For many healthcare professionals, healing a venous leg ulcer (VLU) is a clinical challenge that requires time and attention.
A critical aspect of caring for patients with a VLU is creating an effective wound management plan to help maintain skin integrity throughout the healing process.
While compression and exudate management are critical elements of care, sometimes the wound edge and surrounding skin are overlooked. This is particularly important for VLUs because they produce exudate, creating a moist environment that can change or harm the skin and lead to maceration. When this happens, epidermal loss can occur, further increasing the size and complexity of the wound. Exudate also contains high levels of proteases and bacterial by-products, which can cause inflammation and can contribute to skin injury.
Wound management for venous leg ulcers.
To ensure that the skin heals properly, many healthcare professionals use traditional moisture barrier ointments and creams. However, these do not allow moisture like perspiration or exudate to evaporate, and they can make the skin sensitive, especially if the patient suffers from allergies.1 Many are also opaque, which prevents visualisation of the underlying skin and requires removal during dressing changes.
Beyond maceration, a periwound skin condition may also be complicated by adhesive products. The risk of Medical Adhesive-Related Skin Injury (MARSI) increases with inappropriate adhesive selection, application, or removal. Barrier films can act as a protective interface between the skin and adhesive products. During removal, these films lift from the epidermis, sparing skin cells and helping to prevent painful stripping injuries. Other essential interventions to avoid MARSI include proper skin preparation, application without tension and careful adhesive product removal. Because of the vulnerability of skin in patients with VLUs, non-adhesive products (or those with a silicone adhesive coating) should always be considered.
Polymer-based film-forming barriers can help protect the wound edge and surrounding skin from exudate,2-4 while also helping to avoid the risk of MARSI because they wear off over time with natural cell turnover and cleansing. 3M™ Cavilon™ No Sting Barrier Film forms a transparent and breathable protective coating between the skin and the adhesive. When the dressing is changed, the film is removed instead of the skin cell layers. This terpolymer-based, alcohol-free liquid barrier film helps protect intact or damaged skin from bodily fluids, adhesive trauma, and friction, and can help in the healing process of VLUs.
Maintaining skin integrity in VLUs.
A different approach is needed when the wound edge is already macerated or the surrounding skin is damaged. A cyanoacrylate-based elastomeric skin protectant like 3M™ Cavilon™ Advanced Skin Protectant can help protect the skin and create an environment for healing. The cyanoacrylate component enables attachment to, and protection of, moist, damaged surfaces. Early data has shown positive results when used to manage maceration.5
For many patients with VLUs, years of abnormal venous and lymphatic flow can lead to structural changes of the tissue. This includes epidermal, dermal and soft-tissue thickening. Hyperkeratosis (buildup of dry, flaky skin) and stasis dermatitis (inflammation of the epidermis and dermis) are common.
Whenever dermatitis is present in the surrounding skin, this possibility of secondary infections should be considered. In Foroozan’s research,6 fungal species were present in 27.6% of the skin samples from venous ulcers. If an infection is confirmed, the patient may benefit from a topical antimicrobial. Dermatitis without infection may benefit from a course of topical corticosteroids. 7
As edema resolves, dryness and flaking (desquamation) can become a problem. Daily application of a fragrance-free non-sensitizing moisturizer is the best choice for this topical-sensitive population.
Thinking ‘beyond the wound’ involves building routine assessment and care of the skin into your daily practice. Interventions to protect and preserve the wound edge and surrounding skin may not only help with healing, but also improve the patient’s experience.
Learn more about venous leg ulcers and wound management.
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- Machet L et al. Sensitization to Topical Treatments used in Leg Ulcers: A Meta-analysis (1975-2003) Poster presentation. World Union of Wound Healing Societies. (WUWHS). 2008.
- Coutts P, Queen D, Sibbald RG. Peri-wound skin protection: a comparison of a new skin barrier vs. traditional therapies in wound management. Wound Care Canada. 2003;1(1).
- Cameron J, Hoffman D, Wilson J, Cherry GJ. Comparison of two peri-wound skin protectants in venous leg ulcers. Wound Care. 2005;14(5):233-6.25)
- Serra, N., et al. Effectiveness of the association of multilayer compression therapy and periwound protection with Cavilon® (no sting barrier film) in the treatment of venous leg ulcers. Gerokomos. 2010; 21(3): 124-130.
- LaForet K, Dias J, Muhammad S. Case series using an advanced silicone-based polymer skin protectant for the clinical management of patients with moisture-associated skin damage. (MASD). Canadian Association of Wound Care (CAWC); 2017.
- Foroozan M et al. Prevalence Analysis of Fungi in Chronic Lower Extremity Ulcers. 2011;23(3): 68-75.
- Rzepecki AK, Blaziak R. Stasis dermatitis: Differentiation from other common causes of lower extremity inflammation and management strategies. Current Geriatrics Reports. 2018; 7(1): 222-227.