Management of Venous Stasis Ulcers in the Older Adult

Abstract

Venous stasis disease is common among older adults due to calf muscle pump failure, immobility, chronic edema, and obesity. Increased venous pressure increases the capillaries' permeability allowing fluid, proteins, and blood cells to leak into the tissues. Ulceration is precipitated by reduced oxygen diffusion to the skin and microvasculature damages. While most chronic leg ulcers are caused by venous stasis disease, there is a need to rule out other underlying pathologies including arterial, neuropathic, metabolic, hematological, infectious, malignant, and inflammatory diseases. Compression therapy with high stiffness index is the mainstay of treatment for venous leg ulcers. Adherence to compression therapy could be a challenge in the older population due to reduced dexterity, muscle strength, range of motion, and flexibility. Medications such as pentoxifylline, flavonoids, and zinc have been shown to have a positive role in the management of venous disease.

Knowledge, Attitude, and Practice in the Management of Mixed Arteriovenous Leg Ulcers

“…Compression therapy is one of the most effective strategies in healing of venous leg ulcers. 22-24 Ideally, high compression therapy should be initiated and used consistently so long as tissue perfusion is deemed adequate. In patients with venous predominant disease but coexisting arterial compromise (ABI between 0.5 and 0.8), compression therapy may need to be modified to reduce the strength of compression.…”