Skin ulcerations. In the healthcare field, it’s a condition that can spark worry in a medical team, cause pain for patients, and be terrifying for families. The term brings to mind the image of bedsores, possibly caused by neglect and abuse. But, anyone who has a loved one in a healthcare facility should understand that not all ulcers are the same—and, perhaps somewhat reassuringly, most are not the result of negligence. Ulcers can and do happen, even in the presence of excellent clinical care.

There are a variety of skin ulcers. Most people are somewhat familiar with decubitus ulcers, more commonly known as pressure sores (and also sometimes called bedsores). Kennedy Terminal Ulcers (KTUs), another type of pressure sore, occur at the end of life. There are several other types of ulcers that are non-pressure-related, including venous stasis ulcers, arterial ulcers, and neurotrophic (diabetic) ulcers.

How Venous Stasis Ulcers Occur and What Causes Them

People who are not in the healthcare field may not be familiar with venous stasis ulcers, which are the most common type of lower extremity ulceration. They are the result of a chronic condition in which the leg muscles or valves in the leg veins do not efficiently pump blood back to the heart. Consequently, blood will pool in the lower extremities and leak out of the veins into the surrounding tissue. This leads to breakdown of the tissue and eventual ulcer development. Primary risk factors include deep vein thrombosis, smoking, older age, obesity, previous leg injury, sedentary lifestyle, and phlebitis.

Four Ways to Identify Venous Statis Ulcers

Besides their root causes, there are several characteristics that help identify venous stasis ulcers:

• LOCATION: Venous stasis ulcers are located over bony prominences, often over the medial malleolus (the inner side of the ankle).
• APPEARANCE OF WOUND: Venous stasis ulcers are irregular in shape and are shallow. The wound base will usually have red granulation tissue and yellow fibrin tissue present. If the wound is infected, there may be green or yellow drainage, which can be significant in amount. Venous stasis ulcers are often recurrent and can persist for weeks and even years.
• APPEARANCE OF EXTREMITY: The affected extremity will often present with a dull ache or pain that subsides with elevation, eczematous skin, swelling of the leg, and varicose veins. The skin will likely look thin and tissue-like with brown patches. Eventually the skin will become discolored, irritated, cracked, and crusted or weepy. These changes become permanent.
• TESTING: Diagnosis is based on the appearance of the extremity and wounds. However, confirmatory tests may be performed to examine blood flow in the extremity.

Best Practices for Treating Venous Stasis Ulcers

Once diagnosed, venous stasis ulcer treatment involves managing the disease. Measures include compression treatment with stockings or wraps in order to minimize swelling and promote the return of blood to the heart, avoiding long periods of standing, and keeping legs elevated when possible. When wounds are open or infected, proper treatment includes wet dressings, steroid creams and ointments, and oral antibiotics. Topical antibiotics, drying lotions, Lanolin, and topical analgesics should be avoided.

For some patients, treatment may go beyond the local wound site. Surgical interventions may be considered in order to restore blood flow to the affected areas. These include surgical ablation of the saphenous vein, subfascial endoscopic perforator surgery, treatment of iliac vein obstruction with stenting, and varicose vein stripping. And as always, it’s important to document both preventive and treatment measures to maintain an accurate, detailed medical record.

Venous stasis ulcers can be alarming, just like pressure ulcers and other types of wounds. But with an understanding of their physiological cause and possible interventions, providers and families can work together to find the best treatment and achieve the best outcome for patients. When it comes to skin ulcers, knowing the facts and documenting care can help alleviate emotional upset and prevent unnecessary claims and allegations—a win for everyone involved.