A Closer Look At Venous Insufficiency And Wound Healing In Women

The American Association for Women Podiatrists executive board members recently had a panel discussion on special considerations when it comes to surgery, biomechanics and wound care in the female patient. My topic was women and wound healing. 

When I initially approached this subject, I did not think I would find any significant differences between wound healing in women and men. However, I would like to share with you some of my findings in regard to venous insufficiency and ulcerations in women.

Approximately 50 to 55 percent of women will develop varicose veins in contrast to 40 to 45 percent of men who will develop this condition.¹ Women are more prone to venous stasis/insufficiency than men due to heredity, shoe style, pregnancy and menopause.²

Shoe style. Normal walking coordinates the foot and calf pump. When the foot is off the floor, the veins in the foot fill with blood. As the heel and arch of the foot contact the floor, the blood flows into the relaxed calf veins. The calf muscles subsequently contract, which propels blood up the deep veins.

High heels change the natural walking motion, shifting the weight to the forefoot and toes and causing the calf muscles to remain contracted. This results in a decrease in the filling of the foot and calf veins, and a less forceful calf muscle pump. This lost efficiency causes the pooling of venous blood in the leg.

Pregnancy. As the uterus grows during pregnancy, it puts pressure on the inferior vena cava on the right side of the body. This in turn increases pressure in the leg veins. During pregnancy, the amount of blood in the body also increases, adding to the burden on the veins in pregnant women.

Estrogen. A clear correlation exists between estrogen levels and the rate of wound healing with retarded cutaneous healing in post-menopausal women.^3,4 Decreased healing ability correlates with a reduction in post-menopause steroid use.^3,4

Topical estrogen application treatment to some degree reverses three age-related skin conditions: atrophy, dryness and wrinkles.

1) Skin atrophy. Topical estrogen stimulates keratinocyte proliferation, reduces apoptosis, increases dermal collagen production and inhibits matrix metalloproteinase (MMP) expression.

2) Skin dryness. Topical estrogen alters keratinocyte function, increases dermal water holding capacity and increases sebum production.

3) Skin wrinkles. Topical estrogen increases dermal water holding capacity, increasing the number and orientation of elastin fibers.

Postmenopausal females taking systemic hormone replacement therapy reportedly heal standardized acute wounds more rapidly than age-matched controls, which is in agreement with animal studies.⁵

References

1. Chicago Vein Institute. Varicose vein statistics. Available at https://chicagoveininstitute.com/varicose-veins-statistics/ . Published May 5, 2014. Accessed Aug. 18, 2015.

2. American College of Phlebology. Available at https://www.phlebology.org/patient-information/faq . Accessed Aug. 18, 2015.

3. Wang SB, Hu KM, Seamon KJ, et al. Estrogen negatively regulates epithelial wound healing and protective lipid mediator circuits in the cornea. FASEB J. 2012;26(4):1506-16.

4. Ashcroft GS, Ashworth JJ. Potential role of estrogens in wound healing. Am J Clinical Dermatology. 2003;4(11):737-43.

5. Ashcroft GS, Greenwell-Wild T, Horan MA, et al. Topical estrogen accelerates cutaneous wound healing in aged humans associated with an altered inflammatory response. Am J Pathol. 1999; 155(4):1137-46.

Additional Reference

6. Gouin JP, Kiecolt-Glaser JK. The impact of psychological stress on wound healing: methods and mechanisms. Immunol Clin N Am. 2011; 31(1):81–93.