Leg Ulcer and Compression Day

Transcript:

Hi. I'm Dr Laura Swoboda. I'm a translational scientist, a family nurse practitioner, and a wound specialist in the Milwaukee area. 

Venous insufficiency comes from a lot of issues. Usually, there's valvular incompetence where we normally have valves in our veins that prevent back flow of our blood supply through the venous system and when those become dysfunctional, whether it be through obesity or cellulitis or some other inciating factor, genetics, etc, those valves can fail. And it causes hypertension in the venous system and starts this whole inflammatory cascade that leading, unfortunately, sometimes to ulceration. 

My portion of the preconference [session] today was on other conditions that can cause edema, and there's a lot of other conditions associated with edema, namely, lymphedema. And when we think about really all edema, whether it be from venous insufficiency is also a failure of our lymphatics. We used to go by the Starling principle, which is old, from the 1800s; a principle where we thought most of our fluid was returned through the venous system. But actually, the revised Starling principle now we know that most of our fluid is actually returned through the lymphatics. So if you're getting edema in your lower extremities, it's actually a failure of the lymphatic system and could be classified as lymphedema. So we have lymphedema causing edema. We have trauma, cellulitis, a lot of different things can contribute to edema. 

When I think about treating patients with compression therapy, I'm not just thinking about patients with venous insufficiency. I'm really thinking about any patient that has a lower extremity wound. And then can they tolerate compression? So, do they have the blood flow that it would be safe to use compression for? If they do, really all leg ulcers could benefit from compression therapy. We know that just having a complex wound can present with some edema to the periwound tissue. And if we can use compression, we can increase perfusion, decrease the inflammation, and ultimately help these wounds heal faster. So, I do use compression therapy outside of venus insufficiency regularly.