Generally, in most people, skin wounds heal in days or weeks.
But when the skin does not heal, the affected area may enlarge and become an ulcer. This is caused by insufficient blood circulation in the extremities.
An ulcer develops when an open wound on the skin becomes contaminated with bacteria in the underlying tissues. It can be caused by a minor injury or an underlying disease that affects the veins of the legs.
Leg ulcers are the most common type of venous ulcer and occur just above the ankle.
Venous ulcers are often recurrent and may persist for weeks to years, the nature of these ulcers increases the risk of morbidity and mortality, and have a significant impact on the patient’s quality of life.
They are open wounds on the skin that usually develop on the inside of the leg, just above the ankle and whose symptoms are:
- Edema: swollen ankles
- Discoloration and darkening of the skin around the ulcer is observed
- The skin hardens around the ulcer
- Feeling of heaviness in the legs
- Moderate pain
- Red, scaly, and itchy skin on the legs (varicose eczema)
- Swollen and enlarged veins on your legs (varicose veins)
- Presence of exudate (pus)
Causes of venous ulcers
The root of the problem is the increase in blood pressure in the veins of the leg.
Gravity causes blood to flow back through the damaged valves, causing swelling, thickening in the veins (varicose veins).
Blood accumulates in the smaller veins near the skin, causing damage.
It can also accumulate because the valves in the larger veins are damaged by a previous blood clot (thrombosis).
This damaged skin can eventually break down and form an ulcer.
The main risk factors for the development of venous ulcers are:
- Advanced age
- The obesity
- Previous lesions in the legs
- deep vein thrombosis
- la weep;
Diagnosis for venous ulcers
The characteristic differences in the clinical presentation and the findings of the physical examination can help differentiate venous ulcers from other ulcers of the lower extremities.
The diagnosis of venous ulcers is usually clinical; however, tests such as the ankle-brachial index, ultrasound, plethysmography and venography may be useful if the diagnosis is unclear.
Treatment options for venous ulcers include conservative treatment, mechanical treatment, medications and surgical options.
In general, the goals of treatment are to reduce edema, improve healing of the ulcer and prevent recurrence.
1. Compression therapy
Compression therapy is the standard treatment for venous ulcers and chronic venous insufficiency.
After the ulcer has healed, maintaining compression therapy can reduce the risk of recurrence.
However, this therapy may be limited by pain, obesity and contact dermatitis.
Contraindications for compression therapy include clinically significant arterial diseases and heart failure.
2. The elevation of the leg
The leg elevation requires elevating the lower extremities above the level of the heart, for 30 minutes, three or four times a day, in order to reduce edema, improve microcirculation and oxygen supply and accelerate the healing of the ulcer.
Pentoxifylline (Trental) is an inhibitor of platelet aggregation, which reduces the viscosity of the blood and, in turn, improves microcirculation. Pentoxifylline (400 mg three times a day) has been shown to be very effective in adjuvant treatment for varicose ulcers.
As with pentoxifylline therapy, aspirin (300 mg per day) combined with compression therapy has been shown to reduce the size of the ulcer.
Antibiotics / antiseptics
Bacterial infections are common in venous ulcers and contribute to poor wound healing.
Therefore, the use of antibacterial topics and the use of antibiotics is recommended.
Changes in lifestyle should be made to prevent venous ulcers of the skin:
- Give up smoking
- Lose weight
- Control chronic conditions such as high blood pressure or diabetes
- Consume aspirin to prevent blood clots
- Reduce the amount of salt in your diet
- Exercise regularly
- Wear compression stockings
- Keep your legs elevated when you can