Diagnosis and Treatment of Venous Ulcers

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A venous ulcer, also known as a stasis ulcer or venous leg ulcer, is a shallow wound that usually occurs on the sides of the lower leg, between the calf and ankle. Since venous ulcers often are slow in healing and frequently recur if not properly treated, it is important for health care providers to understand their diagnosis and treatment.

Cause and Symptoms of Venous Ulcers

Poor blood circulation in the legs is the main cause of venous ulcers. When the one-way valves in the legs which keep blood flowing toward the heart are damaged, the blood can back up and pool in the veins. The pooling blood can then leak out into surrounding tissue and cause a breakdown of that tissue into an ulcer.

Dark red or purple skin over the area of blood leakage is the first sign of a developing venous ulcer. In addition, the skin in the area might become thick, dry, and itchy. Left untreated, a painful ulcer may form. The individual may also have achy, swollen legs. If venous ulcers become infected, they may have malodor and purulent drainage from the wound.

One of the first risk factors for developing a venous ulcer is advanced age. Older individuals tend to more frequently have venous insufficiency and their more fragile skin is more likely to become ulcerous. Another important risk factor for developing venous ulcers is obesity. Excess weight puts strain on the body’s circulatory system. Other risk factors are smoking, lack of physical activity, deep venous thrombosis, previous leg injuries and phlebitis.

Diagnosing and Treating Venous Ulcers

Physical examination of venous ulcers shows irregular, shallow wounds that are generally located over bony prominences. Typically, granulation tissue and fibrin are present in the ulcer's base. Other findings usually include lower extremity varicosities, venous dermatitis, and edema. Often patients also have increased pigmentation and hardening of the skin in the lower legs indicative of lipodermatosclerosis. Doppler ultrasound may be used to find the cause of the ulcer and to see how well blood is moving through the lower leg area.

The treatment goal for venous ulcers is to reduce the edema, promote ulcer healing, and prevent a recurrence of the ulcer. Traditional conservative management of venous ulcers usually entails compression therapy, leg elevation to reduce edema, and dressings on the wound. Various types of dressings have proven to be effective as long as they are combined with compression therapy. Pain management should be discussed if an issue for your patient. Oral antibiotics may be prescribed if cellulitis is present. If a venous ulcer does not respond to treatment after three months, surgical management might be considered. Surgical treatment can include debridement of the necrotic tissue, skin grafting, and surgery for reducing venous reflux.

Preventing Venous Ulcer Reoccurrence

A final step in treatment is to help prevent recurrence by encouraging the patient to continue to improve blood circulation. Patients may be instructed to elevate the legs above the heart several times a day. They may also be asked to wear compression stockings to prevent the pooling of blood in the legs. Finally, exercise and walking regularly are an important part of continuing to promote good leg circulation.

Unfortunately, venous ulcers quite frequently reoccur and some open ulcers can persist for weeks or even years. Other severe complications include cellulitis, malignant change, or bone infection. Larger ulcers or ones that do not heal after a long time may need surgical management and hospital stays for treatment.

How common are venous ulcers? In fact, they are the most common lower extremity ulceration, affecting almost 1 percent of the U.S. population. That is why understanding the cause and treatment of venous ulcers is so important for patients, as well as health care professionals. Not only are leg ulcers a difficult problem for patients, but finding way to appropriately care for the increasing number of venous ulcers is an important health care management task.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

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