Venous ulcers are a type of skin ulcer that the legs are more prone to contracting thus the ulcer being more commonly referred to as venous leg ulcers. They are also known as stasis ulcers, gravitational ulcers, or varicose ulcers- though the latter is inappropriate if varicose veins are not present. Skin ulcers develop when a patch of the skin disintegrates resulting in a wound. The most common form of skin ulcers are the venous leg ulcers and occur mostly right above the ankle. They are more likely to affect older people and are more common in women. Reports indicate that 1 in 1000 people will get these ulcers at some point in their lives. This condition becomes more common as you get older. Statistics indicate that 20 in 1000 people will have been affected by these ulcers by the time they are hitting their 80s. They are mostly painless but painful cases have been reported. If not treated in time, the ulcer may become bigger and cause you to have leg problems. Often, a skin inflammation (dermatitis) may develop around the ulcer.
Non-venous ulcers of the skin, however, are less common. For instance, a skin ulcer might be as a result of poor blood circulation because of narrowed arteries in the leg, issues with nerves in the skin, or other problems. Therefore, the treatment for venous ulcers is different to that of non-venous ulcers.
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Causes of Venous Leg Ulcers
The main cause of this condition is the increased blood pressure in the blood vessels of the lower leg. This results in fluid oozing out of the vessels underneath the skin. It will be evidenced by the subsequent thickening, swelling, and damage to the skin. This damaged skin will eventually disintegrate to form an ulcer.
The increased blood pressure in the lower leg veins is because of blood collecting in the smaller veins right below the skin. This pooling and collecting of the blood are due to the damaging of the valves in the larger veins probably because of previous thrombosis (blood clot) in the vein, or varicose veins. The blood will tend to flow back because of gravity through the damaged vessels and pools in the lower veins.
Diagnosis of Venous Leg Ulcers
The venous leg ulcer appearance is often typical. It usually looks different to other types of ulcers caused by issues such as nerve damage or poor circulation. So as to rule out poor blood circulation as the cause, a doctor will normally check the blood pressure in the arm and ankle. The reading given by the ankle blood pressure is then divided by the reading given by the arm to give a ratio of the blood pressure known as the Ankle Brachial Pressure Index (ABPI). If the ratio is less than 0.8, it is classified as low and this indicates that the ulcer is likely caused by poor circulation (peripheral artery disease) rather than issues in the vein. This is crucial to know as the treatments to the conditions are very different. It is recommended that you check your ABPI every six months so as to be sure that the blood circulation in your legs remains good.
Urine and blood tests may also be taken to rule out disorders such as diabetes, anemia, rheumatoid arthritis, and kidney problems, which may aggravate or cause other types of skin ulcers.
In certain cases, you may be required to undergo an ultrasound, CT or MRI scan to show a detailed image of the circulation in your leg.
The ulcer is typically dressed just like any other wound. However, it needs to be dressed every week. During each dressing, the wound is cleaned; normally with ordinary water. It is however unlikely that the ulcer will heal with just dressings. So in addition to being dressed, the following treatments are recommended to help the ulcer heal:
• Compression Bandaging
It is the most fundamental part of the treatment. Compression bandaging aims to counteract the high blood pressure in the leg veins. It gives the ulcer the best chance of healing. This is normally done by applying 2-4 layers of bandages over the wound dressing. When the bandage is applied, the pressure is applied highest on the ankle and progressively lowers towards the knee and thigh. These bandages are reapplied every week and it is recommended that the bandages are applied after you have had your leg elevated for several hours or overnight. Make a point of keeping your leg elevated before it is re-dressed.
It is worth mentioning that if you notice your foot changing color or the pain increases, it could be a sign that the compression is too tight and you’re advised to see your doctor.
• Elevation and Activity
When resting, it is recommended that you keep your leg raised higher than hip level. This aims to assist gravity in pulling the blood towards the right direction; the heart. It will reduce the blood pressure in the leg veins and thus the swelling will reduce. If possible, set four periods a day of 30 minutes each where you lie with your leg raised. However, do not spend your entire day resting; go about your routine as normal but avoid standing still for extended periods. Keep your leg raised when sleeping too.
Other treatments to assist in the healing of a venous leg ulcer include:
• Avoid smoking
• Ask for antibiotics
• Skin care if the skin is inflamed.
• Dietary advice as extra weight often facilitates the development of the ulcer.
If properly dressed and compression bandaging applied every week, the ulcer should heal within 12 weeks.
Often, even after the ulcer has healed, there is a chance of reoccurrence. To avoid this, you are advised to wear a compression stocking during the day for at least five years. It will counteract the increased blood pressure that causes this condition. Replace the stocking every six months at your local pharmacist.
Proper treatment of venous ulcers plus the proper support of the treatment will go a long way in ensuring that the condition does not recur. Also, surgery is recommended for varicose veins after the ulcer heals to avoid a recurrence.