Morbidly obese 75-year old with diabetes mellitus

Compression therapy

Educational Objective:

Discuss the appropriate treatment for venous ulcers.

Key Point:

The most important therapy of venous ulcers is control of edema with compression therapy.

Explanation:

The patient has a large venous ulcer. The erythema seen above and below the ulcer represents stasis dermatitis and not cellulitis. Compression therapy is a key component of the therapy required to treat venous insufficiency and venous ulcers. This can be achieved with the use of compression stockings or multilayer compression wraps. Edema control is the most important element to allow for healing of the ulcerations.

Debridement of the ulceration is indicated in the presence of sloughing or devitalized tissue. Collagenase is an option for some patients; however, this patient has predominantly granular tissue on the surface of the wound, a sufficient base for healing without the need for collagenase.

Superabsorbent dressing will help the patient control her symptoms and will provide her comfort. Dressings are an important element for the treatment of venous ulcers; however, the drainage will continue unabated unless compression therapy is applied at the same time.

All wounds are colonized with bacteria. A diagnosis of infection is based on clinical findings. This wound does not appear to be infected and does not require antibiotic treatment.

References:

O’Donnell TF, Passman MA, et al. SVS/AVF Joint Clinical Practice Guidelines Committee-Venous Leg Ulcer. Journal of Vascular Surgery.2014; 60: 3S-59S

Bonilla-Martinez ZL, Kirsner RS. Venous Ulcers. Diseases of the Skin. Conn’s Current Therapy. 2014; 14: 889-990