An overview of chronic wound characteristics.
VENOUS ULCERS
Predisposing Factors/Cause
Valve incompetence in perforating veins, history of deep vein thrombophlebitis and thrombosis, failed calf pump, history of venous ulcers or family history of ulcers, obesity, age, pregnancy (in women with a family history of venous ulcers)
Location and Depth
May occur anywhere between the knee and ankle, with medial and lateral malleolus the most common sites; usually shallow
Wound Bed and Wound Appearance
Variable appearance, frequently ruddy, "beefy" red, granular tissue; calcification in wound base is common; a superficial fibrinous "gelatinous" necrosis may occur suddenly with healthy appearing granulation tissue underneath
FIGURE
Exudate/Drainage
Frequently moderate to heavy exudate
Wound Shape and Margins
Tend to be large with irregular margins
Surrounding Skin
Pigmented, edematous, macerated; characterized by hyperpigmentation, dermatitis, and lipodermatosclerosis; often accompanied by livedo reticularis; atrophie blanche may be present
Pain
Varies unpredictably; small but deep ulcers around malleoli are typically the most painful; pain often improves with leg elevation
Healing
Epithelialization often fails despite good granulation; average time to healing (based on combined literature) is 53 weeks, depending on degree of venous insufficiency, extent of lipodermatosclerosis, and presence of cardiovascular disease