Venous leg ulcers

Working as a wound care specialist of the lower extremity, I see a variety of medical issues and will often require a medical team approach for complete care. For example, venous insufficiency of the legs where the valves of the veins are no longer functioning properly can cause pooling of blood, swelling of the legs and painful ulcers can develop. What I do as a podiatrist in this scenario involves referring the patient to a vein specialist who can address the underlying source of the ulcer. They will evaluate the competency of the veins and decide on the appropriate procedure to fix the problem. In conjunction, I provide local wound care that may include various therapeutic compression wraps, grafts and a holistic view of the patient. Can the patient tolerate the wraps? Do they have home support to assist them with transportation to their appointments? Caring for these types of patients commands a trusting relationship between the patient and doctor, which is why I love what I do. 

Here's an example of a venous stasis leg ulcer that did well with conservative measures. My wound care protocol:

- Wounds greater than 1 month old that does not change in appearance --> biopsy
- Biopsy demonstrated necrosis of vessels consistent with venous stasis
- Referral to a vein specialist
- Weekly compression dressing, using a hydrating product such as hydrogen plus Silvercel and 2 layer compression
- Skin graft if ulcer is not 40% smaller by 4 weeks
- For long term management, compression hose at 30-40mmHg daily for life
- Calf pump exercises daily have also proven to help decrease edema
- Monitor routinely for recurrence or new sites of ulceration

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