The Wound Healing Society estimates that around 15% of the geriatric population in the United States suffers from chronic wounds. Moreover, it's observed that almost 10% of the population will develop a chronic wound and around 2.5% will die from it. It's worth noting that most of these wounds are chronic wound ulcers that are related to chronic venous insufficiency.
So how long does it take to develop a lower extremity ulcer in chronic venous insufficiency? A lower extremity ulcer or chronic leg ulcer is a non-healing wound that lasts even 3 to 12 months after the provision of appropriate treatment. It can form years after the occurrence of a venous disease although it may also occur suddenly.
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Incompetent valves and high pressure in the blood vessels that result in the pooling of blood in the venous circulatory system are pointed as possible reasons behind chronic ulcer formation. Different ulcer types like venous ulcer, arterial ulcer, neuropathic or diabetic ulcer, and pressure ulcer also have different hypotheses as to the specificities of their mechanisms and differences in their clinical presentation.
Venous ulcer or venous stasis ulcer is the most common type of chronic ulcer, accounting for 70% of cases of chronic leg ulceration. It appears as a shallow, painful ulcer on bony prominences of the lower extremities, particularly the gaiter area (the area above the medial malleolus).
It's an ulcer type characterized by periods of exacerbation and remission. Venous ulcer healing also takes a long time, adversely affecting the quality of life of the individual experiencing this venous disorder.
Three theories are formulated as to the development of venous leg ulceration:
Arterial leg ulcers or ischemic leg ulcers are deep ulcers over bony prominences characterized by round or punched wounds with sharply demarcated borders, with areas of yellowing or necrosis (dead tissues), and exposure of tendons.
It occurs mainly due to tissue and arterial insufficiency in blood flow and oxygen. Other findings to help in its correct diagnosis include impairment in the pulses that may be palpated in the lower extremities, cool limbs, femoral bruit, and prolonged venous filling time.
Three mechanisms are also hypothesized to cause arterial leg ulcers and these include:
Neuropathic ulcer is a condition commonly observed in the soles of the feet of patients with diabetes mellitus, neurologic disorders, or Hansen disease. It's a condition that affects 15% of all diabetic individuals, brought by multiple factors such as peripheral neuropathy and ischemia from peripheral vascular disease, trauma, among others.
Pressure ulcers are chronic wounds over bony prominences brought by tissue ischemia and necrosis brought by unrelieved pressure. Primary risk factors for pressure ulcers include limited mobility, excessive moisture, and altered mental status. It's also estimated that 70% of older patients experience pressure ulcers that can give rise to drastic complications including septicemia, osteomyelitis, and even death.
Other medical conditions that may predispose a patient to chronic ulceration, aside from those previously mentioned include:
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The goals of treatment for the treatment modalities available for chronic ulceration include reduction of edema (swelling due to fluid build-up), wound repair and regeneration for the ulceration, and reduction of the possibility of the rate of recurrence of the ulcer.
It should be noted, however, that despite the variety of the treatment methods available (this includes conservative management, mechanical treatment, medications, and surgical procedures), the healing benefit from these procedures varies and very few studies support their use.
Leg elevation in combination with compression therapy and the use of dressings under compression bandages are considered under conservative management.
The addition of medications in combination with compression therapy and other treatment modalities is done to improve the overall healing benefits of the procedures being undergone. In general, these medications work by reducing blood viscosity through inhibition of platelet aggregation and preventing inflammation and bacterial infection. Common medications and therapies used include:
Surgical treatment should be considered to help reduce the rate of ulcer recurrence in patients that aren't responsive to conservative therapy. Surgical procedures that patients with refractory ulceration include:
Medical management for chronic leg ulcers isn't enough. There's a high chance of venous ulcer recurrence unless the underlying causes such as deep venous thrombosis, varicose veins, and obesity may be addressed.
As such, it's best to go to trusted outpatient vein treatments such as those that Vein Center Doctor can offer to help manage the vascular disease that might have been the reason behind the chronic leg ulcer. The outpatient vein treatments available at Vein Center Doctor include:
Radiofrequency ablation or thermal ablation is a minimally invasive, FDA-approved procedure. It involves stripping veins to prevent saphenous vein reflux. It's an image-guided procedure that requires only local anesthesia and radiofrequency catheters where heat is used to destroy the endothelium (inner layer) of the vein.
This procedure, however, can't be undergone by individuals with an incompetent superficial vein diameter of less than 2 mm, medical history of deep vein thrombosis, prior surgery of endovenous treatment of the same leg, pregnancy, and known malignancy.
Like radiofrequency ablation, endovenous laser treatment is also an image-guided procedure that uses Doppler ultrasound. It also uses heat, but it comes from laser fiber inserted into a catheter in order to close enlarged veins. This process can also shrink the veins through the formation of scar tissue within the blood vessel.
The direction of blood flow will then be transferred to other blood vessels. No stitches will be needed although the area will be covered with bandages. Side effects include bruising that lasts only up to 2 weeks. Very rare ones are nerve damage and blood clots, but these only happen in the hands of poorly-trained practitioners.
This therapy is used for varicose veins and "spider veins". A salt solution will be injected through a very fine needle directly over the area of concern to irritate the endothelium, causing the blood vessel to shrink and for the blood to clot. This procedure typically lasts for approximately 15 to 30 minutes.
Meanwhile, the number of veins injected with the solution is based on the size and location of veins and the condition of the patient. Some side effects include reactions associated with injection such as raised, red areas, bruising, and itching at the injection site that will resolve on their own eventually.
The VenaSeal closure system is a superficial vein therapy against venous reflux that uses no heat and doesn't require the use of anesthesia and compression stockings. This minimally invasive procedure has relatively fewer side effects compared to other treatments.
In terms of amount, 0.1 cc of the VenaSeal adhesive is first delivered every 3 cm intervals by the dispensing unit for 3 seconds followed by compressing the area for 3 minutes.
Compression therapy is the standard of care for individuals with chronic venous insufficiency. Types include elastic compression therapy, inelastic compression therapy, and intermittent pneumatic compression.
Aside from its application in chronic venous insufficiency, the use of compression stockings is also the standard of care for venous ulcers, backed by evidence that the rate of healing is faster with compression therapy than without.
Its lifelong use helps decrease the rate of recurrence of ulcer but its use is limited by factors such as pain and application difficulty. However, it can't be used by individuals with arterial disease and uncompensated heart failure.
It takes years before a lower extremity ulcer develops, although it may also occur all of a sudden. Venous ulcer treatment only can go as far as managing the wound and ulcer formation may recur when the underlying causes aren't addressed such as deep vein involvement.
At Vein Center Doctor, we help in the prevention and management of leg ulcers by addressing them down to their underlying causes. We're experts in managing non-functional and damaged veins and other diseases associated with blood vessels. For healthier leg veins, contact us today at 862-227-1143 (NJ) or 862-227-1054 (NY).
Find exactly what you need to get rid of your vein-related problems. Dr. Sood and the rest of our team at Vein Center Doctor are ready to help: schedule your free consultation today.
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