Venous ulcer, also known as stasis ulcer, is an ulceration mostly found in the lower extremities just above the ankle region. It is often found in the elderly and occurs in women more than men.
Venous ulcers are caused due to increased pressure of blood in the lower extremities. As you age, valves of the larger veins can become damaged. Damage may also occur from previous blood clots and varicose veins. Gravity causes blood to flow back through the damaged valves and accumulate in the smaller veins in the legs lying beneath the skin. As pressure builds, fluid seeps out of the veins under the skin, resulting in inflammation, thickening, and damage to the skin. This then leads to skin breakage, eventually forming an ulcer.
Venous ulcers can be diagnosed in a clinical examination by performing an ultrasound scan. Blood and urine tests may be ordered to rule out other conditions, such as anaemia, diabetes, kidney disorders, and rheumatoid arthritis, which can worsen skin ulcers. Your doctor may also perform an Ankle Brachial Pressure Index (ABPI) to rule out peripheral vascular disease.
Depending on the severity of your ulcer, venous ulcer care can be conservative, medical, and/or surgical. Treatment aims at reducing oedema, hastening healing, and preventing recurrence of the ulcer.
Compression therapy is the mainstream treatment for venous ulcers. It neutralises the increased pressure in the leg veins and allows the ulcer to heal faster. Once the wound is dressed, 2-3 layers of bandages are applied over the dressing from ankle to thigh, in such a way that more pressure is applied at the ankle, gradually reducing towards the thigh. Compression stockings may be used as an alternative to bandaging, but is considered inferior to bandaging.
Keeping your legs elevated above the level of your heart, along with compression therapy, can help reduce oedema, improve circulation, and help in faster healing of the ulcer.
Special dressings are used beneath compression bandages to promote faster healing and prevent the bandage from sticking to the ulcer. A variety of bandages are available and your doctor will decide on the appropriate bandage for you.
Medications such as Pentoxifylline, Aspirin, Iloprost, Oral Zinc, Antibiotics/Antiseptics, along with compression therapy, can help improve circulation, prevent infections, and provide quicker healing of the venous ulcer.
Chronic ulcers that are difficult to be managed by conservative measures and medications will necessitate surgical management. Surgical options may vary from patient to patient. Some of the options include the following:
Dead tissue and bacterial burden are removed using sharp scissors or curettes. This type of procedure has been used for a long time in wound care to provide faster healing of the wound.
Large refractory venous ulcers can be treated by skin grafting. Skin grafting involves transplantation of the skin from a donor site to the diseased area. Healthy skin may be harvested from a different site from the same patient or another patient or artificial skin may be used for transplantation.
Surgery for Venous Insufficiency
Surgery aims to reduce venous reflux, accelerate healing, and prevent recurrence of the ulcer. Surgical options for treatment of venous insufficiency include destruction or removal of the saphenous vein; disrupting the perforating veins with subfascial endoscopic surgery; treatment of iliac vein obstruction with stenting; and removal of diseased superficial veins with phlebectomy, stripping, sclerotherapy, or laser therapy. However, surgery is only recommended as a last resort after using laser or foam sclerotherapy.
For more information about venous ulcer care, book an appointment with Dr. Luke Matar.