Wounds and Ulcers

         Heart & Vascular Care at EvergreenHealth, Kirkland WA
 Compression wrap for chronic
venous ulceration.

A chronic non-healing wound is defined as one which is present for at least one month and is not responding to conventional treatments.  There are generally three causes of chronic wounds on the extremity: Neuropathy, arterial disease, and venous disease. Neuropathic ulceration occurs as the result of neuropathy, or a loss of sensation in the foot or leg. This is most common in diabetic patients where elevated blood sugar adversely affects nerve function. Ulcers occur as the result of repetitive injury due to the fact that the patients cannot feel their feet. In addition, diabetics commonly have foot deformities which cause abnormal pressure points which can also lead to ulcerations.

Arterial ulcerations occur as the result of poor circulation in the extremity. In the face of reduced blood supply, minor trauma leads to a wound which does not have enough blood supply to heal. Commonly, individuals with impaired blood flow that also have diabetes and a higher risk for developing ulcerations, chronic wounds, and gangrene.

Venous ulcers usually originate along the gaiter regions of the leg.  The gaiter area is the region of the lower leg that would normally be covered by a sock. Most commonly, the ulcers occur near the bony prominences at the ankle.  Venous ulcers are the result of chronic venous insufficiency from dysfunctional valves in the veins. Valve dysfunction leads to excessive pressure and fluid capacity within the veins. This excess pressure causes swelling, blood cells to leach out into the fatty tissue under the skin, and can lead to a loss of skin circulation.