Layers of Healing: Wound Care, Compression and Lymphedema

Layers of Healing

This session ran from dressing choice through ultrasound, compression and lymphedema therapy.

Dressings and Debridement

Moisture balance remains the foundation, and the dressing should change as the wound does. A wound should close by roughly 10 percent every one to two weeks, and if it does not, something has to change. Slough is not simply yellow debris: it carries a heavy and uneven bacterial load alongside matrix proteins, so debridement is repeated rather than done once.

Finding the Vein and Compressing the Limb

• Scan standing where possible, or in steep reverse Trendelenburg when an ulcer makes standing impossible.
• Hidden sources include dominant extrafascial tributaries, accessory saphenous veins, and perforators refluxing for at least 500 milliseconds or measuring 3.5 mm and above.
• Compression depends on textile and stiffness, not on layer count or how tightly it is wrapped, and it can be used with care in arterial disease, heart failure and after revascularization.

Not Everything Is Venous

Take a history before assuming a gaiter ulcer is venous. Pyoderma gangrenosum, malignant change, heparin induced thrombocytopenia and self inflicted injury all present as leg wounds.