Causes of VENOUS LEG ULCERS

Despite the prevalence of venous ulcers, they are often neglected or managed inadequately

Patients may walk around for months or even years with local dressing over an ulcer,
or emphasis may be placed on which ointment, antibiotics or an enzyme should be used. After skin graft or other failures,
a patient arrives in our office in pain, with a level of suspicion and frustration after having many opinions and these unsuccessful therapies.
They soon find out that help is here!

PREVALENCE & THE CALF MUSCLE PUMP

Epidemiological studies have found that the prevalence of leg ulceration in the adult population, either active or healed, is almost 1-2%. Although a variety of etiologic factors may cause leg ulcers, the majority of leg ulcers have venous disease and while chronic venous insufficiency has received less attention than arterial insufficiency it is estimated to be 10 times more common.

Despite the prevalence of venous ulcers, they are often neglected or managed inadequately. Patients may walk around for months or even years with local dressing over an ulcer or emphasis may be placed on which ointment, antibiotics or an enzyme should be used. After skin graft or other failures that patient presents to our office in pain, with a level of suspicion and frustration after having many opinions and these unsuccessful therapies.

This is the primary mechanism the body has to return blood from the leg to the heart. The calf pump consists of the calf muscles, the deep venous compartment, a superficial compartment connecting the superficial veins to the deep veins via perforators and then the outflow tract (popliteal veins).

Calf pump dysfunction may occur because of deep venous insufficiency, deep venous obstruction, perforator insufficiency, superficial venous insufficiency, AV fistulas, neuromuscular dysfunction or a combination of above.

The result of calf muscle dysfunction is a failure to lower venous pressure in the distal veins of the leg while walking, a condition referred to as ambulatory venous hypertension. The main factor in calf pump failure is usually venous insufficiency. This final common pathway to venous ulceration is venous hypertension, whether the overload comes from superficial, perforator, deep vein or combination disease.

COMPRESSION IS THE CORNERSTONE OF TREATMENT

All patients with uninfected venous ulceration require compression treatment. The compression treatment should be sustained compression that produces a pressure gradient (highest at ankle).

Compression leads to increased venous flow, decreased pathological reflux while walking, and an increased ejection volume with activation of the calf pump. Tissue pressure is increased, which favours resorption of edema fluid. In order to achieve maximum benefit from compression, the patient needs to ambulate. A regular regimen of at least 30 min daily walking is extremely beneficial.

WOUND CARE

Generally, it is appropriate to choose the least invasive methods first. If there is a lot of exudate, choose a dressing that is highly absorptive. Remember that good compression is useful in reducing non-infectious exudate.

The compression helps to reduce local venous hypertension. Topical antibiotics are generally not used. If used the patient can develop contact dermatitis. If infection is suspected, cultures should be taken and treatment begun with systemic antibiotics. Although no single dressing is adequate for ulcer situations, it is generally accepted that they be occlusive and maintain a moist environment at the wound site, with compression.

A New Technology – TIRS

Terminal Interruption of the Reflux Source

The treatment of venous ulcers continues to be a challenge. Compression therapy helps to prevent recurrence, but fails to heal ulcers. Now, Vein Solutions has introduced a new technique to heal Venous Ulcers: Terminal Interruption of the Reflux Source (TIRS).

This technique targets the terminal source of reflux. Venous ulcers develop because of the venous hypertension at the level of the ulcer. The TIRS procedure targets the venous hypertension, thus allowing healing to occur.

This method is done in our rooms. Under ultrasound guidance, a Fibrovein foam is injected into a venous branch or branches in close proximity to the ulcer bed. The branch may course under the ulcer or lead directly to it. There can be more the one branch that can cause the venous ulcer, and that is why the follow-up visits are so important. Some patients need 2 or 3 TIRS procedures to achieve venous ulcer healing.

Rapid healing starts immediately and average healing time is 6 to 8 weeks. Post-procedure the patient must wear compression stockings and use specific wound care products to keep wound clear from infection.

We have treated patients who had ulcers for 40 years, and after this procedure, were healed in 8 weeks.

WHAT CAN A PATIENT DO TO HELP ULCER HEAL?

1. Maintain a normal weight
2. Avoid smoking
3. Eat healthy
4. Regular walks: minimum 3 times a week for 30 min
5. Long periods of sitting, standing and extremely hot baths should be avoided
6. Raise the foot of the bed, at least higher than the heart
7. Remember diuretics are not used
8. Pentoxifylline seems to reduce WBC trapping, and help with ulcer healing when used in conjunction
with compression therapy

Remember if your ulcer does not respond what could be the problem:

1. Inadequacy of compression
2. Lack of patient compliance
3. Perhaps wrong diagnosis – and a biopsy may be required

FACTS ABOUT COMPRESSION

Consensus is that >40 mmHg pressure at ankle is needed
Type of compression varies
Healing rates traditionally are 40-50% at 6 months
Recurrence rates may be as high as 50%

OPTIMISING LEG ULCER WOUND MANAGEMENT

MAKE A QUICK INQUIRY

Our expert team are supportive, experienced and offer quality care before, during and after your procedure. If you have a quick question please use the form below.

What our patients say

I had a blood clot and then a big vein developed – you could see it on my leg. Then this vein popped and it made a very big deep ulcer and it would not heal. I went from doctor to doctor, and they couldn’t help me. I would have lost my leg, but thanks to Dr van Wyk, my life has changed. Cornelia
After 36 years, then thirty procedures, I heard about Dr van Wyk from a supplier and had an appointment with him. I can say that my legs have all healed, and I can only rejoice and be thankful for the care I received from Dr van Wyk at #Vein Solutions! NO MORE PAIN! JOHAN
I am an 82 year old female patient with severe swelling of right leg, and venous ulcers. Duplex Dopplers show venous reflux. Radio frequency was done, as well as lymph drainage by a Sequential Circulator. The results from Dr. G Van Wyk was #Amazing! Linique

Frequently Asked Questions

What happens at the first consultation?

One of our specialists will assess your medical history and perform a clinical examination of your areas of concern. Clinical photographs of these areas of concern will also need to be obtained for your medical file.

However, clinical examination alone is insufficient, to accurately ‘map out the problem veins’ so patients will also require a duplex ultrasound scan on the legs.

Does the procedure hurt?

The amount of discomfort felt will vary with the individual. The needles used are extremely fine (similar to acupuncture needles) and many are hardly felt at all. The injected solution can sting slightly for short periods of time. If EVLA is used, then minimal discomfort is experienced as it is performed under local anesthetic.

How many treatments will I require?

Your treatment protocol, which includes the number of treatments required, will be determined at your first consultation.

Will vein treatment interfere with my work or home duties?

This is a walk-in, walk-out procedure. Most treatments take about 30 minutes to perform. Following treatment, your daily routine should not be disrupted, normal duties can be resumed.

Does vein treatment require a stay in hospital?

No hospital admission is necessary for our leg vein treatments. Sclerotherapy, ultrasound guided sclerotherapy, endovenous laser ablation, VenaSeal vein glue, etc – all these procedures are performed in clinic.

What are the costs of treatment?

The expected cost for treatment varies between individuals and will be provided in writing following your assessment. All payments are to be made on the day of review/treatment, either by medical aid (medical aid rates – and covered by most medical aids or by cash, eft/pos, credit card or cheque.

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