What are venous ulcers?
Venous ulcers, or venous stasis ulcers, are considered the most severe symptoms of chronic venous disease, where the legs develop open wounds that either healing poorly or not healing at all. On the CEAP classification it is the is the last severity group C6.
What causes venous ulcers?
Chronic venous disease of all forms can cause venous stasis ulcers. The most frequent cause is chronic venous insufficiency, where the valvular functions in the leg veins are abnormal, cause venous blood to reflux back toward gravity. This results in chronic swelling and venous hypertension in the lower legs, which in turn promotes inflammation in the skin. Over time, the inflamed skin simply cannot keep up with the chronic damage, resulting in open wounds.
Other causes of venous hypertension including DVT and May-Thurner Syndrome. DVT is an obstructive process where the veins are congested due to blood clots. May-Thurner Syndrome has features of both obstructive and reflux etiologies and is often an overlooked condition that requires an experienced vascular surgeon to properly diagnose the treat.
What are the risk factors for venous stasis ulcers?
The risk factors for venous ulceration includes family history, female gender, advanced age, obesity, inactivity, prolonged standing, peripheral arterial disease, and history of venous blood clots (DVT) or post-thrombotic syndrome.
What are the symptoms of venous ulcers?
The symptoms of venous ulceration are usually obvious. The open wounds in the legs are often painful and sensitive to any manipulation. There may be signs of chronic inflammation such as redness around the wounds. The wounds are often covered in a thick, yellow slough called biofilm, which is a layer of bacteria that colonized the surface.
Because venous stasis ulcers are always exposed to skin bacteria, the patient may get severe infections such as cellulitis and even sepsis. Although rare, extreme infections may lead to leg amputation or even death.
What are the treatments of venous ulcers?
Treatments for venous ulcers require a multimodal approach:
- Wound Care: Local ulcer care with periodic cleaning and proper dressing is paramount in preventing infection and promoting healing. If a wound is dirty, the body will attempt to wall-off the bacteria rather than trying to close up the wound.
- Compression: Compression stockings or dressings are cornerstone of venous stasis wound management. Compression reduces skin swelling and therefore its inflammation, thus controls the mechanism that drives wound development. Although there is no official consensus in how this should be accomplished, a recent review of treatment algorithms highlights this universal element in treating venous stasis ulcers.
- Venous Disease Treatment: Venous ulcers can be devastating to one’s health, lifestyle, and finances. As such, it is recommended that venous ulcers to be treated aggressively. Although compression is central to the treatment paradigm, it in and of itself does not correct the underlying issue. Any underlying venous and arterial disease should be evaluated by a vascular specialist
- Lifestyle Promotion: Weight loss, increased activity, and other healthy habits play a role in promoting healthy circulation and wound healing.
- Medications: Antibiotics may be indicated if there is wound or skin infection that is not controlled. Pentoxifylline is a medication with microcirculation properties and has proven to increase healing rates of venous ulcers in conjunction with compression therapy. Pentoxifylline’s mechanism of action, however, is not well understood. Steroids may be used occasionally to help decrease skin inflammation and promote wound healing.
How do I know what treatment I need for my venous ulcers?
Venous ulcer diagnosis and treatment may be complex, but you do not have to pick your treatment on your own! Our board-certified vascular surgeons are trained diagnose and manage this serious condition.
If you have chronic venous disease and venous stasis ulcers, please do not wait to contact us. Even if the ulcers heal on their own, their recurrence is extremely high if the underlying condition is not corrected.