2. WOUND CARE: The ulcer surface

Though maintaining proper compression is the key to healing your venous leg ulcer you will also need to take care of the actual wound as it heals. Nature sets a healing time for each type of wound but that healing will only occur if there are favorable conditions for the ulcer to heal. Wounds must be kept clean (free from debris and infection), warm (not hot), protected from the outside environment and allowed to stay moist (not wet).
For your information these are the steps that can be taken in ulcer care:

Cleansing
Most of the time the medical team will rinse the ulcer surface with a simple salt (saline) solution. This will be formulated to be as close as possible to the normal salt concentration in your body fluids.

Debridement
This is the term used for the physical removal of any blood clots, scabs or dry crust on the ulcer through mechanical, chemical or surgical means.

Antibiotics or antimicrobials
These may be used to clear up an infection within the ulcer. A topical antibiotic may be applied to the ulcer surface and or it may be taken orally.

Drug therapy
Other than antibiotics there are few drugs that can improve the healing. Pain killers (analgesics) may be prescribed or recommended.

3. SKIN CARE
The goals of good skin care, especially for the area around the ulcer, are:

• Maintain soft, supple, clean and healthy skin.
• Prevent skin irritation and subsequent damage.
• The use of proper skin care products provides enormous preventative and healing benefits for the patient with fragile and compromised skin.

Some of these products may include:

• A cleanser that will maintain the skin’s healthy pH (the acidity level)
  
• Moisturizing cream, which should be hypo allergenic. This will prevent dangerous itching of dry and delicate skin. Avoid at all costs scratching that itch!
• Protective creams and ointments can protect skin from wetness and soothe the skin thereby speeding up the healing process and preventing possible rashes.

Maintaining good skin condition with these products will also help avoid small breaks in the skin that could lead to ulcer formation.
General skin care tips:
• Ensure adequate bathing or showering to keep skin clean.
• Be sure not to spend too long in the bath and do not use very hot water (this can deplete natural moisture from the skin).
• Towel dry gently to avoid damaging the skin.
• Avoid harsh cleaning agents that can irritate the skin.
• Try to avoid perspiration.
• Regularly inspect the skin for warning signs such as redness, burning sensations or pain. Consult the nurse or physician immediately if you suspect a problem.

4. PAIN MANAGEMENT
Physicians and nurses as well as front line health workers have to ask the right questions to pinpoint the extent of the pain problem. For example: “Can you describe the pain?” “What makes the pain better?” Try to initiate an honest, open conversation on pain issues.
Quality of life research studies have consistently highlighted that pain is an overwhelming issue for patients living with a leg ulcer. It is unfortunate that sometimes patients accept the pain as the norm, believing “it comes with the territory.” Further research has also shown that health workers and even professionals assume that venous leg ulcers are not painful.
Venous leg ulcers are painful because nerve endings are exposed; a moist, occlusive dressing will protect the nerves and can reduce pain. Furthermore, the pain from engorged veins and swollen tissue in the legs can usually be reduced by compression from bandages or stockings and from elevating the legs.
To relieve local pain associated with chronic venous leg ulcers, the non narcotic varieties of pain killers such as ibuprofen or acetaminophen usually help.