Venous Stasis Ulcer

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Venous Stasis Ulcer

What is Venous Stasis Ulcer?

Venous stasis ulcer is a chronic condition that involves blood circulation insufficiency. Venous stasis ulcer is a localized ulceration and is also referred as varicose ulcers as it basically affects the legs or lower extremities. The condition is said to cause some amount of disability to 2 to 5% of the total population. Statistics show that about 70 to 90% of chronic wound cases are due to venous stasis ulcer. Many suffer from this longer than they expect, as some tends to suffer from nonhealing ulcerations.

Venous stasis ulcer is a common occurrence among people with a history of blood circulatory problems, varicose veins and leg swelling. These risks, however, is a great help in identifying the presence of the disease as collection of the patient’s medical history plays a vital role in the identification. Physical inspection is also a great help in identifying the disease. Laboratory tests may be necessary as the patient’s circulatory system is tested. This will assess the patient’s blood circulation and identify the possible risk factors present.

ICD 9 code

The ICD-9 Diagnosis code for venous stasis ulcer is 459.81. This is under the venous (peripheral) insufficiency disease, unspecified.

Symptoms & Signs Of Venous Stasis Ulcer

Venous stasis ulcer begins with localized changes in the color of the skin. The basic characteristics of venous stasis ulcer are the following:

  • There is darkening of the skin that basically turns to dark red to purplish color.
  • The ulcers develop into large wounds. They may somehow appear shallow and are composed of irregular margins.
  • The wound may be darker as infection sets in.
  • The base part of the ulceration is naturally red in color.
  • The wound has a tendency to ooze with blood when not properly handled. When the wound is manipulated, it may bleed out.
  • Area affected may feel numb or is with slight discomfort, as most patients report. Pain develops when infection or edema develops.
  • As the ulcer worsens, edema or swelling may develop and cause for more discoloration. The skin usually develops into a firm structure with a reddish-brown discoloration. The state is usually identified as stasis dermatitis.

Location

Venous stasis ulcer is basically located and found at the distal extremity, lower leg. The inner part of the leg and just a few inches higher from the ankle is the usual area of affectation. Most cases are affecting one leg but some reports show that both legs can also be affected at the same time.

Causes of Venous Stasis Ulcer

The condition is basically caused by a number of precipitating factors. The following are considered some of the causes and risks for venous stasis ulcer development:

  1. Varicosities or varicose veins. Two-thirds among progressive leg vein diseases approximately cause venous stasis ulcer.
  2. Deep vein thrombosis. About 1/3 to 1/2 cases of venous stasis ulcers is due to DVT.
  3. Heart failure. This primarily causes venous stasis ulcer because of improper blood circulation, which greatly affects the peripheral veins specifically located at the legs.

Venous Stasis Ulcer Pictures

Venous Stasis Ulcer

Picture 1 : Venous Stasis Ulcer

Image source : veinsveinsveins.com

leg dorsal Venous ulcer

Picture 2 : Venous Stasis Ulcer on back of Leg

Image source : veinsveinsveins.com

Pathophysiology of Venous Stasis Ulcer

Venous stasis ulcer is idiopathic in cause but certain related factors are linked to its development. Study show that improper blood circulation provides a great influence to the development of venous stasis ulcer. The mechanism of the venous disease primarily starts with a root problem from malfunctioning of venous valves.

This starts when there is a heart problem or mainly because of a cardiovascular disease. When exhaustion causes arteries to have lower blood circulation from the heart, it is proportionate to a higher venous pressure resulting to venous pooling of blood.

This compensatory mechanism is called venous hypertension and is not a very good sign as this result to stretching of veins and extravascular leaking of proteins. This is unhealthy as the blood proteins cause isolation of ECM molecules that help in wound healing. Other vital contents that get leaked out are fibrinogen and proper oxygen.

Because of such occurrence, building of WBCs or stimulation of the inflammatory process starts contributing further damage to the blood vessel walls. Ischemia follows, where proper oxygenation is not attained. Improper blood follow is common in distal areas such as the lower extremities and pooling of blood is subsequent when gravity permits. Since there is great blockage because of WBCs or leukocyte accumulation, venous stasis ulcers follow.

Treatment for Venous Stasis Ulcer

Treatment options are provided to clients suffering from venous stasis ulcer. However, important points must be remembered when treatment is discussed. You should always consult a doctor in order to identify the disease and find its treatment. Once a clear diagnosis is found, suitable treatment is offered and the disease can be managed accordingly. Treating the disease on your own, without the doctor’s proper advice, would only lead to additional problems.

The following is the treatment plan for venous stasis ulcer:

  1. Leg elevation. This is one of the most frequent interventions with venous stasis problems. This can help reduce venous pressure and lessen the edema or swelling of the affected leg. This intervention can be facilitated while lying down and resting the legs on a pile of pillows (It is essential that the affected extremity is at a higher level than your heart, as it facilitates good blood flow and reduce blood flow pressure from the legs).
  2. Compression stockings. This can help lessen the swelling of the legs which is a great influence in venous stasis ulcer development. However, the doctor shall choose the appropriate leg compression stockings or bandage for you and may base it from the severity of the ulcer.
  3. Unna boots. This is found to be good in treating venous ulcers since 1854. The boots are said to contain calamine lotion, glycerin combined with zinc oxide and gelatin in a form of rolled bandages.
  4. Vacuum assisted wound closure. This intervention is a designed for wound therapy. This is also identified as subatmospheric pressure therapy which involves the use of negative pressure as a suctioning device for draining the ulcer contents. After that, a drain tube is placed in order to serve as a vacuum used in a continuous or intermittent manner, depending on the doctor’s order.
  5. Surgical intervention. This is indicated to patients who are suffering from chronic venous stasis ulcer. This will help reduce the discomfort from the ulceration. Either a leg vein ligation or subfascial endoscopic perforator surgery is done. Fasciotomy is also done which uses laser treatment directed on the affected veins.
  6. Essential cleaning of the ulcer. This is the basic care and treatment for venous stasis ulcer. With the above given interventions, keeping the wound clean and at complete care would lessen the severity of the disease.

References

http://my.clevelandclinic.org/heart/disorders/vascular/legfootulcer.aspx

http://en.wikipedia.org/wiki/Venous_ulcer

http://www.dhphomedelivery.com/wound-care-venous-stasis-ulcers.pdf

http://www.woundsource.com/blog/venous-ulcers-and-wound-care-symptoms-causes-and-treatments

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