2nd July 2023

Venous ulcers

Venous ulceration can occur from venous insufficiency and hypertension in the lower limbs. Chronic venous hypertension alters capillary and lymphatic microcirculation, which can subsequently result in capillary leak, fibrin deposition, erythrocyte and leukocyte sequestration, thrombocytosis, and inflammation. In severe and more chronic cases, this can lead to tissue hypoxia and subsequent ulcer formation.

Identification and Symptoms

Diagnosis of chronic venous insufficiency is through the presence of symptoms, examination and venous doppler ultrasound of lower limbs. The main symptoms include leg pain, fatigue, and heaviness. Skin changes include venous eczema and discolouration, dilated superficial veins, and ultimately ulceration in severe cases. Venous ulcers tend to affect the medial aspect of the lower limb and have a poorly defined edge.

Venous insufficiency affecting the lower limbs with characteristic skin manifestations, including venous eczema, lipodermatosclerosis, and orange-brown macular pigmentation from haemosiderin deposition. 

Image Source: Wikimedia Commons (2018). Chronicvenousinsufficiency, Licensed under a creative commons licence. Available for free at: https://commons.wikimedia.org/wiki/File:Chronicvenousinsufficiency.jpg (Accessed on: 14 March 2023).

Treatment

Treatment can be divided into various categories and aims. These include improvement of symptoms, reduction of overall leg oedema, and healing of ulcers.

General measures recommended to patients include leg elevation, regular exercise, avoidance of prolonged standing and appropriate skin care. If ulceration occurs, treatments include compression therapy, ulcer debridement and possible antibiotic therapy depending on appearance and symptoms of ulcers.