This book describes Venous Ulcers, Diagnosis and Treatment and Related Diseases

The worst venous ulcers that I have seen are those from diabetes and varicose veins.

Venous ulcers (also termed venous stasis ulcers or non-healing wounds) are open wounds happening around the ankle or lower leg.

They do not recover for weeks or months, and occasionally continue for longer.

Venous ulcers (VUs) are late markers of chronic venous insufficiency (CVI) and venous hypertension.

In normal disorders, calf muscle contraction and intra-luminal valves stimulate prograde flow while stopping blood reflux.

When retrograde flow, obstruction, or both are present, the resultant chronic venous hypertension is accountable for the dermatologic and vascular complications that result in the formation of a VU.

Some disorders that can cause venous ulcers are:

Venous hypertension

Venous insufficiency

Varicose veins

Blood clots or poor circulation

Diabetes, kidney failure, or inflammatory diseases

Certain medicines

Infections

Obesity

A venous leg ulcer can form after a minor injury if there is a disorder with the circulation of blood in the leg veins.

When this happens, the pressure within the veins rises.

This constant high pressure can slowly injure the tiny blood vessels in the skin and make it fragile.

As a result, the skin can easily tear and form an ulcer after a hit or scratch.

Unless the patient has treatment to increase the circulation in the legs, the ulcer may not recover.

Risk factors

A number of factors can raise the risk of developing a venous leg ulcer, such as:

Obesity or being overweight – raises the pressure in the leg veins

Difficulty in walking – weaken the calf muscles, which can affect circulation in the leg veins

Previous deep vein thrombosis (DVT) – blood clots in the leg can injure the valves in the veins

Varicose veins – swollen and enlarged veins produced by malfunctioning valves

Previous injury to the leg, such as a broken or fractured bone, which may produce DVT or impair walking

Previous surgery to the leg, such as a hip replacement or knee replacement, which can prevent the patient moving

Age – people find it harder to move around as they age

While CVI is a well-known trigger for VU development, venous ulceration happens rarely (5.1%) for unknown reasons.

CVI may happen due to blood reflux, obstruction, or a combination of both mechanisms, producing macro- and micro-circulatory dysfunction.

If the patient has a venous leg ulcer, the patient may also have symptoms:

Swollen ankles

Discoloration and darkening of the skin around the ulcer

Hardened skin around the ulcer, which may make the leg feel hard

Heavy feeling in the legs

Aching or swelling in the legs

Red, flaky, scaly and itchy skin on the legs

Color-flow duplex ultrasound is another non-costly, non-invasive, and highly informative diagnostic test, especially useful for superficial vein assessment.

The method can identify thrombi presence and valve incompetence, which is affirmed when reflux time is > 0.5 s.

Computed tomography and magnetic resonance imaging are favored for deeper vessels since they are often more difficult or impossible to evaluate

The main treatment for VUs depends on two methods: compression therapy and direct wound management.

Occasionally minor surgery (wound debridement) or vein ablation is used to remove any nonliving tissue that stops a wound from healing properly.

With proper treatment, most venous leg ulcers recover within 3 - 4 months.

TABLE OF CONTENT

Introduction

Chapter 1 Venous Ulcers

Chapter 2 Causes

Chapter 3 Symptoms

Chapter 4 Diagnosis

Chapter 5 Treatment

Chapter 6 Prognosis

Chapter 7 Varicose Veins

Chapter 8 Peripheral Vascular Disease

Epilogue