Education resources

Hello. I'm Jason Rasmussen. I'm the wound care physician at the Abbott Northwestern Wound Clinic. Today, we're going to talk about leg ulcers. Leg ulcers are the most common type of wound that we see in the wound clinic. And the key for helping them to heal is controlling the leg edema.

So there's a number of ways that we can control the leg edema. The first and most important is leg elevation. Now some people hear that leg elevation needs to be for an hour at a time three times a day. And that's kind of the old textbook requirement. But that's very difficult to do. And you can imagine that's probably something you'd have a hard time doing.

So the recommendation that I have and what I found works very well for people is I ask people to elevate their legs twice a day for 20 to 30 minutes. But you do need to lay down with your legs higher than your heart. So if you can think of a place in your home where you can get a place set up where you can lay down and elevate your legs higher than your heart. They don't need to be extremely high but just slightly elevated.

And think of water running downhill. We want to use gravity to pull that fluid out of the legs, so that the leg wounds can heal faster. When we have a lot of edema in the leg, the wound tends to drain much more and there is a tightness to the skin. And so, that prevents the wound from healing. So to prevent both of those circumstances, we need to get this edema down.

Now even if you look at your leg and you think, well, I don't have that much edema, I still find that this leg elevation helps the leg wounds to heal tremendously. So I'd encourage you to do that. So again, it's 20 to 30 minutes twice a day, once in the mid morning, once in the mid afternoon. I usually say like maybe 10 o'clock and 2 o'clock.

Now if you work, that is a little bit more of a challenge. But usually, people can work around that as far as finding a break room or somewhere where they can at least get their legs up higher than their pelvis, so that the water is still running downhill. If you need, we can provide you with a letter to your employer stating that it's important for medical reasons that you be allowed to elevate your legs once during the work day.

And then once you get home from work, if you can take a little break, just 20 to 30 minutes and elevate your legs again, then that will take care of the two times a day that you need to do. And I really do find that two times is really essential. One time a day just doesn't do it.

So that's the leg elevation. And that's probably the most important part. But the second part is just as important, and that is compression. And there's a number of different ways we can apply compression to the legs.

You may already wear compression stockings, or you've worn compression stockings in the past. We may use those. Or we may use an ACE wrap type of a wrap. We call it a short stretch wrap. And then there's also Velcro compression garments that have layers of Velcro that cross over and provide compression.

So any of these different methods can provide compression. And that's a bit of a squeeze to the leg. And what that does is it helps prevent the fluid from going back down there after you've elevated your legs. If we don't have any compression, you elevate your legs. You get all that fluid out of your legs. And then as soon as you stand up again, the fluid rushes back down there and fills up the legs. So we need to have the compression along with the leg elevation to keep that fluid out of there.

And then one final method of reducing the leg edema is pumps. And we don't use these for everybody. You generally have to have a wound for six months before the insurance company will approve it. So it's really not available for everybody.

But in certain cases, there's pumps. And we'll show a picture here of pumps that go on the whole leg. And they inflate. They feel nice. It feels like a massage. And you try to do that for an hour a day.

The company recommends two hours, one hour in the morning and one hour in the evening. If you're able to do that, that's great. But that's quite a bit of time. So I usually am happy with one hour a day. So that's another method to control the edema in the leg.

But certainly, the first two are the most powerful and the most common methods that we use to control the edema in the leg, which is the most important thing we can do to help leg wounds to heal. Now the other section or the other thing that we can do to help wounds to heal in general is with your eating and particularly getting extra protein in your diet, things like meats, cheese, yogurt, eggs.

And if your wound is a little bit larger, maybe the size of an orange or bigger than that, then I would recommend getting on protein supplements. You see those at the store like Ensure or Boost. Ensure and Boost are great. And if you want to get those, that would be just fine. But if you look on the side of the package, you'll see how many grams of protein is in those. And it's usually about 10 to 12.

There are other drinks that you can get. At Costco, for example, they have Premier Protein. There's also Ensure Max is another protein supplement that's out now. And they have 30 grams in the same size drink. So if you can get those, that would be better to get more protein in your diet. The key with the protein is the protein is what your body needs to build new tissue and new skin. So you can heal faster if you get more protein in your diet.

So that's it for leg ulcers. Again, so the most important thing we can do is elevate the legs twice a day for 20 to 30 minutes with your legs higher than your heart and really work on getting that protein in your diet. I hope that helps you. Thank you.

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[MUSIC PLAYING] Hello. I'm Jason Rasmussen. I'm the wound care physician at the wound clinic at Abbott Northwestern Hospital. Today we're going to speak about pressure ulcers. Most pressure ulcers that we see in the wound clinic are on the bottom. And we'll talk about that first. But sometimes people do also develop pressure ulcers on their heels. And we'll talk about that second.

So pressure ulcers are fundamentally due to not enough blood supply in the tissue. And the way that this happens is if you push your fingers together very tightly, you'll notice that the tissue of the skin blanches, and you're actually pushing the blood out of that tissue. Now, if we're sitting in a movie theater for two hours or so, we'll naturally reposition ourselves every 15 to 20 minutes without even noticing it.

What happens is there's pressure applied to our bottom. And after a certain while, that skin is not getting enough blood supply. And so it starts sending pain signals to the brain. And without us being consciously aware of it, that pain signal causes our body to shift and reposition to shift the weight to a different area of skin to bear the weight.

Now, if there's a spinal cord injury or multiple sclerosis, something else that impairs the motor function of the body or the sensory functioning of the body, then that signal isn't sent to the brain or it isn't responded to normally. And so the pressure continues and continues. After an hour or so, that tissue will die. And then we're left with an ulcer. And that's what a pressure ulcer is.

So the key thing that we can do to help these pressure ulcers to heal is to prevent the pressure from being applied to the area. One of the most common types of pressure ulcers that we see are on the bottom surface of the bottom, where we sit, our sitting surface of the bottom. And this is from really sitting in the sitting position too long, and particularly in the wheelchair.

And obviously, a lot of people who are in wheelchairs are able to interact with and have quality of life through their interactions while they're up in the wheelchair. So being in the wheelchair is very important to them. But we do need to try to reduce that a little bit in order to allow these pressure ulcers to heal. So the basic idea here, again, is to try to reduce the pressure that's applied to these areas. So for the wounds that are on the sitting surface of the bottom, we try to reduce the time that we're in the wheelchair.

My usual first recommendation is to just be in the wheelchair for three hours at a time, and then get out of the wheelchair, to the bed, and lay down for an hour. And then you can get back up into the wheelchair for another three hours, and then take another break after that. Kind of that pattern. But you do need to be laying down in between. It doesn't work to be sitting up in the bed, because you're still putting pressure on that same sitting surface of the bottom.

The other thing that we can do is to adjust or to try to optimize the pressure reduction surfaces, both for the wheelchair and for your bed. So when you come into the wound clinic, we'll help you get set up if you don't already have a good cushion for your wheelchair. There is gel cushions, and then there's ROHO cushions that have air cells in them. And those provide very good pressure reduction.

And then for the bed, we often like to get an air mattress for the bed, which can distribute your weight over a larger area of your skin, and therefore reduce the pressure to any one particular area of the skin. So those are the key things that we can do for the pressure ulcers that are on the sitting surface of the bottom.

Another area of the bottom that often gets pressure ulcers is more flat on the back, what we call the sacrum, which is basically the very end of the spine. And that's more from laying flat in bed. And so then what we need to do is, again, we need to get that air mattress for your bed that can reduce pressure. And then the other thing is we need to have you repositioned in bed every two hours to make sure that we're shifting weight off of the back.

And then going to that other kind of pressure ulcer, which is on the heels. And this is from the heels pushing into the bed. And so what we want to do here is, again, just get that pressure off of with heels. And a very simple way but also very effective way of doing this is to use pillows.

And what we do is we put the pillows behind the calves so that the feet and the heels are just completely floating in the air with nothing touching them at all. And then that provides, obviously, very good pressure reduction, because there's no pressure applied at the heels at all. So when you're in the bed, if you can use pillows like that behind your calves so that nothing touches the heels, then that helps keep the pressure off of the heels.

And then the other thing that we can do to help with wound healing is with your diet. And that's getting extra protein in your diet, things like meat, cheese, yogurt, eggs. And particularly if you have a bit of a larger wound or a deeper wound, then it's very good to get on protein supplements sooner rather than later. Protein is what your body needs to build new tissue and new skin. So you can heal faster if you get more protein in your diet.

There's a number of different protein supplements that you can get. When you go to the grocery store, you may see things like Ensure and BOOST. And those are perfectly good. If you like those, I'd encourage you to get those. But there's also some other protein supplements that have a bit more protein in them.

You can look on the side where the nutrition information is listed and see how many grams of protein are in each of the different products. Some of them have just 10 or 12 grams of protein in them. That's fine. That's better than nothing. But then there's other protein supplements that have 20 or 30 grams of protein in them. And so it'd be much better to get some of those protein supplements that have more protein.

Some that I can recommend by name, if you go to Costco, they've got Premier Protein. That's got 30 grams of protein in it. And then Ensure has a specific formulation of it called Ensure Max, which also has 30 grams of protein in it. So if you can get either one of those or just really any protein supplement, that will help out significantly.

But the number one most important thing to help pressure ulcers to heal is to keep pressure off of them. And that's by not being in the wheelchair as much, changing your position in the bed or being repositioned at least every two hours, and then getting good pressure reduction surfaces in place as far as a good cushion for the wheelchair, an air mattress for the bed. And then we're getting the heels off of the bed if you've got heel pressure ulcers. So I hope that was helpful for you. And that's all for today. Thank you.

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