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????