An ulcer is simply an open sore in the skin or mucous membrane and can be found anywhere on the body. Some common types of ulcer include aphthous ulcers in the mouth, peptic ulcers in the stomach and pressure ulcers which normally form in the tissue compressed by bony prominences. This article focuses on venous leg ulcers: what they are, how they develop and their diagnosis and treatment.
Defining and Describing Venous Leg Ulcers
Venous leg ulcers tend to develop on the lower legs and ankles and may be preceded by skin changes in the affected area. Sufferers may experience itch and the skin may become scaly with brown patches developing. Alteration in the blood flow and increase in venous pressure around the area can cause changes in the color of the skin, which may vary between different shades of red and blue, and there may be a firm, tender area under the surface. Once the skin has broken down and become an ulcer this may appear as a wound with a red, bumpy and moist base – where the healing tissue is visible – or a yellow-grey layer may be prominent. Venous leg ulcers will often leak serum and are usually painful, particularly when dressings are being pulled off. This pain tends to ease when pressure is applied to the area but if pain is severe, this can indicate infection or an additional vascular problem, for example a blood clot or arterial insufficiency. Venous leg ulcers are slow to heal and will gradually increase in size without treatment.
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Leg Ulcers and Venous Insufficiency
By far the most common underlying cause of leg ulcers is venous disease including chronic venous insufficiency (CVI). Venous disease accounts for around 80 per cent of all leg ulcers with arterial disease the next biggest culprit, to blame in 15 per cent of cases. The remaining 5 per cent are caused by a range of conditions including diabetes, rheumatoid arthritis and others.
In venous insufficiency, the valves of the veins in the legs are simply insufficient or incompetent, allowing the blood to reflux or flow backwards (downwards) and pool in the feet and ankles. Genetic factors can be to blame for faulty valves but lifestyle factors such as long periods of standing or sitting, obesity and smoking can increase the risk of valve damage, developing problems. Blood clots can also damage valves and stop them closing, leading to back-flow. One of the effects of venous insufficiency is an increase in venous blood pressure in the affected limb which damages the fine capillaries on the surface of the skin. Ulcers often form as a result of a minor trauma, which breaks the skin; with blood flow obstructed, the healing potential of the body is compromised and, without treatment, the ulcer will slowly spread.
The Diagnosis and Treatment of Leg Ulcers
A health provider can often diagnose a leg ulcer simply from its appearance, and will be trained to recognize the differences between venous and arterial ulcers and to spot the signs of infection. They may also support their visual inspection with a doppler or a duplex ultrasound. Treatment of a venous leg ulcer is a three-front-process: applying pressure by special compression stockings (with elevation of the leg whenever possible) or Una boot; treating the ulcer with a variety of medicated dressings; and treating the culprit, regurgitant vein, which is increasing the venous pressure and impeding blood flow and perfusion. Following such treatment, almost all venous leg ulcers will heal within a couple of months, depending on size. Unless the culprit veins are ablated the ulcer may never heal. Apart from causing leg ulcers, regurgitant veins can cause progressive thickening and fibrosis of the affected skin and underlying adipose, fatty tissue, leading to lipodematosclerosis. These areas of skin get increasingly leathery and contract causing a characteristic “champagne bottle” appearance of the lower leg. So fibrous and leathery those areas can get that a needle would not penetrate the skin easily.
Leg ulcers are often accompanied by unsightly varicose veins. However, as indicated above, leg ulcer should be treated in synchrony with the veins causing the ulcers. Thus, if you have either varicose veins, leg ulcers of both, we at the Spring of Youth Medical Group -A leading vein clinic of mississippi highly recommend that to find out how we treat your varicose veins leading to complete ulcer healing. Call us on (228) 875-0885 or visit our website.