Venous Ulcers

Venous ulcers are open sores in the skin that occur with sustained venous hypertension and malfunctioning of venous valves. Ulcers develop in areas where blood collects and pools, as swelling there interferes with the movement of oxygen and nutrients through the tissues. Eventually, a visible ulcer develops on the skin. Venous ulcers usually occur just above the ankle on the inside of the leg.

If left untreated, venous ulcers can quickly become infected, leading to cellulitis or gangrene and the risk of foot or leg amputation.

Treatments

Compression Stockings - The most common treatment for venous insufficiency is compression stockings which apply constant, even pressure to the leg. This increases circulation and prevents blood from flowing backward, thereby reducing swelling. Compression stockings can also help prevent venous ulcers from forming, or can help to speed the healing of an existing ulcer. Compression stockings must be worn daily to be effective. Doctors may also prescribe blood thinners, especially in patients with a high risk of blood clots.

Unna Boots - An Unna boot is a moist gauze bandage applied around the lower leg starting at the area of the ulcer to just below the knee. The gauze hardens to form a snug boot on the leg. The support from the boot improves blood flow in the veins and aids in the healing of the ulcer. The boot is left on for up to two weeks and is replaced if the wound has not healed.

Transparent Dressings -  These are clear plastic-like films that are applied over the wound. The dressing is changed every five to seven days. A support stocking is worn over the dressing to hold the dressing in place and improve circulation in the leg and foot.

Hydrocolloid Dressings -  A hydrocolloid dressing is a special bandage with a breathable outer layer to keep liquid, bacteria, and viruses out, and an inner layer to absorb drainage from the wound and promote healing. The dressing also functions as a debridement therapy to remove any dead or non-viable tissue. 

Surgical Therapies

Surgery may be performed for chronic venous insufficiency that fails to respond to other therapies, or for non-healing or infected venous ulcers. Either an open procedure or a catheter-based interventional treatment may be used.

Debridement -  Debridement is often done when a venous ulcer shows signs of infection such as when there is fever, elevated white blood count, and persistent or increased drainage. Debridement involves removing infected tissue and bone, nonviable (necrotic or dead) tissue, foreign debris, and residual material from dressings.  This process activates the production of platelets, a blood component, and growth factors, both of which promote healing.