“Compression can help prevent recurrence”

Decongestion and compression have proven effective when treating vein-related open leg wounds. Dr. Hans-Walter Fiedler, Vascular Specialist, urges physicians to act early – and patients to get involved in active self-management.

Sometimes, a trivial injury is enough; bumping into a shopping cart, for instance. Under unfavorable conditions, a wound that increases in size and no longer closes spontaneously may develop. The diagnosis: venous leg ulcers, the most severe form of chronic venous insufficiency (CVI). Only decongestion, compression – and often a change in lifestyle will help now, explains Dr. Hans-Walter Fiedler, Chief Specialist at the Treatment Center for Vascular Medicine in the Soest area (GMVZ). An open wound is preceded by a condition that has existed for some while. However, too much valuable time usually goes by before patients visit his practice. “Skin is often blotchy, and the tissue thick and hard because of impaired perfusion”, elaborates the vascular specialist. “This is a process that can rarely be reversed. The reason being that blood cells no longer reach the tissue from the inside, allowing fungus and bacteria to enter from the outside. By using compression early, many problems can be prevented, including recurrence.”

When wounds no longer heal by themselves

But what can cause venous leg ulcers? If edema develops in the ankle area over a longer period of time, this may lead to irreversible changes in the blood and lymph vessels, in the skin, and in the subcutaneous fatty tissue. Subsequently, wounds can no longer heal by themselves and may become chronic. Four major factors play a role during the development of this type of edema: the first factor is the increased capillary filtration caused by the rising pressure in the blood vessels, based on, for example, widening of the vessels, medication, vein problems, or cardiac insufficiency. The second factor is a reduced retention capacity of water in the blood caused by a lack of protein. The third factor is the increased permeability of the walls of the small blood vessels, sometimes based on chronic inflammation. And, lastly, the fourth factor is damage to the lymphatic system, which results in reduced drainage of the interstices.

“By using compression early, many problems can be prevented, including recurrence.”

Dr. Hans-Walter Fiedler

Compression helps reduce chronic build-up and therefore excess pressure in the venous system. The venous blood flow toward the heart is increased, the function of the venous and lymph vessel valves is often improved, the surrounding tissue is decongested by reducing accumulated water, and metabolic waste products as well as tissue fluid are removed more effectively.

Obesity – a risk factor

Better education is required because the number of those affected is increasing. Up to one percent of the adult population is affected by venous leg ulcers¹. In the over 70-year-olds, this is almost three percent according to Dr. Hans-Walter Fiedler. Plus: “We don’t just get older but also fatter,” the vascular specialist points out, who specifies obesity as a major factor for venous leg ulcers, in addition to thrombosis, heart disease, and varicose veins. By now, this applies to around 30 to 40 percent of patients suffering from venous leg ulcers.

It is not just the serious physical restrictions that cause problems for patients with venous leg ulcers. Many also suffer from socio-medical consequences. Pain, unpleasant odor, and discharge from the wound, in combination with restricted mobility and sleeping problems, cause psychological stress and can result in patients withdrawing, becoming lonely, or even developing depression.

“Every merely ‘adequately’ wrapped bandage is worse than a well fitted compression stocking.”

Dr. Hans-Walter Fiedler

VenoTrain ulcertec: easy handling, improved wound healing

Early treatment is essential so it doesn’t get that far. A venous cause must be removed surgically as soon as possible. In all other cases, treatment starts with two or three weeks of, ideally complete, physical decongestion, for which Dr. Hans-Walter Fiedler primarily uses medical adaptive compression systems. During subsequent compression using stockings – accompanied by stage-specific wound therapy – he relies on two-component systems consisting of an overstocking and a liner, such as the VenoTrain ulcertec.

Dr. Hans-Walter Fiedler specifically emphasizes that the liner secures the wound dressing around the clock and also exerts gentle compression at night. The fact that patients can don and doff the overstocking of the VenoTrain ulcertec by themselves in the morning and evening without problems increases compliance and encourages regular wearing of the product. His recommendation to physicians is that they should also prescribe a donning aid straight away if needed.  For carers, too, who often lack the practice of wrapping bandages, the VenoTrain ulcertec makes work easier and saves time. “Every merely ‘adequately’ wrapped bandage is worse than a well fitted compression stocking,” explains the lymphology specialist. The thin overstocking fits into any footwear without slipping. In addition to pain reduction, this represents improved quality of life for patients who may be more inclined to leave the house.

Self-management education

If conservative treatment is successful, a trend toward improvement should be recognizable after three months at the latest. Otherwise, there is no way to avoid surgery if there has been no healing after six to twelve months, the specialist reports. According to Dr. Hans-Walter Fiedler, education is also part of successful treatment and the prevention of recurrence, meaning the continuous and clear explanation of the practical treatment steps. He talks about compliance, i.e. the active cooperation of physician and patient with the purpose of making decisions together and agreeing on treatment goals because: “Prescriptions are passive. It’s just as important for patients to accept the treatment and carry out active self-management.”

“Prescriptions are passive. It’s just as important for patients to carry out active self-management.”

Dr. Hans-Walter Fiedler

¹ Rabe E et al., Bonn Vein Study conducted by DGP, Phlebology 1, 2003, 32:1–4

Compression stocking system for wound and vein treatment
The VenoTrain ulcertec two-component compression stocking system offers a dual strategy for wound and vein treatment, particularly during the healing phase of a venous leg ulcer. The liner secures the wound dressing by applying continuous gentle compression without slipping. This promotes healing around the clock. It is available as a below-knee or thigh-high model. The overstocking is worn over the liner, which – in combination with the unique rhomboid knit – makes donning and doffing of the product easier. It features the classic properties for vein support, a high level of wearing comfort, and promotes circulation.

Pictures: Steffi Behrmann, Adobe Stock, Bauerfeind AG