Venous Leg Ulcers

Causes of Venous Ulcers

Leg ulcers may be caused by pressure inside your legs as well as outside. If you have damage to your veins, blood may pool in your lower legs, causing them to swell. The skin in your lower legs and feet will stretch, and ulcers will form.
Venous ulcers are due to the pressure behind the skin cutting off blood flow, causing the surface layers of the epidermis to die. Venous ulcers are common in people who are overweight, or who suffer from heart disease, high blood pressure, or diabetes. Pregnant women and people who break a femur and must spend time in a full-leg cast may also develop venous ulcers.

Pathophysiology of Venous Ulcers

There are two types of blood vessels in your body, arteries and veins. The arteries are under pressure and pump blood through the body. The veins simply channel blood back up to the heart and lungs for reoxygenation.
To keep the blood from flowing backward between heartbeats, veins have valves that close as the heart pumps, so that blood moves forward toward the heart. If these valves become weakened or damaged, some blood may leak backward between pulses, causing a condition called “venous hypertension.”
Venous hypertension can result in swollen veins in the lower legs, and lead to blood and other fluids leaking into the surrounding tissues. This leads to tissue damage and swelling and causes reduced blood flow to the skin.

Deep Vein Thrombosis (DVT)

People with deep vein thrombosis, or DVT, are at higher risk for venous ulcers. DVT is a condition where blood clots form in the lower extremities and break loose. They travel back up the veins until they reach a spot where they are too large to continue moving. The same conditions that lead to venous ulcers also lead to DVT, so having one puts you at risk for the other.

Symptoms and Treatment of Venous Ulcers

Venous ulcers are best treated by preventing the cause of the ulcer, so treating your blood pressure or heart disease is the best way to avoid an ulcer. Early signs of a developing ulcer may include:
  • Leg swelling, cramping, and “heaviness”
  • Itchy, flaking, or thinning skin in the feet and ankles (“stasis dermatitis”)
  • Shiny, tight, warm, or distended skin
  • Dark red, purple, or brown skin (sign of fluid leaking into the tissue)
  • Formation of a small shallow sore with irregular edges
If you see these signs, you should contact a doctor or skincare specialist at once. The ulcer can best be treated before it develops further. Early treatment of your ulcer will include:
  • Keep the wound clean and bandaged
  • Keep the dressing dry. Moisture can soften healing tissue, causing the wound to get bigger
  • Clean and change the bandages according to instructions from your doctor
  • Wear compression stockings to reduce fluid pressure in your legs
  • Keep your leg elevated as much as possible
  • Walk or engage in other exercises. This improves blood flow and promotes healing

Preventing Venous Ulcers

If you are at risk for venous ulcers, you should take steps to avoid developing them. Venous ulcers are difficult to treat and tend to become chronic unless the underlying cause is treated.
Keep your skin clean and moisturized, especially on your legs and feet.
If you smoke, quit. Even reducing the amount of smoking improves your circulation and oxygen uptake.
Eat healthy foods, drink plenty of water, and exercise. Walking even a moderate amount improves circulation to your feet and legs.
If you have high blood pressure or high cholesterol, see your doctor about medication and diet control.

Treating Venous Ulcers

Venous ulcers are difficult to treat because of their location and because the underlying cause of the swelling and blood pooling must be treated before any long-term resolution can be achieved. However, there are some things that can be done to treat the ulcers and avoid serious complications like sepsis.

Control the swelling. Compression is key to dealing with venous ulcers. Many patients resist compression wraps or stockings because they are painful and difficult to apply. If patients and caregivers can find a solution that works for both of them, this is the number one key to treating ulcers, because wounds need good circulation to heal, and compression helps improve circulation.

Treat the wound by removing biofilm. Although the need to remove dead tissue (“debridement”) has always been known, there is a growing understanding that biofilm, a thin layer of biological material that attracts bacteria, must be prevented in order to promote healing. Remedium offers a full line of holistic treatments in line with current best practices to keep these wounds free of stubborn resistant biofilm in wounds.

Encourage patient engagement by involving them in their care. Patient compliance to treatment is one of the largest challenges that treating venous leg ulcers have. Older patients may not understand why they need to carry out all these wrapping and cleaning regimens, especially if the doctor doesn’t bother to explain them. Education encourages patient compliance and helps reduce potential recurrence of the ulcers.