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Venous Ulcer Symptoms, Diagnosis, and Treatment

A venous ulcer is a wound that doesn't heal on the lower leg or ankle. Underlying conditions that affect blood flow cause these ulcers.

At the UPMC Heart and Vascular Institute, you can access testing and treatment under one roof. Our experts find the underlying cause and provide wound care to keep you healthy.

Contact the UPMC Heart and Vascular Institute

To request an appointment, contact the UPMC Heart and Vascular Institute:


What Is A Venous Ulcer?

Venous ulcers (also known as venous stasis ulcers or nonhealing wounds) are open wounds around the ankle or lower leg.

They do not heal for weeks or months and sometimes longer.

Venous stasis ulcers are often on the ankle or calf and are painful and red.

A yellow, fibrous tissue may cover the ulcer and have an irregular border. Drainage and discharge are common with venous stasis ulcers.

This type of ulcer is common in people who have varicose veins or a history of leg swelling.

Causes of venous ulcers

Venous ulcers occur because of poor blood flow in the leg veins.

Valves inside the leg veins control blood flow through the veins. But these valves can get damaged, altering blood flow and leading to ulcers.

Without adequate blood flow, your body has trouble healing, causing the ulcers to linger.

Venous ulcers often form because of an underlying issue that reduces wound healing or damages the skin, such as:

  • Venous hypertension. When you walk, usually your blood pressure drops in the legs. When that doesn't happen, you have venous hypertension, which causes ulcers to form.
  • Venous insufficiency. When the leg veins cannot pump blood back to the heart, the blood pools in your legs, causing swelling. Over time, the swelling damages the skin and makes it hard for your body to heal.
  • Varicose veins. Problems in the leg vein valves lead to blood pooling in the lower leg. This pooling causes varicose veins and can lead to an ulcer.
  • Blood clots. Blood clots block the vein, reducing blood flow to the lower leg.
  • Poor circulation (peripheral artery disease). Reduced blood flow from poor circulation slows healing.
  • Diabetes, kidney failure, or inflammatory diseases. These conditions can slow healing or cause swelling.
  • Certain medicines. Some medications can suppress the immune system or cause swelling. That makes it harder for ulcers to heal.
  • Infections. Infections can spread or get into the bloodstream, reducing healing.
  • Obesity. Excess weight puts pressure on veins in the legs, so ulcers take longer to heal.

Venous ulcer risk factors

Factors that affect blood flow in the legs can put you at a higher risk of venous ulcers.

These include:

  • Obesity.
  • Blood clots (deep vein thrombosis).
  • Standing for long periods.
  • Uncontrolled swelling.
  • Older age.
  • Sitting for long periods with legs dangling or positioned below heart level.
  • Family history of ulcers.
  • Sedentary lifestyle.
  • Lymphedema (a blockage in the lymphatic system).
  • Personal history of venous ulcers.
  • Trauma, such as a fracture or burn.

Venous ulcer complications

Venous ulcers often heal slowly and can be hard to treat. They lead to an open wound, which carries a risk of causing problems.

Some complications of venous ulcers include:

  • Infection. Bacteria, viruses, or fungi can lead to infection of the wound. Some severe infections, such as osteomyelitis or septicemia, can occur and require antibiotics.
  • Worsening or nonhealing ulcer. An untreated ulcer or underlying

Venous Ulcer Symptoms and Diagnosis

Symptoms of venous ulcers

There are many signs of venous ulcers, including:

  • Leg swelling and cramping.
  • Dull ache or feeling of tiredness or heaviness in the leg or calf.
  • Itchiness and tingling, red or discolored skin.
  • Signs of pooling blood, including dark red, purple, and brown spots with hardened skin.
  • The skin surrounding the ulcers may be shiny, tight and warm, or hot to the touch.
  • The ulcers may have unevenly shaped borders.

An infected ulcer may have:

  • More pain at and around the ulcer.
  • Redness or heat around the ulcer.
  • Pus or green drainage from the ulcer.

When to see a doctor about venous ulcers

You should make an appointment right away if you form an ulcer.

The earlier you get treatment for the cause, the faster the wound should heal.

Diagnosing venous ulcers

Your doctor performs a physical exam to diagnose a venous ulcer. You may also have some tests to learn the cause.

Vascular surgeons and the team at UPMC's Heart and Vascular Institute actively look for the causes of ulceration. Treatment focuses on the underlying reason to keep the ulcer healed.

You may have a duplex ultrasound to diagnose abnormal veins. An ultrasound uses sound waves to see your venous system.

Using Doppler ultrasound in this test lets the doctor see the speed of blood flow through the leg veins. This test looks for blood clots, blockages in the deep veins, and varicose veins.

Venous Ulcer Treatment

After your doctor assesses your veins, they'll design a treatment plan based on your needs.

Compression

  • Compression of the leg is vital to healing venous wounds.
  • You may need to use compression dressings for this treatment.
  • The pressure from the compression dressing counteracts the pressure from the veins of the leg and allows the skin to heal.
  • Compression stockings can help prevent the ulcer from returning after it heals.

Unna boots to treat venous ulcers

  • Your care team applies moist gauze around the lower leg, from the base of the toes to just below the knee.
  • This gauze then hardens to form a snug boot on the leg.
  • The support from the boot helps improve blood flow in the veins and heal the ulcer.

Transparent dressings to treat venous ulcers

  • A member of your care team applies a transparent, plastic-like film over the wound.
  • A support stocking worn over the dressing helps hold it in place and improves circulation in the limb.

Hydrocolloid dressings

  • A hydrocolloid dressing over the venous ulcer promotes healing.

Varicose vein treatment

  • Your doctor can use vein ablation and sclerotherapy (shots) to close varicose veins.
  • Phlebectomy is an outpatient treatment that removes varicose veins.

Growth factors

  • Researchers are studying new medicines that use growth factors. The goal of these drugs is to promote the growth of new tissue.

Surgery to treat venous ulcers

  • Wound debridement removes nonliving tissue that keeps a wound from healing.

At-home venous ulcer care

You must take steps at home to care for your ulcer to ensure proper healing.

  • Elevate your legs often.
  • Avoid sitting with your legs dangling.
  • Practice good, consistent wound care.
  • Keep all of your doctor appointments with vascular surgery.
  • Avoid removing the dressing by yourself at home.
  • Avoid scratching your leg.
  • Maintain a healthy weight.
  • Quit smoking or using tobacco products.
  • Eat a healthy diet with fruits, veggies, and protein.