Venous-insufficiency ulcers are usually located on the medial aspect of the lower leg or medial malleolus. It is also common to find venous ulcers in areas exposed to trauma, such as the anterior shin. Venous ulcerations do not occur on the plantar aspect of the foot, and rarely occur above the knee.
Venous-insufficiency ulcers are generally superficial, irregular in shape, and have moderate- to- high amounts of drainage. If the dressing does not absorb enough wound drainage, the wound edges will be white and fragile due to maceration. The wound bed contains beefy, red granulation tissue but may take on a ruddy appearance. A thin, yellow fibrous coating may cover the wound bed, giving it a glossy look.
Venous insufficiency is often associated with many skin changes. Cellulitis, Dermatitis and dry, scaling skin” which may cause intense itching are common. Superficial varicosities and evidence of previous ulceration may be present. Lower- extremity edema is usually always present. In cases of long-standing venous insufficiency, the edema may become firm or indurated. Initially, skin changes may include a subtle erythema. With chronic venous insufficiency, the skin becomes stained and more darkly pigmented, due to hemosiderin deposition. Hemosiderin is a by-product of the breakdown of red blood cells, which have been forced into the interstitium by venous hypertension. The term lipodermatosclerosis is used to describe the hyperpigmentation and accompanying erythema, induration, and plaque-like structural changes that occur due to long-standing venous insufficiency. The skin and subcutaneous tissues are more fibrotic and less elastic than healthy tissue.
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Myers, B. (2007). Wound Management; Principles and Practice. Upper Saddle River, Prentice Hall, PA., Page 259.