Cause of Venous Stasis Ulcers in Question
In the past it was thought that the vast majority of venous ulcers were related to deep venous insufficiency, often from previous Deep Venous Thrombosis (DVT). Subsequently, it was thought that perforators (veins connecting superficial and deep veins) were the major etiology. More and more it appears that the superficial venous system is involved. This is good news as these superficial veins are not important compared to their deep vein relatives and this makes treatment safer.
Some fancy terms under investigation include: microvascular disease, uncontrolled inflammation, thrombophilia, fibroblast senescence and disordered extra cellular matrix production, failure of epithelialization, malnutrition and bacteria colonization. Thus, there is much to learn and much we don’t know. At least we do know that there is a relationship between venous insufficiency and ulcers. And don't forget that venous insufficiency, an easy to treat problem, is the cause of varicose veins.
Graded Compression Stocking to treat Venous Stasis Ulcers
Reviewing the literature it appears that applying compression is better than not. Multicomponent bandages work better than single component systems. Also, multi component systems (bandages or stockings) appear to perform better when one part is an elastic bandage.
Of note, when compression alone is used for ulcer treatment, ulcers are almost guaranteed to recur if compression is discontinued.
As we get further beyond standalone compression treatment for ulcers, there are far more questions than answers.
There is evidence that adding surgery to compression treatment appears to decrease the chance of recurrent ulcerations and increase ulcerfree time. However, surgery does not appear to improve ulcer healing rates. Current endovenous thermal and chemical ablation techniques appear to be promising in treating these ulcers and there are studies to support this. Equally as important, most patients would choose endovenous procedures over stripping. Thus we are left with the question of which veins should be treated and how.
How about Wound Care?
According to the Cochrane Database there is strong evidence that the effectiveness of healing leg ulcers is not influenced by the type of wound dressing beneath the compression bandage.
What Should You Do if you have a Venous Stasis Ulcer?
The best stratagy would be to visit both a highly recommended wound care center and vein specialist.