Venous Ulcers Diagnosis And Treatment

Venous ulcer, also known as stasis ulcer, is the most common etiology of lower extremity ulceration, affecting approximately 1 percent of the U.S. population. Possible causes of venous ulcers include inflammatory processes resulting in leukocyte activation, endothelial damage, platelet aggregation, and intracellular edema.

The primary risk factors for venous ulcer development are older age, obesity, previous leg injuries, deep venous thrombosis, and phlebitis. On physical examination, venous ulcers are generally irregular, shallow, and located over bony prominences. Granulation tissue and fibrin are typically present in the ulcer base. Associated findings include lower extremity varicosities, edema, venous dermatitis, and lipodermatosclerosis.

Venous ulcers are usually recurrent, and an open ulcer can persist for weeks to many years. Severe complications include cellulitis, osteomyelitis, and malignant change. Poor prognostic factors include large ulcer size and prolonged duration. Evidence-based treatment options for venous ulcers include leg elevation, compression therapy, dressings, pentoxifylline, and aspirin therapy. Surgical management may be considered for ulcers that are large in size, of prolonged duration, or refractory to conservative measures.

Venous Ulcer Diagnosis

If a venous ulcer is suspected, your physician will do a complete physical, including a check of your blood pressure in your arm and your ankle. Accurate diagnosis is the foundation of good ulcer care. The diagnosis is typically made based on the description of how the ulcer began and physical exam findings. Additional tests may include:

Ankle-brachial index test: During this test, blood pressure cuffs are placed on the arms and ankles. A handheld ultrasound device or ‘Doppler’ is used to listen to the blood flow and measure the blood pressure. This helps doctors understand if there is a decreased blood flow to the lower legs and feet.

Ultrasound: An ultrasound device can measure blood pressure on various points of your arm or leg, which will help the physician determine if you have any blockages and how quickly blood flows through your arteries in the lower leg.

Treatment

Treatment for venous ulcers includes controlling the high pressure in the leg veins and treating the ulcer.

Controlling Pressure in the Leg Veins

Controlling swelling is essential for patients with venous ulcers. Leg elevation, with the feet at or above the level of the heart, several times throughout the day and while sleeping, can help reduce swelling. Compression wraps or bandages are often applied to the legs. These can be changed as often as multiple times a day or as infrequently as once a week, depending on the amount of fluid draining from the ulcer.

Treating the Ulcer

The first step in treating a venous ulcer is to remove any dead tissue around the sore and then to apply a special dressing to encourage healing. The dressing will need to be changed about once a week. Sometimes a compression stocking will be worn over top of the dressing.

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