Venous leg ulcer is a chronic disease that is difficult to heal, and is also a significant cosmetic problem. It most often affects elderly people who already suffer from venous insufficiency or other diseases that burden the veins, e.g. diabetes. Learn how to treat venous leg ulcers and how to care for the lower limbs to prevent the disease from recurring.

Venous leg ulceris an unpleasant and very troublesome ailment that develops as a result of neglected or poorly treated varicose veins, but also affects those who have previously had phlebitis or thrombosis . A venous leg ulcer is a wound that does not heal for 6-8 weeks, or whose area does not decrease by as much as 20% after 2-4 weeks of treatment. We call it a chronic non-healing wound. It is located on the leg, above the ankle, in front or on the inside of the limb. It is difficult to treat, and it usually causes profuse exudate requiring frequent dressing changes. Why is there such a wound at all? If the veins - superficial, deep or piercing - are insufficient - they cannot supply the tissues with sufficient oxygen and nutrients, and they therefore die over time. Necrosis, on the other hand, leads to skin defects.

Factors leading to venous insufficiency

To develop venous leg ulcers, chronic venous insufficiency must first develop. There are several ways to failure:

  • high venous pressure that lasts for a long time, e.g. all day, day after day. Here, the culprit may be some disease of the veins, but also diabetes or old age, and - often - an incorrect lifestyle, e.g. low physical activity, sedentary work.
  • venous reflux, i.e. reverse blood flow in the veins - it results from the lack (destruction), underdevelopment or insufficiency of the venous valves
  • obstruction in the venous system, narrowing of the veins as a result of thrombosis
  • pressure on the veins

If the blood does not flow properly through the veins, pathological changes begin to appear, such as vein widening, varicose veins, cracking, haemorrhage, and finally necrosis.

Who is at risk of venous leg ulcer?

Venous leg ulcers affect approx. 20 million people worldwide (more oftenwomen) and it usually affects the elderly - 15% of elderly people have this condition. Diabetes, atherosclerosis, smoking and obesity increase the risk of developing the disease, so it can be expected that, as the aforementioned diseases of civilization take more and more tolls, there will also be more patients with venous leg ulcers. After the age of 70, half of women and about 40% of men already have varicose veins (which very often results from an incorrect lifestyle).

Symptoms of venous leg ulcer

  • badly healing, painful wound located in the ankle area on the lower limb
  • odorous effusion

The abundant exudate from the wound causes the patient's body to lose electrolytes and proteins. This not only makes the wound heal more difficult, but also affects the deterioration of the overall functioning of the body.

Worth knowing

Many patients neglect the initial symptoms of an ulcer, leading to the formation of large wounds. And the bigger and older the wound, the more difficult the healing process. Extensive wounds that have not healed for years often lead to reduced movements in the ankle joint, foot deformities and permanent disability. A bacterial or fungal infection may also develop. Therefore, it is not worth underestimating the changes that appear on the skin, and as soon as something worries us, you should immediately seek medical advice.

Tests to help identify the cause of an ulcer

Individual tests indicate the cause of the ulcer:

  • Doppler ultrasonography - enables the assessment of the structure and function of the veins of the lower extremities
  • plethysmography - gives a picture of blood flow through peripheral vessels running close to the surface of the body, enables the assessment of venous reflux
  • phlebodynamometry - examines the pressure in the dorsal vein of the foot
  • phlebography with contrast - allows you to assess the light in the vein and visualize it on an X-ray image
  • functional tests: Trendelenburg (used to evaluate the efficiency of deep veins and to evaluate the valves of the lower limbs), Perthes (used to evaluate the efficiency of deep veins) and Pratt (determines the location of ineffective connecting veins (piercing, perforators) of the lower limb.

Treatment of venous leg ulcer

The healing process of venous leg ulcers is very difficult and lengthy. It requires patience and perseverance from the patient. The source of, unfortunately, frequent failures is the lack of consistency in action.

In the treatment of ulcers, special dressings (reimbursed by the National He alth Fund), as well as bands and compression stockings (compression therapy) are used.Specialized dressings maintain an appropriate, moist environment in the wound, but at the same time absorb excess secretions. They do not adhere to the wound, thanks to which they are painless when changing, they protect against microbes and other external contamination.

When treating venous leg ulcers, you should also increase physical activity, and rest with elevated legs. Massage - e.g. pneumatic massage gives good results. Older people, at risk of developing venous thrombosis, are given low molecular weight heparin in prophylactic doses.

You should also remember about proper hygiene of the sick place, as it greatly supports the treatment. Detergents remove dirt and germs. However, you should use mild agents that do not affect the skin's protective barrier, with a pH of 5.5 or liquid preparations containing an admixture of substances that modify the acidity of the product (e.g. phosphate, citric acid) and enriched with physiological lipids, ceramides and moisturizing agents.

Treatment treatment

Sometimes the skin defect is so large that it is considered a transplant from another place (which of course means that we then have two wounds to heal, although the one from which the skin is removed has a "he althy" basis and heals much faster). Then the wound needs to be properly prepared, because, unfortunately, the transplant may not be accepted. Other methods of treating venous leg ulcers include endovascular laser ablation, gluing varicose veins, compression sclerotherapy.

Worth knowing

Venous leg ulcer, unfortunately, has the property that it sometimes recurs. Even an apparently well-healed wound does not necessarily mean that trouble is over. It may be that the problem of venous insufficiency has not been solved. That is why patients, even after the wound has healed, should be prophylactically still wearing specialist bands and compression stockings.

Category:

Cardiology