Departments: Practice Points
As we move into week 24 of assessing and treating a venous ulcer, there are 3 key objectives to remember:
* repeat physician evaluation
* monitor healing and outcomes
* provide patient education.
Management of vascular ulcers has improved over the past decade as clinicians have come to realize the importance of proactive measures and a multidisciplinary team approach. In addition, the introduction of newer treatment modalities, such as the use of growth factors and biologic skin replacements, hold the promise of treating difficult wounds, accelerating the wound healing process, and preventing new wound formation to a degree not previously thought possible. Performing the appropriate diagnostic tests is paramount when evaluating the patient with a suspected venous ulcer. The results of the tests will provide the basis for proper interventions and patient management. The success of the interventions and healing rates are evident as you monitor healing and report outcomes. Lastly, patient education is paramount and a cornerstone of the wound healing pathway.
The sample figure in this column, as in previous columns, provides the clinician and physicians with evidence-based recommendations of the care of venous-related wounds.1 Key decision points are provided based on research that combines healing rates with expected outcomes. If the patient does not meet a given healing rate, closure objective research suggests that he/she will experience delayed healing in the weeks to come. The provider may, at this point, act on further evidence-based adjunctive therapy recommendations altering the patient’s negative outcome.
1. Hess CT. Clinical Guide: Skin and Wound Care. 7th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2012.
2. Falanga V, Margolis D, Alvarez O, et al. Rapid healing of venous ulcers and lack of clinical rejection with allogeneic cultured human skin equivalent. Arch Dermatol 1998; 134: 293–300.
3. Kanter J, Margolis D. A multicenterstudy of percentage change in venous leg ulcer area as a prognostic index of healing at 24 weeks. Br J Dermatol 2000; 142: 960–4.
4. Robson MC, Cooper DM, Rummana A, et al. Guidelines for the treatment of venous ulcers. Wound Repair Regen 2006; 14: 649–62.