Ask the Expert

Q: Who is at risk for developing chronic wounds?
A: Dr. John Crew: People with one or more of the following are at risk for developing chronic wounds:

  • Chronic medical conditions, such as diabetes, high cholesterol, severe burns, cancer or AIDS
  • Vascular disease, including heart disease, hypertension, atherosclerosis, anemia, varicose veins or deep venous thrombosis
  • Elderly, immobile or obese people are at a greater risk
  • Unhealthy lifestyle or habits like smoking, poor diet and hygiene or lack of exercise
  • Previous history of ulcers, multiple surgeries or prolonged periods of bed rest
  • Weak immune system, as in patients taking corticosteroids, chemotherapy or radiotherapy

Q: What causes venous stasis ulcers?
A: Dr. John Crew: Venous ulcers are the most common type of ulcers occurring in the lower limbs, accounting for more than half of all ulcer cases.

Venous leg ulcers occur when the one-way valves of the veins fail to maintain the blood flow toward the heart and prevent any back flow. This problem with blood flow is known as venous insufficiency. The venous system in the lower limbs includes the deep, superficial and perforator veins. The deep veins lie between the muscles, the superficial veins in the upper layers just below the skin, and the perforator veins are located in between, connecting the other two types of veins. In damaged valves, the blood backs up and pools in the veins, building up pressure, causing edema, which prevents nutrients and oxygen in the blood from reaching the body tissue. Eventually, the tissue breaks down and forms an ulcer.

To help prevent venous leg ulcers, these measures may be followed:

  • Avoid long periods of standing or sitting
  • Raise the legs above the heart and use compression stockings as often as possible
  • Maintain a healthy lifestyle that includes regular moderate exercise, a healthy diet (low in fat, rich in fruits and vegetables) and reduce body weight, if overweight
  • Quit smoking, reduce alcohol consumption and try to stay active
  • Inspect the lower limbs daily and look for any color changes or cracks in the skin

Q: What is Lymphedema?
A: Dr. John Crew: Edema is the medical term for swelling. Lymphedema is chronic edema (usually in the extremities but not confined to) caused by damage to the lymphatic system. Lymphedema is an accumulation of lymphatic fluid in the interstitial tissue that causes swelling, most often in the arm(s) and/or leg(s), and occasionally in other parts of the body. The lymphatic system is the bodies filtering system that aids in destroying pathogens, filtering wastes, removes excessive fluid, and assists the circulatory system to deliver nutrients, oxygen, and hormones.



Q: What are the causes of chronic wounds?
A: Dr. James Stavosky: Conditions such as diabetes, poor circulation, edema of the legs, and pressure can all be causes of chronic wounds. There can be many causes for a wound to become chronic. The most common are infection, poor blood supply and pressure.


Q: What is the best way to treat wounds?
A: Dr. James Stavosky: When wounds become chronic, they are difficult to treat at home. They should be evaluated by a medical professional. And if they’ve been there longer than a month, it should be seen by wound care professional or at the wound care center.


Q: What are the complications of chronic wounds?
A: Dr. James Stavosky: Chronic wounds heal very slowly. This increases their likelihood of becoming infected. Infection can lead to gangrene, which then could lead to amputation. If the chronic wound becomes worse, it could lead to loss of life.


Q: Since chronic foot wounds are particularly common, especially among patients with diabetes, what steps can be taken to prevent them?
A: Dr. James Stavosky: It is important to inspect your feet daily. You should look for calluses, changes in color, hotspots, and wounds. If you are unable to inspect them yourself, you should have a family member or caregiver do it for you. Proper shoe gear is important for preventing increased pressure in your shoes that could lead to wounds