Venous ulcers can be an insidious foe if you're not familiar with causes, cures

This chronic ailment can strike young and old, healthy and infirm

Approximately two million adults in the United States suffer from leg ulcers. A variety of underlying physiological or biochemical disorders can be responsible for lower-extremity ulceration. But most leg ulcers - 70% to 80% - result from venous disease and venous hypertension.

Venous disease is chronic and must be clinically addressed throughout the lifetime of the person who has it. Surveys have found that the prevalence of venous ulcers is about 1.5 in 10,000 adults. However, a far higher percentage of those with venous disease develop ulcers as a result of the condition. While aging does increase the risk of venous disease and therefore venous stasis ulcers, the condition can strike young, otherwise healthy adults. Women are more prone to the condition than men.

Wrong treatment is dangerous

Other causes of leg ulcers include arterial disease, which accounts for about 20% of leg ulcers, diabetes, and rheumatoid arthritis. Patients with arterial disease should be referred to a specialist, such as a vascular surgeon, for assessment and possibly surgery. Using compression therapy (which is still considered the best treatment for venous ulcers) on patients with arterial disease can cause serious consequences. (See related story, p. 78.)

Even with proper treatment, venous ulcers are painful and debilitating. A survey of ulcer patients at Boston University found that 81% believed their problem adversely affected their mobility, and 57% said their mobility was severely impaired. Also, nearly two-thirds said they experienced severe pain. (For a full report on the survey, see related story, p. 78.)

In this issue of Wound Care, we examine the causes and treatments of venous disease and venous stasis ulcers, and survey some of the many options for compression therapy, including the Unna boot, the Charing Cross, and even Velcro. We also talk with experts in the field about solutions to one of the most common treatment conundrums: applying bandages too tightly or too loose. In addition, we survey manufacturers about the products they offer.