What is it?

A venous stasis ulcer, also known as a venous insufficiency ulcer, means that there is an impairment or lack of venous blood flow to an area of the skin. These ulcers occur in the lower legs, between the knee and the ankle. The most common place for them to develop is around the ankle. In most cases, there is a change in the color of the skin before it actually opens (ulcerates), like a red spot or a black and blue bruising. Due to the lack of circulation, which provides the essential nutrients for the skin to survive, the skin begins to die in this spot and opens (ulcerates.) These wounds are typically shallow (do not get very deep.) They are often irregular in shape and tend to elongate (like a run in stockings.) Left untreated, they do not get better and will get worse.

How does it happen?

Gravity works well at getting the blood down to the feet, but when it comes to getting the blood back up the leg towards the knee and thigh, the ankle area becomes most vulnerable. The blood is pushed up the veins when your heart pumps and by your blood pressure. When it can’t make it upwards, it pools and collects in the veins, expanding them like a small balloon. The valves in the veins can’t open and close properly due to this distention. Tissues inside the skin depend upon the circulatory system to bring nutrients, (like oxygen) and to remove waste products from the cells. When the circulation reduces the tissues discolor, devitalize and die. This causes an opening in the skin called ulceration.

How is it treated?

Various treatments for compression are available for consideration including an Unna’s boot, but it may not be the only effective compression device. Another intervention is a compression stocking such as Jobst®, Profore®, etc. These are designed to compress the circulatory structures of the lower leg to help improve blood flow. Think of holding the end of a garden hose in your hand with water running through it. The water comes out at a certain pressure until you begin to squeeze or compress your hand around the end. As you squeeze it, you will notice that the water begins to shoot out with more force, similar to a spray nozzle. You have done nothing to the pressure coming into the hose but have increased the pressure coming out. Other uses for compression devices are to control edema or swelling and even to prevent blood clots from settling in the legs. Compression devices need to be prescribed as they may not be medically appropriate for use on some patients.

What about skin grafts?

Skin grafts can be an effective choice in healing venous stasis ulcers but are not typically used until over-the-counter and topical options have failed, primarily due to the high cost associated with the graft.  If you and your physician choose to use a graft, it is important not to let the graft dry out following surgical application.  The choice of which dressing to use over a graft can be just as important as the graft itself in that the dressing must maintain adequate moisture to prevent the graft from drying out.  A study was performed by Dr. Jonathan Moore using AmeriGel® Hydrogel Saturated Gauze Dressing over different types of skin grafts. The study, “Creating the Ideal Microcosm for Rapid Incorporation of Bioengineered Alternative Tissues Using an Advanced Hydrogel Impregnated Gauze Dressing: A Case Series,” demonstrated that AmeriGel® Saturated Gauze Dressing, when used over a graft, healed wounds in an average of 17.8 days. If you don’t use AmeriGel® over the skin graft, it can take up to months to heal otherwise. To downlod this study, click the link below.

Creating_Ideal_Microcosm-0908.pdf

How do I care for the wound?

AmeriGel® Wound Dressing has been approved by the FDA for venous stasis ulcers as well as other types of wounds. Apply AmeriGel® to your wound along with proper dressing changes twice a day for the first week and then once a day thereafter. Cover the wound with a gauze moistened with saline (saltwater.) Next, place a dry piece of gauze over the wet gauze and secure it in place. It will help clean out any necrotic (dead) or devitalized (dying) tissue while combating infection. The wound may require moisture from time to time. When it’s time to remove the dressing, the gauze may be dried out and stiff because the wound absorbed the moisture from the gauze. Other times, the gauze will still be damp and may have a mucous deposit or drainage on it because the wound did not require additional moisture. The wound should always be covered 24 hours a day until healed. Once the wound heals, it will require 2-3 weeks for the skin to mature. During these weeks, the wound can reopen if the skin dries out or cracks. We recommend you apply Amerigel® Care Lotion at least twice a day to the affected area for a period of 30 days.

How can these ulcers be prevented?

Once an ulcer has developed, statistics show that another one will develop within 3-5 years. You know that preventing ulcers is well worth the effort if you have experienced the pain and frustration associated with healing wounds. Many patients will continue to wear some type of compression stocking every day while they are on their feet to help the circulation. While a Venous Stasis ulcer may have healed the poor circulation which caused the ulcer has not been corrected. Use Amerigel® Care Lotion on your lower legs, particularly around the ankles daily. This helps the skin retain its natural moisture, promoting healthier skin that is less prone to problems.