Venous Ulcers
Summary
Venous Ulcers breakdown area of the skin which typically forms on the inside of the lower leg as a result of poor venous blood flow. Often, an ulcer is preceded by lower limb swelling (edema). Use of compression stockings and increases in physical activity may help prevent progression to a venous ulcer.
Treatment consists of compression dressings, removal of dead tissue. To prevent recurrence patients should wear compression stockings, increase physical activity as able, and elevate their legs when sitting.
Clinical Presentation
The heart pumps oxygenated blood via arteries (arterial system) throughout the body including down to the lower legs and feet. Veins are the blood vessels that allows blood to return back to the heart (venous system). This return of blood back to the heart via the venous system is aided by valves within the veins and contraction of the lower extremity muscles, both of which help ensure that blood keeps moving back to the heart.
Venous ulcers occur because of prolonged high blood pressure in the veins of the legs leading to swelling and tissue injury. Normally, valves within the veins maintain a low pressure and only allow blood to flow back towards the heart. Failure of a valve within a vein increases pressure and impairs the forward flow of blood within the venous system. This inefficient venous blood flow can lead to a lack of oxygen in peripheral tissues which can degenerate and form an ulcer. Venous ulcers typically form along the inside of the lower leg, whereas arterial ulcers normally form at the tips of the toes.
Formation of an ulcer is often preceded by lower limb edema (swelling from fluid buildup).
An associated infection of the venous ulcer is common. Signs include redness and swelling around the ulcer, fever, and green, foul smelling discharge may also occur.
Treatment
Various forms of compression bandages (or compression socks) may be used to help decrease lower leg swelling and improve local circulation thereby allowing the ulcer to heal. However, patients may need to remove their compression bandages or socks if they notice numbness, tingling, pain, or blue/purple discoloration of the toes.
Physical activity will also help improve blood flow as the muscles of the calves pump blood as they contract helping to improve the venous circulation. Some form of compression socks should be worn during physical activity as well.
In some cases, removal of dead tissue (debridement) may speed the healing of the ulcer. If other treatments fail, skin grafting or removal of the entire ulcer followed by skin grafting, may be an option. Venous ulcers have a high rate of recurrence. To prevent another ulcer care should be taken to wear compression stockings, elevate the legs when sitting, and perform regular calf exercises.
Edited July 12th, 2020