What is venous skin ulcer?

Venous skin ulcer: Overview

A venous skin ulcer is a shallow wound that develops when the leg veins do not move blood back to the heart normally.

Your veins have one-way valves that keep blood flowing toward the heart. When the valves are damaged, the blood can back up and pool in the vein. The blood may leak out of the vein into tissue around the vein. The tissue can break down and form an ulcer.

The first sign of a venous skin ulcer is skin that turns dark red or purple over the area where the blood is leaking out of the vein. The skin also may become thick, dry, and itchy. Without treatment, an ulcer may form. The ulcer may be painful. Your leg also may swell and ache. If the ulcer becomes infected, the infection may cause an odor, and pus may drain from the ulcer. The area around the ulcer also may be more tender and red.

Venous skin ulcer

A venous skin ulcer is a shallow wound caused by venous insufficiency, a condition in which the valves in the blood vessels are damaged and allow some blood to back up in the veins. The slowed circulation causes fluid to seep out of the overfilled veins into surrounding tissues, causing tissue breakdown and ulcers.

Venous skin ulcers, also called stasis leg ulcers, typically develop on either side of the lower leg, above the ankle and below the calf.

The first sign of a skin ulcer is an affected area of skin that turns dark red or purple. It may also become thickened and dry and itchy. Without treatment, an open wound (ulcer) may form. Venous skin ulcers often weep clear fluid and are covered with yellowish film.

The most effective treatment for venous skin ulcers is frequent elevation of the legs above the level of the heart and use of compression stockings during waking hours.

What are the symptoms of a venous skin ulcer?

The first sign of a venous skin ulcer is skin that turns dark red or purple over the area where the blood is leaking out of the vein. The skin also may become thick, dry, and itchy.

Without treatment, an ulcer may form. The ulcer may be painful. You also may have swollen and achy legs.

If the wound becomes infected, the infection may cause an odor, and pus may drain from the wound. The area around the wound also may be more tender and red.

Call your doctor when you first notice the signs of a venous skin ulcer, because you may be able to prevent the ulcer from forming. If an ulcer has formed, get treatment right away, because new and smaller ulcers tend to heal faster than larger ones.

How is a venous skin ulcer treated?

The first step involves improving blood circulation. To do this, you can:

  • Lift your legs above the level of your heart as often as possible. For example, lie down and then prop up your legs with pillows.
  • Wear compression stockings or bandages. These help prevent blood from pooling in your legs.
  • Walk daily. Walking helps your blood circulation.

To help your ulcer heal, your doctor may also remove dead tissue from the wound (debridement).

After your ulcer has healed, continue to wear compression stockings. Take them off only when you bathe and sleep. Compression therapy helps your blood circulate and helps prevent other ulcers from forming.

If your ulcer doesn't heal within a few months, your doctor may advise other treatment, such as:

  • Medicine to speed healing or get rid of an infection (antibiotics).
  • Skin grafting, which may be needed for deep or hard-to-heal ulcers.
  • Vein surgery, which may keep ulcers from coming back.

What are some different types of compression therapy for venous skin ulcers?

Compression therapy is the main treatment for venous skin ulcers. If you have a venous skin ulcer, your doctor may first want to reduce the buildup of fluid in your lower leg. After your lower-leg swelling has been reduced, compression is used to create more constant pressure on both the flexing and resting leg muscles. There are several types of medical devices for compression therapy. Your doctor will recommend the type that will work best for you. If you have an open wound, it will be covered with a dressing before the compression device is applied.

Unna boot.

This is a stiff bandage made with gauze and zinc oxide paste wrapped around the lower leg. This type of bandage improves blood flow by putting greater pressure on leg muscles when they are flexing and less pressure on the leg during rest. It is used to reduce a large amount of swelling in your lower legs. An Unna boot can be left on for 7 to 10 days.

Long-stretch bandage or short-stretch bandage.

These are flexible bandages that are wrapped tightly around the lower leg to reduce swelling and improve blood flow. The bandages are used to help heal a venous ulcer. The ulcer is covered with a dressing before the bandage is put on. The bandage is put on the leg by a health professional. Caregivers can be trained to apply them too.

Active compression pump.

This pump goes around your lower leg. It has air bags that inflate and deflate periodically to force blood to flow out of your lower leg toward your heart. The pump can be used to help heal a venous ulcer that has not been helped by other types of treatment. The pump is used for several hours each day. It is used along with compression stockings.

Compression stockings.

Specially fitted compression stockings are designed to help prevent fluid from pooling in the legs. You should wear these stockings every day from the time you wake up until you go to bed. Remove them only for bathing and sleeping. They can help venous skin ulcers heal and help prevent them from coming back.

How is a venous skin ulcer diagnosed?

Your doctor will diagnose venous skin ulcers by asking questions about your health and looking at your legs. Your doctor may also use duplex Doppler ultrasound to find out what is causing the ulcer. This test shows how well blood is moving through the lower leg.

Your doctor may use other tests to check for problems related to venous skin ulcers or to recheck the ulcer if it does not heal within a few weeks after the start of treatment.

Treating venous skin ulcers at home

Venous skin ulcers develop when the lower leg veins are weakened and cannot efficiently move the blood back toward the heart. Pooled blood and fluid in the lower legs then leads to tissue breakdown. You can prevent or heal a venous skin ulcer by helping your blood circulate back toward your heart.

  • Elevate your legs during sleep.

    While you are sleeping, you can help your blood circulate back to your heart by elevating your feet above the level of your heart. Prop the foot end of your bed up on 6 in. (15 cm) to 8 in. (20 cm) blocks.

  • Elevate your legs while awake.

    During waking hours, try to elevate your legs above the level of your heart for 30 minutes, 3 to 4 times a day.

    Elevating your legs may be all the treatment you need if you have mild venous insufficiency. But if you continue to have problems with venous skin ulcers, you will need additional treatment.

  • Exercise.

    Doing regular foot and ankle exercises can help strengthen your leg muscles and improve blood flow in your legs. While you are sitting (or standing), flex your ankles by pointing your toes away from you and then pointing them up. Do 10 repeats of the exercise several times each day. This exercise is especially important for people who need to sit or stand for long periods of time.

    Walking is also good exercise for improving blood flow in the legs.

  • Use compression stockings.

    Specially fitted compression stockings are designed to help prevent fluid from pooling in the legs. You should wear these stockings every day from the time you wake up until you go to bed. Remove them only for bathing and sleeping. They can help venous skin ulcers heal and help prevent them from coming back.

Areas Affected by Venous Skin Ulcers

Leg and foot areas affected by venous skin ulcers

A venous skin ulcer is a shallow wound that develops when the leg veins do not move blood back toward the heart normally. Most venous skin ulcers develop on either side of the lower leg, above the ankle and below the calf.

What causes a venous skin ulcer?

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. In venous insufficiency, the valves are damaged, and blood backs up and pools in the vein. Fluid may leak out of the vein and into the surrounding tissue. This can lead to a breakdown of the tissue and an ulcer.

Veins that become blocked also may cause fluid to pool, leading to these ulcers.

Some things can increase your risk of venous skin ulcers. These include:

  • Deep vein thrombosis, in which a blood clot (thrombus) forms in the deep veins of the legs.
  • Obesity.
  • Smoking.
  • Lack of physical activity.
  • Work that requires many hours of standing.

There are two other types of skin ulcers that can happen on the lower leg or feet. They are different from venous skin ulcers.

  • Arterial skin ulcers are less common than venous skin ulcers. They happen when artery disease is present (sometimes in combination with venous disease). These ulcers tend to be extremely painful. They are usually on the toes and feet.
  • Neuropathic skin ulcers are also known as diabetic neuropathic ulcers. They occur in people who have little or no sensation in their feet because of diabetic nerve damage.

What is a venous skin ulcer?

A skin ulcer is a type of wound that develops on the skin. A venous skin ulcer is a shallow wound that occurs when the leg veins don't return blood back toward the heart the way they should. This is called venous insufficiency.

These ulcers usually form on the sides of the lower leg, above the ankle and below the calf.

Venous skin ulcers are slow to heal and often come back if you don't take steps to prevent them.

A venous skin ulcer is also called a stasis leg ulcer.

Venous skin ulcer: When to call

Call your doctor now or seek immediate medical care if:

  • You have symptoms of infection, such as:
    • Increased pain, swelling, warmth, or redness.
    • Red streaks leading from the ulcer.
    • Pus draining from the ulcer.
    • A fever.

Watch closely for changes in your health, and be sure to contact your doctor if:

  • Your ulcer is not healing.
  • You have new ulcers.
  • The ulcer starts to bleed, and blood soaks through the bandage. Oozing small amounts of a mix of blood and fluid is normal.
  • You have new bleeding.
  • You do not get better as expected.

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