General measures Exercise. Local wound therapy One benefit of moist wound treatment is documented One can use different forms of wound dressings. When changing dressings (VW) should be used if necessary drinking water or physiological saline solution for cleaning. The edge of the ulcer can be protected from maceration (softening of the tissue) with zinc … Venous Leg Ulcer: Therapy
Medical history (history of illness) represents an important component in the diagnosis of venous leg ulcer. Family history Social history Current anamnesis/systemic anamnesis (somatic and psychological complaints). Have you noticed any skin changes on the lower legs? Ulcer Hyperpigmentation Eczema Hardened, atrophic skin Whitish discoloration of the skin If so, how long have these been … Venous Leg Ulcer: Medical History
The following interventional/surgical venous therapies (level of evidence: III/B) can be performed in the presence of venous leg ulcer: In varicosis (varicose veins), postthrombotic syndrome (PTS) – removal of insufficient vein segments using the following procedures: Surgical removal Sclerosing (sclerosing) procedures (laser, foam sclerosing/chemical substances). Venous valve reconstruction/transplantation Ulcer excision (peeling), ulcer debridement (wound cleansing). … Venous Leg Ulcer: Surgical Therapy
The following symptoms and complaints may indicate venous leg ulcer: Leading symptoms Ulceration (ulcer) on altered skin. Hyperpigmentation Eczema Dermatosclerosis – hardened, atrophic skin. Atrophy blanche – whitish discoloration of the skin; often painful. Predilection sites (body regions where the disease occurs preferentially): onset above or behind the medial malleolus (inner ankle). Therapy-resistant ulcerations occur … Venous Leg Ulcer: Symptoms, Complaints, Signs
Pathogenesis (development of disease) Venous leg ulcer is the result of chronic venous insufficiency (CVI). Chronic venous insufficiency represents an obstruction of outflow in the venous system of the lower extremity. It occurs due to hypertension (high blood pressure) in the venous system with hypervolemia, which leads to circulatory disorders due to damage to the … Venous Leg Ulcer: Causes
Blood, hematopoietic organs – immune system (D50-D90). Werlhof’s disease (idiopathic thrombocytopenic purpura, ITP) – autoantibody-mediated disorder of platelets (thrombocytes) with spontaneous small-spot bleeding. Polycythaemia vera – abnormal proliferation of blood cells (particularly affected are: especially erythrocytes/red blood cells, to a lesser extent also platelets (blood platelets) and leukocytes/white blood cells); prickly itching after contact with … Venous Leg Ulcer: Or something else? Differential Diagnosis
The following are the most important diseases or complications that may be contributed to by venous leg ulcers: Skin and subcutaneous (L00-L99). Hypodermitis (subcutaneous inflammation). Recurrent venous leg ulcer Infectious and parasitic diseases (A00-B99). Infection of the wound Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99) Neuropathic pain (approximately 56% of cases). … Venous Leg Ulcer: Complications
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; furthermore: Inspection (viewing) of skin [leading symptoms: Ulceration (ulcer) on altered skin. Hyperpigmentation Eczema Dermatosclerosis (hardened, atrophic skin) Atrophy blanche (whitish discoloration of the skin; often painful)] Elicitation of pulse status (bds. … Venous Leg Ulcer: Examination
Laboratory parameters of the 1st order – obligatory laboratory tests. Small blood count Inflammatory parameters – CRP (C-reactive protein). Fasting glucose (fasting blood glucose), if necessary oral glucose tolerance test (oGTT). Blood gas analysis (BGA) Albumin (blood protein) Laboratory parameters 2nd order – depending on the results of the history, physical examination and obligatory laboratory … Venous Leg Ulcer: Test and Diagnosis
Therapeutic target Pain relief and healing Therapy recommendations See under surgical therapy Support of healing (platelet aggregation inhibitors, rheologics, prostaglandins; flavonoids such as diosmin/hesperidin combo; coumarin/troxerutin combo; sulodexide; horse chestnut extract); drug therapy alone will not be successful Substitution of trace elements (iron, selenium, zinc) and vitamins (vitamin C, folate)/if necessary, taking a dietary supplement … Venous Leg Ulcer: Drug Therapy
Obligatory medical device diagnostics Doppler sonography (ultrasound examination that can dynamically visualize fluid flows (especially blood flow)) or duplex sonography (ultrasound examination: combination of a sonographic cross-sectional image (B-scan) and the Doppler sonography method; medical imaging technique that can dynamically visualize fluid flows (especially blood flow)) of the lower leg veins (epi-, trans-, and subfascial, … Venous Leg Ulcer: Diagnostic Tests
