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The most common cause of leg ulceration is venous insufficiency. Venous ulcers often lie near the ankle joint as the venous hypertension is highest at this level. Venous ulcers are often associated with other skin changes such as pigmentation, eczema, dryness and thickening.
Venous ulcers usually start spontaneously or following minor trauma or scratching. Once the skin breaks down, ulcer formation can be quite rapid. Venous ulcers are typically shallow with ragged edges and a moist centre. Pain is not a feature unless the ulcers are badly infected with inflammation of the surrounding skin.
Whilst a number of factors contribute to the development of venous ulceration, venous hypertension appears to play a pivotal role. Abolishing the effect of the high venous pressure on the skin is therefore the cornerstone of any successful treatment. Initially, other causes of leg ulceration such as chronic ischaemia or autoimmune diseases must be excluded first. In most cases, this can be done by clinical examination. If a concomitant arterial disease is found, this is always treated first. Venous ulcers are notoriously slow to heal. The deleterious effects of venous hypertension on the skin take many years to develop. Unsurprisingly, reversing this effect requires time, patience and compliance. Treatment itself is mainly via a special compression dressing which is applied to the affected leg. This dressing will extend from the base of the toes to the knee regardless to the size or position of the ulcer. The dressing is designed to exert an external pressure on the leg to counteracts the venous hypertension. It does not need to be changed more than once a week unless the ulcer is too moist. Most ulcers will require several weeks if not months of compression dressing before complete healing. In resistant cases, admission to hospital for bed rest, leg elevation and antibiotic therapy, venous surgery and ulcer skin grafting may be required.
Unfortunately, recurrence rates for venous ulcers are high. Patients should therefore continue to wear compression stockings and avoid prolonged unsupported leg dependancy. |
Venous ulcers
Four layer compression bandaging is very effective in treating venous ulcers. Most ulcers will heal in three months. However, some ulcers may take up to eighteen months. |
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