1. U NNA B OOT Used to treat a Venous Stasis Ulcer Ashley Webb

2. P ATIENT H ISTORY 67 y.o. white female Sudden onset of open ulcer on medial Right LE 6 x 8 x <1 cm Yellow necrosis 100%

3. H ISTORY C ONTINUED Medical Conditions: HTN DM Medications: Coumadin Pt. never brought the rest of the list to the clinic

4. G OALS 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

5. I NITIAL E VAL /T REATMENT 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

6. W EEK 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

7. W EEK 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

8. W EEK 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

9. W EEK 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

10. U NNA B OOT P RODUCT

11. U NNA B OOT 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

12. C OST AND H EALING R ATES IN T REATING V ENOUS U LCERS 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

13. D UODERM WITH COMPRESSION VS. U NNA B OOT 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

14. Z INC IN W OUND H EALING 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

15. C ONCLUSION 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

16. R EFERENCES 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.

17. Q UESTIONS ????