Leg Ulcer Treatment
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What is a Venous Ulcer?
A venous ulcer (ankle ulcer) is an open sore or wound that is common in patients with venous disease. A venous ulcer occurs on or around the ankle, and may be referred to as an ankle ulcer. Patients suffer from pain, itchiness, and heaviness in the affected leg. The ulcer is slow to heal and may keep returning. Patients with venous insufficiency are at particular risk for developing this condition. Indeed, the portion of individuals with at least one ulcer is increasing, especially in older people and those with chronic illnesses1.
What Causes a Venous Ulcer?
Venous insufficiency is one of the major causes of venous ulcers 2. Venous insufficiency results from deficient valves, causing backflow of blood, and/or a blockage that causes blood to pool in the veins 3. The build-up of pressure produced when fluids accumulate in the ankle causes the skin to swell and rupture, and this is the process of ulceration. Poor blood flow also interferes with the skin’s ability to heal itself, leading to a chronic venous ulcers4.
Who Are at Risk?
Research shows that older people are more prone to developing venous ulcers. This could be because they are less active and their bodies do not work the way they used to before. You are at risk if you have or had2:
- Varicose veins or spider veins
- History of blood clot or deep vein thrombosis (DVT)
- Post thrombotic syndrome (PTS)
- Inflammatory disease
- Signs of obesity
- An inactive lifestyle
- A family history of ulcers
What are the Symptoms?
Venous ulcers can be painful and itchy depending on the size and severity. These are usually reddish, and if infected, may ooze yellowish or greenish fluid. Patients experience swelling in the area surrounding the ulcers. The skin feels tight and looks shiny because of the swelling.
How is it Diagnosed?
A careful clinical examination is necessary to find out whether the lesion is an ulcer or just an infected wound. The doctor will ask questions about your medical history. It is important to be open and forthcoming with the doctor. It can be helpful to keep a record of the symptoms that you have been experiencing; this information can help your doctor reach the correct diagnosis and plan the correct treatment.
How to Prevent Venous Ulcers (Ankle Ulcers)
You are more likely to reduce the risk of developing venous ulcers by reducing risk factors. Some risk factors are outside of your control, such as gender and age; however, maintaining a healthy weight, getting regular exercise, and reducing high blood pressure can reduce your overall risk. Walking is a good exercise to prevent venous ulcers, but also remember to elevate your leg and wear compression stockings as well if you have been diagnosed with venous disease.
How to Treat Venous Ulcers
The main purpose of venous ulcer (ankle ulcer) treatment is to heal the wound, relieve the pain and treat the infection, if there is any. Some treatments for ankle ulcers can be done at home, including elevation and exercise. Both of these activities help improve blood flow toward, through, and away from the affected area, which promotes healing5,6. Many doctors recommend using compression stockings or bandages to reduce the pressure in the leg veins and protect the lesion against infection. These products also serve as a dressing that allows the wound to heal faster. Stockings or bandages with higher compression tend to be more effective than low compression stockings. Likewise, multi-layer bandages perform better, on average, than single-layer bandages7.
Your physician or wound care nurse will give you instructions as to how to take care of your venous ulcer. Ulcers should be cleaned gently and thoroughly with mild, “non-soap” cleansers such as Dove or Olay. Once clean, the area can be treated with emollients and conditioners to minimize dryness and lubricate the skin. In some cases, a doctor must debride the ulcer, which means surgically removing dead and dying tissue8.
Various medications can be used to treat venous ulcers. These include medicines such as aspirin, stanozolol, pentoxifylline, and carboprostacyclin. Your doctor may recommend venous surgery to treat the root cause of the problem and alleviate the symptoms or complications. Skin grafting may be used to promote healing, prevent infection, and improve the look of chronic venous ulcers8.
Despite successful healing of venous ulcers, many patients suffer recurrence. It is important to understand if the ulcer is due to venous insufficiency. A special test, known as a duplex Doppler ultrasound, and other tests can help the doctor evaluate blood flow through the legs and determine if poor circulation is the underlying cause of the ulcer. The patient should also be evaluated to determine if the venous insufficiency is due to an obstruction. This is done through the use of various imaging modalities. Venous outflow obstruction is present in 60% of venous ulcer patients9.
Venous insufficiency with an obstruction can be properly treated with a stent. A stent is a small mesh tube that is placed inside the vein to open it back up again. Stenting can aid in the healing of ulcers and help prevent reccurrence.
VENITI provides a modern way to treat venous disease, including severe complications like venous ulcers. Contact us to inquire about this innovative treatment option and schedule a consultation.
- Lal BK. Venous ulcers of the lower extremity: Definition, epidemiology, and economic and social burdens. Semin Vasc Surg. Mar 2015;28(1):3-5.
- Vlajinac H, Marinkovic J, Maksimovic M, et al. Factors related to venous ulceration: a cross-sectional study. Angiology. Oct 2014;65(9):824-830.
- Eberhardt RT, Raffetto JD. Chronic venous insufficiency. Circulation. Jul 22 2014;130(4):333-346.
- Comerota A, Lurie F. Pathogenesis of venous ulcer. Semin Vasc Surg. Mar 2015;28(1):6-14.
- Abu-Own A, Scurr JH, Coleridge Smith PD. Effect of leg elevation on the skin microcirculation in chronic venous insufficiency. J Vasc Surg. Nov 1994;20(5):705-710.
- Padberg FT, Jr., Johnston MV, Sisto SA. Structured exercise improves calf muscle pump function in chronic venous insufficiency: a randomized trial. J Vasc Surg. Jan 2004;39(1):79-87.
- Dale JJ, Ruckley CV, Gibson B, et al. Multi-layer compression: comparison of four different four-layer bandage systems applied to the leg. Eur J Vasc Endovasc Surg. Jan 2004;27(1):94-99.
- Collins L, Seraj S. Diagnosis and treatment of venous ulcers. Am Fam Physician. Apr 15 2010;81(8):989-996.
- Marston W, Fish D, Unger J, Keagy B. Incidence of and risk factors for iliocaval venous obstruction in patients with active or healed venous leg ulcers. J Vasc Surg. 2011;53:1303-1308.
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