Venous Leg Ulcers

venous leg ulcer

Venous Leg Ulcers
A skin ulcer is where an area of skin has broken down and you can see 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 can be painless but some are painful.

What causes venous leg 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. This causes 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 collecting in the smaller veins next to the skin. The blood tends to collect and pool because the valves in the larger veins are damaged.

How is a venous leg ulcer diagnosed?

The appearance of a venous leg ulcer is usually fairly typical. It often looks different to ulcers caused by other problems such as poor circulation or nerve problems.
To rule out poor circulation as a cause, it is usual for a doctor or nurse to check the blood pressure in the ankle and in the arm. The ankle blood pressure reading is divided by the arm blood pressure reading to give a blood pressure ratio called the Ankle Brachial Pressure Index (ABPI). If the ratio is low (less than 0.8) it indicates that the cause of the ulcer is likely to be poor circulation (peripheral vascular disease) rather than venous problems.

Certain blood and urine tests may also be done to rule out conditions such as anemia, diabetes, kidney problems and rheumatoid arthritis which may cause or aggravate certain types of skin 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.

Compression bandaging

This is the most important part of treatment. The aim is to counteract the raised pressure in the leg veins. This gives the best chance for the ulcer to heal. The common method is for a nurse to put on 2-4 layers of bandages over the dressing. When the bandages are put on, the pressure is put highest at the ankle and gradually less towards the knee and thigh.

Elevation and activity

When you are resting, if possible, try to keep your leg elevated (raised) higher than your hip. This is particularly important if your leg is swollen. When you sleep overnight, if possible, try to keep your leg raised. You can do this by putting some pillows under the bottom of the mattress.

Other treatments

  1. Try to stop smoking if you are a smoker.
  2. Antibiotics are sometimes advised for short periods.
  3. Painkillers if the ulcer is painful.
  4. Skin care..
  5. Dietary advice if your diet is not very good..
  6. Iron tablets or other treatments if you are anaemic.
  7. Pentoxifylline improves blood circulation.
  8. A skin graft may be advised for a large ulcer, or for one that does not heal well.
  9. Surgery for varicose veins or other vein problems is advised in some cases.

What is the outlook (prognosis)?

Up to 7 in 10 venous ulcers heal within 12 weeks if treated with compression bandaging which is reapplied every week or so. If compression is not used and an ordinary dressing or compression stockings alone are used, the chance of healing is less.

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