WOUND HEALING AND
VENOUS STASIS ULCERS
Wounds heal best if:
- They are clean (free of necrotic tissue and bacteria/yeast/fungi)
- They are moist (occlude dressing)
- They have a normal arterial and venous blood supply (no constrictive
dressings and no swelling)
To achieve this:
- Debride the wound with forceps, scissors, and/or curette, and gently
clean with dilute Hibiclens if necessary.
- Apply an ointment (Bactroban 3X/day) and Telfa. Secure with tape, or
apply one of the many semipermiable dressings. Change as wound discharge
- Make sure that the wound dressing is not restrictive. Try to keep extremity
at heart-level, not dependent.
When closing with suture:
- Evert (pucker) the wound. An expert in the field said, "You
cannot over-evert the wound." Anticipate the contractile and pulling
- Remove facial sutures in 3 - 5 days.
- Before using support hose on venous stasis ulcers, insure that you
can palpate pedal pulses.
- Optimum ankle pressure for support hose is around 40mm Hg.
- Vein stripping is done because of:
- Significant pain / discomfort
- Significant bleeding from varicosities
- Intractable venous ulcers
- Keliods are most likely to occur in Polynesians, Orientals, Blacks,
and certain families. Anatomically, they most commonly occur on the trunk
and over areas of marked tension.
- It takes months for wound strength to approximate the strength of normal