Leg wounds are a common and difficult problem. Having a chronic leg wound can significantly affect quality of life and affect a person’s wellbeing.
Of all leg wounds, 70% are from vein problems although this is often not recognized nor managed properly. Some are from other vascular causes – like blocked arteries, with resultant decreased oxygenation of the tissue. In addition, there are other causes such as trauma, infection and microvascular causes.
In terms of vein problems, there has been more research understanding venous disease and why some people end up with damaged and pigmented skin, eczema and wounds. This is thought to be partly due to increased venous pressure, actually starting from the pelvic veins and putting extra strain on the legs.
The microcirculation has also been recognised as an important player in chronic wounds, with dilated small veins, not able to carry blood properly and aggravating inflammation.
Wounds may also develop after patients have had deep vein thrombosis. This is often associated with leg swelling and skin damage. This is known as Post Thrombotic Syndrome and this needs a complete vein assessment and intense management.
All patients with deep vein thrombosis should be on a prevention programme for Post Thrombotic Syndrome. We run this with the lymphoedema therapists along with treatment programmes for those suffering Post Thrombotic Syndrome (PTS).
Anyone with a leg wound should have a full vascular assessment to assess the arteries and veins. A nutritional assessment should also be done as optimal vitamin levels are vital to wound healing.
Importantly, to optimally heal a wound one needs to ensure:
- The circulation is adequate
- There is no swelling
- There is no infection
- The patient is nutritionally optimised.
Dr Laura Redman and Sr Emily Abendanon are part of the Cape Advanced Wound Care Clinic at Christiaan Barnard Memorial Hospital, and Dr Redman is on the editorial board for the Wound Healing South Africa.
Before and after venous procedures, Sr Emily Abendanon will help with wound care management, compression and offer overall lifestyle advice. She has a great passion for wounds and is determined to help every patient, being readily available. Sr Emily will assess patients holistically and individually to ensure the best healing and outcomes.
Wound Care and Compression
Compression stockings are a non-surgical treatment option of venous disease. These stockings are classed according to the amount of pressure they deliver to the leg. These stockings are graded, that is, the pressure at the ankle is greater than the pressure at the knee.
To determine the correct class of pressure for each patient, an assessment needs to be carried out to categorise the symptoms. Compression stockings help the symptoms of venous disease for the time they are worn. They will not, however, prevent progression of disease. Once they are off they are not treating the symptoms.
Surgery has shown superiority over compression in uncomplicated varicose veins with better symptom relief, improved quality of life and in cost-effectiveness. Surgery is also advantageous in accelerating ulcer healing and reducing the rate of recurrence.
Compression, however, has a larger role in venous disease – pre- and post-operatively. It is important to know which class of stocking is best for your type of veins and it is very important that you are correctly measured and understand the concept behind compression.
Sr Emily Abendanon, is not only a wound care nursing sister, but alsoa certified lymphoedema therapist. She will measure patients correctly for the appropriate compression and assist with all lymphatic modalities of reducing swelling. Lymph management and wound care go hand in hand. Everyone with a leg wound should have a vascular assessment.
Compression, does however, still play a vital role and needs to form part of the wound care (such as layered compression) or in addition to wound care dressings. Again, the entire limb needs to be properly evaluated including the muscles, nerves and foot structure as these may all also play a role in healing.
Dr Laura Redman started a MultiDisciplinary Team called ‘Limb 4 Life’ where all practitioners who treat limb problems can discuss and manage cases together. These practitioners include lymphoedema therapists, wound care nurses, podiatrists, orthotists and physiotherapists.
At the OptiVein Centre, we will ensure that not just the wound is being treated but the underlying cause and the patient as a whole, as well in order to prevent recurrent wounds.