Venous ulcers otherwise known as Venous Stasis, insufficiency or varicose ulcers, are sores in the leg caused due to poor blood circulation within the veins. Venous leg ulcers are slow to heal and may exist for a period ranging from few weeks to years. Ulcers usually occur on either sides of the lower leg little above the ankle. Similar to the mechanism behind Varicose Veins, failure of venous valves cause pressure in the veins to increase, allowing blood to pool down. Additionally, the increase in pressure weakens the vein walls, through which proteins in the blood and blood cells seep into tissues causing Oedema. Breakdown of surrounding tissues due to lack of oxygen and nutrients follow due to the accumulation of blood proteins. Necrosis of the subcutaneous tissues present as open sores that can grow to be shallow, large wounds with irregular margins.
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Causes
Venous stasis ulcers are more common in older people, particularly in women. Previous injuries to the leg such as fractures, muscle tear or burns can lead to formation of Ulcers. Family history of Venous insufficiency, Varicose Veins, Diabetes, circulatory problems such as Deep Vein Thrombosis and Phlebitis are conditions that may increase the chances of getting Venous Ulcers. Obesity, pregnancy, smoking and postural demands at workplace such as prolonged sitting or standing can be relevant reasons that may cause Venous stasis ulcers.
Signs and Symptoms
- Scaling and Erythema of the lower extremities
- Itchy or burning sensation in the affected leg
- Yellow or brown discolouration underneath the skin
- Dark red or purple patches of blood accumulation
- Swelling of the entire leg
- Wounds covering a large area with relatively less pain
- Mostly shallow wounds with indistinct margins
- Pain may be felt if the wound is infected
- Foul smelling wound discharge if infected
- Fever with infection
Complications due to Venous Leg Ulcers
Infection of the wound can lead to serious conditions like Osteomyelitis and Sepsis.
Immobility is another complication that can arise if the wound is left untreated.
If a venous ulcer presents for many months or years, a malignant tumour may arise.
Recurrence rates of Venous ulcers are high.
Diagnosis/Evaluation
Physical examination by a doctor is necessary for evidence of pigmentation, skin damage and extent of the sore. Checking for Varicose Veins in the standing position also is essential for possibility of Venous stasis ulcers. Pulse palpation at the ankle will reveal if the arteries around the area are in full function. Patient history to find predisposing factors to the cause of the Ulcer will outline the treatment plan to alleviate the root cause. Other tools for specialist evaluation include:
- Ankle-Brachial Index (ABI) determines if there is an accompanying arterial insufficiency
- Doppler ultrasonography – Rules out Peripheral Arterial diseases and guides to know which blood vessels are damaged or blocked and how this should be treated.
- Doppler bidirectional flow studies – measurement of blood flow in the veins and arteries of the leg so that venous valves can be assessed and arteries checked.
- Venography
- Tissue Biopsy – To test for malignancy
Physical Examination – The doctor will inspect and palpate the affected limb for signs of tenderness, bleeding or ulcers. The presence of Varicose Veins can be more easily examined while standing for a while.
Best treatment for Varicose veins at Laser vein clinic
To uproot the underlying cause with strong sustained compression methods and wound healing are the best recovery measures for Venous Ulcers.
Compression methods are either use of stockings or bandages.
Ulcer dressings to allow better healing and keep regular check on infections.
Antibiotic treatments are prescribed when the wound is infected.
Associated symptoms of Oedema, Pain and skin irritation can be treated by pain killers, exercises and topical applications respectively.
Preventive measures to avoid repeated ulcers of the leg is important, as it is very likely to recur if neglected. Exercises, postural corrections, lifestyle changes and regular follow up are utmost essential.
Superficial vein surgeries can reduce the recurrence of Venous Ulcers. Ablation of incompetent superficial veins have shown to improve deep venous function thus minimising chances of recurrence of Ulcers. Endo venous ablation therapy and other newer therapies such as key hole endoscopic surgeries and venal seal closure systems are new effective ways of Venous ulcer treatment.
Varicose veins treatment in Chennai can be done by a number of methods including ablation of the incompetent veins, Endo venous ablation therapy, key hole endoscopic surgeries and venal seal closure systems. These treatments are minimally invasive and help reduce the recurrence of Venous Ulcers. The treatment is tailored to the individual needs of the patient and can help improve the quality of life.