Venous leg ulcers are a common problem. It is estimated that 10 to 35% of the population has some type of venous disease. Chronic venous disease is the underlying cause of 80-95% of leg ulcers. These ulcers are very slow to heal.
The central problem is that vein disease decreases the ability of the veins to return fluid from the lower extremities back to the heart. The increased venous pressure that results is transmitted to the capillaries, resulting in skin and subcutaneous tissue changes. The tissue becomes poorly nourished and fragile resulting in the skin changes and ulcers characteristic of venous insufficiency (also called venous stasis). The disorder is common in the ankles because there is less supportive tissue in this area. Common causes of vein disease are blood clots in the deep veins of the leg and failure of the valves in the veins (valvular incompetence). Other conditions that cause the legs to swell, such as congestive heart failure or kidney disease lead to similar changes.
The diagnosis is based on the typical appearance of the skin changes and edema. In addition to the edema, the skin becomes brownish stained, has dilated blood vessels and is often inflamed. Ulcers are usually shallow and located on the lower part of the leg, especially on the inside aspect. Vascular laboratory tests may be ordered to obtain information about the veins or to rule out co-existing artery disease, particularly in diabetics.
The mainstay of treatment is to counteract the increased venous pressure through the use of compression stockings or dressings. Generally 30-40 mm of compression will be effective. No dressing or wound care product can be effective if this essential part of treatment is omitted. In fact, the vast majority of the patients referred to the clinic heal their wounds with simple compression therapy alone. The ‘DIME’ (page 5) principles of wound healing are then applied to maintain a healthy wound environment. Hyperbaric oxygen is not useful or indicated for venous stasis disease, except in rare cases where a surgeon uses a human skin graft.
Exercise regularly and avoid sitting or standing for prolonged periods. Keep your legs elevated when sitting. Do not smoke as it will further reduce your circulation and wound healing. Avoid constrictive clothing and wear well-fitting shoes. Moisturize the skin with an unscented, hypoallergenic skin lotion such as Lubriderm. Avoid situations that will bump or injure the legs and avoid extremes hot or cold exposure to the legs. Watch for signs of infection: if increased redness, fever or increased pain develop, notify your doctor.
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