Venous ulcers happen when blood pools in the legs. The subsequent pressure damages surrounding tissues, and this causes one or more wounds to form.
Venous ulcers are often unevenly shaped wounds that appear in the lower part of the leg and ankle. They typically appear below the midpoint of the shin and are usually shallow, with a defined border.
The lower leg wounds are common, affecting 1% to 3% of the general population, and 4% of those are 65 and older. If not treated, venous ulcers can lead to severe infection that requires amputation.
What Causes Venous Ulcers?
Venous ulcers happen due to poor circulation in the veins of the legs. The calf muscle is the main pump that moves blood through the veins. When the calves contract, blood gets pushed up into bigger veins of the leg and the pelvis.
Valves in the veins prevent blood from moving in the wrong direction. If the valves don’t work as well as they should, blood pools at the ankles causing pressure, and the vein walls can also become scarred or weak.
When the veins don’t adequately pump blood back up the body, doctors call it venous insufficiency.
Risk factors for venous insufficiency, and venous ulcers include:
- Age, as the veins and valves naturally weaken.
- Blood clots.
- Diabetes, as elevated blood sugar can damage veins over time.
- Diseases that cause inflammation.
- Family history of venous insufficiency.
- Pregnancy, which puts added pressure on the veins.
- Uncontrolled high blood pressure.
- Varicose veins.
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How Do Doctors Treat Venous Ulcers?
The treatment for venous ulcers depends on the size of the ulcer, underlying conditions, and other factors. Most of the time, venous ulcers don’t require hospitalization.
The most common treatment is compression therapy. This may include bandages, snug-fitting socks, or a sleeve. Your doctor will prescribe the most ideal compression device for you.
The compression counters the pressure from the veins, so that the tissue can heal. Doctors usually recommend patients wear the compression socks throughout the day and take them off at night.
For those who can’t wear compression socks, due to painful swelling, for instance, doctors use intermittent pneumatic compression pumps. This is a plastic sleeve with air chambers that inflate and deflate periodically to put pressure on the leg.
Your doctor may prescribe pentoxifylline, a drug that lowers certain proteins in the blood and improves blood flow. Elevated cholesterol levels can contribute to disease in your arteries as well, causing further damage. In this case, your doctor may also prescribe a statin to lower cholesterol.
Your doctor may prescribe an antibiotic lotion to prevent infection. If the ulcer is infected or you’re at a high risk of developing infection, you may be prescribed oral antibiotics.
Signs of infection include redness, warmth, swelling, yellow pus, or odor at the wound, as well as fever or chills. If you’re seeing signs of infection, you should call your provider.
Debridement and Surgery
Debridement, a process that removes dead cells, can speed healing. Various debridement techniques include chemical debridement, rubbing the wound with an exfoliating pad, and water therapy.
Those with severe or recurring venous ulcers may need surgery. This includes skin graft surgery or surgery to close off a vein (ablation) to reduce pressure.
How Can You Prevent Venous Ulcers?
Improving your circulation and reducing pressure on your legs can help prevent venous ulcers. The following steps can help you avoid them:
- Improve your lifestyle by eating healthy foods and getting more sleep.
- Lose weight if you are overweight.
- Manage your blood pressure through stress management and/or medication.
- Raise your legs so that your feet are above your heart, several times a day.
- Wear compression stockings as often as your doctor recommends.
- Quit smoking.
While most venous ulcers go away with time, some can cause serious complications, like infection. As always, prevention is the best medicine.
Dr. Allen Gabriel. Vascular ulcers. Medscape. Link
National Library of Medicine. Venous ulcers – self-care. Link
Dr. Susan Bonkemeyer Millan. Venous ulcers: Diagnosis and Treatment. American Family Physician. Link
Dr. Sherry Scovell. Patient education: Lower extremity chronic venous disease (Beyond the Basics). UpToDate. Link
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