Venous leg ulcers are, by far, the most common form of ulcers affecting the lower extremities. They represent a severe form of venous disease and may be the end-stage of chronic venous insufficiency. Venous ulcers occur most commonly at the ankles and involve an open wound. Venous ulcers can have a very significant impact on quality of life, with major disability and social impairment. Since this is a condition that often doesn’t heal without treatment, it tends to be chronic, frequently relapses, and thus causes massive health care expenditures.
Venous ulcers typically occur within areas of dark, reddish-brown skin that are hard and feel warm to the touch. The area may be very painful and may itch continuously. White scar tissue may also develop in the area as well.
Cause of Venous Leg Ulcers
Venous ulcers are usually caused by varicose veins and chronic venous insufficiency, and may occur after the above conditions have existed for some time. Venous reflux (or valve failure) or other vein conditions can lead to increased pooling of blood, causing venous hypertension (increased pressures in the veins of the lower leg), which leads to the pooling of blood. These venous conditions may come from more superficial veins (like varicose veins), deeper veins (related to deep vein thrombosis or DVT) or from perforator veins, which connect the veins of the superficial and deep vein systems. When these high pressure conditions exist, fluid can leak out into the surrounding tissues, inflammation of the tissues occurs, and the normal transfer of nutrients and oxygen to the tissues is impaired. Over time, the diminished level of nutrients and oxygen and the inflammation created causes damage to the surrounding tissues, which can result in skin discoloration and tissue death.
It is critical that venous ulcers be treated appropriately by a vein specialist. Diagnostic testing will help to determine the particular pattern of diseased veins causing the problem. Treatment will typically involve attempts to reduce the swelling in the area and the pressure in the veins. Possible treatments often include wound dressings,compression stockings or bandages, varicose vein treatments (e.g., VNUS procedure) and/or a special cast-like boot (called an ‘Unna boot’). In severe cases, a skin graft to replace damaged tissue may be warranted.