Venous Insufficiency Ulcer Symptoms and Treatment

Venous ulcers also referred to as stasis, insufficiency or varicose ulcers, are the result of malfunctioning venous valves causing pressure in the veins to increase. These typically occur along the medial or lateral distal (lower) leg. The resulting venous hypertension causes blood pooling when it is not as efficiently pumped back towards the heart, otherwise known as venous insufficiency. In addition, the increase in pressure stretches the vein walls, allowing proteins in the blood and blood cells to leach into the subcutaneous tissues, resulting in oedema and the eventual breakdown of said tissues due to lack of oxygen and nutrients. Specifically, deposits around the capillaries of the protein fibrin, which normally plays a role in clotting, prevent oxygen and nutrients from flowing to the surrounding muscle and tissue and in turn lead to necrosis and ulceration (Fibrin Cuff Theory).

Veins are responsible for carrying deoxygenated blood back to the heart from various bodily tissues. The venous system operates at relatively low blood pressure, relying on the contraction and expansion of skeletal muscles to propel blood past the one-way valves in the veins on its way back to the heart. The circulatory system relies on this pressure gradient to push blood through the arteries and into the veins.

Symptoms

When a venous ulcer begins to develop, stasis dermatitis may be present causing scaling and erythema of the lower extremities. Hemosiderin staining may also occur, causing the presence of brownish or yellow patches underneath the skin. Other skin changes may include the appearance of dark red or purple as a result of blood leaching into the surrounding tissue. Venous ulcers will present with shallow but large wounds with irregular margins that typically develop on the lower leg or ankle.

Treatment of Venous Insufficiency Ulcers

In addition to treating the superficial wound and oedema, the secondary goal in treating venous ulcers is to alleviate the underlying condition. One of the most common treatments is compression therapy, which serves to decrease blood vessel diameter and pressure, increasing effectiveness and in turn preventing venous reflux. However, compression should only be used in patients without the significant arterial disease, as it would only then exacerbate extant conditions. Compression wraps or other compression devices may be suggested in the treatment of eligible patients. An Unna boot extending from the toes to just below the knee can also help to promote healing, reduce infection and promote blood return to the heart. The boot consists of moist zinc or zinc and calamine impregnated gauze which is allowed to harden then wrapped tightly with an elastic bandage.

The following precautions can help minimize the risk of developing venous ulcers in at-risk patients and to minimize complications in patients already exhibiting symptoms:

• Examine feet (especially between the toes) and legs daily for any unusual changes in color or the development of sores.
• Avoid sitting or standing for extended periods of time.
• Avoid crossing legs while sitting.
• Quit smoking. Smoking contributes to blood clotting in the veins.
• Elevate legs regularly.
• Avoid tight-fitting clothing and ensure that footwear is properly fitted to avoid points of rubbing or pressure.
• Protect legs and feet from injury and infection.
• Avoid extreme temperatures.
• Exercise as frequently as is comfortable.

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