What is a Venous Leg Ulcer?
A Venous Leg Ulcer is an open wound that usually forms near the ankle due to chronic poor circulation. The ulcer has a weeping, raw appearance and the skin surrounding the ulcer is dry, itchy, and reddish-brownish in color. Venous leg ulcers are usually slow to heal.
According to an article in the American Journal of Surgery, venous leg ulcers account for 85 percent of all lower-extremity ulcers, with treatment costs of $3 billion and more than 2 million lost workdays per year. A venous leg ulcer is one of the most serious results of the progression of chronic venous insufficiency. This often-painful open wound affects the quality of life of patients and is slow to heal.
Ulcer patients interact directly with a wound clinic or physician and a certified fitter in the management of the wound. Compression plays an important role in the healing of a wound and certainly in the post-wound care. Once your wound is healed, you should wear graduated compression stockings for life.
What causes a venous ulcer?
According to Dr. David Ross in article published in Northeast Florida Medicine in 2012, "over 70 percent of chronic wounds in the lower extremities result from venous disease." The article also states that compression stockings are helpful in preventing ulcers.
When suffering from chronic venous insufficiency, the vein wall becomes stretched and weakens, the valves do not close. This starts the cascade of reflux and pooling which does not correct itself and only continues to worsen over time (another cause of valve incompetency is a blood clot). Once the blood seeps through the vein wall and into the tissue it can then go through the fragile skin and become an open leg ulcer.
Venous leg ulcers are often chronic and difficult to heal. In fact, the recurrence rate of venous leg ulcers is 72 percent. They commonly appear on the inside of the leg (medial) above the ankle. They are shallow and can be painful. Swelling in the lower leg often occurs. There is often brownish discoloration of the skin due to the leakage of the iron-containing pigment in red blood cells (hemosiderin) into the tissue. 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. Caution regarding arterial ulcers: approximately 10-20 percent of ulcers are arterial ulcers. Arterial ulcers typically appear on the outside of the leg, whereas venous ulcers usually appear on the inside of the leg. Your physician can help determine the type of ulcer you have and best treatment.
A visual assessment is done first and the wound size is recorded. Patients may also have a Doppler Ultrasound exam, a contrast venogram (X-ray test that takes pictures of the blood flow) or impedance plethysmography.
What is the treatment for a venous leg ulcer?
The primary treatment includes controlling the infection and healing the wound. A wound heals slowly and may take many months, depending of its size. Managing pain and minimizing the edema as well as protecting the healthy skin are also important during treatment. Steps to improve venous flow should be taken. Traditionally, short-stretch compression bandages are worn postoperatively until healing is nearly complete, after which the patient is fitted in a knee-length graduated compression stocking at 30-40 mmHg or higher. Only your physician will be able to assess your condition and prescribe the most effective treatment.
Nearly 80 percent of venous leg ulcers can be healed with good wound management. The recurrence rate of a venous ulcer after treatment approaches 70 percent. Once the leg ulcer is healed, the patient should wear a minimum of 30-40 mmHg SIGVARIS medical graduated compression stocking for life to aid in non-recurrence of the ulcer.
Note: Graduated compression stockings are CONTRAINDICATED for severe arterial insufficiency.
The SIGVARIS Cotton Underliner and Natural Rubber products are often prescribed for patients with ulcers. The SIGVARIS Cotton Underliner is useful for layering stockings. Patients may also wear the SIGVARIS Cotton Underline at night to keep dressings in place and to make donning medical compression stockings easier the next morning.
Sources: Ross, David S. Venous Stasis Ulcers: A Review. Northeast Florida Medicine. Vol 63, No. 2 2012. Nelzen O, et al. Venous and non-venous leg ulcers: Clinical history and appearance in a population study. Br J Surg. 1994;81:182. National Institute of Health. BMJ 2004 June 5; 328(7452): 1385-1362