What is the cornerstone of treatment for venous stasis ulcers due to chronic venous insufficiency?

• A. Wet-to-dry dressings
• B. Oral antibiotics
• C. Hyperbaric oxygen therapy
• D. Compression therapy with an Unna boot

Answer: (D)

The main idea here is that sustained compression to reduce venous hypertension is the foundation of healing venous stasis ulcers caused by chronic venous insufficiency. These ulcers stem from increased venous pressure that leads to edema, skin changes, and tissue breakdown. By applying external pressure, you decrease the transmural venous pressure, improve venous return and lymphatic drainage, and lessen edema. This creates an environment where the wound can granulate and epithelialize more effectively.

An Unna boot, a zinc-oxide paste bandage, provides consistent circumferential compression over several days. That steady support directly combats venous hypertension, reduces leg swelling, and protects the wound while promoting healing. Other options don’t address the underlying hemodynamics: wet-to-dry dressings debride without correcting pressure or edema and can irritate or macerate tissue; antibiotics are only for infection; hyperbaric oxygen isn’t a standard cornerstone of therapy. Before starting compression, ensure adequate arterial perfusion with an ankle-brachial index check, and combine compression with leg elevation and appropriate wound care, with plans to address venous reflux if needed.