Non-Healing Wounds?

Venous disease is the likely culprit.

Juan Joseph

Juan Joseph discovered the piano while growing up in the Dominican Republic in the mid-1990s. Years later, after he moved to Florida, the reverent Christian found a way to display his talent and worship the Lord at the same time.

“One day after services, I noticed that the door to the church was open, and I saw a piano and started playing,” Juan recalls. “One of the deacons came out and said, That’s beautiful, and he asked if I would become a musician for the church. I said, Sure.

“That’s how I became the piano player at First Haitian Baptist Church in Fort Myers, which is a Haitian American church. I’ve been playing piano there since 2007. I play a mix of contemporary songs and hymns. I love the hymns but prefer the contemporary music.”

In addition to his service to the church, Juan has worked for the Fort Myers Housing Authority for 10 years. He’s on his feet a lot with his job, and in 2012, he developed serious problems with his legs, particularly his left leg.

“I had clot issues in my left leg and very poor circulation in that leg,” Juan asserts. “A few years ago, my leg started swelling, and after eight to 10 hours of work, it would be really big. I had to lie down and elevate the leg to get the circulation flowing.

“There was a little pain and itching and a rash on my leg. The skin on the leg was really bad, especially around my ankle. There was also an ulcer on my left leg, and it was becoming infected.”

Over time, Juan’s symptoms got worse, then his partner suggested he visit Joseph G. Magnant, MD, a board-certified vascular surgeon at Vein Specialists in Fort Myers and Bonita Springs. Dr. Magnant is dedicated to the modern and comprehensive evaluation of leg vein disorders and uses the most advanced minimally invasive techniques to treat them.

“Juan’s primary complaint was a left medial ankle ulcer that was somewhat chronic,” Dr. Magnant reports. “He had the ulcer for six to eight months. We evaluated him using ultrasound and discovered he had great saphenous vein insufficiency as well as leakage in several branches of his saphenous vein.

“We treated Juan’s great saphenous vein using radiofrequency ablation, which uses heat from radiofrequency energy to seal leaking veins. He came back later, and we treated the branches with an injectable foam called Varithena®, a proprietary chemical for sclerosing injections. Within two weeks, his ulcer was nearly closed.”

Progressive Disease

About 90 percent of the chronic wounds on the lower extremities are venous ulcers, Dr. Magnant underscores. The remainder are related to arterial disease, diabetes or neuropathic disease.

“There are probably half a million or more people with venous ulcers in this country at any given time,” the vascular surgeon approximates.

While venous ulcers are common, they are not normal. They represent the most advanced stage of venous disease.

“Venous disease is progressive,” Dr. Magnant elaborates. “It does not start with an ulcer. It starts with leg swelling and then skin discoloration around the ankle or just above the ankle. The discoloration can progress to skin thickening, a condition called stasis dermatitis.

“When these abnormal areas of skin are traumatized, either by accident or when doctors perform a biopsy, the result is a wound that is slow to heal and becomes an ulcer. These wounds tend to colonize with bacteria and become infected, which can spread into the bloodstream. If the patient has an artificial heart valve, joint replacement or anything else they weren’t born with in their body, that may become infected as well.”

“If you have been going to a wound care clinic for a while and you don’t see results in your wound in terms of healing, you may want to consider a vascular evaluation.”- Dr. Magnant

Many patients with chronic leg ulcers seek help in wound care clinics. Often, they receive treatment for months and their wounds still do not heal; if they do, they tend to recur. The problem is wound care clinics often don’t treat the root cause of the wounds: venous disease.

“Wound care clinics typically place patients in hyperbaric chambers and use forceps to remove dead skin from the wounds,” Dr. Magnant details. “But what those patients really need is an ultrasound evaluation, pulse check, venous disease study and a good vascular history review to rule out other reasons for the wound as well as a detailed vascular physical examination.

“Vascular surgeons can generally determine if a wound is a venous ulcer by simply looking at it. Venous ulcers typically form on the medial area of the distal leg, just above the ankle. They are beefy red because there is adequate arterial blood flow to them. The problem with venous ulcers is there is not enough blood leaving the area and going back up the leg, resulting in excess edema.

“If you have been going to a wound care clinic and you don’t see results, you may want to consider a vascular evaluation.”

The wounds need two processes to heal, Dr. Magnant informs.

First, they need granulation, which is healing of the base of the wound, he describes.

“The wound requires a steady supply of oxygen for this to occur because cells need oxygen to replicate and fill the wound with healthy cells and tissue,” he says.

The second is contraction, which is the closing in of the wound from the edges. Contraction occurs when cells called myofibroblasts pull up healthy tissue and place it into the wound.

Venous disease hinders both of these wound-healing processes.

“Fluid that oozes out of leaking veins causes the leg to swell,” he explains. “The fluid in the tissues impedes oxygen delivery to the wound, so it cannot granulate. Secondly, contraction cannot take place because the leg is too swollen.”

“The Ulcer is Gone”

Juan underwent his final procedure at Vein Specialists in January. He is pleased with the results thus far.

“Dr. Magnant said it may take a while for my leg to be completely normal, but it’s way better now,” Juan reveals. “The ulcer is gone, the skin is getting back to normal, and the swelling has pretty much stopped. I’m still wearing compression socks to make me a little more comfortable, but little by little, I can feel a difference.”

The church pianist is impressed by Dr. Magnant as well. He gives the vascular surgeon high marks for expertise and bedside manner.

“Dr. Magnant is a very good doctor,” Juan describes. “He’s very nice and friendly. I like that he talks to me. And he knows what he’s doing. I recommend him to anyone who has a vein problem like mine.”

©FHCN article by Patti DiPanfilo. Juan’s photo courtesy of Juan Joseph. Before and after images courtesy of Vein Specialists. js


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    • Vein Specialists

      Vein Specialists is 100 percent dedicated to identifying and treating vein disorders. Led by Dr. Joseph G. Magnant, they understand that the venous system varies between patients and consists of both deep and superficial venous systems and a net... Read More

    • Joseph G. Magnant, MD, FACS, RPVI

      Joseph G. Magnant, MD, FACS, RPVI, is a Fellow of the American College of Surgeons and is board certified by the American Board of Surgery in vascular surgery. He earned his medical degree from Medical College of Virginia. He completed a g... Read More