Varicose ulcers are a significant problem for many patients with varicose veins.
They are caused by poor perfusion (supply of blood rich in nutrients to the tissues) in the lower extremities.
The skin and the tissues that cover them are deprived of oxygen, killing these tissues and causing an open wound.
In addition, lack of blood supply can cause minor scratches or cuts not heal and eventually become ulcers.
The arteries are responsible for bringing blood rich in nutrients and oxygen to the body’s various tissues.
Ischemia, which usually refers to a restriction in the blood supply, can lead to varicose ulcers caused by a narrowing of the artery or damage to the small blood vessels in the extremities.
Reduced blood flow, in turn, leads to tissue necrosis and ulceration.
Ulcers will generally heal within a few weeks of treating varicose veins.
The most common causes of varicose ulcers are:
• Limitations of blood vessels due to the existence of a peripheral vascular disease
• Chronic vascular insufficiency
• Vasculitis (inflammatory damage of the blood vessels)
• Diabetes mellitus
• Renal insufficiency
• High blood pressure
• Atherosclerosis (thickening of the arteries due to accumulation of fatty materials)
• Limited joint mobility
Symptoms of varicose ulcers
Varicose ulcers are characterized by a perforated appearance that is generally rounded; the margins in the wound are well defined and uniform.
They are often found on the tips of the toes, the outer ankle, or where footwear is the pressure when walking.
The wounds often extend to the underlying tendons and show no signs of new tissue growth. The damaged base typically does not bleed and is yellow, brown, gray, or black.
Often, the extremity will feel cold and even cold to the touch, and the limb will have little or no distinguishable pulse.
The skin and nails will also appear atrophied, with noticeable hair loss in the affected limb. The skin acquires a shiny, thin, dry, and tense appearance.
In addition, the base color of the skin may turn red when it is hung and pale when it is raised. These ulcers are usually excruciating.
A common source of temporary relief from this pain is to hang the affected leg over the edge of the bed, allowing gravity to help blood flow to the ulcer region.
Varicose ulcers are distinguished from venous ulcers, in which venous ulcers present with redness and edema (swelling) at the site of the ulcer and may be painless.
Several different factors can increase a person’s risk of having a varicose ulcer on the leg, which include:
• Age: the peripheral circulation becomes less efficient with old age.
• Presence of varicose veins: the one-way valves that prevent blood from traveling backward in the vein stop working, and the blood pool stretches and distorts the vein.
• Smoking: Tobacco constricts the vessels of the circulatory system.
• Arterial diseases: problems in the veins are more likely if the person already has other diseases of the arteries.
• Certain disorders: including diabetes mellitus and arthritis.
• Medications: some cardiovascular medications may contribute to leg edema (swelling due to fluid buildup) and altered circulation.
How varicose ulcers are diagnosed
The means of diagnosis that are commonly used are:
• Transcutaneous oxygen measurement
• Brachial ankle index
• Absolute foot systolic pressure
• Buerger test
• Arterial Doppler studies
The main objective of treating varicose ulcers is to increase circulation in the area of the lesion, surgically or medically.
In extreme cases, surgical options range from revascularization to restoring normal blood flow to amputation.
Ischemic wounds differ from other serious wounds in that the wound environment should be as dry as possible to decrease the risk of infection.
Using cadexomer iodine around the margins of the wound is an option.