September 24, 2015
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What is an Ulcer?

An ulcer is a type of wound that begins via a break in the skin or a mucus membrane and does not heal in a timely fashion. They can be very shallow (superficial) or proceed to a more serious level where they extend to muscle or even bone. Ulcers often become infected and thus take even longer to heal and have been shown to be a significant factor contributing to a decreased quality of life for patients and an increase in the ever rising costs of healthcare! 

This diagram shows a few types of wounds, but specifically an example of an ulcer.

There are a few different ways that ulcers can form on the Lower Extremity, but in particular we will explain venous stasis ulcers.  

Who gets them?

Many people are at risk for developing venous ulcers including those with Diabetes, Heart Failure and Obesity. Tobacco usage has also been proven to worsen these issues and put the user at risk for blood clots and heart attacks. These conditions all affect vascular health and put you at further risk for developing the chronic edema and concomitant ulcers. 

Why do they form?

Poor circulation is the real culprit behind a venous ulcer. Veins carry the blood back to your heart after it is pumped to your feet. They are able to carry the blood “upstream” so to speak by utilizing many small valves. 

These valves are absolutely essential to ensuring that the blood doesn’t collect in your legs!

When these valves cease to function, the veins of the lower extremity can no longer transport the blood back to the heart. Over time, because of the constant pressure of blood flow, the blood is forced out and collects in the tissues outside of the vessels! This condition called Venous Insufficiency causes swelling, pain and a discoloration of the skin over time called “brawny” discoloration. 

The discoloration of the skin comes from a pigment in the red blood cells called Hemosiderin. This is a serious symptom and the discoloration is permanent!

    The abnormal swelling causes the skin to be stretched beyond its capacity. This can be particularly problematic in older patients whose skin is thinner than that of their younger counterparts. An ulcer forms when the integrity of the person’s skin becomes compromised, either due to a traumatic event (a scratch or cut) or when the skin itself is stretched to the breaking point and is too weak to serve the normal function.

How are they treated?

    Venous ulcers are treated in a multitude of ways depending on the size, number and associated complications. Firstly, it is crucial to understand that since the ulcer formed due to the chronic edema, it will not heal unless that is first managed. This can be achieved by using compression stockings and elevating the limbs above the heart to improve the venous return. Medications called diuretics may also be prescribed to help eliminate the excess water from the body.

Additionally, since an ulcer is an open wound, proper wound care is essential. A wound specialist should inspect the area weekly to treat and monitor the progress of the ulcer. The wound may require mechanical debridement, which is procedure in which the physician uses a blade to remove the non-viable tissue and creates a fresh “bed” for the wound to heal. Wound care products are available now to help speed up the body’s natural healing abilities, many of which are diminished in those patients who are at risk for developing these ulcers.

                  When an ulcer is particularly stubborn and will not heal, special measures are taken to solve the problem. These include things like skin grafts, hyperbaric oxygen treatments and even surgery to restore the veins in the legs! 

By utilizing proper wound care techniques this wound was able to heal beautifully.

If you or someone you know needs help with a venous ulcer or symptoms similar to these don’t hesitate to contact us! Dr. Garibaldi and Dr. Kurtz each have years of experience treating these ulcers successfully by using the latest techniques and best standard of care.