VARICOSE ULCERS

1. VARICOSE ULCERS
Venous Ulcers, Stasis Ulcers, Ulcus Cruris
A venous leg ulcer is the most common type of leg ulcer, accounting for 80-
85% of all cases. Venous leg ulcers develop when persistently high blood
pressure in the veins of the legs (venous hypertension) causes damage to
the skin, which eventually breaks down and forms an ulcer.

2. A varicose ulcer is a painful, bloody lesion that appears on the skin when
underlying veins are unable to pump blood efficiently.
venous valves that exist to prevent backflow of blood do not function properly
pressure in veins increase
blood is not pumped as
effectively into or out of the
area and it pools
venous hypertension exists
arteries no longer have
significantly higher pressure
than veins
blood proteins to leak into the
extravascular space, isolate ECM
molecules and growth factors,
preventing them from helping to
heal the wound
stretch veins

3. Venous leg ulcers affect around 1 in 500 people in the UK.
This rate rises sharply with age with an estimated 1 in 50 people over the
age of 80 developing venous leg ulcers.
RISK FACTORS:
- immobility
- obesity
-have varicose veins
-DVT
-diabetes
-age
-peripheral arterial disease

4. -a chronic non-healing wound with broken skin and exposed tissue.
-usually found on the inside of the leg, just above the ankle
-painful, particularly when infected
-pitting oedema
- lipodermatosclerosis
- atrophie blanche
SYMPTOMS

5. DIAGNOSIS
-GP diagnosis based on symptoms and a physical examination (varicose
veins - standing up and ulcer - lying down)
-Look for symptoms of a venous leg ulcer and feel your pulse at ankles
(check arteries)
- Doppler study: taking a measurement of blood pressure in each leg, at the
ankle, and comparing it with the blood pressure in arm. The arterial blood
pressure should be about the same in the arms and legs (differentiate
between arterial and venous ulcers – different treatments!)
- Colour duplex ultrasound scan: measurement of blood flow in the veins
and arteries of the leg so that venous valves can be assessed and arteries
checked

6. -70% of small ulcers will heal within 12 weeks.
-Larger ulcers may take longer to heal.
-Treatment involves cleaning and dressing the wound and using compression
bandages to control blood pressure inside the legs.
Compression treatment: 70% of ulcers to heal within six months.
Ulcer dressings: provide conditions for the ulcer to allow healing. Clean the ulcer
(remove debris and dead tissue that accumulates on the surface of the ulcer between
dressing changes), use a simple, non-sticky dressing.
4E’s: education, elevation, elastic compression and evaluation.
-Active movement
-Leg elevation
-Emollient use
-Treating the underlying condition
-Treatment of any infection?
TREATMENT

7. Varicose vein surgical treatments e.g.: endovenous
ablation, vein ligation/stripping, endoscopic vein
surgery, ambulatory phlebectomy, transilluminated
powered phlebectomy, subfascial endoscopic
perforator surgery, clariVein, endovenous thermal
ablation, foam sclerotherapy
Artificial skin (collagen and cultured skin cells)

8. COMPLICATIONS:
Unless underlying risk factors such as immobility, obesity and
varicose veins are addressed, there is a high risk of a venous leg
ulcer reoccurring.
- loss of mobility
- infection (rarely infection could lead to more serious conditions
such as osteomyelitis or sepsis)
PREVENTION:
-wearing a compression stocking
- losing weight if you are obese
-taking care of your skin.

9. Websites
•http://www.oculusis.com/us/dc/varicose/varicose2.php
•http://www.bolandcell.co.za/L-MESITRAN_2008.html
•http://www.drvaibhavinamdar.com/varicose-ulcer.html
•http://www.worldwidewounds.com/1997/september/Thomas-Bandaging/bandage-paper.html
•http://www.tayfungurbuz.com/variscerrahisi_en.asp
•http://www.nhs.uk/Conditions/Leg-ulcer-venous/Pages/Diagnosis.aspx
•http://en.wikipedia.org/wiki/Venous_ulcer
•http://www.wisegeek.com/what-is-a-varicose-ulcer.htm
•http://www.rightdiagnosis.com/v/varicose_ulcers/symptoms.
htm
•http://www.netdoctor.co.uk/surgical-procedures/varicose-
ulcer-treatment.htm

10. Websites
•http://www.oculusis.com/us/dc/varicose/varicose2.php
•http://www.bolandcell.co.za/L-MESITRAN_2008.html
•http://www.drvaibhavinamdar.com/varicose-ulcer.html
•http://www.worldwidewounds.com/1997/september/Thomas-Bandaging/bandage-paper.html
•http://www.tayfungurbuz.com/variscerrahisi_en.asp
•http://www.nhs.uk/Conditions/Leg-ulcer-venous/Pages/Diagnosis.aspx
•http://en.wikipedia.org/wiki/Venous_ulcer
•http://www.wisegeek.com/what-is-a-varicose-ulcer.htm
•http://www.rightdiagnosis.com/v/varicose_ulcers/symptoms.
htm
•http://www.netdoctor.co.uk/surgical-procedures/varicose-
ulcer-treatment.htm