Venous ulcers, also called stasis leg ulcers or venous skin ulcers, are shallow wounds that do not readily heal. Before beginning a venous ulcer management program, the doctor will run a diagnostic test to determine the extent of the damage. Patients will be encouraged to make simple lifestyle changes to encourage healing. Depending on the cause of the condition, some patients may take medications, while others may require surgery, such as vein removal or skin grafting.
The exact method of venous ulcer management will vary slightly, depending on the underlying cause. Venous ulcers are a result of venous insufficiency, which means that the veins in the legs fail to pump the blood back up to the heart. This causes cell death, which can lead to ulcers. Venous ulcers are associated with obesity, high blood pressure, and a sedentary lifestyle. They can also be caused by multiple pregnancies, previous surgeries, or a history of blood clots, as well as varicose veins.
To determine the underlying cause and develop a venous ulcer management plan, the doctor will review the patient's medical history and do a physical examination. He may also order an ultrasound test to determine the extent of the damage, and to see how the blood flows through the leg. During the physical exam, the doctor will look for the typical signs of a venous ulcer, such as thickened or oozing skin, swelling, and discoloration.
The first step in venous ulcer management is usually to clean the wound. Debridement, which is the process of removing dead tissues, is performed with wet and dry dressings to encourage healing. Patients who have an infected ulcer will likely take oral antibiotics. An infection is indicated by redness, a warm sensation, and pain. Some patients may use a topical cellular therapy drug that can also help to encourage healing.
After cleaning the wound, the next step in venous ulcer management is applying a clean dressing. The doctor will show the patient how to change the dressing, sometimes as often as every few hours. Some patients will wear compression stockings over the leg to help prevent blood pooling, while others may require compression bandaging, which is often done by a nurse.
Patients will also be encouraged to take frequent walks to encourage blood circulation, as well as to elevate the leg above the heart. Depending on the patient, venous ulcer management may also include addressing the underlying cause. Those who are obese will be encouraged to lose weight, while those with a sedentary lifestyle should include more exercise in their daily routines. Patients with high blood pressure may need to take medication, along with eating a low-sodium diet.
If the ulcer refuses to heal for six months or longer, or if it heals and then returns, the patient may need surgery. Some surgical venous ulcer management plans may involve skin grafting, but this will only benefit patients who do not have an actively infected ulcer. Another surgical procedure is vein stripping, which means that the surgeon will tie off the affected varicose veins and remove them.