If a wound is not healing or progressing after a few weeks, something could be wrong. Standing for long periods, sitting for long periods, pregnancy, and being overweight can contribute to venous insufficiency, which can result in venous wounds. These injuries and other types of chronic wounds can be identified and treated at Jefferson Surgical Clinic. Christin Elledge, Family Nurse Practitioner specializing in vascular surgery and wound care, explains the different types of wounds to be aware of and why early identification and treatment is paramount to healing.
Chronic Wounds
Chronic wounds include any wound lasting about four weeks or longer.
Commonly, chronic wounds that don’t heal is related to venous insufficiency, but this is not always the case. It’s important to see a doctor who can help identify the underlying cause, which could also be diabetes or arterial occlusive disease. Some patients can have all three, and each type of wound is treated differently depending on the cause.
Venous Insufficiency
Venous wounds are caused by underlying venous insufficiency. Basically, it’s a result of veins that are not working properly. This condition keeps the veins from pumping blood back up to the heart as sufficiently as it should.
Approximately, 80% of people have some component of venous insufficiency, but not everyone with venous insufficiency develops a venous wound. This is a genetic condition that can affect everyone from children to older adults. Some people have venous insufficiency in both legs; some just have it in one.
Some signs of venous insufficiency can include leg swelling, browning of the skin, bulging veins or spider veins, and general heaviness and aching in the leg.
The first step in caring for venous insufficiency is to manage any swelling. Using a compression wrap or compression socks on a weekly basis (and perhaps more) can help in this process. Patients are also encouraged to elevate the affected leg whenever possible and to move, walk, and bike to get the blood flowing. Idle standing or sitting allows blood to pool in place and further worsens the swelling.
An ultrasound may be needed to determine if any minor procedures can be done to treat the insufficient veins. This could include laser ablation of the diseased vein to relieve unnecessary pressure in the leg and can improve discomfort while a patient heals.
Downtime after the procedure is usually a day or two, and it is beneficial for patients to periodically walk and elevate their legs above the level of their heart and continue to follow up with local wound care and compression therapy.
Diabetic Peripheral Neuropathy
Peripheral neuropathy is numbness, tingling, and burning from nerve damage, usually in the hands and feet that can result in decreased sensation. A common cause of peripheral neuropathy is diabetes, which makes patients who are diabetic at higher risk for developing a wound without realizing it.
This can happen when a diabetic injures their foot but does not feel the pain, and therefore does not know that an injury has occurred. Or they wear new shoes that don’t fit right but they don’t have enough sensation to realize it. Eventually, patients can notice redness developing higher on their leg and discover they’ve had a wound on their foot for a very long time. Foot checks should be done daily. Diabetic patients are also encouraged to wear shoes with socks, avoiding tight-fitting shoes and sandals.
If wounds continue to go untreated, this can result in an amputation. This happens when the wounds are already too compromised and prone to infection and have infiltrated the bloodstream to the bone.
Arterial Disease
Arterial occlusive disease is caused by plaque buildup in the artery which deprives the legs and feet of blood flow.
To improve the chances of healing a wound, the first step in care is to check blood flow and pulse on the feet. If there is no pulse, then noninvasive testing in the form of ultrasounds is done to look at the status of a patient’s arteries.
Significant blockages can require more invasive testing/interventions like ballooning or stenting. In some situations, this may result in surgery.
Determining Cause and Treatment
JSC can determine all these conditions through our inpatient and outpatient facilities.
Early identification and intervention are key to a patient’s success in healing the wound and decreasing the chance of recurrence. Some patients come in much too late, but had a wound been identified earlier, aggressive measures may not have been needed.
Oftentimes, if patients notice a new wound, they can come in that day for an appointment. Our in-house vascular labs can perform same-day scans during that visit, depending on a patient’s insurance coverage, allowing patients to know their diagnosis and next steps before they leave the office.
For more information, or to schedule an appointment, contact us at (540) 283-6000.