Venous ulcers of the lower extremities can be a frustrating disease process for clinicians. Do I send them to wound care center (WCC), do I need to order specific studies, are they venous or arterial?
These are valid points.
A good history and physical can usually delineate venous versus arterial. If you are still unsure, ABI’s are in order. The majority of ulcers on the medial malleolus regions are venous in nature. Sending your patient to a WCC is usually the first step. This, however, can lengthen the healing process. How, you ask? If they have underlying venous disease or vein reflux that is the instigating factor for the ulcer; this needs to be diagnosed and addressed. Unfortunately, the majority of insurance companies mandate a three month period of 20-30mmHg compression socks, increasing activity (walking), and elevation before they will pay for fixing the venous reflux through Endo Venous Thermal Ablation (EVTA), Venoseal, or foam sclerotherapy. With this being said, please encourage your patients to start conservative measures as soon as you diagnose them. Refer them to a vein specialist for Venous US to assess for venous insufficiency.
WCC physicians should continue their treatment plan until patient has met the three month moratorium of their insurance carrier; at this point the treatment plan to expedite the wound healing via EVTA, Venoseal or foam sclerotherapy can be addressed. No, not all ulcers are venous, but the majority of those that are can be helped with detailed venous workup and minimally invasive procedures to expedite the healing process.
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