The most common form of wound that peripheral vascular patients experience is a varicose ulcer. These form because of high pressure inside the veins causing a blood protein essential to forming clots, called fibrinogen, to leak out into the tissues. The blood vessels can usually handle this fibrin with special enzymes, but because the pressure has caused the leaking into the tissues where there are no enzymes, the fibrin interferes with the circulation's ability to deliver oxygen and nutrients to the tissues. Accumulation of this fibrin and the disturbance of circulation leads to formation of thick, hard tissue and often brown discolored skin. The tissue can die due to a lack of oxygen and then ulcers form in that spot.

Risk Factors for Developing Ulcers or Wounds

• Chronic Venous Insufficiency with resultant chronic leg swelling
• Diabetes
• Deep venous thrombosis damaging venous valves
• Severe or long term swelling from backward flow of venous blood
• Not wearing compression stockings
• Tight shoes rubbing vulnerable skin
• Trauma from going barefoot

• Prescription Compression Stockings The compression of the stocking functions similar to the muscles in the leg, squeezing the veins so that the blood is pushed upward. Custom fit compression stockings should be prescribed by your doctor and carefully fitted for the best results. It is essential that they give plenty of support to the lower leg without squeezing the calf or thigh and the doctors' prescription ensures exact compression distributed in a graduated manner up the leg. Stockings should be put on as soon as you get out of bed and be worn on all day.
  
  • Compression stockings are most effective when leg swelling is at a low point, such as after elevation or in the morning.
  • The compression counters, or balances the increased venous pressure in the legs.
  • The compression reduces venous volume in the legs, increases venous flow.
  • The compression supports superficial veins and increases flow in the deep veins.
• Unna Boots are a dressing saturated with gelatin, zinc oxide and caledryl and applied from the toes to the knee then wrapped with an elastic bandage. The patient can be up and about, but must elevate the legs 4-5 times per day above the level of the heart.
  • Hypercolloid dressings promote healing and helps with the removal of dead tissue in the ulcer, or wound. The wound is directly applied over a cleansed wound and changed every 1-7 days, depending on the amount of drainage from the area.
  • Regranex is a gel applied in a thin coat over a cleansed wound or ulcer site, covered with a saline moistened dressing and then some form of support, or compression such as support hose. This stimulates new tissue formation. It is left on for 12 hours, removed for 12 hours with the process repeated for a few weeks, or until healing occurs.
  • Transparent dressings provide a moist environment for the wound, or ulcer to heal. This clear dressing is applied directly over the area after cleansing and is covered by a support stocking or ACE wrap. It is usually changed every 5-7 days.

Warning Signs for Wounds Contact the office if any of the following occur:

• Increased pain
• New discoloration of legs or surrounding area
• Change in temperature of leg
• Foul smelling drainage from wound
• Fever
• Larger, or new, additional ulcers or wounds

Prevention of Wounds

• Inspect feet daily for abrasions, ulcerations, or infections. Use a mirror on the floor if it is difficult to see the entire foot and heel.
• Cleanse feet daily with soap and water, drying well afterwards.
• Do not soak feet in hot water.
• Treat dry skin with a general hand lotion or moisturizer.
• Avoid ill-fitting or worn shoes.
• Do not walk barefoot and avoid trauma to your feet.
• Do not apply heating pad or hot packs to feet.
• Check with the doctor before trimming calluses or radically trimming toenails. See a podiatrist for any significant concerns.
• Contact the doctor immediately if any problems should develop with your feet.