The venous hypertension ulcers constitute the largest percentage (between 75% and 90%) among the total of the veins. Because of its high incidence (between you 2% and 3% of the population) their care, are in some studies 50% of the total time in primary care nursing.

Chronicity and recurrence are the most relevant clinical characteristics, half are open over nine months, 20% are up to two years, and 10% to five, with relapse a third of the originally healed within twelve months of healing.

Venous stasis ulcers

Venous stasis ulcers

They are generally treated mostly in the outpatient setting, although there are worse criteria that require consultation or hospitalization:

  • Ulcers very extensive, up from 10 to 12 cm., With great loss of substance.
  • Presence of severe edema.
  • Regional signs of infection, lymphangitis or cellulitis.
  • Excessive pain.

It is crucial to perform a thorough history of the patient, especially to investigate personal, employment and associated risk factors.

Always be a comprehensive study by Echo-Doppler to assess the possibility of surgical treatment (phlebotomy, perforator ligation or sclerotherapy), which will correct venous hypertension.

As general measures:

  1. Treating risk factors.
  2. Treat pain if present.
  3. Insist on postural measures, to rest several hours a day with members high daily walks, or to avoid being too long standing still.
  4. Primordial using elastic restraint, even with active ulcers, to promote venous return.

Local measures include:

  1. Analgesics prescribed before the treatment if the ulcer was painful.
  2. Gently remove the dressings, if pre-moistening of gauze.
  3. Clean the ulcer with saline, removing all traces of exudate.
  4. Promote the removal of necrotic tissue with surgical derangement, enzymatic or autolytic.
  5. If signs of infection, taking culture, providing systemic antibiotic, change the dressing regularly, until the disappearance of clinical signs of infection. Do not use occlusive cure. Apply antibacterial silver dressings.
  6. If exudate, using absorbent dressings such as calcium alginate, hydrocolloid those hidrofibra or coal and silver mesh, and if possible cure to apply the dressings semiocclusive appropriate, within the range of water activation dressings (hydrocolloids , foam, etc) at the level of exudate, watching for signs of local maceration. Do not use adhesive dressings if the surrounding skin is affected.


  7. Once the bed ulceral this healthy tissue, using a hydrocolloid dressing or a polymer foam and change only when necessary.
  8. Ensure hygiene and skin protection emulsions using moisturizing the surrounding skin and strophic areas.
  9. Do not abuse sensitizing products such as topical corticosteroids, although in case of eczema may require extensive use for some time. Local pruritus should be treated in a system to prevent scratching.
  10. Treat and prevent edema.

Allergic contact eczema and irritation:

  • Faced with eczema induced either by a preparation applied externally, or by the own secretion from the wound, apply a short-term treatment with local steroids. Depending on the degree of eczema is more effective treatment with a potent steroid, class 3 or 4 for a short period of time, that the use of a preparation of low power for long periods. The basis of preparation is chosen depending on the moisture content of the wound and patient awareness.
  • Local treatment should be hypoallergenic and take into account a possible sensitization.Strength of Evidence = C

Bath

  • You can capitalize on change of bandages for washing the leg, with a mild soap sanitary purposes, which keeps the skin supple and the patient produces a pleasant sensation of freshness.
  • Interactive self-adhesive bandages have the great advantage of allowing the bath or shower after removing the dressing.
  • Interactive self-adhesive dressings improve patient comfort and allow you to shower. Strength of Evidence = C

These guidelines are not binding for doctors and nurses, and do not constitute a mitigating responsibility.

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