II. History
- After Paul Gerson Unna, German dermatologist 1850-1929
III. Indications
- Refractory Venous Stasis Ulcer
- Ankle Sprain with venous insuffiency or atrophy
- Localized Neurodermatitis
IV. Mechanism
- Prevents edema development
- Medication impregnated dressing
- Zinc Oxide paste
- Calamine lotion
- Glycerin
- Gelatin
V. Technique
- Reduce local edema before boot application
- Patient prepares leg at home on boot application day
- Ulcer covered with bandage
- Ace bandage applied firmly from foot to knee
- Leg prepared for Unna Boot
- Ace bandaged removed at clinic
- Skin cleansed and ulcer debrided as needed
- Apply Skin Lubricant to normal skin of leg
- If chronic inflammation present around ulcer:
- Apply medium potency Topical Corticosteroid
- Apply Unna's Boot per package instructions
- Layered application (avoid creases or folds)
- Starts behind first Metatarsal
- Ends below tibial tubercle of knee
- Overlap each turn half of width of previous turn
- Cast dries within 1 hour (firmness of cardboard)
- Consider covering cast with ace bandage when dry
- Layered application (avoid creases or folds)
- Follow-up
- Unna's Boot changed every 7-10 days
- Remove with bandage scissors
- Change bandage if drainage penetrates cast
VI. Advantages
- Comfortable and soothes skin
- Protects skin from scratching
VII. Disadvantages
- Sticky Sensation in warm weather
- Contact Dermatitis may occur in some patients
- Less effective for Non-Ambulatory Patients
- Pressure decreases with reduced edema (reapply)
VIII. References
- Habif (1996) Clinical Dermatology, Mosby, p. 79
- Rosen (1998) Emergency Medicine, Mosby, p. 618
- Wooten (2001) Clin Fam Pract 3(3):599-626 [PubMed]