das magazin / 26 October

    365 days of improved quality of life.

    A year in the life of venous ulcer patient, Rosie.


    Rosie is 66 years old and has recently started her retirement. She finally has the time to attend viewings at art galleries, or to really start enjoying nature in long walks out in the countryside. Rosie has, however, been noticing some minor changes in her body recently, particularly in her legs. In the evening, she always feels compelled to rest her legs up as they’re often tired and feel heavy. By morning, she wakes up to a new day and has generally forgotten about her leg issues. Over time, however, her legs start to get worse. Rosie starts to get the feeling she is become thin-skinned, in the literal sense of the word. Knotted varicose veins and brown-coloured spots have started appearing on her legs, but Rosie simply puts this down to the natural process of getting older. When she’s out tending to her garden one day she slips and cuts herself on her calf: a small injury, but it doesn’t want to heal, grows larger and starts to produce more and more exudate. It is at this point that she starts to get seriously worried, and turns to her GP, who refers her to a venous specialist. The phlebologist, Dr. Bergens, quickly identifies that Rosie is suffering from chronic venous insufficiency, and that a chronic wound has formed on her calf, a lower leg ulcer (also known as Ulcus cruris venosum).

    In a healthy person, arteries carry the blood from the heart to the cells of the body, supplying them with oxygen. The blood is then transported through the veins, back to the heart, and on to the lungs. Valves in the veins have a vital function here, acting as dams to prevent back-flow. The heart works against the action of gravity to pump blood up from the legs towards the heart, with venous valves opening to allow blood to flow, and then closing again, stopping blood from flowing back towards the feet. In this process, the role of our natural calf-muscle ‘pumps’ is essential, which can be achieved by moving around and exercising. In cases of chronic venous insufficiency, as in Rosie’s case, the venous valves stop working properly, and no longer close fully. Blood-flow from the legs back towards the heart is disrupted, and blood gets pooled and backed up, right back up to the smallest blood vessels. This causes certain waste products and proteins from the blood to be released into the tissues, triggering inflammatory processes. If compression therapy is not applied, the initial symptoms of ‘heavy legs’ and varicose veins can then develop into a lower leg ulcer, also known as an “Ulcus cruris venosum”.

    The right treatment for every phase - with the correct compression

    Dr. Bergens, the phlebologist, is confident that he can help Rosie with professional wound care and a long-term, targeted, 3-phase compression therapy.

    In the acute phase

    Professional wound care...

    Firstly, Dr. Bergens goes about treating Rosie’s wound. The first vital step is debridement, a type of wound-cleaning procedure. Debridement involves cleaning the wound in the quickest, most effective and low-pain way possible. To do this, the doctor uses Debrisoft, from L&R, a product specially designed for use in minimally-invasive, mechanical wound cleaning, whilst also keeping pain to a minimum and being very easy and quick to use. As Rosie has very sensitive skin, Dr. Bergens then applies a wound dressing: L&R’s PU foam dressing, Suprasorb P sensitive. This innovative dressing can offer a range of different advantages and is suitable for a vast array of different wound types. It is made up of up to five different material layers, which offer the benefit of efficient exudate management to support wound healing, whilst at the same time protecting the skin.

    ... in combination with powerful compression

    For Dr. Bergens, it is really important to stay up to date on the most recent science, keeping himself regularly informed on the latest guidelines. He knows all too well the importance of compression therapy in treatment of the underlying disease at play in cases of venous leg ulcers. For the ulcer to heal well and to reduce the oedema in Rosie’s legs, a compression therapy should be started immediately. This technique applies pressure to the tissues and the venous system, thus promoting the return of blood to the heart and increasing drainage of lymph fluids. Dr. Bergen’s treatment of choice in this case is a compression therapy using short-stretch bandages.

    As he is interested in finding an effective and economical treatment, he decides to use Rosidal Sys, a set which includes all the different components required for application of a phebological compression bandage. Over the initial treatment period, the bandage must be changed daily as the leg will quickly shrink in circumference, and the wound dressing has to be regularly refreshed. Following this phase, Dr. Bergens switches to Rosidal TCS, a practical combination of the innovative and protective compression bandage with an integrated textile skin protection, Rosidal SC, and the cohesive short-stretch compression bandage, Rosidal CC. This bandage can be applied and left in place on the leg for several days, if the wound condition allows. Rosie describes the bandages as being comfortable, and can wear them at night with no trouble. She is relieved to see that her oedema is improving each and every day.

    In the conditioning phase

    Compression therapy with ulcer stockings

    Treatment in the acute phase is just the start, however, as next we have the conditioning phase. Rosie’s leg no longer shows any severe oedema, and her ulcer is healing well. Dr. Bergens now recommends her to change to a standard compression stocking which will continue to support healing of the ulcer whilst also making it possible for Rosie apply treatment herself and regain some independence. Actico UlcerSys is a two-layered medical compression stocking system by L&R, which Dr. Bergens uses to ensure the therapeutic pressure required continue to be applied to the leg. Rosie is delighted as she can make a return to her active lifestyle, and will not need to travel to Dr. Bergens clinic as often as before. After some teaching from an expert, she finds it easy to put on the stockings: they are comfortable, and she feels a relief that her wound will close up completely with time.

    In the maintenance phase

    Compression therapy using medical compression stockings

    Rosie has now reached what is known as the maintenance phase. She is now aware that she will have to wear compression stockings for the rest of her life in order to improve her blood flow and prevent any recurrences of the disease. She has found a compression stocking which she likes, VENOSAN, which she can wear and easily carry on her life as normal. Whether she’s wearing trousers or a skirt, Rosie always feels comfortably dressed when wearing her VENOSAN compression stockings. After a period of somewhat isolating herself from the outside world, her zest for life and all things active has returned, and she is back to seeing the new exhibitions at her favourite museum.  She is light on her feet once again, literally, and is back to enjoying life to the fullest.

    From the acute phase, to the conditioning phase, right up to the maintenance phase: L&R supports patients like Rosie in all the phases of their therapy for lower leg ulcers. That is what make us stand out in our care of lower leg ulcers: wound care and compression from a single source.