can be treated with topical antibiotic dressing applications for a short duration.17

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Treatment of venous ulcers It is necessary to address the chronic venous insufficiency by improving venous return and reducing edema. Goals for treating venous ulcers include reversing venous hypertension and its as- sociated symptoms, complete wound healing, and prevention of recurrence.4

Venous ulcers have a high recurrence rate. the heart.3,4

The simplest form of treatment is elevation of the legs above The legs should be elevated for 30 minutes four

times daily, which reduces edema and helps improve circulation. Compression is considered the standard of care, with better

healing rates than in patients who did not use compression; in advanced disease, compression is required.12

In addition to using

compression stockings or devices, the patient must be adherent to leg elevation. After the ulcer is healed, compression may still be used to prevent recurrence. Methods of compression include inelastic, elastic, and pneumatic options.3 Inelastic compression includes application of zinc oxide-impreg-

nated, moist bandages that combine dressing and compression, and harden after application. This method provides compression/ pressure with ambulation and muscle contraction only (no com- pression/pressure at rest). These bandages can be uncomfortable due to the inelasticity and inability to conform to changes in the size of the leg.3

Depending on the amount of exudate from the

wound, an accumulation of exudate can lead to a foul smell and require frequent changing. Elastic compression includes compression stockings or ban-

dages (ACE wraps are not recommended, because they do not provide enough pressure). The common therapeutic compression level is 30 to 40 mmHg at the ankle, but they are available in varying degrees of compression and can be custom fit.3


are removed at night, but can be difficult for patients to apply. Multilayered elastic bandages are an alternative to stockings, but they need to be applied by a professional and changed frequently. Elastic compression needs to be replaced every six months. Pneumatic devices or sleeves applied to the legs deliver inter-

mittent compression through inflation and deflation. They are not recommended for patients who have arterial insufficiency. Surgical options for treating venous insufficiency can reduce

the venous influx and prevent future ulcerations. Depending on the severity of the disease, surgical options include vein ligation, phlebotomy, or vein bypass.4

Nonsurgical interventions include sclerotherapy and thermal ablation.

Treatment of arterial ulcers PAD is progressive; without treatment, it can lead to gangrene or amputation in a short time. The only effective way to heal an arterial ulcer is to increase the blood supply to the lower leg and foot. Patients with arterial ulcers benefit from referral to a vascular surgeon or interventional radiologist, and patient treatment goals include establishing pain relief and adequate circulation to avoid amputation.4 Indications for surgery include pain, ischemia, and ulceration with gangrene.9,18

Percutaneous balloon angioplasty and stent placement can be performed, as well as bypass surgery. 24 Visit us at • 2016

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