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Inframalleolar venous ulcers heal with Unna boot therapy
Camille L Karren1, Nisha D S Gill-Jones2, Justin M Robbins3
1Department of Medical Education, Touro College of Osteopathic Medicine, Middletown, NY.
Summary
Inframalleolar ulcers in venous disease can be effectively treated with Unna boots, often combined with vein stenting. This approach shows significant therapeutic benefit for patients with venous stasis disease and leg swelling.
Area of Science:
- Vascular Surgery
- Dermatology
- Wound Healing
Background:
- Inframalleolar ulcers in venous disease are uncommon and poorly described.
- Venous stasis disease often presents with bilateral leg swelling, impacting wound healing.
- Understanding healing factors and recurrence rates is crucial for effective treatment.
Purpose of the Study:
- To investigate wound healing factors, recurrence rates, and treatment response of inframalleolar ulcers.
- To evaluate the efficacy of Unna boot treatment, with or without endovenous/iliac vein stenting.
- To highlight the challenges and outcomes associated with this specific ulcer presentation.
Main Methods:
- Retrospective single-center study of 71 patients with inframalleolar venous ulcers (83 limbs).
- Inclusion criteria evolved to include mixed arterial-venous disease (ABI > 0.6).
- Treatment involved Unna boots, ACE wraps, and in 65 patients, endovenous/iliac vein stenting.
Main Results:
- A 51.8% success rate (>90% healing) was observed for inframalleolar ulcers.
- Primarily venous ulcers healed better than mixed etiology ulcers (p=0.01).
- Heel ulcers had higher recurrence rates (p=0.002) but not inferior healing (p=0.10).
Conclusions:
- Inframalleolar ulcers in venous stasis disease warrant attention, especially when associated with bilateral leg swelling.
- Unna boot compression therapy is accessible, cost-effective, and offers significant benefits.
- Adjunct stenting may improve outcomes in select patients with venous insufficiency.
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