What are venous ulcers?

Some patients with advanced varicose vein disease develop what is known as a venous ulcer. This is a type of shallow wound that typically occurs on the inner part of the leg just above the ankles, although it can also occur on the outer part of the lower leg.

What causes venous ulcers?

Venous ulcers are usually caused by varicose veins and chronic venous insufficiency, and may occur after those conditions have existed for some time. Venous reflux (or valve failure) or other vein conditions can lead to increased pooling of blood, causing venous hypertension (increased pressure in the veins of the lower leg), which leads to the pooling of blood. These venous conditions may come from more superficial veins (like varicose veins), deeper veins (related to deep vein thrombosis or DVT) or from perforator veins, which connect the veins of the superficial and deep vein systems.

When these high pressure conditions exist, fluid can leak out into the surrounding tissues, inflammation of the tissue occurs and the normal transfer of nutrients and oxygen to the tissue is impaired. Over time, the diminished level of nutrients and oxygen and the inflammation created causes damage to the surrounding tissues, which can result in skin discoloration and tissue death.

How are venous ulcers treated?

A comprehensive ultrasound examination by a physician skilled in the use of ultrasound for venous diagnosis is an absolute requirement before a treatment plan can be devised for a patient.

Then, the first and most important treatment for venous ulcers is the use of leg compression. This can be done either with the use of elastic stockings, or non-elastic surgical wraps. Elastic stockings are more commonly known as surgical compression stockings. An example of a non-elastic surgical wrap is an Unna boot” or “Unna dressing.” This dressing, which is a wrap impregnated with zinc oxide, calamine, and glycerin, has been in use for close to one hundred years. It typically is changed every two or three days, and remains an excellent weapon for the initial treatment of venous ulcers. As the ulcer heals the transition is usually made to using an elastic surgical compression stocking.

Venous ulcer patients with superficial venous disease—which includes great saphenous vein reflux, small saphenous vein reflux, and incompetent perforator veins—may all benefit from procedures designed to correct these conditions. Ultrasound guided sclerotherapy has been found to be especially effective in the treatment of incompetent perforator veins. Some patients are found to have disease resulting from venous obstruction of the iliac veins, which are located in the abdomen. This condition can usually be treated by placement of a venous stent.

Although patients may occasionally benefit from drugs that increase the microvascular blood circulation, medications generally are not of much use in the treatment of venous ulcers.

Most patients—and many physicians—assume that this frustrating condition is caused by an infection. Consequently, many patients are initially treated with a variety of antibiotics, both by mouth and/or by applying antibiotic ointment. While it is possible to recover bacteria from these ulcers, typically they are not the cause of the ulcer.

Treatment with antibiotics generally is of no benefit and may cause problems such as allergic reactions.