Venous Leg Ulcers

Venous leg ulcers (VLU) are chronic skin wounds that occur on the lower leg secondary to the chronic venous insufficiency (CVI) when the veins in the legs are unable to pump venous blood effectively. Chronic venous insufficiency is a term describing the changes that can take place in the tissues of the leg, due to longstanding high pressure in the veins. This high pressure in the veins usually occurs:

1. when blood flow in the veins is abnormal, secondary to venous valve incompetence, causing reverse flow (reflux) in the veins, or

2. when the veins in the legs become blocked (less common).

The prolonged high pressures in the veins appear to lead to low level chronic inflammation in the surrounding tissues and may lead to thickening and discoloration of the skin of the legs, stasis dermatitis and non-healing ulcers around the ankle area.

 

Stasis Dermatitis

 

Stasis dermatitis (or stasis eczema) occurs when varicose veins cause fluids to build up in the lower legs. The swelling produces pressure beneath the skin and prevents adequate blood and oxygen from reaching the skin. This causes the skin at the ankles and shins to develop redness (erythema), scales, erosions, crust and itch. Scratching of itchy areas may lead to an open wound, which could turn into a non-healing ulcer. Conventional treatment options usually include:

 

• Wearing elastic support hose (compression)
• Leg elevation
• Having varicose vein surgery
• Using moist dressings to soften the thickened yet fragile skin and to control infection

Ulceration

 

Venous ulcers (VU) are ulceration of the skin and subcutaneous that occurs secondary to chronic venous insufficiency. Typical venous ulcers are located on the inner part of the ankles. The base of ulcer is usually red in color and may be covered with yellow fibrous tissue. There may be a green or yellow discharge if the ulcer is infected. Fluid drainage can be significant. The ulcers are usually irregularly shaped. The surrounding skin is often discolored and swollen. The skin may appear shiny and tight, depending on the degree of swelling.

 

Treatment of Venous Leg Ulcers

 

Venous leg ulcers are usually recurrent, and an open ulcer can persist for weeks to many years. Conventional treatment options for venous leg ulcers include leg elevation, compression therapy to minimize swelling (edema) and pain, and dressings.

 

Venous leg ulcers are difficult to heal due to many complex issues, including:

 

• Increased venous pressure, aggravated by prolonged standing or sitting
• Excessive wound drainage and formation of bacterial biofilms that are resistant to antibiotic treatment
• Swelling (edema)
• Excessive wound drainage (exudation)
• Poor blood circulation (ischemia)
• Disrupted epidermal barrier and susceptibility to infection
• Infection with antibiotic-resistant biofilms
• Eschar and fibrous tissue formation
• Itch, burning sensation and pain
• Prolonged inflammation
• High risk for recurrence, as many patients have to continue doing the same job with lengthy periods of sitting or standing, counterproductively contributing to elevated venous pressure and ultimately, wound healing.

Facing these challenges and to improve the speed and quality of healing, one may consider using a multi-functional botanical therapy with these features:

 

• Including botanicals with broad-spectrum anti-microbial properties to protect wound bed from infection and to inhibit formation and growth of bacterial biofilms without harming nascent, delicate regenerating tissue;
• Employing naturally anti-inflammatory and analgesic botanicals to suppress prolonged inflammation and pain;
• Combination with botanicals that promote microcirculation of the low extremities to allow fast drainage and tissue regeneration;
• Ability to absorb wound fluid (exudate) and reduce malodor, and yet maintain a physiologically moist wound healing environment without causing maceration
• Allowing painless and less frequent dressing change;
• Healing wounds fast and effectively with maximum restoration of skin function and minimal scarring to reduce the chance of recurrence.