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Venous Ulcers

A venous ulcer or varicose ulcer is an open sore which can be difficult to treat, and very very slow to heal. Generally, venous ulcers appear around the ankle and they can take anywhere from weeks, to years, to completely disappear. They are often caused by impaired blood flow so if you have varicose veins or circulation issues, it is important to understand how venous ulcers form, and how they can be prevented.

 

Venous ulcer formation

Venous ulcers can form when the vein valves in your legs stop functioning properly due to weakness, scarring or blockage. Blood can start flowing backward and pooling in the legs. It is a result of untreated varicose veins or impaired blood flow whose backward flow raises pressure in the leg veins. It stretches the vein so that it becomes porous causing the blood to leak out into the skin and surrounding tissue, causing itching, inflammation and the formation of stasis dermatitis, or the painful wounds known as ulcers. The constant high pressure can also gradually damage the tiny blood vessels in your skin and make it fragile. As a result, your skin can easily break and form an ulcer after a bump or scratch.

 

What causes them?

There are a number of factors which could cause venous ulcers to form, similar to that of varicose veins or circulation impairment caused by chronic venous insufficiency. For example:

  • Varicose veins: if you have had, or currently have, varicose veins then your chances of developing skin inflammation which causes itchiness which results in the breaking down of the skin.

  • History of blood clots in the legs means you’re at risk of fluid build-up that can lead to venous ulcers.

  • Family history can predispose you to weak veins and risk of developing vein disease.

  • Hormonal factors: pregnancy and birth control, all increase your chances of developing venous insufficiency and ulcers.

  • Old age: venous disorders are more common in older populations.

  • Lifestyle factors: smoking, obesity and sedentary lifestyle (prolonged sitting/standing) can cause venous insufficiency.

  • Damage: in rare cases, an injury such as a burn or trauma to the muscle can cause venous ulcers.

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

  • Previous surgery to the leg, such as a hip replacement or knee replacement, which can prevent you from moving about

  • increasing age – people find it harder to move around as they get older, particularly if they suffer from arthritis

 

What to expect

The process is the same as that of Varicose vein treatment which requires the treatment of the underlying cause. If concerned about your symptoms below, call us at (506) 648-7013:

  • Inflamed swollen legs with heaviness and cramping.

  • Itching, burning, pain and tingling sensation in the legs.

  • Hardening or discolouration of the skin (dark red, purple, brown).

  • Formation of superficial red-yellowish sores with uneven borders.

  • Discomfort in the affected area – it may become shiny, tight or warm.

  • Infection, foul odour and pus may be discharged from the ulcer.

 

Treatment

With appropriate treatment, most venous leg ulcers heal within 3 to 4 months. Treatment should always be carried out by a healthcare professional trained in compression therapy for leg ulcers. Usually, this will be a professional nurse.

 

Cleaning and dressing the ulcer

The first step is to remove any debris or dead tissue from the ulcer and apply an appropriate dressing. This provides the best conditions for the ulcer to heal.

 

Compression

To improve vein circulation in your legs and treat swelling, your nurse will apply a firm compression bandage over the affected leg. These bandages are designed to squeeze your legs and encourage blood to flow upwards, towards your heart.

There are many different types of bandage or elastic stockings used to treat venous leg ulcers, which may be made in 2, 3 or 4 different layers. The application of a compression bandage is a skilled procedure and they should only be applied by trained healthcare staff.

Treating associated symptoms

Swelling in the legs and ankles

Venous leg ulcers are often accompanied by swelling of your feet and ankles (edema), which is caused by fluid. This can be controlled by compression bandages. Keeping your leg elevated whenever possible, ideally with your toes at the same level as your eyes, will also help ease swelling. You should put a suitcase, sofa cushion or foam wedge under the bottom of your mattress, to help keep your legs raised while you sleep. You should also keep as active as possible and aim to continue with your normal activities. Regular exercise, such as a daily walk, will help reduce leg swelling. However, you should avoid standing or sitting still with your feet down. You should elevate your feet at least every hour.

 

Itchy skin

Some people with venous leg ulcers develop rashes with scaly and itchy skin. This is often due to varicose eczema, which can be treated with a moisturizer and occasionally a mild corticosteroid cream or ointment. In rare cases, you may need to be referred to a dermatologist (skin specialist) for treatment. Itchy skin can also sometimes be caused by an allergic reaction to the dressings or creams applied by your nurse. If this happens, you may need to be tested for allergies.

It’s important to avoid scratching your legs if they feel itchy, because this damages the skin and may lead to further ulcers

Looking after yourself during treatment To help your ulcer heal more quickly, follow the advice below:

 

  • Try to keep active by walking regularly. Sitting and standing still without elevating your legs can make venous leg ulcers and swelling worse

  • Whenever you’re sitting or lying down, keep your affected leg elevated – with your toes level with your eyes

  • Regularly exercise your legs by moving your feet up and down, and rotating them at the ankles. This can help encourage better circulation

  • If you’re overweight, try to reduce your weight with a healthy diet and regular exercise

  • Stop smoking

  • Moderate your alcohol consumption

  • Be careful not to injure your affected leg, and wear comfortable, well-fitting footwear.

Treating an infected ulcer

An ulcer sometimes produces a large amount of discharge and becomes more painful. There may also be redness around the ulcer. These symptoms and feeling unwell are signs of infection.

 

After the ulcer has healed

Once you’ve had a venous leg ulcer, another ulcer could develop within months or years. The most effective method of preventing this is to wear compression stockings at all times when you’re out of bed. Your nurse will help you find a stocking that fits correctly and that you can manage yourself. Various accessories are available to help you put them on and take them off.

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