is a widely employed method.
Q. How does the surgeon determine what is good tissue vs. non-healing tissue?
A. To verify that we have sufficiently removed all of the dead, diseased, and infected tissue, we analyze the tissue that is removed as well as the tissue that is left behind. These specimens are analyzed under a microscope for cellular abnormalities. As well, we utilize genetics studies to research non-healing genes.
Q. What is Apligraf and how will it help my venous ulcer heal?
A. Apligraf is a human living cellular therapy that has been shown to accelerate healing of chronic wounds. Derived from fetal foreskin, Apligraf stimulates healing of the wound by initiating the release of a multitude of growth factors into the wound, stimulating the natural healing process.
