#ulcers #legs - Chronic Venous Ulcers: an overview.

Venous leg ulcers are the commonest cause of chronic, non-healing ulcers of the leg. They occur in adults, males and females, and can take a long time to heal. There are many other causes of chronic leg ulcers and an evaluation by a doctor is needed to make sure the diagnosis.

The legs veins are responsible to return the blood from the lower extremities to the heart, helped by valves that ensure the “one-way” upward flow of blood. In many patients with venous leg ulcers, these valves do not work properly, causing accumulation of venous blood in the lower legs. This can lead to swelling and darkening of the skin, and eventually to the development of venous leg ulcers.

Risk factors include:

1. past history of a blood clot in the leg veins (deep vein thrombosis)
2. lower leg injury
3. varicosities
4. obesity
5. smoking
6. prolonged standing
7. difficulty for walking, because of the loss of calf-muscle pump action. 

Most patients with venous leg disease complain of local pain and swelling, especially towards the end of the day. The skin becomes dark brown or red in colour; an itchy red rash with scaling and crusting can also occur. Small or large varicose veins can be seen. Venous leg ulcers are often located just above the ankle. They are usually wet,oozing and very painful.

Once the diagnosis is confirmed, venous leg ulcers can be treated effectively by good wound care and the use of compression therapy. The latter can improve the venous flow and decrease the swelling of the legs. Compression therapy usually consists of special “elastic” bandages. The arterial blood supply of the lower limbs must be adequate (and checked to be so) before compression therapy is started.

Once the leg ulcer is healed, it is important to prevent recurrences by wearing support stockings, which must be replaced every 3 to 6 months or as soon as they lose their elasticity. Other important measures include:

1. good skin care and hydration
2. regular exercise
3. weight management
4. stopping smoking
5. leg elevation above the level of the heart when lying down.