Lower Extremity Wounds: Venous Ulcers

Venous ulcers account for 70% to 90% of all chronic lower extremity (LE) ulcers. Their treatment is challenging. Onset usually occurs between the ages of 60 and 80 years. Around 7 million people suffer from LE venous disease in the US and 3 million of them will develop venous ulcers. The annual cost for the management of LE venous ulcers is between $2.5 and $3.5 billion. Education, support, and access to medical supplies are crucial in managing this condition.

What is Lower Extremity Venous Disease?

As blood flows into the veins of the LE, valves within the veins prevent a backflow of blood. The valves play an important role in the development of venous disease. The valves allow for a one-way upward blood flow back to the heart. It adds extra stress by traveling against gravity.

When the valves become weak or incompetent, blood flows back into the veins, creating increased pressure in the venous system. This pressure distends or stretches the walls of the veins, causing the blood to pool. Chronic pressure from swelling on the venous system causes the heme in the red blood cells to leak into the skin. This is called hemosiderin deposits or staining. The LE becomes reddish-brown in color.

What is a Venous Ulcer?

The backup of blood pooling into the LE builds pressure. This in turn causes excess fluid in the LE where an open sore can form easily. Venous ulcers usually occur above the ankle and below the knee. The start of an ulcer will appear as red and inflamed skin. This is often unnoticed because it looks like an insect bite or bruise. The inflamed area will progress and become weepy, leaking fluid. The affected skin starts to die, creating an ulcer. It will look deeper and continue with inflammation. At this stage, some may start to heal, often to re-open.

Once the wound has developed it may not heal on its own. It is best to contact your doctor for evaluation and instruction on caring for the wound. It is important to keep the wound clean as the risk for infection is high.

 

Signs and Symptoms of Venous Disease/Ulcer

  • Leg swelling, leg heaviness, and cramping
  • Dark reddish/brown or purple coloring of the lower leg
  • Dry, hard skin
  • Itching and tingling
  • Shallow open sores with a red base (The base may be covered with yellow tissue or film)
  • The sore has uneven edges at the borders
  • Unpleasant odor from drainage
  • The skin around the ulcer may be shiny and tight, warm or hot to the touch
  • Leg pain
  • Wounds take a long time to heal

Risk factors for Venous Disease/Ulcers

  • Varicose veins, history of blood clots, blockage of lymph vessels
  • Chronic venous insufficiency
  • Family history of venous disease
  • Obesity
  • Pregnancy
  • Smoking
  • Sitting or standing for long periods of time or a sedentary lifestyle
  • Diabetes and high blood pressure
  • Those with LE muscle damage secondary to fracture or burn injury

Venous Leg Ulcer Treatment - Compression Therapy

If you notice signs and symptoms of venous disease, there are some things you can do to decrease the risk of an ulcer. First, elevate your legs when sitting or lying down. This helps the fluid to be pulled by gravity to a higher point where it can be reabsorbed by the body. Second, wear compression stockings. Compression keeps fluid from accumulating in the LE.

If ulceration develops, treat it early.

  • Compression bandages can be worn for up to 7 days. They help reduce pain and swelling and help with the healing.
  • Elevate your feet above your heart as much as possible
  • Be active, walk daily. Exercise will improve blood flow
 

When to call your doctor?

It’s always a good idea to keep your doctor informed of changes in your health. If you are concerned you may have venous disease or are developing a venous ulcer, call for an evaluation.

Signs of infection include:

  • Redness of surrounding skin with increased warmth and swelling
  • Increased drainage that is cloudy or has odor
  • Bleeding
  • Fever or chills
  • Increased pain

Preventing Venous Ulcers

Some risk factors are modifiable. You can take steps to lower your risks. Simple lifestyle changes will help to improve blood flow and improve healing if you already have an ulcer. Here are some easy changes you can make:

  • Check your feet and legs daily for changes in coloration or skin breaks
  • Stop smoking. Nicotine is a vasoconstrictor and decreases blood flow
  • Lose weight if you need to. The goal is to keep your body mass index less than 25
  • Try to walk or exercise daily to increase blood flow to the LE
  • Eat a healthy diet, drink plenty of fluids and get a good night's rest
  • If you have venous insufficiency, elevate LE when possible
  • Wear compression stockings even if you do not have an ulcer

Managing venous disease and ulcers is a lifelong task. Maintenance includes the above-mentioned tips for preventing ulcers. The recurrence rate is high, so changes in lifestyle are important. Vein surgery can help heal chronic ulcerations and improve blood flow. Consider discussing with a vascular specialist.

 

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