Explore causes, effective treatments, and prevention strategies for venous leg ulcers. Trust Meri Sehat for comprehensive health insights.

Venous Leg Ulcers

A. JABBAR DENTAL CLINIC KARACHI

Sadia Khan

Overview

Venous ulcers are open sores that occur when the veins in the legs are not pushing the blood back up to the heart as efficiently as they should. 
&nbsp;

Venous leg ulcers (VLUs) typically occur on the medial side of the lower leg between the ankle and the knee, recur frequently, and take more than 2 weeks to heal.<a href="#accordion">[13]</a>

Studies suggest that VLUs are the most common type of leg ulcers, accounting for nearly 80% of all cases.<a href="#accordion">[12]</a>&nbsp;It is estimated that around 1 in 50 people aged 80 and above has one.<a href="#accordion">[15]</a>

A recent survey showed that the population affected by VLUs was almost the same in different regions of the world &ndash; 1.27% (Asia), 1.67% (Western Europe), 2.87% (Eastern Europe), and 3.97% (Latin America).<a href="#accordion">[14]</a> 
&nbsp;

Sign and Symptoms

These include:

<ul>
	<li>Open, shallow wound with irregular edges</li>
	<li>Surrounding skin is hard and discolored</li>
	<li>Dull or throbbing pain in the affected leg</li>
	<li>Itching and tingling</li>
	<li>Varicose veins</li>
	<li>Varicose <a href="https://merisehat.pk/disease/eczema">eczema</a></li>
	<li>Edema or swelling, usually worsens at night and improves with leg elevation</li>
	<li>Foul odor</li>
	<li>Pus or other fluid oozing out from the sore 
	&nbsp;</li>
</ul>

Causes

The lower leg veins have one-way valves that pump blood toward the heart. When the veins become blocked or scarred, or these valves become weak, it can cause blood to reflux or pool in the legs just below the ankle. This is called venous insufficiency. The persistently high pressure in these veins, along with the buildup of fluid, deprives tissues of essential nutrients and oxygen. As a result, the cells die, and a wound develops at the site. 
&nbsp;

Other causes include:

<ul>
	<li>Some skin conditions</li>
	<li>Infection</li>
	<li>Peripheral vascular disease</li>
	<li>Cancer</li>
	<li>Leg injury 
	&nbsp;</li>
</ul>

Diagnosis

The diagnosis of VLUs involves a comprehensive evaluation of the patient&#39;s medical history, clinical presentation, and diagnostic tests.

The healthcare practitioner will ask about the patient&rsquo;s history to assess if the ulcer is due to any other underlying condition. They will also ask about the physical activity, occupation, weight changes, and injuries the patient has sustained recently. Medical history includes reviewing blood clots and other related issues, along with any medications the patient is taking.

They will then examine the ulcer, evaluating its size, location, appearance, duration of the wound, skin condition around the wound, and range of motion while the individual is lying down or standing up. 
&nbsp;

Doctors may suggest the following tests to diagnose VLUs:

<ul>
	<li>Wound swab culture in case there is suspicion of infection</li>
	<li>Doppler ultrasound to identify venous reflux, deep vein thrombosis, and arterial insufficiency</li>
	<li>Biopsy to rule out other causes of non-healing wounds, such as malignancy or vasculitis 
	&nbsp;</li>
</ul>

Treatment

It is crucial to get venous ulcers checked and treated immediately by a doctor to heal and prevent infection. They don&rsquo;t heal naturally, and the longer the treatment is delayed, the greater the likelihood of permanent damage to the surrounding tissue.

<ul>
	<li>Wound Cleaning And Dressings: The wound should be cleaned every day to remove dead tissue and bacteria. Also, special dressings ensure the level of moisture in the wound is enough to promote healing and reduce inflammation. 
	&nbsp;</li>
	<li>Compression Therapy: Compression bandages or compression stockings apply external pressure to the leg to improve circulation and reduce pain and edema. 
	&nbsp;</li>
	<li>Medications: Topical medications, such as antimicrobial ointment, can help manage infection. Systemic medications, such as antibiotics or pain relievers, may also be prescribed. 
	&nbsp;</li>
	<li>Other Treatments: In cases where the VLUs are not responding to standard therapy, other options such as skin grafts and venous procedures (e.g., sclerotherapy or ablation) may be needed to close the wound. 
	&nbsp;</li>
	<li>Home Care Measures: A healthy lifestyle can help accelerate the healing process. It includes walking regularly, wearing comfortable and well-fitting footwear, and being careful not to injure the affected leg. 
	&nbsp;</li>
</ul>

Untreated or poorly managed, VLUs may include:

<ul>
	<li>Reduce quality of life as it becomes dangerous or difficult to perform daily activities with an open wound, increasing frustration, depression, and anxiety</li>
	<li>Developing resistant bacteria in case of frequent use of antibiotics</li>
	<li>High recurrence rate and life-threatening infections</li>
	<li>Amputation in case of nonhealing ulcers 
	&nbsp;</li>
</ul>

The most common risk factors include:

<ul>
	<li>Age, with older individuals being more susceptible</li>
	<li>Underlying conditions like deep vein thrombosis, diabetes, paralysis, and obesity</li>
	<li>Family history of venous disease</li>
	<li>Previous fracture or injury</li>
	<li>Surgery (e.g., knee replacement)</li>
	<li>Lifestyle, with individuals who sit or stand for long periods (usually for work) being more susceptible</li>
	<li>Pregnancy 
	&nbsp;</li>
</ul>

The following measures can help reduce the risk and promote leg health:

<ul>
	<li>Take regular breaks, move around, or engage in physical activity</li>
	<li>Reduce weight (if obese or overweight)</li>
	<li>Raise the legs above the heart level for a short time</li>
	<li>Avoid smoking</li>
	<li>Take blood thinners (if prescribed) and manage other chronic conditions like blood pressure, sugar, and cholesterol levels</li>
	<li>Keep the skin of the lower legs well-moisturized 
	&nbsp;</li>
</ul>

Key Points

<ul>
	<li>Venous ulcers are open sores that occur when the veins in the legs are not pushing the blood back up to the heart as efficiently as they should.</li>
	<li>The characteristic signs and symptoms of venous leg ulcers include open wounds, edema, and skin changes.</li>
	<li>The main cause of venous leg ulcers is venous insufficiency.</li>
	<li>Diagnosis of venous leg ulcers is based on clinical assessment, wound swab culture, Doppler ultrasound, and biopsy if necessary.</li>
	<li>Treatment options for venous leg ulcers include wound dressings, compression therapy, medications, surgical interventions, and home care measures.</li>
	<li>Complications of venous leg ulcers include recurring infections, amputations, and reduced quality of life.</li>
	<li>The most common risk factors for venous leg ulcers are age, obesity, deep vein thrombosis, and family history of venous disease.</li>
	<li>Preventive measures for venous leg ulcers include regular exercise, weight management, avoiding smoking, and keeping the skin moisturized.</li>
</ul>

[1] Žulec, M., Rotar-Pavlič, D., Puharić, Z., & Žulec, A. (2019). “wounds home alone”—why and how venous leg ulcer patients self-treat their ulcer: a qualitative content study. International Journal of Environmental Research and Public Health, 16(4), 559.

[2] Petherick, E., Cullum, N., & Pickett, K. (2013). Investigation of the effect of deprivation on the burden and management of venous leg ulcers: a cohort study using the thin database. Plos One, 8(3), e58948.

[3] JĂ¤Rbrink, K. (2016). Prevalence and incidence of chronic wounds and related complications: a protocol for a systematic review

[4] Hall, J., Buckley, H., Lamb, K., Stubbs, N., Saramago, P., Dumville, J., … & Cullum, N. (2014). Point prevalence of complex wounds in a defined united kingdom population. Wound Repair and Regeneration, 22(6), 694-700.

[5] Serag, R. M., Shaheen, E., Sobeh, D., & Mahdy, N. (2022). Effect of an educational program regarding care of wound healing for venous leg ulcer patients’. Port Said Scientific Journal of Nursing, 9(2), 181-196.

[6] Pannier, F. and Rabe, E. (2013). Differential diagnosis of leg ulcers. Phlebology the Journal of Venous Disease, 28(1_suppl), 55-60.

[7] Nag, F., Chatterjee, G., Ghosh, A., & De, A. (2020). Clinico-etiological evaluation of chronic leg ulcer in a tertiary care center of eastern india. Indian Journal of Dermatology, 65(6), 495.

[8] Kirsner, R. S. and Vivas, A. C. (2015). Lower‐extremity ulcers: diagnosis and management. British Journal of Dermatology, 173(2), 379-390.

[9] Ohn, J., Byun, S., Kim, I. S., & Park, K. C. (2015). Venous leg ulcer in a sarcoidosis patient: a case report. Annals of Dermatology, 27(6), 744.

[10]  Ronicke, M., Baur, A. S., Kirr, M., Erdmann, M., Erfurt‐Berge, C., & Ostalecki, C. (2022). Epidermotropism of inflammatory cells differentiates pyoderma gangrenosum from venous leg ulcers. JDDG: Journal Der Deutschen Dermatologischen Gesellschaft, 20(5), 619-627.

[11] Ronicke, M., Baur, A. S., Kirr, M., Erdmann, M., Erfurt‐Berge, C., & Ostalecki, C. (2022). Epidermotropism of inflammatory cells differentiates pyoderma gangrenosum from venous leg ulcers. JDDG: Journal Der Deutschen Dermatologischen Gesellschaft, 20(5), 619-627.

[12] Nicolaides, A.N. The Most Severe Stage of Chronic Venous Disease: An Update on the Management of Patients with Venous Leg Ulcers. Adv Ther 37 (Suppl 1), 19–24 (2020).