Stasis ulcers, also known as venous stasis ulcers, are chronic wounds that typically form on the lower legs. They result from venous insufficiency, a condition in which the veins struggle to send blood from the limbs back to the heart. This insufficiency leads to increased pressure in the veins, which damages the skin and underlying tissue, causing ulcers.

Symptoms and Causes:

Stasis ulcer is characterized by swelling, itching, and a sensation of heaviness in the legs. The skin around the ulcer often appears brownish or purplish due to poor blood flow and may become thick and hardened. Common causes include deep vein thrombosis (DVT), varicose veins, and obesity, exacerbating the pressure on veins and hampering proper blood circulation.

Treatment and Management:

Managing stasis ulcers involves addressing the underlying venous insufficiency. Compression therapy, which uses bandages or stockings, is a cornerstone treatment to improve blood flow and reduce swelling. Elevating the legs, maintaining a healthy weight, and exercising regularly can also help. Wound care includes cleaning the ulcer, using dressings to protect the area, and possibly using medications to treat any infection. In severe cases, surgical interventions such as vein ablation may be necessary.

Vascular Ulcers

Vascular ulcer is chronic wounds categorized into venous ulcers (stasis ulcers) and arterial ulcers based on origin. While stasis ulcers stem from venous insufficiency, arterial ulcers arise from poor blood flow due to arterial diseases.

Arterial Ulcers:

Arterial ulcers, or ischemic ulcers, occur due to inadequate blood supply to the tissues, often because of peripheral artery disease (PAD). These ulcers are typically found on the feet, especially on the toes, heels, or pressure points. They are often painful, with a punched-out appearance and pale, excellent surrounding skin.

Symptoms and Causes:

Arterial ulcers are usually accompanied by symptoms of PAD, such as intermittent claudication (leg pain while walking), reduced hair growth on the legs, and weak or absent foot pulses. Factors contributing to arterial ulcers include atherosclerosis, diabetes, smoking, and hypertension.

Treatment and Management:

The primary goal in treating arterial ulcers is to restore adequate blood flow to the affected area. This may involve lifestyle changes, medications to improve circulation, and, in some cases, surgical procedures like angioplasty or bypass surgery. Wound care for arterial ulcers focuses on keeping the ulcer clean and protected, avoiding pressure on the affected area, and addressing any infections.

Hyperbaric Chamber Treatment

Hyperbaric oxygen therapy (HBOT) involves placing patients in a chamber where they breathe pure oxygen at higher-than-normal atmospheric pressure. This treatment has shown promise in accelerating the healing process of various types of ulcers, including stasis and arterial ulcers.

Mechanism and Benefits:

In a hyper chamber, the increased oxygen pressure helps dissolve more oxygen in the blood. This high oxygen concentration reaches the tissues, promoting angiogenesis (the formation of new blood vessels), reducing inflammation, and enhancing the ability of white blood cells to fight infection. It also stimulates collagen production, which is vital for wound healing.

Applications:

HBOT is particularly beneficial for ulcers that are resistant to conventional treatments. It is often used as an adjunct therapy for diabetic foot ulcers, radiation-induced injuries, and chronic refractory osteomyelitis. Sessions typically last about 90 minutes, and patients may need multiple sessions to see significant improvement.

Considerations and Contraindications:

While HBOT is generally safe, it is not suitable for everyone. Contraindications include untreated pneumothorax, certain types of lung disease, and some ear and sinus conditions. Potential side effects include barotrauma (injury caused by pressure changes), oxygen toxicity, and claustrophobia.

Conclusion

Stasis ulcers and vascular ulcers present significant challenges due to their chronic nature and underlying circulatory issues. Effective management requires a multifaceted approach, including lifestyle modifications, appropriate wound care, and, in some cases, surgical intervention. Hyperbaric oxygen therapy offers a promising adjunctive treatment by enhancing the body's natural healing processes through increased oxygen delivery. Understanding these ulcers and the potential of advanced therapies like HBOT can significantly improve patient outcomes and quality of life.