What are venous leg ulcers?

Venous leg ulcers are sores that develop after veins in the legs have been damaged and occur due to improper functioning of valves in the veins. They are the major cause of chronic wounds, occurring in 70% to 90% of chronic wound cases. They often can be deep, are common in the elderly, become infected easily, and may become malignant along the edges. They are common, costly to treat, and respond best to early diagnosis and treatment.

Venous insufficiency results from inadequate function in any of the following: Superficial veins, deep veins, bicuspid valves allows backflow of blood which leads to oedema of the lower extremities after resulting in venous leg ulcers.

The other types of leg ulcers (which account for the remaning 10%-30%) are arterial ulcers, diabetic ulcers, pressure ulcers, and ischaemic ulcers. Other less common causes include trauma, inflammation, malignancies, metabolic conditions, and infection.


Symptoms of venous leg ulcers

- swollen leg
- the skin surrounding a venous ulcer is dry, itchy and sometimes brownish in colour
- eczema may appear (varicose eczema).
- the ulcer has a weeping, raw appearance and is usually painless unless infected.
- venous leg ulcers are often located just above the ankle, typically on the inside of the leg.


What are the Causes of Venous Ulcers?

The following conditions indicate an increased risk for venous ulceration:

- Varicose veins
- High Blood Pressure
- Phlebitis (inflammation in the deep veins)
- Multiple pregnancies
- Lower-limb oedema
- Fractures or Injuries
- Previous vein surgery
- Sitting or standing for long periods
- Obesity
- Old leg ulcers that may have damaged part of the venous system
- A family history of venous disease/ deep vein thrombosis


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 it indicates that the cause of the ulcer is likely to be poor circulation rather than venous problems. This is very important to know as the treatments are very different. (An ABPI may be checked every six months or so to make sure the circulation to the legs remains good.)

Routine blood and urine tests may also be done to rule out anaemia, diabetes, kidney failure, arthritis, etc, which may cause or aggravate certain types of skin ulcer.


How are venous leg ulcers treated?

Treatment depends on the factors that cause the ulcer or have prevented healing. Once these factors are under control, for example the blood sugar level in diabetes, the ulcer should heal by itself.

Treatment may involve wound cleansing, anti-inflammatory treatment and application of dressings.

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. However, an ulcer is unlikely to heal with just dressings. In addition to a dressing, there are other treatments to help the ulcer heal.

The cornerstone of therapy for venous ulcers is the use of compression in the form of gradient compression therapy. The leg may be wrapped in a boot-like dressing that offers both medication soothing to the skin and compression. The usual method is for a nurse to put on 3-4 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. These are generally changed weekily along with the dressing on the ulcer.

Oral antibiotics are prescribed if there is infection and topical steroids are sometimes used for the surrounding skin irritation and painkillers may be prescribed if the ulcer is causing pain.

Elevation of the affected leg is also said to help in the treatment of venous leg ulcers, especially if the leg is swollen. This helps reduce the swelling thereby reducing the pressure of the blood in veins of the leg.

In some instances a skin graft may be advised if the ulcer is not healing or is particularly large.

Certain lifestyle changes may help if diagnosed with a venous leg ulcer such as trying to stop smoking if you smoke, ensuring that the skin surrounding the ulcer is well moisturised and as healthy as possible as the skin is often dry and scaly. It is also important to ensure that you have a well balanced, healthy diet.

Unfortunately In the long term leg ulcers have a tendency to recur in elderly people, and sometimes may require years of therapy.

For further help and information click on Venous Leg Ulcers to take you to the The Circulation Foundation