Dr. Cacovean Adrian

Venous ulcer

The simplest understanding of venous ulcer is if you do the following exercise.
Look at the nail of the thumb, right hand. The nail has a pink color, if you are healthy and have no nail or circulatory disease. Pink is given by the finest veins in the human body, those which make the exchange between blood and what you must be the living human flesh: they are the capillaries. One cannot see them individually with the naked eye, because they are too small, but one can see the blood in the transparent nail. Now press the nail with the index finger from the left hand. If you press right, the nail goes white. What does that mean? Why does the nail go white by pressing?

You don’t need advanced knowledge of hemodynamic physiology (science dealing with the laws of blood flow through blood vessels of a man and through his heart). I will tell you some simple data about the pressure the blood is moving through the capillary veins: it is only 5 millimeters of mercury. Whitening is nothing but the action of emptying of blood the capillaries they have, by pressing on the nail. If you continue pressing on the nail and you keep it white for a longer time (I do not advise you to do the experiment to the end), the nail will not get blood and finally the nail will "fall" blackened and dead.

Does anybody know what eschars are? Perhaps you have heard of seating injuries, eschars, lie flat, the wounds of people who are long in bed. The same thing that happens to the nail pressed and cleared from the capillary blood happens to human skin pressed by a human’s weight in places that support the bed, i.e. the buttocks, back, elbows, ankles, when the man is sick and stays a long time unmoved in bed (usually the hospital). That skin dries and dies and sometimes the eschar extends to the bone. You may wonder why I am telling you about eschars with, falling of nail pressed a long time and you still cannot see the connection with the subject: venous ulcer.

I do not wonder at all, I understood that a long time ago. The venous ulcer is also an eschar. Skin pressure does not come from outside but from within, from diseased veins. How so? If you go on the website and open the page with varicose veins, there I have explained how varices occur and how blood, instead of going to the heart, comes back in the foot by some broken valves and reach to push the skin and suffocating it and drain it of capillary blood that gives life to the skin.

What I don’t understand:
1. Why do patients go for a solution at the skin doctor (dermatologist)?
2. What's the point to do skin grafts in a place where even the original skin is dry?
3. How is it that in Romania, the departments of dermatology have more beds for patients with venous ulcers than all the beds held for vascular surgery, which is the discipline of law for all vascular pathology (arterial, venous and lymphatic)?
4. Venous ulcer healing in a patient hospitalized in dermatology or another section is due to bed rest, not due to treatment. The hospitalized patient lies in bed, and so not much pressure is in the veins of the legs and the skin can thus breathe. Healing is not related to treatment, but to hospitalization.
5. Has anyone analyzed the admissions and treatment costs elsewhere and chronic venous disease in sick leave and even retired for medical reasons?
6. Chronic venous disease is to me a polyclinic pathological case and sometimes of hospitalization within 3 days if the patient has an accepted surgical indication.
7. Why it is called so and is not called venous eschar?

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