What causes venous leg ulcer?

Venous leg ulcers result from progression of venous disease, notably chronic venous insufficiency (CVI).

Chronic venous insufficiency is a condition that occurs when the venous walls and/or valves in the leg veins are damaged or not working effectively.

The valves should ensure that blood flows up the leg,not down. If they are not closing properly, the blood stagnates in the veins, resulting in very high pressure in the veins when in an upright position.

This constant high pressure can gradually damage the tiny blood vessels in your skin, leading to leakage of blood into the tissue. This eventually leads tolocal inflammation of the tissue.

A minor injury can open a leg ulcer

A venous leg ulcer can develop after a minor injury if there’s a problem with the circulation of blood in your leg veins and a local inflammation of the tissue has started to develop. As a result, your skin can easily break and form an ulcer after a knock or scratch.

How is venous leg ulcer diagnosed?

For all ulcer patients, it is recommended to take a close look at the medical history:

• personal or familiar history of varicose veins, treated or not
• personal or family history of deep vein thrombosis and/or superficial vein thrombosis and/or pulmonary embolism
• personal history of significant trauma or lower limb surgery
• a previous venous ulcer
• presence of diabetes

Your health care professional will examine your leg, both when you’re standing up and lying down. 

They’ll also feel your pulse at the ankles to make sure the arteries in your leg are working properly. To rule out peripheral arterial disease (a condition affecting the arteries) as a possible cause of your symptoms, your health care professional will carry out a test known as a Doppler study.

Further examinations might be done in order to assess the blood flow in your veins.

What is the treatment for leg ulcer?

If you are diagnosed with venous leg ulcer, you are probably already working closely with a wound clinic or your physician and a certified fitter in the management of the wound.

Control and heal the wound: medical compression plays an important rule

The primary treatment of a venous leg ulcer includes controlling any infection and healing the wound. This may take several months, depending of the size of the wound. Managing pain and minimizing the edema as well as protecting the healthy skin are important.

Compression helps to improve vein circulation in your legs and to treat swelling. It plays an important role in the healing of your wound and in post-wound care.

Traditionally, short-stretch compression bandages are used in the initial phase of treatment of large ulcers until healing is nearly complete or the patient can be fitted in a knee-length graduated compression stocking at 30-40 mmHg or higher.

Compression stocking systems

Also, compression stocking systems are available. They consist of a normal compression stocking and a patented low-compression understocking. These systems offermany benefits above and beyond those of bandages:

• Easy to don, meaning that assistance with compression treatment is not required in many instances
• Comfortable and discreet, even with shoes
• No unpleasant pressure when lying in bed, as only the patented understocking is worn at night
• The understocking keeps the wound dressing in place while you are sleeping
• No damage to the wound when applied correctly – neither when donning nor doffing the stocking

Summary

Leg ulcer is the most serious consequence of venous disease.

Basic medical knowledge on venous disorders

• With the term Chronic Venous Disorder (CVD) we describe a long-standing condition involving impaired venous return.
• If vein valves don’t close properly, a reflux results: the blood leaks downwards and stagnates in the vein, thereby leading to venous hypertension. This condition is known as chronic venous insufficiency (CVI) which may cause edema, skin change, and, in some cases, ulcerations.
• If left untreated, chronic venous insufficiency can result in the formation of serious disorders, including phlebitis and pulmonary embolism. To distinguish the different manifestations of CVD, the CEAP classification system is used.
• Acute venous disorders usually occur without pre-existing conditions, but they can also be triggered by chronic venous disorders. In any case, medical treatment is immediately required. Acute venous disorders include superficial thrombophlebitis, deep vein thrombosis (DVT), pulmonary embolism, post-thrombotic syndrome, and variceal bleeding.