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.

 

Venous Ulcers Development Stages
Development Stages – Venous Ulcers

Diagnosis of Venous Ulcers:

Non-healing or recurring wounds on the inner aspect of the lower leg are most likely venous ulcers. Your doctor will make the diagnosis based on the history of other complaints like swelling and pain in the legs, presence of dilated, torturous veins or any other skin changes (usually the skin tends to get dry, itchy and pigmented over the legs). A thorough clinical examination of the ulcer and it’s surrounding skin will provide him with further information. Presence of co-morbidities like diabetes, hypertension and elevated cholesterol levels also favors the above diagnosis which is confirmed by carrying out the following investigations –
  1. 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
  2. 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
  3. X-ray: To look for periostitis which is the involvement of membrane enveloping neighboring bones
  4. Biopsy from the ulcer edge: To rule out any cancerous changes (that is, to exclude the possibility of a Marjolin’s ulcers
  5. Other routine blood investigations
Based on the careful analysis of history given, clinical examination and investigations performed, your doctor will arrive at the final diagnosis of chronic venous insufficiency which has subsequently lead to the formation of venous ulcers.

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.

 In order to promote healing of the ulcer, infection and blood sugars need to be brought under control to begin with. Antibiotics and diabetic medication are prescribed accordingly. Other parameters like blood pressure and cholesterol levels are also to be maintained within desirable limits. Dressing is done over the ulcer and the compression stockings/ bandages are wrapped over the dressing. Elevation of the limb, it’s massage and exercise are highly encouraged.
Varicose Veins Stockings
Compression Stockings – Varicose Veins
This method of treatment is actually given by something known as the Bisgaard’s regime which outlines the measures to reduce oedema, increase venous drainage, so as to aid the process of ulcer healing. It’s described more in detail:
” 4 ME ABCDE ” is the mnemonic used.
  1. 4 layered bandage to achieve high compression but within the comfort zone of the patient. It is changed once a week.
  2. Massage of the indurated area and whole calf.
  3. 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.\
  4. 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.
  5. Bandages
  6. Care of ulcer – Clean wounds heal better and faster hence it is cleansed regularly with povidone iodine, hydrogen peroxide and normal saline.
  7. Dressing with EUSOL
  8. Exercise – Passive and active exercises to improve circulation, preserve joint mobility and strengthen the calf muscles.
Once the ulcers shows healthy signs of healing, it can be covered using a skin graft if needed. After the ulcer heals, surgery or other less invasive interventions may be suggested to tackle the underlying venous derangement so as to prevent it’s recurrence in the future.