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Venous Ulcers
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When the venous system in the leg fails to work normally the pressure in the leg veins rises. This reduces the circulation in the lower leg particularly around the ankle leading to swelling, discomfort, skin changes and eventually ulceration. Varicose veins, a previous DVT, or primary failure of the valves in the veins can all contribute to this.
A form of eczema can occur in the calf, sometimes over an area of varicosity. The skin is red and itchy. Areas of the calf and around the ankle may develop a brown stain in the skin. The ankle area may be prone to swelling towards the end of the day. Sometimes the entire lower leg feels tight and hard, and may look red and inflamed. This may be acute lipodermatosclerosis (LDS) due to the high venous pressure or an infection (cellulitis).
There are many theories to explain why the raised pressure in abnormal leg veins leads to skin problems. There is some evidence to support all these theories and they probably all play a role to some extent. The skin becomes vulnerable, and is poor at healing. A small injury, insect bite, or minor infection which would normally heal, instead progresses, and an area of skin breakdown results. This does not heal and is called an ulcer. In the presence of venous disease, the term Venous Ulcer is used. There are many other factors that prevent ulcers from healing such as infection, poor blood supply via the arteries and reduced sensation via damaged nerves. These may all interact with venous disease producing a complex problem. Achieving healing in a difficult ulcer can be a major challenge and may require a team of specialists.

When the cause of the ulcer is mainly venous disease the main principles of treatment are as follows:

1. Simple dressing on the ulcer for protection, keeping it clean and allowing healing.

2. If there is active infection, antibiotics to treat that as a short course. (Bacteria will be on the surface of an ulcer and this "colonisation" does not need antibiotics.)

3. Layered bandaging over the dressing to compress the leg from the bottom upwards. This assists flow of blood in the deep veins of the leg. This is vital to improve the circulation in the ulcer tissues. This brings in oxygen and nutrients to allow healing. Without this a venous ulcer is unlikely to heal. Upto 75% of venous ulcers can be healed by a bandage over 3-6 months.

4.To also help healing and to try and prevent the ulcer occurring again there is also a role for direct treatments to the faulty veins of the legs. See the LINK to Venous/Endovenous procedures.