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Leg Ulcers

A leg with a large venous ulcer on it

A venous skin ulcer is a type of wound that develops after veins in the legs have been damaged and they do not return blood back toward the heart as they normally would. Venous ulcers can be shallow or deep, and they usually occur on the sides of the lower leg, above the ankle and below the calf. They are common in the elderly, become infected easily, are slow to heal and often come back if steps are not taken to prevent them.

Venous ulcers are caused when the valves are damaged and blood backs up and pools in the vein (venous insufficiency). This blood may leak out of the vein and into the surrounding tissue. This can lead to a breakdown of tissue and an ulcer. Veins that become blocked may also cause blood to pool, leading to a venous ulcer.

Risk factors for venous ulcers include:
  • history of leg injury
  • obesity
  • phlebitis
  • family history of varicose veins
  • sitting or standing for long periods of time
  • deep vein thrombosis
  • previous vein surgery
Symptoms of venous ulcers include:
  • swelling and aching (may improve with elevation of limb)
  • pain
  • discoloration of skin (dark red or purple) over the are where the blood is leaking
  • thick, dry, itchy skin
  • odor, pus, redness, tender (may indicate infection)

Call your physician when you notice the first signs of a venous ulcer because you may be able to prevent the ulcer from forming. If an ulcer does form, contact your physician immediately.

The goals of prevention and treatment are to reduce leg swelling and reduce the pressure in the veins. If swelling is adequately reduced, a venous ulcer may never form or may heal on its own.

Prevention and treatment may include:
  • specially designed bandages and pressure stockings to help reduce swelling
  • elevating the leg whenever possible
  • drugs that remove extra fluid from the body (diuretics) are sometimes used to treat swelling due to heart failure
  • antibiotics if there are signs of infection

For deep or severe venous ulcers on the foot or lower part of the leg, a paste may be applied to the foot and leg. The paste hardens and is wrapped with a bandage, forming a soft, castlike boot. With the extra protection provided by the boot, the ulcer can heal more quickly.

If a venous ulcer is very deep or does not heal, healthy skin taken from another part of the body may be applied (transplanted or grafted) over it. Sometimes skin taken from another person and grown in the laboratory is used.