Archive for September, 2014

Venous Leg Ulcers

September 20, 2014


The lower extremity is a common place for wounds to occur. Often times, even with treatment, wounds may not heal and can leave wound care experts perplexed. There are a variety of reasons as to why a wound may not heal, an example of which includes improper functioning of the deep veins in the legs. Venous leg ulcers are becoming more recognized and require treatment that addresses the underlying issue of the disease before the problem becomes worse.

Venous Stasis and Chronic Venous Insufficiency

Venous stasis is a condition characterized by pooling of blood in veins and occurs in the lower extremity. Veins are responsible for collecting blood from tissues and returning it to the heart. Valves within the veins keep blood from flowing backwards in the legs. When these valves are not working properly, gravity keeps blood from returning upward towards the heart. This condition is called Chronic Venous Insufficiency (CVI), which often occurs as a person ages or is not mobile for an extended period of time.

Symptoms of CVI may include swelling of the legs, itching and flaking of stretched skin, leaking of fluid through the skin, and a heavy feeling in the legs. It is useful to think of the legs as balloons in this instance – as the balloons swell with air and stretch, they reach a breaking point and “pop”. Similarly, prolonged swelling causes the outer layers of the skin to break and leads to ulcer formation. This is particularly troubling for diabetics with peripheral neuropathy who have trouble healing wounds. These ulcers often occur near the medial malleolus or the lateral malleolus of the ankle, which is where the major veins from the foot travel.

Many wound experts have trouble healing these wounds because they do not address the underlying issue of why the wound is present. In order for the wound to begin to close, the swelling needs to be corrected. If the wound is not healed in a timely manner, the affected limb may become infected.

Risk Factors

There are many risk factors that can lead to formation of a venous ulcer. Previously having a DVT [] is a major risk factor for venous valve insufficiency. Older age and prolonged immobilization can also cause blood to pool in the legs. Oftentimes this manifests as varicose veins, although presence of these superficial veins does not mean they will become a venous ulcer and is largely a cosmetic issue. A prolonged history of obesity and smoking can also lead to CVI. Women are more likely to suffer from this illness, mainly because the anatomy of the female pelvis is different from a male’s, leaving them more likely to suffer from obstruction of the iliac vein in the hip in a condition called May-Thurner syndrome that more commonly affects the left leg, rather than both.


There are a number of vascular tests that your doctor may want to recommend. Doppler ultrasound is a safe procedure that is used to study blood circulation in the form of sound waves. Your doctor may also want to measure the blood pressure in your leg veins to make sure that increased pressure is not causing too much stress on the valves. These tests can be performed in the office and used to decide what the best course of treatment will be.

Treatment and Education

As the wound progresses in age, it begins to fill with dead tissue that can prevent it from healing. An infection may be present, in which case appropriate antibiotic therapy needs to be implemented. Once any infection is addressed, the wound needs to be cleaned of debris. A dressing is applied to the wound to protect it from the outer environment.

Once this is done, the most important step is to provide compression to the affected limb with a bandage or stockings. This compression will help improve circulation in the legs and allow for blood to be pushed against gravity towards the heart. If a bandage is used, it needs to be applied correctly by a healthcare professional in such a way that provides compression without constricting blood flow through the legs. The dressing and compression will need to be changed every week. Elevation, when combined with compression, will allow for circulation from the lower extremity to the heart to occur and will reduce the swelling. Once this is accomplished, the skin surrounding the open wound is able to close and heal.

Very serious cases of CVI may require surgery from a vascular surgeon. However, this is very rare. Bad habits, such as smoking and excessive drinking, should be discontinued to prevent delay in healing of the wound. Maintain a healthy lifestyle to keep blood flowing well through your legs.

Treating this condition can be a lengthy and arduous process. The compression might feel uncomfortable and will be tempting to remove. If this is the case, your doctor may recommend using an anti-inflammatory medicine to help with the pain. Keep in mind the importance of the compression to help heal your wounds. With proper recognition of this condition, and the right attitude, great improvements can be made to ensure that you are healthy again.