When wounds won't heal
Wounds on the lower leg that heal poorly, if at all, are called venous leg ulcers.
They often occur near the medial malleolus (inside ankle bone). This normally affects elderly people with several underlying diseases. The onset of venous leg ulcers is favoured by diabetes or a weak heart. Women suffer from venous leg ulcers more often than men. The main cause is usually venous insufficiency that has lasted for years. Doctors then speak of venous leg ulcer.
How a venous leg ulcer develops
Due to the chronically dysfunctional veins (medical: chronic venous insufficiency), the veins are no longer in the position to transport blood quickly from the legs to the heart. The blood pools and widens the veins. This so-called stasis ultimately damages the smallest blood vessels, the so-called capillaries. These supply the cells with oxygen and nutrients and transport metabolic breakdown products away from the tissues. The damaged capillaries can no longer fulfil this function satisfactorily. First of all, the skin in the affected areas becomes sensitive, loses its elasticity and grows hard. Eventually the skin dies off and even the slightest, barely noticed injury turns into an open weeping wound.
The open wound is very painful. Micro-organisms that colonise the wound and its surroundings cause unpleasant odours. In many cases, those affected are afraid to go out and avoid contact with other people. The patients take on a protective posture due to the pain. They barely move the affected leg at all. This lack of mobility, in turn, switches off the pump mechanism that transports the blood back in the direction of the heart and starts a vicious circle.
Healing prognosis
Some people suffer from venous leg ulcers for many years, but the healing prospects are also good for such patients: around 90% percent of all venous leg ulcers can be healed using all the treatment procedures available today.
Preconditions for wound therapy
Efficient treatment of chronic wounds is based on the two underlying principles, wound debridement and treatment of the underlying condition. These principles describe the two main points of medi's wound care concept. medi also offers versatile solutions for preventing relapse. Besides the tried-and-tested dual-component below knee compression stocking system, mediven ulcer kit, medi also offers medical wound debridement cloths and a completely new approach in compression therapy: circaid juxtacures.
Efficient treatment of venous leg ulcer comprises:
- Wound debridement and wound care: cleansing of the wound and care of the surrounding skin.
- Compression treatment is an element of wound care, even if many people believe that wound care is restricted to cleaning and dressing skin defects.
- Treatment of the underlying disease: in the case of venous leg ulcer, this means that the venous disease has to be treated. Medical compression stockings are used as disease-modifying treatment.
- Solutions to effectively prevent relapse of the diseases.
Besides pain control and compression, wound management plays an important role in venous leg ulcer and should be carried out by doctors or trained carers. You should never try to treat the wound yourself with ointments and bandages. Open wounds must be debrided, dead tissues removed. Special dressings make sure that the wound does not dry out and promote the healing process.
Phases of treatment and healing
Phase 1: wound debridement
As a result of the chronic insufficiency of the leg veins, venous leg ulcer wounds are usually surrounded by hardened connective tissue that must be removed. Alternatively, ointments can be used that soften the debris and biofilm and clean the wound. Special non-woven materials swell up in the moist wound and absorb the wound secretion. Dressings with silver particles are used to disinfect inflamed wounds that are infected by bacteria.
Phase 2: formation of new connective tissues
During the second phase of wound healing the body refills the gap in the skin. In order to promote the growth of the connective tissue, flat dressings (hydrocolloid and hydropolymer dressings) are applied that stimulate the production of connective tissue and keep the wound moist.
Phase 3: growth of new skin
During the third phase of wound healing, the wound contracts and skin cells grow inward from the wound margin to close the wound. Since phases 1 and 2 of wound healing are severely impaired in chronic insufficiency of the leg veins, most venous leg ulcers do not reach the third phase without supportive wound treatment. In this last phase, too, the wound must have a balanced level of moisture and the dressing must not be allowed to adhere to the tender young skin. Thin flat dressings (hydrocolloid or hydropolymer dressings) are usually used for this purpose. To shorten this phase, a wound that is granulating satisfactorily may be covered by a thin skin graft taken from the patient at surgery (under local anaesthetic, if necessary). There are a number of surgical procedures for this, at which small islands of skin are transplanted or thin skin grafts are applied to the wound, as a mesh if necessary.
Inelastic compression garments from medi
Inelastic compression garments from medi can help you treat chronic venous diseases.
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Wound debridement of venous leg ulcers