VENOUS LEG ULCERS
Ulcerations or chronic non-healing sores of the lower leg, ankle or foot are most commonly caused by chronic venous insufficiency. These ulcers are frequently found to be associated with varicose veins or patients who have had deep venous thrombosis in the past.
Other causes of ulceration of the lower extremity such as diabetic foot ulcer, atherosclerotic occlusions of arterial blood flow, rheumatoid arthritis and infection must be considered before treatment is initiated.
Venous ulcers are caused by changes at the microcirculatory, capillary, and cellular levels. The venous high pressure caused by the gravity induced abnormal backward flow in the leg veins causes an inflammatory reaction which in turn damages the tissues of the skin in the most dependent areas, the lower leg, ankle and foot. With minor trauma, maybe no more than an abrasion from scratching, a non-healing sore develops. Over time the small wound may become much larger and deeper. These ulcers are painful and difficult to heal using usual wound care measures. Good compression stockings, elevation, and intensive wound care may be successful in achieving healing, but frequently the ulcer recurs, especially if the patient omits the compression.
With the use of ultrasound for accurate diagnosis and delineation of all the sources of the high venous pressure and with minimally invasive venous ablation procedures, vein surgeons are now able to cure over 90% of chronic venous ulcers and prevent their recur‐ rence. These results are far superior to those obtained from the vein stripping procedures of the past.
Patients with leg ulcers that are resistant to healing should seek early diagnosis and treatment. For venous ulcers best treatment results can be expected from phlebologists skilled in the use of minimally invasive diagnostic and treatment techniques.