What are the aims of this leaflet?
This leaflet has been written to help you understand more about venous leg ulcers. It will tell you what venous leg ulcers are, what causes them, what can be done about them, and where you can find out more about them.
What is a venous leg ulcer?
A venous leg ulcer is an open wound in the skin of the lower leg due to high pressure of the blood in the leg veins.
What causes venous leg ulcers?
The main cause of venous leg ulcers is faulty valves inside the leg veins. These valves normally allow the blood to flow up the leg towards the heart, and they also prevent backward flow down the leg. If the valves are faulty, backward flow is not prevented and pressure builds up inside the veins. The persistent high pressure in the leg veins, caused by the faulty valves, damages tiny blood vessels in the skin. The skin will become dry, itchy and then inflamed. Due to the poor blood supply it doesn’t heal well, and so the skin can easily break down to leave an open wound after minimal trauma. This is how the ulcer forms.
Some people are born with weak valves. In others, the valves are damaged after a venous thrombosis (a blood clot forming within a vein). Valves tend to weaken with age. Sometimes they are a result of faulty veins’ valves and narrow arteries in the limbs. Any infections of the wound can make the ulcers bigger and painful and delay their healing.
Are venous leg ulcers hereditary?
Venous leg ulcers are not hereditary; however, some of the things that increase your chances of developing a venous leg ulcer do run in families - such as poor valves, a tendency to have a blood clot or to have abnormal veins and arteries in the lower limbs.
What does a venous ulcer look like and what are its symptoms?
Before the ulcer appears, you may notice your leg swelling and you may find it painful to stand for long periods. Brown spots and patches may appear on the skin, and the altered blood flow in the leg can make the skin look red or blue. The skin of the lower leg may become itchy and scaly, and firm tender areas may develop under it.
The ulcer itself is an open wound. The bed of the ulcer may show bumpy, moist and red healing tissue, or may be covered in a yellowish-grey layer. Ulcers often leak fluid, the amount of which can vary.
A venous ulcer can be painful, although the pain is usually relieved when the pressure is controlled by raising the leg or by wearing compression (tight and stretchy) bandages or stockings. Some patients find that it can be painful during dressing changes when their ulcer is exposed to the air. However, if your ulcer gives you severe pain, this may mean that it has other causes, such as blockages in the arteries, infection or development of a blood clot in the vein, and so you should tell your doctor immediately.
There can be associated leg swelling, due to inflammation in the skin. Long-standing inflammation can also lead to thickened skin, scaliness, and harmless firm bumps on the skin.
How will a venous ulcer be diagnosed?
The changes seen in your skin will indicate to your doctor that you have a venous leg ulcer. The doctor or nurse will feel for the pulses in your foot and may measure the blood pressure in your leg with a small ultrasound probe (“Doppler”), or more specialised investigation of the circulation in an X-ray department. Occasionally other tests are needed to exclude other conditions that can look like a leg ulcer, such as diabetes, or inflammation of the blood vessels (vasculitis). These tests include removing a small piece of skin for microscopic examination (a biopsy), and/or blood tests.
Can a venous leg ulcer be cured?
Yes, however, healing of the ulcer can take time and it depends on your general health and other skin conditions. If there are other conditions such as diseased arteries which are contributing to the ulcer, it may be more difficult.
How can a venous ulcer be treated?
It may be necessary to wash legs in a bucket using tap water and a bath emollient or soap substitute drying carefully afterwards. Occasionally potassium permanganate (a