Venous Ulcers

THE CONDITION

Venous ulcers are wounds or open sores on the lower extremities. They are very slow to heal and often reoccur, accounting for 80-90% of all leg ulcers.

They are often associated with venous valvular insufficiency, or may be a complication of a post-thrombotic syndrome (blood clots). The pathway to venous ulcers is venous hypertension and the underlying associated inflammatory process. The patient may suffer from pain, infection and disfigurement. Venous ulcers are more common in people who have a history of leg swelling, pain, varicose veins or a history of previous blood clots in the deep venous system. The ulcers are associated with considerable economic, psychological and social impact.

Veins located in the lower extremities are blood vessels that return blood to the heart. When the valves inside the veins become damaged and fail to work properly or if there is an obstruction to blood flow secondary to a blood clot in the vein, then blood pools and backs up in the lower extremities. This increased pressure in the veins causes fluid to leak into the surrounding tissues. Swelling develops followed by an intense inflammatory response in the tissues or vein walls. Movement of oxygen and nutrients from capillaries into the tissue is reduced and leads to tissue breakdown and ulcer formation.

Venous ulcers are most commonly located around the anklebone - particularly the inside one. The first sign of an impending ulcer is the appearance of a dark purple or red skin over the affected area. Often the skin is dry and has the appearance of a rash or eczema. Venous ulcers may rapidly develop once these skin changes are present. Other symptoms include swelling, pain, skin color changes, dry skin or rashes. The borders of the ulcer are usually irregular and they often weep a clear fluid while being covered in a yellowish film. Venous ulcers can become infected. These ulcers are very tender and inflamed in appearance.

THE TREATMENT

Treatment goals of venous ulcers include relief of pain and healing of the ulcer as well as preventing recurrence of the ulcers.

Our specialists will individualize the treatment options to the patient based on the location, size and duration of the venous ulcer. Venous ulcers and venous hypertension are often prescribed compression dressings and stockings to minimize the swelling. 

Topical wound care treatment may be necessary along with antibiotics intially if they appear infected. Elevation of the leg will also help to reduce the swelling and venous hypertension. Venous ulcers may take months to heal and may chronically reoccur.

The second approach to healing venous ulcers is by closure of the incompetent venous system, which causes the underlying venous hypertension. This can be achieved by methods such as surgical removal of the veins, endovenous laser ablation or sclerotherapy (injections).

Compared with compression stockings as a stand-alone treatment these surgical techniques offer promising results with fewer recurrences of the venous ulcer. The ulcers also tend to resolve much quicker after one of these treatments compared with dressings and stockings alone.