A Beginner’s Guide to Venous Skin Ulcers

About 1% of American adults suffer from venous skin ulcers, also referred to as venous stasis ulcers. These skin ulcers occur from increased pressure in the veins of the lower leg over a long period of time. The increased pressure leads to swelling and chronic inflammation that can progress to an open skin wound.  The wounds often last for weeks or months and are difficult to heal, with a high rate of recurrence. This article discusses venous skin ulcers in more detail.

The cause

Venous skin ulcers occur most commonly in the lower leg, often just above the ankle. The cause is often increased pressure in the veins due to venous insufficiency, which means the blood is pooling in the veins in the lower legs.  The specific cause is failure of the valves in the leg veins.  The valves are important to keep the blood in the veins moving toward the heart, which reduces the pressure in the veins.  Failure of the valves allows blood to pool in the lower leg, especially when sitting or standing for long periods.  The pooling of the blood comes produces increased volume, and therefore increased pressure in the veins of the lower leg.  This results in chronic inflammation of the skin and soft tissue, and over time, the risk of a venous ulcer.  Vein valve failure is common in patients with varicose veins, previous injury to the legs, and previous deep vein thrombosis (DVT) or blood clots in the deep veins of the leg.

Another cause of these ulcers is chronic swelling in the lower leg not related to vein disease, but related to lymphedema.  Longstanding obesity is often associated with lymphedema, producing swelling and chronic inflammation in the lower leg, and may lead to a skin ulcer that appears identical to venous ulcers.  An ultrasound exam will quickly and reliably determine if the problem lies with the veins, or lymphedema.

The symptoms

Usually, swelling and inflammation are present before the skin breaks down and forms an ulcer.  Signs of chronic inflammation include redness, tenderness, and itching that lasts for days or weeks, especially if this happens or worsens when you have been standing for long periods.  These symptoms and the skin breakdown usually occur in the lower leg, just above the ankle.  The ulcer can also become infected with foul smelling drainage, worsening pain, and fever. If signs of infection are present you should seek medical attention immediately as this can be very serious.

The treatment

Compression bandages are often the first line of treatment for venous skin ulcers. The pressure provided by the bandages will reduce the swelling and inflammation, which will improve the skin's ability to heal. Leg elevation will also help to reduce the swelling and inflammation. Ultimately, if the ulcer occurs due to superficial venous insufficiency, or increased pressure in the veins in the lower leg, treatment of the cause (the diseased veins) will greatly shorten the healing time, and reduce the risk of another ulcer.  The vein treatment may include endovenous radiofrequency or laser ablation, or chemical ablation with ultrasound-guided sclerotherapy.  An ultrasound exam of the veins will determine the source of the pressure, and the treatment.

Prevention

Weight loss, treating your vein disease, and seeking medical attention for chronic swelling and inflammation in the lower leg before you develop an ulcer will help prevent skin ulcers related to venous insufficiency or lymphedema.

Schedule a consultation

At Reeder Vein we see and treat this problem frequently.  If you have chronic swelling and redness of the lower leg, and wish to know your risk for a venous ulcer, please contact us to schedule a consultation.