How Is A Venous Ulcer Treated
The Vascular Associates of San Diego team has extensive expertise in treating venous ulcers. First, they need to apply compression to your leg, and ensure the wound is clean, free of dead tissue, and has a specialized dressing to encourage healing.
To improve your circulation and help the venous ulcer to heal, they also need to treat the diseased vein causing the problem. Leg ulcers can take months or sometimes years to heal, but treating the problem vein produces faster and more effective results.
It also reduces your risk of developing an infection, which, if severe, could lead to amputation.
For expert assessment and treatment of your venous ulcer, call Vascular Associates of San Diego or book an appointment online today.
Other Types Of Leg Ulcer
Other common types of leg ulcer include:
- arterial leg ulcers caused by poor blood circulation in the arteries
- diabetic leg ulcers caused by the high blood sugar associated with diabetes
- vasculitic leg ulcers associated with chronic inflammatory disorders such as rheumatoid arthritis and lupus
- traumatic leg ulcers caused by injury to the leg
- malignant leg ulcers caused by a tumour of the skin of the leg
Most ulcers caused by artery disease or diabetes occur on the foot rather than the leg.
Page last reviewed: 11 January 2019 Next review due: 11 January 2022
Principles For Ulcer Prevention
The cornerstone of vascular ulcer prevention is to prevent skin damage and to reduce pressure on the feet. Skin damage prevention is primarily achieved with keeping the skin moist, often with emollients. In ambulatory patients, pressure reduction is achieved with proper shoe fit, checking the shoes before putting them on and proper padding. A good protocol for ulcer prevention in hospitalized, bed-ridden, patients is to off-load the feet with the following:
- Sheep skin under the lower extremities
- Toe separation by using lamb wool
- Prevention of pressure from above by using a specialized cage
- Heel off-loading with a rook-boot
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What Causes Venous Stasis Ulcers
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Venous skin ulcers are caused by poor blood circulation from the legs, such as from venous insufficiency. Your veins have one-way valves that keep blood flowing toward the heart. In venous insufficiency, the valves are damaged, and blood backs up and pools in the vein.
Secondly, how can venous stasis ulcers be prevented? Preventing venous ulcers
Similarly, you may ask, what is the best treatment for venous stasis ulcers?
Compression therapy has been proven beneficial for venous ulcer treatment and is the standard of care. Leg elevation minimizes edema in patients with venous insufficiency and is recommended as adjunctive therapy for venous ulcers. The recommended regimen is 30 minutes, three or four times per day.
What causes ulcers on the lower legs?
arterial leg ulcerscaused by poor blood circulation in the arteries. diabetic leg ulcerscaused by the high blood sugar associated with diabetes. vasculitic leg ulcers associated with chronic inflammatory disorders such as rheumatoid arthritis and lupus. traumatic leg ulcerscaused by injury to the leg.
To help treat a venous ulcer, the high pressure in the leg veins needs to be relieved.
What Is Vascular Wound Care
Vascular wound care is a type of treatment designed to promote the healing of vascular wounds while preventing further problems like infection. At Washington Vascular Specialists, Dr. Choudry and his team offer several different types of vascular wound care.For mild or moderate vascular wounds, Dr. Choudry might recommend a compression bandage or stocking. The pressure these garments encourage circulation and boost your bodys natural healing ability. To achieve the best possible results, Dr. Choudry might ask you to raise your leg for set periods of time throughout the day. This usually means propping your leg up for half-hour intervals 3-4 times each day.If you have a vascular wound thats infected by bacteria, Dr. Choudry might recommend taking prescription antibiotics. He might also wrap your vascular wound in a moist dressing to speed up the healing process.For serious vascular wounds caused by poor circulation or circulatory damage, surgical intervention may be necessary. Vascular surgery can improve the circulation in your legs, lowering your risk of complications in the future.
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Signs And Symptoms Of Venous Disease/ulcer
- Leg swelling, leg heaviness, and cramping
- Dark reddish/brown or purple coloring of the lower leg
- Dry, hard skin
- Itching and tingling
- Shallow open sores with a red base
- The sore has uneven edges at the borders
- Unpleasant odor from drainage
- The skin around the ulcer may be shiny and tight, warm or hot to the touch
- Leg pain
- Wounds take a long time to heal
What Is A Venous Leg Ulcer
A skin ulcer develops when an area of skin breaks down to reveal the underlying flesh. Venous leg ulcers are the most common type of skin ulcer. They mainly occur just above the ankle. They usually affect older people and are more common in women.
Venous leg ulcers are the most common type of leg ulcer, causing about 3 in 4 of all leg ulcers. They affect about 1 in 100 people in the UK at some stage in their lives. Venous leg ulcers become more common as you get older. Most are painless but some are painful. Without treatment, an ulcer may become larger and cause problems in the leg. Skin inflammation sometimes develops around a venous ulcer.
Non-venous skin ulcers are less common. For example, a skin ulcer may be caused by poor circulation due to narrowed arteries in the leg, problems with nerves that supply the skin, or other problems. The treatment for non-venous ulcers is different to that of venous ulcers.
The rest of this leaflet deals only with venous leg ulcers.
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Venous Leg Ulcer Risk Factors
There are multiple identified risk factors that are associated with the development of VLUs. The genetic makeup and environmental conditions can influence both the predisposition of an individual to develop venous disease and the progression and perpetuation of the disease.5 Hemochromatosis C282Y and some factor VIII V34L gene variations may be associated with increased risk and more severe forms of CVI, causing an increased size of venous ulcers.6 Other risk factors, including family history, age, sex, pregnancy, estrogen, patterns of sitting and standing, posture and obesity, may indicate a predisposition for CVI.5
How much do you know about venous leg ulcer management? Take our 11-question quiz to find out!
What To Expect After Treatment With Cvm
At CVM, we’re ready to help diagnose and treat your leg ulcers at our select wound care locations:
Our expert team will carefully consider all potential chronic pelvic pain causes, with a special emphasis of diagnosing any potential vascular disorders.
We provide complete chronic pelvic treatment for pain. Aside from implementing innovative techniques to treat your pain, including treatments for vascular issues, we’re committed to listening to your concerns and treating your pain seriously. Many of our patients go on to have significant improvement or resolution of their symptoms.
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Main Differences Between Arterial And Venous Ulcer
What Causes Vascular Wounds
Vascular wounds occur when you damage the skin on your leg, especially the thin skin surrounding your ankle. If the veins in your leg, which send blood back to your heart, arent pumping as they should, it can cause your blood to flow backward.This backflow of blood increases the pressure in your lower leg, causing your skin to weaken. This backflow also makes it harder for cuts, scrapes, or other wounds to heal. Vascular wounds can occur anywhere on your leg, but theyre most common near bony areas, such as your ankle.
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Arterial Vs Venous Ulcer
The difference between arterial and venous ulcers is that they arise due to different underlying reasons, which makes their symptoms, treatment, healing time, wound type, pain property, and many other characteristics different from each other. Although they are both ulcers, they differ from each other in a variety of ways.
An arterial ulcer is a type of chronic wound developed due to the damaging of skin tissue as a result of ischemia. Ischemia is a condition in which there is a lack of blood flow to the tissues from the heart. Since bringing blood to the different parts of the body is the work of the arteries thus the name arterial ulcer is given to this type of wound.
Venous ulcer is a type of chronic wound development due to damaging of skin tissue as a result of lack of proper circulation of the blood back to the heart or due to stagnation of the blood mostly associated with added pressures. Since veins are responsible for bringing blood back to the heart hence, this wound is called a venous ulcer.
What Is The Treatment For Venous Leg Ulcers
The ulcer is dressed in a similar way to any other wound. Typically, a nurse will do this every week or so. The wound is cleaned when the dressing is changed – normally with ordinary tap water. However, an ulcer is unlikely to heal with just dressings. In addition to a dressing, the following treatments help the ulcer to heal.
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How Are Stasis Ulcers Diagnosed
Stasis ulceration is usually a clinical diagnosis, made on the basis of the patients history and examination findings, and includes the presence of risk factors for venous stasis, that is, congestion and slowing of venous circulation, and the characteristic features of the wound and surrounding tissues.
- Duplex ultrasonography is used to confirm venous obstruction or valvular incompetence prior to saphenous vein ablation surgery
- Concomitant arterial disease is identified using the ankle-brachial index
Other investigations to evaluate venous insufficiency and provide haemodynamic information may include:
- Intravenous ultrasonography
- Haematological studies of the coagulation system.
Swelling In The Legs And Ankles
Venous leg ulcers are often accompanied by swelling of your feet and ankles , which is caused by fluid. This can be controlled by compression bandages.
Keeping your leg elevated whenever possible, ideally with your toes at the same level as your eyes, will also help ease swelling. You should put a suitcase, sofa cushion or foam wedge under the bottom of your mattress, to help keep your legs raised while you sleep.
You should also keep as active as possible and aim to continue with your normal activities. Regular exercise, such as a daily walk, will help reduce leg swelling. However, you should avoid standing or sitting still with your feet down. You should elevate your feet at least every hour.
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Controlling Pressure In The Leg Veins
Controlling swelling is essential for patients with venous leg ulcers. Leg elevation, with the feet at or above the level of the heart, several times throughout the day and while sleeping, can help reduce swelling. Compression wraps or bandages are often applied to the legs. These can be changed as often as multiple times a day or as infrequently as once a week, depending on the amount of fluid draining from the ulcer. Once the leg ulcer is smaller or nearly healed, elastic compression stockings may be recommended. Compression stockings are sized to fit the legs and are typically put on in the morning and worn throughout the day. A venous pump may be prescribed for patients with severe swelling.
How Are Leg Ulcers Diagnosed
To diagnose leg ulcers, the team at Heart Vascular and Leg Center conducts a physical exam, reviews your medical history, and asks about your symptoms and lifestyle. Afterward, your provider orders testing to pinpoint the underlying cause.
Depending on the size and severity of your leg ulcer, your provider might recommend a CT scan, MRI, vascular ultrasound, or X-rays. These diagnostic imaging procedures play a crucial role in developing a custom treatment plan.
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Diagnosis Of Leg Ulcers
- examine the wound
- perform some tests to measure the blood flow in your lower leg, such as the ankle-brachial index. This test compares blood pressure readings taken at the ankle and at the arm using a device called a Doppler machine
- recommend an angiogram for an arterial ulcer, to find out if the artery needs surgery to clear the blockage.
Treatment For Leg Ulcers
- cleaning the wound using wet and dry dressings and ointments, or surgery to remove the dead tissue
- specialised dressings a whole range of products are available to help the various stages of wound healing. Dressings are changed less often these days, because frequent dressing changes remove healthy cells as well
- occlusive dressings ulcers heal better when they are covered. These dressings should be changed weekly
- compression treatment boosts internal pressure, using either elasticised bandages or stockings. This is particularly effective if multiple layers are used
- medication includes pain-relieving medication and oral antibiotics if infection is present
- supplements there is evidence that leg ulcers may heal faster with mineral and vitamin supplements, but only if the person suffers from a deficiency. Zinc, iron and vitamin C may be used
- skin graft is a surgical procedure, where healthy skin is grafted onto the prepared wound site
- skin cancer and infection if ulcers fail to heal or if they increase in size, both these conditions will need to be ruled out
- hyperbaric oxygen this is now an accepted treatment for ulcers that resist other methods of healing, such as diabetic ulcers.
Identifying The Cause Of Venous Ulcers
The root of the problem is increased pressure of blood in the veins of the lower leg. This causes fluid to ooze out of the veins beneath the skin, followed by swelling, thickening, and damage to the skin. The damaged skin may eventually break down to form an ulcer.The increased pressure of blood in the leg veins is due to blood pooling in the smaller veins next to the skin. This pooling occurs because the valves in the larger veins are damaged by a previous thrombosis causing blockage of the vein, or by weakening of the walls of the veins causing the valves to malfunction,as in varicose veins. When the valves no longer function properly gravity causes blood to backflow down the leg in the erect individual and pool in the lower leg veins. This produces high pressure in the veins which results in damage to the surrounding tissue and ultimately to skin breakdown and ulceration.
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Skin Grafts And Artificial Skin
Two layers of skin created from animal sources as a skin graft has been found to be useful in venous leg ulcers.
Artificial skin, made of collagen and cultured skin cells, is also used to cover venous ulcers and excrete growth factors to help them heal. A systematic review found that bilayer artificial skin with compression bandaging is useful in the healing of venous ulcers when compared to simple dressings.
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Can Leg Ulcers Be Prevented
To prevent and promote healing of ulcers:
- Avoid injury, particularly when pushing a supermarket trolley. Consider protective shin splints.
- Walk and exercise for at least an hour a day to keep the calf muscle pump working properly.
- Lose weight if you are overweight.
- Stop smoking.
- Check your feet and legs regularly. Look for cracks, sores or changes in colour. Moisturise after bathing.
- Wear comfortable well-fitting shoes and socks. Avoid socks with a tight garter or cuff. Check the inside of shoes for small stones or rough patches before you put them on.
- If you have to stand for more than a few minutes, try to vary your stance as much as possible.
- When sitting, wriggle your toes, move your feet up and down and take frequent walks.
- Avoid sitting with your legs crossed. Put your feet up on a padded stool to reduce swelling.
- Avoid extremes of temperature such as hot baths or sitting close to a heater. Keep cold feet warm with socks and slippers.
- Consult a chiropodist or podiatrist to remove a callus or hard skin.
- Wear at least Grade 2 support stockings if your doctor has advised these. This is particularly important for the post-thrombotic syndrome, leg swelling or discomfort, and for long-distance flights.
- Have a vascular ultrasound assessment and consult a vascular surgeon to determine whether any vein treatment should be carried out.
- Horse chestnut extract appears to be of benefit for at least some patients with venous disease.
What Is Venous Ulcer
The identifying feature of a venous ulcer is its irregular appearance. The wound is granular in appearance and itchy, unlike arterial ulcers. This is caused when the blood from the leg is not returned to the heart and remains stagnant in the affected area.
The underlying cause thus does not always oxygenated blood to reach this area and hence cause tissue to almost undergoes oxygen starvation and hence crack up and bleed continuously. Usually, the site of occurrence of venous ulcers is the medial side of the leg and aspects such as the gaiter of the leg.
Sometimes hair may develop from the wound. Usually, they are also painless however show periodicity of pain. Usually, the pain is during the nighttime only. The affected area, however, remains warm, unlike arterial ulcers that occur cold to touch or perceive.
The risk factors of venous ulcers are pregnancy, diabetes, obesity, thrombosis, malnutrition, vein surgeries, varicose vein, and any such reason causing the blood to be stagnant in the area. Dilation of veins occurs at the leg, which is a common symptom of venous ulcers.
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