Venous ulcers (open sores) can occur when the veins in your legs do not push blood back up to your heart as well as they should. Due to damaged valves, the blood backs up in the veins, building up pressure. If not treated, increased pressure and excess fluid in the affected area can cause an open sore to form.Venous skin ulcers are caused by poor blood circulation from the legs, such as from venous insufficiency. Your veins have one-way valves that keep blood flowing toward the heart.
Diagnosis of Venous Ulcers:
- Venous Doppler/ Duplex scan: It is done to assess the status of blood flow in the lower limbs as venous ulcers are caused due to stasis of blood in that region
- Discharge from infected ulcers for culture and sensitivity: To check for the types of bacteria present and figure out which antibiotics will be effective against them
- X-ray: To look for periostitis which is the involvement of membrane enveloping neighboring bones
- Biopsy from the ulcer edge: To rule out any cancerous changes (that is, to exclude the possibility of a Marjolin’s ulcers
- Other routine blood investigations
Treatment methods for Venous Ulcers:
As discussed earlier, the ulceration is a result of pooling of blood in the lower limbs due the inability of veins in the legs to drive it back towards the heart. Therefore, the ulcer will fail to heal unless a favorable environment is created. This can be achieved only by the treatment of underlying causes first.
- 4 layered bandage to achieve high compression but within the comfort zone of the patient. It is changed once a week.
- Massage of the indurated area and whole calf.
- Elevation of the affected limb – Can be achieved by placing it on top of pillows for about half an hour, at least 3-4 times a day.\
- Antibiotics – To treat infected ulcers. Antibiotics are selected based on the culture and sensitivity report which gives an idea about the nature of bateria present and it’s susceptible to the drugs.
- Care of ulcer – Clean wounds heal better and faster hence it is cleansed regularly with povidone iodine, hydrogen peroxide and normal saline.
- Dressing with EUSOL
- Exercise – Passive and active exercises to improve circulation, preserve joint mobility and strengthen the calf muscles.