According to an article in the American Journal of Surgery, venous leg ulcers account for 85% of all lower-extremity ulcers, with treatment costs of $3 billion and over 2 million workdays per year.¹ A venous leg ulcer is one of the most serious results of the progression of chronic venous insufficiency. This often painful open wound affects the quality of life of patients and is slow to heal.
Ulcer patients interact directly with a wound clinic or physician and a certified fitter in the management of the wound. Compression plays an important role in the healing of a wound and certainly in the post-wound care. Once your wound is healed, you should wear graduated compression stockings for life.
What causes a venous ulcer?
When suffering from chronic venous insufficiency, the vein wall becomes stretched and weakens, the valves do not close. This starts the cascade of reflux and pooling which does not correct itself and only continues to worsen over time (another cause of valve incompetency is a post-traumatic damage). In consequence, the small nutritional vessels of the skin are damaged causing edema, inflammation, hardening of the tissue and malnutrition of the skin. On these preconditions, a venous ulcer may easily develop.
Venous leg ulcers are often chronic and difficult to heal. They often appear on the inside of the leg (medial) above the ankle. They are shallow and can be painful. Swelling in the lower leg often occurs. There is often brownish discoloration of the skin due to the leakage of the iron-containing pigment in red blood cells (hemosiderin) into the tissue. The wound itself is often irregular and there may be weeping discharge as the tissue fluid seeps from the wound. There may also be indications of infection. Caution regarding arterial ulcers: approximately 10-20% of ulcers are arterial ulcers. In addition to venous diagnostics with duplex ultrasound the arterial circulation should be controlled in each ulcer patient.
What is the treatment for a venous leg ulcer?
The primary treatment includes controlling a possible infection and healing the wound. A wound heals slowly and may take many months, depending of its size and other risk factors. Managing pain and minimizing the edema as well as protecting the healthy skin are also important during treatment. Steps to improve venous function should be taken. Traditionally, short-stretch compression bandages are worn initially until secretion has reduced. In most of the small and medium size ulcers the compression can be continued with a compression stocking or a special ulcer stocking system (SIGVARIS UlcerX) at 30-40 mmHg until healing. Your physician will be able to assess your condition and prescribe the most effective treatment.
Nearly 80% of venous leg ulcers can be healed with good wound management. The recurrence rate of a venous ulcer after treatment can vary depending on the type of procedure and patient compliance. Studies show that recurrence can range as low as 26-28% and reported as high as 69%.² Once the leg ulcer is healed, the patient should wear a minimum of 30-40 mmHg SIGVARIS medical graduated compression stocking for life to aid in non-recurrence of the ulcer.
Graduated compression stockings are CONTRAINDICATED for severe arterial occlusive disease.
¹ American Journal of Surgery (2002, vol. 183. n2, pp. 132-137 (14 ref.)
² Bryant RA, editor. Acute and Chronic Wounds. St Louis Mosby; 1992, p 164-204
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