Venous Leg Ulcers
Considered the most common form of leg ulcer, venous leg ulcers (VLUs) are slow-healing wounds that result from damage to the valves inside our leg veins. They typically form in the area between your knee and ankle joint and can cause further complications if left untreated. VLUs can cause significant discomfort and may even lead to poor mental health due to the wound’s unsightly appearance. Prompt wound care management from a wound care service provider in Singapore is vital to allow the wound to heal properly and prevent further complications.
What Causes Venous Leg Ulcers?
Within our veins are valves that help regulate blood circulation, snapping open and shut as they channel blood back to your heart. These valves also maintain blood pressure within the veins, allowing it to drop whenever you walk. When the valves are damaged, blood pressure in the affected area can drastically increase due to a backflow of blood back into the veins. As this happens, it can gradually weaken the skin and cause an ulcer. Healing is also hindered because the vein is weak, and blood may leak due to the pressure pushing against the walls.
VLUs can also result from other conditions, such as varicose veins, where blood pools (or accumulates) in the lower leg due to faulty valves in the veins, and chronic venous insufficiency, which happens when your leg veins cannot effectively pump blood back to the heart, causing blood to pool in the lower leg and cause severe swelling that can cause VLUs to form.
Various risk factors can increase the likelihood of VLUs appearing. These can include obesity, smoking, older age, previous injuries to the veins or legs, and a family history of venous (related to the veins) conditions. If you have had a prior blood clot, it may also have damaged the veins and increased your risk of VLUs.
Where Do Venous Leg Ulcers Appear?
VLUs typically form on the legs. More specifically, VLUs generally form on the lower leg’s gaiter area, between the knee and your ankle joint. If your lower calf muscle appears like “an upside-down champagne bottle or inverted bowling pin,” that may be an early sign that you have a VLU forming.
Symptoms of Venous Leg Ulcers
Early symptoms of VLUs may include swelling, itching, and pain in the affected area, though some may not experience any symptoms in the initial stages. You may notice that the skin around the ulcer may appear discoloured or hardened.
Other signs and symptoms include:
● Pain and discomfort in or around the wound
● No signs of improvement in the wound after two weeks
● Reddish-brown staining around or along the wound area
● Foul-smelling discharge from the wound
● Dry, itchy, or scaly skin
● Pain in the affected leg whenever you walk
● Soreness or heaviness in the affected leg
Management of Venous Leg Ulcers
Prompt wound care will ensure that the ulcer can heal over time, but additional treatments will also be crucial to address the root cause of VLU formation. You will be assisted by a dedicated wound care specialist or tissue viability nurses who will provide you with the knowledge you need to effectively manage your wounds, whether with their support in a clinical setting or when you are at home.
Wound Dressing
Wound dressings are the most essential component in managing VLUs. They aim to protect the wound and promote healing by:
● Preventing it from being exposed to harmful bacteria or infection
● Keeping it clean and moist (but not wet)
● Absorbing any oozing fluids while preventing adhesion to the wound (which can be painful to remove)
● Reduce the intensity of unpleasant odours from the wound
The type of dressing you use will depend on the nature of the wound itself. Soft silicone or foam dressings are ideal for VLUs with frequent discharge or bleeding, effectively absorbing any discharge while keeping the wound clean and moist. Alginate dressings derived from seaweed absorb wound fluid and maintain an ideal moist environment to ensure the wound heals nicely. For odour control, charcoal dressings are effective in masking unpleasant odours.
You will need to periodically change your dressings to ensure the wound’s condition does not worsen. The frequency of dressing changes will also depend on the nature of the wound and the type of dressing used. Your supporting wound care specialist or nurse will advise you on the dos and don’ts of your dressing.
Compression Therapy
Compression bandages are applied on top of your dressing to help promote better blood circulation. These bandages will squeeze your legs firmly to encourage blood to flow towards your heart and prevent VLUs from occurring or worsening. The bandage is also beneficial in reducing swelling and preventing the wound dressing from getting wet or damaged. You will need to change the compression bandage once a week when you also change your wound dressing.
Your supporting wound care specialist or nurse will provide the ideal compression bandages for your treatment, ensuring that they are firm enough to promote blood flow back to the heart but not too tight that you frequently experience discomfort in your leg. Sometimes, a short walk can help alleviate this discomfort, but contact your doctor or nurse immediately if the discomfort persists.
Physical Therapy
Regular exercise and physical therapy can also help to improve blood circulation, supporting positive outcomes from compression therapy and proper wound dressing. Exercises to strengthen the legs and promote movement can help to facilitate smooth venous blood flow from your legs to the heart. Further benefits can also be seen with some light to moderate physical massage by a trained medical professional while avoiding the wound. Some studies have noted that physical therapy can improve recovery outcomes, but further research is needed to determine the extent of physical therapy’s benefits.
Surgery
For severe cases of VLUs, surgery may be necessary to ensure a smooth recovery and minimise further harm to your well-being due to the ulcer and the risk of infection. One such surgical option is subfascial endoscopic perforator surgery (SEPS), where a surgeon uses a small balloon to separate surrounding tissues from the affected vein and then clips that vein to let blood drain out into healthy veins instead. In other instances, heat, ultrasound or foam are used to seal the affected vein.
If necessary, surgical debridement can be performed to remove any infected skin around the ulcer to prevent further complications and help facilitate healing.
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