A venous ulcer is a wound caused by poor circulation in the veins of the lower legs, ankles, or feet. It develops when damaged and weakened veins are not strong enough to pump blood back up to the heart, causing pressure to build up in the veins. The increased pressure also causes skin to break down and form open sores that take a long time to heal.

If venous ulcers are identified and treated early, it can prevent further complications, including an infection, prolonged pain and discomfort, and even further tissue damage. Careful treatment and timely intervention significantly improve healing outcomes, minimize recurrence risk, and contribute to increased patient quality of life.

What is a Venous Ulcer?

An open wound that forms because the veins in your legs don’t correctly return blood to the heart is called a venous ulcer. Poor circulation causes the blood pressure in the veins to increase, leading fluid to leak into surrounding tissues and break down the skin. Venous ulcers are found on the lower leg near the ankle and do not heal quickly, sometimes needing specialized care.

Causes and Risk Factors

The most common cause of a venous ulcer is chronic venous insufficiency (CVI), a condition where the veins struggle to return blood to the heart due to faulty valves or weakened vein walls. This leads to blood pooling in the lower legs, which increases pressure and eventually damages the skin. Additional causes and risk factors include:

Poor circulation: Inadequate blood flow in the veins due to weakened vessel walls or valve failure.

Varicose veins: Enlarged, twisted veins that increase the likelihood of venous ulcers.

Blood clots (deep vein thrombosis): These clots can block proper blood flow, leading to increased pressure in the veins.

Obesity: Excess weight puts added pressure on the veins, contributing to circulation problems.

Prolonged standing or sitting can worsen venous circulation by stressing the leg veins over time.

Age and genetics: Older adults and those with a family history of venous insufficiency are more prone to venous ulcers.

Common Symptoms and Development Over Time

Symptoms of a venous ulcer usually start pretty mild, with swelling and skin discoloration of the affected area in the form of red or purplish spots around the ankle. Dry, itchy, scaly, and sometimes broken-down tissue may develop; however, these changes occur slowly over time. As the ulcer worsens, an open wound, usually shallow and irregular, with a red or yellow color.  The surrounding skin may be tight or hardened, and the wound may ooze clear fluid.

Venous ulcers can worsen if not treated; they tend to grow bigger and are more likely to become infected. Pain, increased swelling, and foul-smelling discharge suggest that you need quick medical attention immediately. If venous ulcers are identified and treated early, more damage to the tissue can be prevented.

What Venous Ulcers Look Like

If present, venous ulcers have distinct visual features that help to separate them from other leg wounds. All of these ulcers grow slowly, but early detection of the appearance of these ulcers is critical to proper treatment and healing. Here are the things to watch for when determining if you have a venous ulcer.

Visual Symptoms of a Venous Ulcer

Changes in red or purple skin discoloration.

Sometimes, skin discoloration is one of the first signs of a venous ulcer, with reddish or purplish patches often near the ankles or lower legs. Blood is not being carried back to the heart efficiently, resulting in a buildup of pressure and fluid within the tissues, which is why this discoloration occurs. Over time, this causes inflammation and damage to the skin.

Irregular-shaped shallow wounds

Since venous ulcers are not the same as other types of wounds, they are usually shallow and irregular in shape compared to the clean, round edges typical of other wounds. Most often, the base of the ulcer looks red or yellow, depending on how much it is healing or infected. The wound edges may not look even, and the skin beyond it may be swollen, thickened, or hardened.

It can affect surrounding swelling and dry, itchy skin.

A venous ulcer usually is accompanied by swelling (edema) in the lower legs and ankles. As a result of fluid accumulation and poor venous return, this swelling results. Along with the swelling, the skin around the ulcer may dry, scale, and itch — causing discomfort. The skin can also break and crack, putting you more at risk for additional irritation and infection.

Location (Usually Happens near Ankles or Lower Legs)

Usually, venous ulcers appear around the ankles or the lower legs, most commonly on the inner side of the leg. The highest venous pressure is in this area, and it is the most vulnerable area at the risk of ulcers. Their position as a key diagnostic characteristic is that they rarely occur higher up on the leg or foot.

Differentiating Venous Ulcers from Other Types of Leg Ulcers

While venous ulcers share some characteristics with other types of leg ulcers, such as arterial ulcers or diabetic ulcers, there are notable differences that help distinguish them:

• The borders of a venous ulcer are usually shallow and irregular, but they are typically well-defined for an arterial ulcer. Arterial ulcers are also more painful and often on toes, feet, or bony areas.
• While venous ulcers often begin in the lower legs, diabetic ulcers generally occur on foot pressure points (e.g., soles or heels). Venous ulcers may not present like diabetic ulcers, with less swelling and discoloration.
• Arterial ulcers cause more painful symptoms than venous ulcers and may not hurt, especially when things like infection or swelling cause them to hurt. Venous ulcers are more likely to have accompanying symptoms like itching, swelling, and discoloration near the ankles.

Knowing these visual signs and symptoms is essential in telling the difference between a venous ulcer and other wounds and starting the proper treatment to promote healing and prevent complications.

What Would Be Your Best Method for Dressing a Venous Stasis Ulcer?

Appropriate wound care and dressing are important in treating a venous ulcer as this will help promote healing, lessen pain, and avoid infection. These ulcers form because the wound results from poor blood circulation, so effective treatment will be provided for the wound and the underlying circulatory issue. Wound care aims to protect the ulcer and prevent infection, manage moisture, and promote healing by improving circulation.

Importance of Proper Wound Care and Dressing

When dressing a venous ulcer, it’s crucial to choose a dressing that controls exudate (fluid), helps to keep the wound moist and healing, and provides a barrier to infection. The wrong type of dressing can slow healing, cause problems, or be very uncomfortable. Successful treatment of venous ulcers requires regular dressing changes and additional treatment with compression therapy.

Overview of Different Dressing Types

Compression Therapy

Compression therapy is one of the most effective treatments for a venous ulcer, as it helps improve blood circulation in the legs. By applying pressure to the affected area, compression stockings or bandages assist the veins in moving blood back to the heart, reducing swelling and promoting healing.

Why it’s important: Since poor circulation is the leading cause of venous ulcers, compression therapy directly targets the root of the problem, improving the healing process.

Types of compression: Compression bandages, stockings, or wraps can be used depending on the severity of the ulcer and the patient’s mobility.

Moist Wound Dressings

Keeping the ulcer moist helps the skin heal faster and more efficiently. Hydrocolloids, alginates, and foams are examples of moist wound dressings commonly used for venous ulcers:

Hydrocolloids: These dressings form a gel-like layer over the wound, maintaining moisture and creating a protective barrier.

Alginates: Made from seaweed, alginate dressings are highly absorbent and are ideal for ulcers that produce a lot of exudates.

Foams: Foam dressings also manage excess fluid and provide cushioning to reduce pressure on the wound.

Why it’s important: A moist environment promotes cell regeneration and faster healing, preventing the wound from drying out and scabbing.

Antimicrobial Dressings

Antimicrobial dressings are crucial if a venous ulcer shows signs of infection (e.g., increased pain, foul odor, or pus). These dressings contain agents like silver or iodine that kill bacteria and prevent infection from spreading.

Why it’s important: Infections can severely delay healing and lead to more severe complications, so addressing them early is critical.

Step-by-Step Guide to Dressing a Venous Ulcer

Clean the wound

Cleanse the venous ulcer using a saline solution or wound cleanser to remove debris, bacteria, and excess fluid. Avoid using harsh chemicals or antiseptics that can damage the surrounding skin.

Apply the appropriate dressing

• Choose a dressing that maintains a moist environment, absorbs exudate, and protects the wound from contamination. An alginate or foam dressing may be best if the wound drains heavily.
• For infected ulcers, select an antimicrobial dressing to control bacterial growth.

Compression application

After applying the dressing, use compression bandages or stockings to promote circulation. Wrap the bandage firmly but not so tight that it cuts off circulation. Your healthcare provider may recommend multi-layer compression systems for more severe cases.

Change dressings regularly

Dressing changes should be done based on the amount of drainage and the condition of the wound, typically every 1 to 3 days. Monitor for signs of infection, worsening of the ulcer, or excessive moisture.

Monitor progress

Assess the ulcer’s healing progress regularly and adjust the dressing type or frequency if necessary. Seek medical advice if healing is slow or signs of infection persist.

Additional Treatments: Elevation, Exercise, and Medication

In addition to proper wound care and dressing, other treatments can accelerate healing and prevent venous ulcers from recurring:

Elevation:

Elevating the legs above the heart helps reduce swelling and pressure in the veins, improving circulation. Patients are encouraged to elevate their legs for 30 minutes several times a day.

Exercise:

Regular, low-impact exercise, such as walking, promotes blood flow in the legs, aiding healing and reducing the risk of future ulcers. Exercise also strengthens the calf muscles, which assist in venous return.

Medication:

If there is an infection, topical or oral antibiotics may be prescribed. Sometimes, doctors may also recommend medications that improve circulation or reduce swelling.

By combining the right dressing techniques with supportive therapies like compression, elevation, and exercise, venous ulcers can heal more efficiently, reducing pain and the likelihood of recurrence. Proper care is critical to ensure lasting results and a healthier quality of life.

Conclusion

A venous ulcer is a wound that occurs due to poor circulation in the lower legs and is on a more or less chronic basis. Timely intervention for early symptoms, such as skin discoloration, swelling, and shallow wounds, is important. Proper wound care may prevent healing and complications from a leg ulcer, including compression therapy, moist wound dressings, and antimicrobial treatments. By understanding why the ulcers occur and what might increase your chance of getting them, such as chronic venous insufficiency, patients and healthcare providers know how to take steps to prevent them.

Early venous ulcer treatment significantly improves healing outcomes and minimizes the risk of infection or recurrence. This addresses the wound and the circulation problems underneath, and patients can recover faster and get better long-term results. Though venous ulcers can be a chronic condition, there is good evidence that consistent wound care, regular monitoring, and other therapies such as elevation and exercise can aid in successful management and improve overall quality of life.