Assessment & Management of Venous Leg Ulcers

According to Columbia University Medical Center, 1 million patients in the United States and Europe have venous leg ulcers each year. Typically, these ulcers appear below the knee and on the inside of the leg above the ankle. When veins in the legs become damaged and sores or ulcers develop and penetrate deeply into the skin.

Cause

• Venous leg ulcers are caused by reduced blood circulation in the legs. Due to the reduced blood flow, blood pools in the leg veins. The increasing pressure on the smaller blood vessels creates leakage into surrounding tissue and swelling occurs. This swelling interferes with the flow of oxygen and nutrients into the tissue and damages the tissue, creating venous leg ulcers.

Diagnosis

• Diagnosis of venous leg ulcers is done first by the physician taking a thorough medical history. Next a patient will often see a wound specialist who will perform tests such as MRIs, CT scans and X-rays. Symptoms of venous leg ulcers include white scar tissue around the ulcer, swelling and dark reddish-brown skin discoloration. Cellulitis often occurs with venous leg ulcers and appears as red, warm and tender areas with pus or fluid leakage from infection.

Compression Treatment

• Compression therapy is the main treatment for venous leg ulcers. Compression dressings include compression stockings and compression wraps. The type of wrap needed depends on the the condition and location of the ulcers. Some types of compression bandages include collagen wound dressings, antimicrobial dressings, hydrogels or hydrocolloids, moist dressings, composite dressings or synthetic skin coverings.

  The goal of compression treatment is to reduce edema and swelling of the leg ulcers. This is aiding by frequently elevating the legs.

Drug Treatment and Debridement

• Generally, antibiotics are prescribed for venous leg ulcers only when cellulitis occurs. Topical antibiotics should be avoided as they can cause allergic reactions that can worsen the skin ulcer. However, debridement or the removal of dead or infected tissue or bone is a standard treatment option in leg ulcers. Debridement also activates platelets; this helps with controlling bleeding and can jump start the healing process.

Skin Grafts

• Another treatment for venous leg ulcers is skin grafts. Skin grafting is usually split thickness grafts especially in the case of large or non-healing wounds. These can be difficult to perform and must be done by a surgeon skilled in the particular techniques required for venous leg ulcers. Sometimes it's necessary to mesh split thickness grafts to allow for wound drainage so that the graft is not dislodged or disrupted.