Veinous Leg Ulcers

What is a venous leg ulcer?
A skin ulcer is where an area of skin has broken down. Venous leg ulcers are the commonest type of ulcer. They occur just above the ankle, usually affect older people and are more common in women. About 1 in 50 people develop a venous leg ulcer at some stage. Untreated, an ulcer may enlarge and cause problems in the leg.

What causes venous leg ulcers?
The root of the problem is increased pressure of blood in the veins of the lower leg. These cause swelling, thickening, and damage to the skin. The damaged skin may eventually break down to form an ulcer.

The pressure in the veins is high if the valves in the larger veins have been damaged by a previous deep vein thrombosis or because of untreated varicose veins. Gravity causes blood to backflow through the damaged valves and pool in the lower veins.

What is the treatment for venous leg ulcers?
A venous ulcer is unlikely to heal with just dressings. Compression bandaging is the most important part of treatment. The aim is to counteract the raised pressure in the leg veins. A nurse puts on 3-4 layers of tight bandages over the dressing. The pressure is highest at the ankle, and gradually less towards the knee and thigh.

(A compression stocking over the dressing is sometimes used as an alternative, but not as effective as bandaging.)

The bandages are re-applied every week.

Up to 7 in 10 venous ulcers heal within 12 weeks if treated with compression bandaging which is re-applied every week or so. If compression is not used and an ordinary dressing or compression stockings alone are used, the chance of healing is reduced.

A skin graft may be advised for a large ulcer, or for one that does not heal well.

Surgery for varicose veins or other vein problems may be advised in some cases. This may correct the 'back pressure' of blood pooling in the veins, and allow an ulcer to heal.

Preventing a recurrence of venous skin ulcers
Venous leg ulcers commonly recur after they have healed. To prevent this, your should wear a support (compression) stocking during the daytime for at least five years after the ulcer has healed. This counteracts the raised pressure in the veins that causes venous leg ulcers. You should get a new stocking about every six months as the elastic tends to 'go' after a while.

There are different classes (strengths) of compression stockings - class 1, 2 and 3. The higher the class (class 3) the greater the compression. Ideally, wear class 3 stockings. However, some people find class 3 stockings too tight and uncomfortable, but class 2 may be fine. It is still best to wear some sort of compression stocking than none at all.

A leg ulcer is much less likely to recur if you wear compression stockings regularly.

Sometimes surgery for varicose veins or other vein problems is advised after an ulcer has healed to help prevent a recurrence.