Overcoming Vein Disease: A Patient’s Guide to Diagnosis, Treatment, & Recovery

Answers to your questions about venous leg ulcers

Venous ulcers are slow-healing wounds caused by circulatory problems. Some people cope with them for years, not knowing that more effective treatments are available. If you or someone you know lives in the Atlanta area and is suffering from venous leg ulcers please contact our office to discuss your treatment options.

Why do venous ulcers occur?

Venous leg ulcers occur when there is a buildup of pressure inside the veins.

Healthy veins regulate blood flow using tiny, one-way valves that keep your blood flowing towards your heart. If the valves have become weakened or damaged the blood will reflux (flows backwards) and pool inside the vein.

Over time, pooled blood increases pressure in the vein and fluid begins to seep into surrounding tissues. This is known as fluid retention or edema. Excess fluid irritates the dermal (skin) tissue causing inflammation and, over time, breakdown. Broken down tissue results in a chronic wound.

How do venous ulcers form?

At first, the skin may become red and irritated and be mistaken for a rash or bug bite. As the condition progresses, the affected area may start to look more like a blister or bruise, the skin may become dry or cracked, and it may begin to weep.

As the tissue continues to break down, one or more small sores will form. These may heal on their own only to reform again and again. Eventually the wound will get deeper and fail to heal without special care.

Symptoms to look out for include:

Swelling of the legs
Thickened or hardened skin
Skin that is discoloured (red, purple, or brown)
Small blisters
Cracked or dry skin

Venous ulcers are also commonly associated with varicose veins.

Why don’t venous ulcers heal?

The exact reason why it is so difficult for venous ulcers to heal is still not fully understood. We believe it is, at least in part, due to pooled venous blood depriving surrounding tissues of the oxygen and nutrients they need to heal. This is why solving the underlying circulatory problems can aid recovery and, in most cases, stop the ulcer from coming back.

Are venous ulcers painful?

Everyone experiences pain differently. As such, some patients may not experience any pain with venous leg ulcers. Others may experience symptoms ranging from discomfort and aching to deep, chronic pain.

Venous ulcers may also be accompanied by cellulitis, an infection where the skin and subcutaneous tissues around the wound become inflamed, warm, painful, and tender to the touch.

Do venous ulcers bleed?

Usually not. Venous ulcers tend to be large, shallow sores that have a yellow-white film on top. They are often wet or weeping. However, there are typically no large blood vessels in the area and, therefore, very little bleeding.

Do venous ulcers itch?

Yes, venous ulcers frequently do itch. However, try not to scratch because this will only further irritate and damage the skin. Scratching can also introduce bacteria from under your nails to the area which increases the risk of infection.

Can venous ulcers lead to amputation?

Only in the rarest of circumstances. If a venous ulcer became so severely infected that the infection spread to other tissues (like the bone), then it is possible that a venous ulcer could lead to amputation. This risk is remote, but is a good reason to take care of your skin and see your doctor about any concerns. The sooner you seek treatment, the better your outcome is likely to be.

Can venous ulcers cause death?

As with amputation, death resulting from a venous ulcer would be highly unlikely.

That being said, venous ulcers are open wounds. As such, they are a potential source of infection. Any infection—particularly in an immunocompromised patient—is cause for concern. That’s why it is so important to follow all of your doctor’s care instructions and seek treatment for the underlying circulatory issues.

Who treats venous leg ulcers?

Many medical professionals treat venous leg ulcers. It is not uncommon for patients to first see their primary care doctor or dermatologist when they notice skin changes. These doctors may provide treatment at their office or refer you to a specialist, such as a wound care clinic, a vascular surgeon, or a general surgeon.

How are venous ulcers treated?

The most commonly prescribed treatment for venous ulcers is compression. Your doctor may bind your wound in a special pressure bandage called an unna boot. Or they may dress the wound in sterile bandages and ask you to wear compression stockings. This compression helps keep blood from pooling in the veins so the ulcer can heal over time.

It’s important to keep a venous ulcer clean and dry to prevent infection. If infection does occur you will be prescribed with appropriate antibiotics. Be sure to take all medication as prescribed.

The underlying circulatory issues that are causing the ulcer also need to be addressed. This is done with an outpatient procedure called venous closure. There are several methods of venous venous closure available, including: