Venous Leg Ulcers

1. What is a venous leg ulcer?
   A venous leg ulcer is the most common type of leg ulcer, accounting for at least 2/3 of all cases. Venous leg ulcers develop in patients with chronic venous insufficiency whereby persistently high blood pressure in the veins of the legs (venous hypertension) causes damage to the skin. The skin eventually breaks down and forms an ulcer. They are difficult to heal and often recur.
   
   The symptoms of venous ulcers include pain, itching and swelling in the affected leg. There may also be other signs, such as brownish skin discolouration (hyperpigmentation) or hardened skin around the ulcer. The wound itself is often irregular and there may be weeping discharge as the tissue fluid seeps from the wound. There may also be indications of infection.
   
   

2. Who will be affected?
   You are at risk of developing a venous leg ulcer if you:

   • have Varicose Veins
   • have previous history of Deep Vein Thrombosis
   • are unable to move properly
   • are obese
     
     
3. How do you diagnose a venous leg ulcer?
   A patient with a new leg ulcer should be referred to a vascular specialist for expert assessment. Ultrasound scan is required to diagnose problem with the veins that has caused the ulcer.
   
   Ultrasound scan will provide colour images of your vein structure and identify any abnormalities in the veins. It will also measure the speed and direction of your blood flow in the veins.
   
   Special investigations may also be required to exclude other causes of leg ulcers such as arterial (ischaemic ulcers) and neuropathic (diabetic) ulcers. It has been estimated that approximately 10-15% of venous ulcers are associated with arterial insufficiency (Mixed venous-arterial ulcers). These ulcers can cause considerable pain and distress for the patients and pose some difficulties in wound care.
   
   Characteristics of a venous leg ulcer are:
   • Ulcers are usually located just above the ankle
   • Surrounding skin hyperpigmentation or lipodermatosclerosis
   • Presence of visible varicose veins
   • Ulcers can be of any sizes with healthy granulation tissue in the ulcer bed
   • Ulcers may be green and smelly with infection and evidence of surrounding tissue swelling and cellulitis
     
     
4. What are the treatments for venous ulcers?
   Treatment the underlying cause will effectively allow ulcer healing.
   Effective treatment for venous leg ulcers are:
   • Compression bandaging
   • Meticulous wound care to prevent infection and promote healing
   • Leg elevation
   • Improve mobility
   • Reduce obesity
   • Improve nutrition
   • Skin grafting in selected patients
   • Endovenous procedures or venous surgery in patients with varicose veins
     
     
5. Will the venous leg ulcer come back?
   Unfortunately, in many patients venous ulcers will recur either at the same or different sites. It is therefore very important that treatment continues after the first ulcer has healed, especially if the underlying problem with the veins cannot be treated surgically.
   
   
6. Can venous leg ulcers be prevented?
   The most usual form of long term preventive treatment is the use of graduated compression stockings. Other ways to help prevent a venous leg ulcer are losing weight if you are obese, improving mobility and taking care of your skin.
   
   Compression stockings
   Venous leg ulceration is almost always preceded by the skin changes of hyperpigmentation or lipodermatosclerosis. The gold standard long term management is the use of graduated compression stockings, once the treatable venous problems such varicose veins have been completed. It is particularly important when the underlying venous problems cannot be treated surgically such as deep venous reflux or obstruction following an episode of deep vein thrombosis
   
   Lose weight
   Venous ulcers are much more common among people who are obese than in people of normal weight. Losing weight can help prevent venous leg ulcers because excess weight contributes to high pressure in the leg veins, which can cause damage to the skin.
   
   Skin Care
   Practicing good skin hygiene is important. Use a moisturiser regularly on your legs, particularly if you have had a previous venous leg ulcer so that the skin doesn’t flake or crack easily. If the skin is not broken or leaking fluid but is inflamed (and not infected), your doctor may recommend an anti-itch cream, such as one containing hydrocortisone.
   
   Cellulitis ie is a skin infection caused by bacteria in the legs in patients with venous problems is very common. Early treatment is crucial. Mild cellulitis can be treated with oral antibiotics but more severe may require hospital admission for intravenous antibiotics.
   
   
7. What will happen if I do nothing about my venous leg ulcer?
   A venous ulcer will not usually heal without specialist assessment and treatment. The ulcer needs to be kept clean and dressed regularly, otherwise it may become infected and get much larger in size. Venous ulcers can be painful. It can also limit one’s mobility with significant impact to quality of life.
   
   The longer you have a venous ulcer the more damage that is done to the skin of the leg and the more difficult is to heal, even with specialist treatment.