VenousUlcer

Non-Healing Ulcers or Wounds

We might all be familiar with ulcers in a general manner, but certain types of ulcers behave quite differently due to various contributing factors. These are nonhealing ulcers or nonhealing wounds, and if not treated with care and in good time, such wounds can pose a serious risk to the patient’s health. Severe cases may lead to amputation of the affected limbs or loss of life in the most extreme circumstances. The nonhealing ulcers cases we treat here at La Jolla Vein & Vascular fall under peripheral arterial disease (PAD) and a subcategory of arterial disease.

Non-healing wounds or ulcers do not follow the usual healing process and are referred to as chronic wounds should they persist beyond 3 weeks. Such wounds can be a heavy burden to live with for anyone. Still, the board-certified vascular surgeons and specialists at La Jolla Vein & Vascular are dedicated to administering effective treatment and management solutions to all patients so they may resume a healthy, productive, and pain-free life.

Types of Non-Healing Ulcers

In general, patients will present with one of three categories of non-healing ulcers, with these categories being broadly defined by the major causative factors allowing for their development. These are:

These are found to account for between 70% up to 90% of non-healing wounds or non-healing ulcers. Mostly occurring in elderly patients, they are believed to come about as a result of a failure of the valves in a person’s blood vessels of both arteries and veins. These valves are responsible for preventing the backflow of blood as it passes within them. The consequent outcome is a lack of nutrient and oxygen-rich blood from reaching the affected tissues and sets up the conditions favoring non-healing wounds.

These are ulcers that are brought about by the restriction of blood flow to certain regions of the body due to the persistent and prolonged application of pressure upon them. It is mostly encountered among patients with full or partial paralysis and those who are bedridden for extended periods.

These are also highly prevalent chronic wounds, and are on the increase among patients owing to the ever-increasing cases of diabetes among the population. In fact, the prevalence of chronic wounds among diabetics makes this demographic 15% more likely to have to undergo limb amputation as a complication of the condition.

The high amputation rate among diabetics is attributable, in part, to the neuropathic effects of the ailment. Neuropathy leads to a lack of pain perception in the affected individual, meaning that they may be entirely unaware of minor wounds on their feet and legs in good time, allowing for their infection or repeat injury. It is also made more likely by the immunosuppressive effects of the condition, which makes the patient more vulnerable to infection.

Vector illustration of a medical Diabetic foot

Causes of Non-Healing Wounds

The underlying factors contributing to the risk of developing a non-healing ulcer or wound are widely varied. What they have in common is their ability to interfere with the way the body normally functions with regard to wounds.

diabetes foot

This condition is prevalent in people living with certain circulatory ailments such as atherosclerosis, diabetes, alcoholism, etc. In a healthy person, the nerves will send signals to the brain whenever pain or discomfort is experienced in any body tissues. Neuropathy makes this system non-functional; tissue can be damaged without warning signals being sent to the brain. This will prompt the person to change position or remove the object, causing injury. Over time, the affected area might see the development of an ulcer.

A person’s circulatory system is responsible for delivering blood rich in oxygen and nutrients to all the tissues in the body that need it. Without it, tissues will begin to die. Due to their extremity (distance from the heart) and the effect of gravity, a person’s feet will often be the first problem area for a person with an impaired circulatory system. Peripheral artery disease (PAD) is a particularly culpable condition in this instance as it may lead to numbness, skin discoloration, severe pain, ulcers, or even the patient’s demise if left unchecked.

The formation of non-healing ulcers will indicate that an advanced stage of certain conditions has been reached in a patient. These conditions include high blood pressure, diabetes, kidney failure, high cholesterol, or peripheral artery disease (PAD). These conditions contribute to the formation of ulcers by causing ischemia, or the interruption of oxygenated blood to all parts of the body, or by damaging the nerves in the wound areas…

Contributing Lifestyle Habits

Some various habits and lifestyles will place patients at a heightened risk of developing non-healing ulcers. Smoking, for instance, has the effect of narrowing the vessels carrying blood to body tissues, thus increasing one’s chances of developing ulcers. A sedentary lifestyle involving little to no active movement will also carry the risk of encouraging ulcer development due to the constant pressure applied to certain tissues. Old age is also a factor here, as our skins will gradually lose their ability to repair themselves as quickly and efficiently as they once did.

Symptoms of Non-Healing Ulcers

You shouldn’t allow a wound to fester for weeks on end before seeking professional assistance, especially if you fall under one or more of the risk categories we’ve outlined above. The following are some warning signs to look out for:

  • Darkening or bluish discoloration around the wound edges

  • Significant pain around the wound that persists without improvement or progressively grows worse

  • Foul odor or smell emanating from the wound

  • Swelling and redness emanating from the wound and spreading to surrounding skin and tissue

  • Continuous leaking, draining, or weeping from the wound.

Notice that these symptoms are mostly indicative of infection. This is a good measure as it often indicates a failure of the body’s natural mechanisms to deal with the wound through its normal processes. The rapid and timely intervention will be called for to forestall further tissue damage and complications.

Symptoms of Non Healing Ulcers

Treatment of Non-Healing Wounds

As we’ve seen, there is a very wide range of causes that may contribute to the formation and persistence of non-healing ulcers. It follows that the methods or treatment options at the disposal of healthcare professionals will also be varied. Doctors will discuss the available options with their patients in order to arrive at the best possible options, but the type and severity of the wound will be the decisive point of consideration. These measures include:

This involves the application of tightly bound wraps to the affected limbs or regions in order to provide support to the vascular system, which might be operating under lower pressure than it should due to the wearing out of the vascular walls and muscles that support the efficient flow of blood to and fro the tissues that need it.

doctor will start by doing a thorough physical examination. The doctor will also want to learn about your signs, symptoms, personal health history, risk factors, and family health history. The doctor will ask you several questions regarding your medical conditions, such as diabetes, heart disease, and kidney disease. They will also ask you whether you experience pain or cramps in your leg while walking or exercising.

The doctor will also ask about your family history of PAD and other heart diseases. You will also discuss your smoking habit, either current or in the past. After gathering the information, the doctor will proceed to perform a detailed physical examination. The process involves checking for weak pulses in your leg, listening for poor blood flow in the legs using a stethoscope. The physician will also check for any problems on your legs, such as sores, swelling, and pale skin.

Technological progress has made it possible to develop special dressing materials made out of smart polymers that work by adjusting their absorptive qualities depending on the hydration levels of the wound area, among other specialized positive actions. Antibiotics may also be employed topically to non-healing ulcers and these help by reducing the bacterial levels present in the wounds in question while maintaining the optimal levels of environmental moisture suitable for wound repair.

ose PAD. This test usually compares the blood pressure in your arm with the blood pressure in your ankle. The doctor usually uses a pressure cuff together with an ultrasound device. Sometimes, the physician may request you to walk on a treadmill and have the doctor take the readings before and immediately after the exercise. The procedure will help the doctor to capture the severity of the narrowed arteries.

There are plenty of measures that patients will be able to implement in the treatment and management of non-healing ulcers if armed with the proper knowledge and aids where required. Regular cleaning and disinfecting of wounds, proper bandage care, manual repositioning of paralyzed limbs, and avoidance of habits that contribute to the incidence or severity of these types of ulcers will be of significant benefit to many.

This treatment method works by pulling away the fluid in the wound that nourishes bacteria by the application of negative pressure. It is also known as vacuum-assisted wound closure for this reason. This action will also reduce tissue swelling and bring up fresh blood and nutrients to the problem area, which assist in the healing processes.

In many cases, surgical procedures may be called for to rectify any underlying conditions that might be remedied in this way. Patients with atherosclerosis or blood clots in their vascular system, for example, might undergo surgical procedures to remove these clots or clear built-up cholesterol plaques in their system, thus removing the condition that encourages the formation and persistence of non-healing ulcers.

Growth factors refer to the biomaterials generated naturally in our bodies that play the role of replacing tissues as they are damaged or degraded, as in the case of wounds and infections. These factors include epidermal growth factor, insulin-like growth factor (IGF), vascular endothelial growth factor (VEGF), and more. What your medical practitioner will do is introduce or stimulate these factors directly onto the wound in order to speed up the healing and re-growing processes.

Skin grafts taken from donors (cadaver, usually) are another option here referred to as allografts. These grafts provide a covering to the wound without integrating with the host body and work by encouraging and providing a structure for the growth of epithelial cells. Severe cases might not be suitable for this intervention, however, and will do better with grafts taken from elsewhere on the patient’s own body.

Debridement more simply refers to the removal of dead or dying (necrotic) tissue from the site of a non-healing wound. The goal is to minimize the risk or opportunity for infection by eliminating the necessary medium for bacterial growth and proliferation, which such tissue provides. This is an especially relevant measure undertaken in the fight against diabetic non-healing ulcers, as amputation will usually be carried out in cases where infection has progressed past a certain limit.

This is the idea behind the rather outlandish yet scientifically sound application of maggot therapy in the management and treatment of chronic wounds. Here, live, disinfected maggots will be introduced to the wound by a medical professional. Maggots will happily devour necrotic tissue while not touching healthy tissue. This directly leads to a reduction in the bacterial presence in the wound, thus encouraging rapid healing as well as pain and odor mitigation.

La Jolla Vein & Vascular Treatments
for Non-Healing Ulcers

The treatment for PAD has two main goals. One is to manage the symptoms, including leg pain, allowing you to resume your normal physical activities. The second one is to top the progression of atherosclerosis in the body

OUR PATIENTS SAY

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I am pleased to recommend La Jolla Vein & Vascular. I am in the process of receiving treatment there. The entire medical staff are super friendly, welcoming and very helpful. Everyone is courteous, including the physicians. I’ve had one doctor follow my case. He’s the one who always treats me at appointments and closely follows my health. I am very comfortable going there. Would go again if needed and encourage anyone who’s thinking of making an appointment to do so asap. You’ll see what a wonderful experience it is. It’s the people who make it so special!

Monica M.

The office is exceptional, from front desk, to exam staff to the physicians. They have created a welcoming, relaxing environment, and take their time in examining and consulting with you to provide the best outcome. I highly recommend La Jolla Vein & Vascular for the assessment and treatment of your vein and vascular function.

Nancy F.

Everyone here is so nice! Usually front desk medical personnel are so rude. The front desk ladies Alejandra, Anna, and I think her name is Liz, went above and beyond to take care of me and my insurance issues. The techs are great too! Rachel and a male technician assisted me…both of them implemented different techniques to make me feel more at ease during an uncomfortable and painful process. These procedures were rough…and I am grateful everyone was so sweet to me. Thanks again. 

Melissa B.

The staff kept you informed as to when you would be seen and the wait was not too long. Emily took care of my ultrasound and was very accommodating giving me an extra pillow and playing a video to watch. The office is very courteous and professional- Nadia answered our questions and offered us a bottle of water. I have been seeing Dr. Bunke, but now Dr. Lucas and will continue coming to La Jolla Vein Care! 

Rebecca D.

From my greeting at the front desk to the ultrasound and visit with the doctor, I received excellent care. It’s clear they care about their patients and all the staff couldn’t have been nicer or more helpful. I also appreciate how much time the doctor spent with me to explain the results and the next steps. I would definitely recommend this office to friends with vein issues. 

Anne S.

Beautiful facility! I walked in without an appointment and they took me right away! It was even the end of the day…I was so grateful…Every single person was soooo pleasant! Super impressed ❤️ 

Susan M.

I have been having leg treatments for several months now La Jolla Vein Care. Every time I go to an appointment; the staff is so friendly and takes such good care of me; always informative; not in a rush and always friendly (especially Alejandra & Anna to name a few). Of course Dr. Lucas is amazing. The treatments have changed my life. Overall this has been an incredible experience. 

Brigid Z.

Dr De Young is personable and thorough in his explanations. Exceptional. 

James R.

The staff members that I interacted with were all professional, conscientious and empathetic to my complaints and discomfort. I was taken into the ultrasound room a few minutes before my appointment time. I did not have a long wait before the ultrasonographer came and ran the machine. It was also a short wait before Dr. Steinburg came into the room with a warm, welcoming smile. We discussed my ultrasound and the things I was experiencing . I scheduled another appointment for next year and was offered a bottle of water upon leaving the office. All in all, I thought it was a very satisfactory appointment.

Renee P.

We were early and didn’t have to wait at all. The tech that did my husband’s ultrasound, Monica, was very accommodating with my husband’s Parkinson’s. Doctor Lucas whom we hadn’t seen before, came to us instead of making my husband walk down to another office. She spent a lot of time getting caught up on Steve’s background issues/conditions. I was impressed by this medical group before, so I was surprised that the staff was even better this time around; I honestly didn’t think there was room for improvement! 

Linda N.

Highly recommend! Entire staff are warm& friendly, professional and accommodating. The doctor took the time to thoroughly explain everything and encouraged me to ask questions. I never felt rushed. Significantly better experience than the other 2 vein clinics I’ve been to on the east coast. I wish I could’ve just come here from the beginning. 

M.

When I arrived for the first time, I could barely walk. My legs were red and swollen. After my treatments, I can now walk again. I’m so thankful to the doctor and his staff. They are caring, supporting and knowledgeable about my issues. Five Stars all the way!!!! 

Pamela M.

I had the best experience at La Jolla Vein Care. Dr.Bunke is an amazing doctor with the best bedside manners, she truly cares about her patients, she explained everything to me. My procedures where so easy I was impressed how painless and fast my appointments. Anna M was very helpful scheduling my treatments and checking on me to make sure all of my questions were answered. I am very pleased thank you !!! I truly recommend La Jolla Vein Care!

Henda S.

The staff at La Jolla Vein Care Center are outstanding. They are friendly and helpful. Dr. Lucas and my ultrasound tech were both very thorough, kind and answered all of my questions. The new office was beautiful. I feel very confident that I am in good hands and that any up coming treatments will be successful. Thank for for making me feel so comfortable.

Ginger T.

La Jolla Vein care has the best staff ever. They are so nice, accommodating and professional!! Dr. Bunke is the best doctor that I ever seen. She is so friendly upfront and has the best bed side manner. I thank this office for letting me be their patient. 💜. Plus they are so careful with COVID which I really appreciate!!! 

Darlene H.

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