This large venous ulceration was treated in our offices by endovenous laser therapy, injection therapy and compression bandaging. The progression of the healing is easily seen here.
Venous or Varicose Ulcers
Venous ulcerations, also called varicose ulcers,
are a complication from varicose veins and venous insufficiency. The ulcer itself is an area in the leg, almost always on the inner side of the ankle, where there is a ‘hole’ in the skin. The term ulcer or ulceration actually means a deficit of tissue. Just as with a stomach ulcer, where there is a deficit of tissue, it is the same basic situation with varicose ulcers. Other, non-venous medical conditions that can cause leg ulcers include diabetes, trauma, and ulcers from hardening of the arteries.
Causes of Venous Ulcerations
The causes of venous ulcers are multifactorial. Long standing venous insufficiency causes changes in the tissue with a progressive hardening of the once supple tissue, known as lipodermatosclerosis. The ankle has more pressure and weight on it then ‘higher’ parts of the leg like the calves or thighs. It also is obviously a longer distance that blood there would have to travel in its route back to the heart if it starts in the ankles. The constant high pressure at the lowest parts of the legs causes a slow leakage of blood cells and other blood components from the veins in that area. When a bruise or injury occurs, a dark black and blue mark may form. You will notice that as it heals it becomes yellow or golden brown. This is caused by the red blood cells present in the tissue and outside of the blood vessels.With varicose ulcer patients the slow constant leakage of red blood cells into the tissue doesn’t cause a sudden black and blue bruising but rather a steady rust like darkening of the skin. It also becomes hard and wood like as it progresses. The skin is not as healthy as normal skin and is much more prone to a skin breakdown and ulcer formation from even a simple scratch or bump.
Treatment of Varicose Ulcers
The treatment of venous ulcers needs to focus on both the short term and long term situations. To often doctors focus only on the healing of the ulceration now but don't do enough to try to prevent future problems and ulcer recurrance.Treating the underlying varicose veins, venous insufficiency and venous reflux will help stop the primary cause of the problem. This can be done with lasers, micro-surgery, compression hose or injection compression therapy, and will both help the ulcerations heal faster as well as hopefully slow or stop the venous problems.There is also the need to treat the ulcer itself and this is done very successfully with compressive bandages known as Unna boots. These soft cast like dressings help blood flow return to the heart by narrowing the veins, stopping backflow of blood into the legs, and reducing both swelling and inflammation. There is almost never a need for antibiotics, as even very large varicose ulcers almost never get infected.