of Vascular Disease
1. What is
a venous ulcer?
ulcer is damage and loss of skin above the ankle that is the result of a problem
with the veins in the leg.
Venous ulcers are quite common, difficult to heal and often recur.
is the problem with the veins?
Veins are part of the blood circulation system.
The veins carry blood back to the heart so that it can be pumped into the
arteries. Leg veins have flexible valves inside that
ensure the blood can only flow back to
the heart, especially when standing and walking.
The most important veins are deep inside the leg, surrounded by the
muscles. During walking, the rhythmic contraction of the leg muscles
squeezes these veins and actually pumps the blood back to the heart! A
number of problems with the veins can cause this pump to fail and if this
happens the venous blood pools in the legs on standing and walking and the blood
pressure in the veins increases. Over a number of years the excessive
pressure damages the skin and eventually and an ulcer develops.
3. How do you diagnose a
venous ulcer has a characteristic appearance:
commonly situated on the lower leg just above the ankle.|
surrounded by brown-stained skin.|
veins are often visible as well.|
of the foot and heel usually look normal.|
ulcer can be of any size.|
ulcer is often green and smelly because of infection.|
About two thirds of leg ulcers with this appearance are
venous ulcers. To diagnose problem with the veins that has caused the
ulcer requires a special test using ultrasound. A patient with a new leg
ulcer should be referred to a specialist for expert assessment.
4. What will happen if I have a
venous ulcer and I do nothing about it?
venous ulcer will not usually heal without expert advice and treatment.
Unless it is kept clean and dressed regularly a venous ulcer can become infected
and get much larger very quickly. Venous ulcers can be very painful and
limit mobility and quality of life. The longer you have a venous ulcer the
more damage that is done to the skin of the leg and the more difficult is is to
heal, even with expert advice.
do you cure a venous ulcer?
three important principles involved in effective treatment of a venous ulcer:
Keep the ulcer clean and dressed regularly to prevent
infection and promote healing.
the cause investigated by a specialist.
the underlying cause effectively to allow healing and prevent
6. What treatments are there for venous ulcers?
There are three effective forms of treatment for venous ulcers:
Elevate the affected leg for as long as possible to prevent
pooling of the blood and allow healing.
Apply special compression bandages to the leg for support when standing and walking.
Surgically remove any leaky veins that are contributing to the
7. Who will do the compression bandaging?
The compression bandaging must done by a person who has been trained to do it
properly. This will usually be a district nurse, or a nurse in a leg ulcer clinic. If the bandage is put on too loosely it doesn't work; if it
is put on too tightly it may make the ulcer worse or cause other ulcers to
8. What if I need surgery?
If the specialist assessment shows that there are problems with the veins under
the skin then your specialist may recommend surgery to remove these veins or the
prevent the blood flowing the wrong way in these veins. For more details
see varicose veins.
9. How long does it take for
the ulcer to heal?
time taken for a leg ulcer to heal is difficult to predict. The following
factors are important for healing:
ulcers will heal in a few days, others take weeks or months and some never heal.
10. What can I do to speed up my recovery?
Common sense tells you that a good diet, plenty
of rest, and regular dressings will allow the healing process do its job.
12. Will I need to come back to hospital?
It is usual
for patients with leg ulcers to be reviewed at intervals in a special leg ulcer
clinic. This is to ensure that the treatment is effective and no
complications have developed such as infection.
13. Will the
ulcer come back?
in many patients venous ulcers will recur either at the same of different
sites. It is therefore very important that treatment continues after the
first ulcer has healed, especially if the underlying problem with the veins
cannot be treated surgically. The most usual form of long term treatment
is the use of graduated compression socks.