In “What is the best initial treatment for venous stasis ulcers?” (Clinical Inquiries. J Fam Pract. 2013;62:433-434), Dr. Poynter et al seemed to say that various kinds of compression stockings are suitable. What about going back to the Unna boot?
I have had great success treating venous stasis ulcers with the Unna boot. This calamine-infused gauze dressing, which can easily be applied in a primary care setting, has been replaced by wound treatments that are much more expensive—and may be less effective. Cost matters, and all things being equal, it’s time to promote the Unna boot once more.
Charles Mayer, MD, MPH
Seattle, Wash
As a family physician certified by the American Board of Venous and Lymphatic Disease, I would like to point out a couple of things.
First, while the authors discussed compression, they did not define what that meant. This is important, as many physicians prescribe TED hose for venous stasis ulcers, although it does not provide enough compression.
Secondly, fixing the underlying problem should be considered part of the initial treatment. Studies show that a combination of compression and intervention is the best way to ensure long-term healing of venous stasis ulcers.1,2 I would recommend that such patients be referred to a phlebologist for evaluation. Compression alone has a poor long-term outcome for the healing of ulceration.
Lornell E. Hansen II, MD, FAAFP
Sioux Falls, SD