I’m Told I Have a Venous Stasis Ulcer, Why Won’t It Heal?

By Jill Buterbaugh, RN, MSN, CRNP, FNP-BC

Venous stasis ulcerations are the result of years of microscopic changes in the tissues in combination with abnormal pressures in the veins and tissues.  These ulcerations don’t just suddenly appear but start as swelling, discoloration and rashes.  Treating and healing them is not a simple process either but the main reason that the wounds don’t heal very quickly is usually the inability to control swelling.

First of all, early treatment is important in treating venous disease.  Large bulging varicose veins that are accompanied by physical symptoms such as pain, heaviness, swelling, phlebitis or skin rashes should be treated.  Treatment should be initiated by having a thorough evaluation of the venous system and discussing options with a specialist trained in managing venous disease.

The treatment of swelling is one of the most challenging symptoms to control because taking a fluid pill just isn’t the answer when it is caused by venous disease.  It takes work and the work is on the part of the patient.  Compression treatment is the only non-surgical way to control symptoms of venous disease.  This is symptom control, not treatment.  The veins and wounds will not “go away” or be fixed by wearing compression, but compression treatment forces the blood from the surface veins into the deep system so it can be more efficiently returned to the heart.  This reduces the sluggish or stagnant blood that engorges the dilated veins.

When the veins remain engorged and over-dilated, fluids leak out of the vessels into the tissues.  The body then relies on the lymphatic system to clear this extra fluid but often it simply can’t and the fluid accumulates resulting in swelling and increases drainage from wounds.  Ordinary compression stockings sometimes work, but sometimes multiple layers of wraps, special wraps and even leg pumps have to be used to resolve the swelling.  This takes commitment both on the provider and the patient because missing even one appointment can sometimes set back healing significantly.  At times, lymphedema treatment is necessary to stimulate the lymphatic system to drain correctly.  Team effort is sometimes necessary to resolve chronic swelling.

Increased exercise also helps move the fluids out of the legs into the general circulation so it can be eliminated.  The calf muscle is an important part of this process so simple exercise such as walking does help to improve swelling.  Even if a person can’t walk for long distances, short walks frequently will help too.  Doing some calf muscle exercises like toe raises and calf stretches also help.

A healthy diet rich in antioxidants is important for weight loss and vein health.  Antioxidants improve the strength and maintain the elasticity of the vein walls decreasing the chance of damage.  Weight loss is important because excess weight increases the pressure in the tissues as well as increases the amount of work it takes to return the blood and fluids to the heart and kidneys.  A healthy diet is also important for the body’s immune system to be able to function correctly and heal the wound.

Another reason wounds sometimes don’t heal is because of lack of wound care.  It is important that providers skilled in healing wounds are involved in the care so referrals to wound care centers are important.  Although it is a burden at times to go to “all of these appointments,” it is necessary for proper care.  It is very hard to keep wound clean and warm enough to heal without proper debridement of non-healthy tissues and control of drainage.

Healing wounds takes time and commitment.  Missing appointments and not following instructions are sometimes unavoidable due to time and financial constraints, but alternate plans can usually be made.  It is a group effort where everyone involved is critical to the care and includes medical providers, lymphedema therapists, wound care centers and most importantly, you, the patient.  For more information or an evaluation for recommendations, please feel free to contact us at Advanced Vein Care.  We would love to be part of your team.

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