U NNA B OOT Used to treat a Venous Stasis Ulcer Ashley Webb.
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Transcript of U NNA B OOT Used to treat a Venous Stasis Ulcer Ashley Webb.
UNNA BOOTUsed to treat a Venous Stasis Ulcer
Ashley Webb
PATIENT HISTORY
67 y.o. white female
Sudden onset of open ulcer on medial Right LE
6 x 8 x <1 cm
Yellow necrosis 100%
HISTORY CONTINUED
Medical Conditions: HTN DM
Medications: Coumadin Pt. never brought the rest of the list to the clinic
GOALS
Short Term Goals Wound will be free of all drainage and all
infection
Long Term Goals Wound will be 100% closed Minimal Right LE erythema
INITIAL EVAL/TREATMENT Whirlpool 15 Minutes
Sharps debridement with tweezers
Dressed with (1) 5x9 xeroform, (2) packs of 4x4, (1) ABD pad, (1) 4” kling
Instructions: Limit weightbearing Elevate Right LE Perform Ankle Pumps Return Daily for wound management
WEEK 1 & 2
Unna boot applied to Right LE in spiral fashion covered with (1) 4” kling
Good pedal pulse Keep on for 5 days
Wound cleansed with saline Slough removed with 4x4 and tweezers Redressed with new Unna Boot (2) 4” kling secondary to drainage
WEEK 3 & 4
Wound Measurements: 1x1x1 cm Redressed
2 wounds are present # 1) < 1 x 1 x 1 cm #2) .5 cm x .5 cm x < 1 cm
WEEK 5 & 6
3 small wounds 2 medial wounds both < .5 cm in all dimensions 1 new wound distal to lateral malleolus
Measuring 1 cm x .25 cm x < 1 cm
1 small spot on medial & lateral side
WEEK 7 & 8 & 9
No drainage Small lateral wound remains Redressed with Unna Boot
Wound now dressed with: Bactroban 2x2 3” Kling
Goals met. Doctor order to wear support hose
UNNA BOOT PRODUCT
UNNA BOOT VS. HYDROCOLLOID DRESSING WITH COMPRESSION
STOCKING
60 Patients with Venous Stasis Ulcers
Superiority of hydrocolloid dressings when used with compression stockings in terms of patient convience
COST AND HEALING RATES IN TREATING VENOUS ULCERS
Unna Boot vs. CircAid Thera-boot
Neither one is superior in healing rates
Unna Boot lose compression rapidly
Less time spent applying Thera-boot
Significantly less cost with CircAid Thera-Boots than traditional treatment with Unna Boot
DUODERM WITH COMPRESSION VS. UNNA BOOT
Duoderm healing rate was faster at 4 weeks Duoderm healing rate was faster at 12
weeks, however not statistically significant
50% of Duoderm group healed completely
43% of Unna Boot group healed completely
ZINC IN WOUND HEALING
Zinc is essential trace element in the human body
Topical administration of zinc appears to be superior to oral therapy
Benefit: hypersensitivity to topical zinc oxide is rare
CONCLUSION
Unna Boot is effective in healing venous stasis leg ulcers
However other dressings when applied with compression can also have the same healing effects
Many studies have not found one dressing to be superior
REFERENCES Cordts,P.R., Hanrahan, L.M., Rodriguez, A.A., Woodson, J., LaMorte, W.W.,
Menzoian, J.O. A prospective, randomized trial of Unna’s Boot versus Duoderm CGF hydroactive dressing plus compression in the management of venous leg ulcers. Vascular Surgery. 1996; 21: 55-71.
DePalma, R.G., et al., Comparison of Costs and Healing Rates of Two Forms of Compression in Treating Venous Ulcers. Vascular Surgery. 1999; 33: 683-689.
Koksal, C., Bozkurt, A.K. Combination of hydrocolloid dressing and medical compression stocking versus Unna’s Boot for the treatment of venous leg ulcers. Swiss Med Weekly. 2003; 133:364-368.
Lansdown, A.B., et al. Zinc in wound healing: theoretical, experimental, and clinical aspects. Wound Repair and Regeneration. 2007; 15: 2-16.
QUESTIONS????