The Hospital Is No Longer Needed: Cenla Health - Alexandria, Pineville, Louisiana

“Among the most difficult and challenging patients to care for are patients with venous leg ulcers.  They are miserable with pain and discomfort of chronic open wounds with foul smelling drainage," says Dr. James David, vascular surgeon.

Ulcers are breaks in the layers of skin that fail to heal.  The most common cause of chronic leg ulcers is poor venous circulation in the legs.  These are known as venous stasis ulcers.  Approximately 70% of all leg ulcers are venous ulcers. 

A leg with venous problems has a very characteristic appearance:
• The leg is swollen.
• The skin surrounding a venous ulcer is thin, itchy and sometimes brownish in color.
• Eczema may appear.
• The ulcer has a weeping, raw appearance.

Most of venous leg ulcers occur because the valves connecting the superficial and deep veins are not functioning properly.  This allows pooling of blood and edema fluid to leak into the tissues. Edema interferes with small vessel circulation to the skin. Wounds will not heal because of this compromised blood flow.

How has treatment changed?  “I have memories of the crowded wound clinics at Charity Hospital in New Orleans where as a student and young resident, I cleaned and wrapped legs in a dressing called an unna boot," says David. “Treatment had not changed very much until a few years ago when surgeons learned how to deal with the underlying cause-incompetent veins-with minimal invasive techniques under local anesthesia in the office. Tying off these veins before this innovation, if it could be done, required a long incision under general anesthesia with prolonged weeks of healing. Patients sometimes lost their leg to staph infections in these open wounds."

With the advent of radiofrequency treatment of veins (VNUS Closure) incompetent veins are treated through needle holes.  Hospital admission and the operating room are no longer needed.

One such patient is James Myrick, a former Army Ranger and current Silver Senator. Mr. Myrick began having circulatory problems in his legs in the 1950's after sustaining injuries in the Korean War. For years he was accustomed to reduced feeling in his legs and feet. After things deteriorated about 4 months ago and he developed leg ulcers, he was referred to Dr. David.  He was evaluated and first sent for lymphedema therapy to reduce swelling and congestion. Dr. David then performed VNUS closure on both legs. Since VNUS closure Mr. Myrick states he has “felt the bottom of my feet for the first time in decades" and “can't tap dance yet, but I get around pretty well."

“The healing of these wounds and improved quality of life given these patients is one of the most gratifying experiences for me as a surgeon. The smiles of grateful patients are rewarding. I never dreamed I would want to advertise venous leg ulcers as part of my practice," say Dr. David.

Information on these new treatments can be found by logging on to vascularclinic.com.  Dr. David practices at the Vascular Clinic in Alexandria and can be reached at 318-445-0058.