Compliance is Crucial to Management of Venous Stasis Ulcers

Ulcers are wounds or sores that will not heal or keep returning. They may or may not be painful. The leg is usually swollen and may burn or itch. There may also be a rash, redness, brown discoloration or dry, scaly skin.Venous ulcers are located below the knee and are primarily found on the inner part of the leg, just above the ankle.

The bottom of a venous ulcer is usually red. It may also be covered with yellow fibrous tissue or there may be a green or yellow discharge if the ulcer is infected. Fluid drainage can be significant with a venous stasis ulcer.

The borders of a venous ulcer are usually irregularly shaped and the surrounding skin is often discolored and swollen. It may even feel warm or hot. The skin may appear shiny and tight, depending on the amount of edema (swelling). The skin may also have brown or purple discoloration about the lower leg, known as “stasis skin changes.”

Venous stasis ulcers are common in patients who have a history of leg swelling, long standing varicose veins, or a history of blood clots in either the superficial or the deep veins of the legs. Ulcers may affect one or both legs.

Venous stasis ulcers affect as many as 2.5 million people in the US and are more common in women than men. A estimated 500,000 persons are diagnosed each year with venous stasis ulcers. There is a high rate of recurrence in noncompliant patients.

Risk Factors

  • Increased age
  • Chronic venous insufficiency
  • Post-thrombotic syndrome

Symptoms or Clinical manifestations

Preceding symptoms

  • Swelling and aching of the legs
  • Dependent edema
  • Varicose veins
  • Reddish-brown discoloration
  • Eczematous changes with redness, scaling, and pruritus

Ulceration

  • Lower leg and ankle, most often in the medial malleolus are; recurrence at the same location is common
  • Associated with weeping, oozing, and crusting
  • Typically range in size from 0.5 cm to 10 cm across

A 15 year study* was accomplished to document the results of patients who wore compression stockings during therapy for chronic venous ulcerations. The study objective was to document the healing percentage and long term recurrence rate of venous ulcers when applying compression therapy. In the study of 113 patients with severe chronic venous insufficiency, 93% (105 patients) achieved complete ulcer healing in a mean of 5.3 months. 96% of the patients wore 30-40mmHg knee-high or thigh-high stockings; 2% wore 40-50mmHg knee-high stockings and 2% wore 20-30mmHg knee-high stockings.

At the conclusion of the study, information was available on 73 of the 105 patients who experience ulcer hearing after wearing compression stockings. 58 of the 73 patients remained compliant with compression stockings and of these 58 patients, 22% had recurring venous ulceration within 36 months. The other 15 of the 73 patients, who were not compliant with wearing compression stockings, had a 100% recurring venous ulceration within 36 months.

*Mayberry JC, Moneta GL, et al. Fifteen-year results of ambulatory compression therapy for chronic venous ulcers. Surgery, 1991, 109:578-81

4 Responses

  1. Try different types. Good advice from my Drs., surgeon, and wound care nurses. I’ve only tried three different manufacturers. One gives me no problems. One I like but could not get in an open toe, but is equal to my favorite. Since only one foot needs the open toe I am mismatched some days – I with a toe one without. The third make rolls down on my thigh.

    • Hi Janet, Even if you have tied different Manufacturers, there are different styles of which may work better for you. That is why we have Certified Fitters to assist you in selecting a garment. Please take you measurements and call one of our Certified Fitters. Be sure and tell them you have been in wound care and the compression which you should be wearing. The manufacturers are always coming out with new garments. Please let them know what is your favorite, what works and what does not. Thanks, Vanda

  2. Vanda
    love the site
    Have a problem wearing 20-30 compression jobst
    keep cutting into ankles-rolling down knee cutting in badly
    how can I solve this?

    • Hello Bernadette,

      When I hear complaints such as this, I feel the garment does not fit you properly. Please call our toll free number 1-844-472-8807 with your measurements and one of our Certified Fitters will make sure you are in a garment which is appropriate for you. If you like ask for Amber.
      Thank so much for your comments, Vanda

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