I live in Alger Ohio 45812 Thank you so very much.

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Dear Linda:

I am sorry about your ulcer. It sounds like a chronic problem with the deep valves in your ankle are faulty and allowing reflux of venous blood into the superficial skin. Have your doctors try using Profor dressing changes with Iodosorb Gel? I have successfully used this in many lower extremity venous ulcers followed by some form of either Regranex or Apligraf or similar products. Keeping your leg about 18 cm above your heart level seem like the best height for leg elevation. Seems like the Iodosorb gel (a cadexamer iodine have significant antimicrobial activity, stimulate formation of granulation tissue, promote wound healing with minimal side effects. Best to you.

Dan Klein, DPM, CWS

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Have you ever had surgery to your abdomen or leg . or a broken bone in your leg or abdomen. You could have a problem with the return of fluids to your body. Check your yellow pages or hospital for a lymphedema specialist.

Jan PT CWS

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Has anyone addressed nutrition to you. Have you increased your protein intake? Multiply your weight in kg. X 1.5. That is the amount of protein you need in grams.
Are you a diabetic? If so, are your blood sugars under control? Add soy protein to your diet.

elena, RN
Home Health

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Linda, I don't want to sound simplistic here but if you truly have a venous ulcer, the gold standard of treatment is compression and elevation. If you have decent blood flow through your leg arteries you may receive compression to your legs. Leg blood flow can be determined by palpable pulses in your feet or ABI testing on your legs - during this test they put blood pressure cuffs on your legs. You don't mention whether or not there is swelling, drainage, etc. Often people will receive compression pumping and placement of Unna's boots to reduce the swelling. If there is significant drainage, a foam dressing or an alginate type dressing could be place over the wound under the boot. You should try to locate a true wound center in your area and get a referral there. Becky, PT

You're correct that she's incorrect. A stage IV ulcer should be fully granulated if it's filling in. It may certainly start necrotic, but won't close until it's granulated. Also, granulated wounds may have
nearly any kind of exudate. Serosanguinous is very common, and purulent may occur if there's an infection (yes, possible on healthy tissue).
Any basic wound care text should provide you supporting information on this.

Renee C, MSPT, MPH, CWS

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I think you are on track. Until the wound is closed the lymphatic and capillary systems are still producing structures and fluid and protein are still leaking to the wound surface.



Jan PT CWS
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Amy-
In my experience, Stg 4 ulcers are the best about granulating, currently in the facility I work at we have 2 stg 4 ulcer that are 100% granulated and on vac treatment because of the exudate.
Remember in order for the wound to be a stg 4 you only have to see bone, tendon, or ligament once during an assessment. And once you have seen it that wound will always be a stg 4, even after it closes.
Regeneration of the dermis and subcutaneous doesn't even begin until the wound has closed and stayed that way 6-8 weeks and you can't "down grade" a wound until the subcutaneous,dermis and epidermis have been restored.
Tina (LVN, Treatment nurse)

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Amy, A Stage IV wound with 100% granulation tissue in the wound bed sounds as though it is healing well. It would have to have been down to the bone at some point in order to be staged a IV but now is a healing Stage IV evidenced by the presence of granulation tissue. Almost any wound can have exudate at any time prior to re-epithelialization. Maybe your organization needs to come to common ground on definition of these terms and others. Often people will use the same word for different situations. Becky, PT

CR

unsigned

Rfalcon

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Clean; unless you are using sterile gloves, solution, gauze, ointment, and dressings. In that case aseptic would be the correct term.
Tina (LVN, Treatment nurse)