What is a venous skin ulcer?

A skin ulcer is a type of wound that develops on the skin. A venous skin ulcer is a shallow wound that occurs when the leg veins don’t return blood back toward the heart the way they should as a result of insufficiency. These ulcers usually form on the sides of the lower leg, above the ankle and below the calf. Venous skin ulcers (stasis ulcer) are slow to heal and often come back if you don’t take steps to prevent them.
Some things can increase your risk of venous skin ulcers. These include:

• Deep vein thrombosis, in which a blood clot (thrombus) forms in the deep veins of the legs.
• Obesity.
• Smoking.
• Lack of physical activity.
• Work that requires many hours of standing.

There are two other types of skin ulcers that can happen on the lower leg or feet. They are different from venous skin ulcers.
• Arterial skin ulcers are less common than venous skin ulcers. They happen when an artery disease is present (sometimes in combination with venous disease). These ulcers tend to be extremely painful. They are usually on the toes and feet.

• Neuropathic skin ulcers are also known as diabetic neuropathic ulcers. They occur in people who have little or no sensation in their feet because of diabetic nerve damage.

What are the symptoms of skin ulcer?
The first sign of a venous skin ulcer is skin that turns dark red or purple over the area where the blood is leaking out of the vein. The skin also may become thick, dry, and itchy. Without treatment, an ulcer may form. The ulcer may be painful. You also may have swollen and achy legs. If the wound becomes infected, the infection may cause an odour, and pus may drain from the wound. The area around the wound also may be more tender and red.

Treating a venous leg ulcer
With appropriate treatment, most venous leg ulcers will heal within three to four months. Treatment should always be carried out by a healthcare professional trained in compression therapy for leg ulcers.

1. Cleaning and dressing the ulcer – The first step is to remove any debris or dead tissue from the ulcer and apply an appropriate dressing. This will provide the best conditions for the ulcer to heal.

2. Compression bandages -To help improve the circulation in your legs, your doctor will need to apply a firm compression bandage over the affected leg. These bandages are designed to squeeze your legs and encourage blood to flow upwards, towards your heart. The application of a compression bandage is a skilled procedure and should only be done by a healthcare professional trained in leg ulcer management.

3. Keeping your affected leg elevated whenever possible, ideally with your toes at the same level as your eyes, will also help ease swelling – You may find it helpful to put something firm – such as a rigid suitcase – under the end of your mattress, to help keep your legs raised while you sleep.
You should also keep as active as possible and aim to continue with your normal activities. Regular exercise, such as a daily walk, will help reduce leg swelling. However, you should avoid sitting without your legs raised or standing still for longer than an hour at a time.

4. Appropriate antibacterial agent – This is mainly for infected ulcers.

Looking after yourself during treatment
To help your ulcer heal more quickly and preventing recurrence, follow the advice below:

• Try to keep active by walking regularly. Sitting and standing still without elevating your legs can make venous leg ulcers and swelling worse.
• Whenever you are sitting or lying down, try to keep your affected leg elevated.
• Regularly exercise your legs by moving your feet up and down, and rotating them at the ankles. This can help encourage better circulation.
• Stop smoking, eat a healthy diet and moderate your alcohol consumption. This can help the ulcer heal faster.
• Be careful not to injure your affected leg, and wear comfortable, well-fitting footwear.
• You should visit your doctor once a week to have your dressings and compression bandages changed. They will also monitor the ulcer to see how well it is healing. Once your ulcer is healing well, you will probably need to see your doctor less often.
• Once you have had a venous leg ulcer, there is a significant chance another ulcer could develop within the next few months or years. The most effective method of preventing this is to wear compression stockings at all times when you are out of bed.
Please feel free to send an email to kumarsukhraj@yahoo.com or call 6228032 for further enquiry and discussion on the topic. Patient education plays an important role in the diagnosis and management of diabetes and any other illness. Please look forward for a continuation of the discussion on common health problems in the next publication.

Reference
“Varicose veins”. in Health Encyclopaedia. nhsdirect.nhs.uk

(By Dr. Kumar Sukhraj)