Venous stasis ulcers, also known as venous insufficiency ulcerations are shallow wounds that form as a result of malfunctioning venous valves usually in the legs. Up to 80-90% of ulcers are classified as venous stasis ulcers. These ulcers are quite painful and usually occur in the medial part of the leg.
How do they occur?
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Increased blood pressure in the venous arteries— venous hypertension— occurs as a result of weakened venous arteries. This disrupts the pressure gradient between the arteries and veins, which is essential to allow blood to be pumped from the arteries into the veins. The result is poor blood flow into and out of the veins and hence into the affected area.
Venous hypertension is also though to weaken the veins allowing blood proteins to be leaked into the blood stream and interfering with the healing process and activating key inflammatory pathways. White blood cells accumulate in the wound and prevent proper oxygen delivery to the area further preventing the wound from healing.
Diagnosis
Diagnosis is made by assessing the severity of the wound using the CEAP (clinical, etiology, anatomy and pathophysiology) classification system. A clinical severity score is then used to give a prognosis, higher scores represent a poor prognosis. The wound is usually shallow, irregular and located over bony areas.
Treatment
The first mode of treatment is prevention. Those with a history of venous ulcers in the family are advised to wear compression stockings to improve blood flow and prevent ischemia (lack of oxygen). Unfortunately sufferers have found that venous ulcers are recurrent and hence prevention is one of the primary modes of treatment.
Once a venous ulcer is diagnosed the primary aim of the treatment is to create an environment where skin is able to grow across the wound. Graduated compression is applied to the affected area to reduce the abnormally high pressure in the veins. Appropriate bandages are applied to the area and changed regularly. Antibiotics are also prescribed to prevent bacterial infection of the wound.
Alongside these treatment measures the patient is advised to keep the leg elevated to minimise edema in the affected area.
