Venous leg ulcer (ulcus cruris venosum)

When wounds won't heal

Venous leg ulcers are wounds or sores on the lower leg that heal poorly usually because of insufficient blood circulation.

Venous ulcers occur when there’s a break in the skin on the leg, often occurring near the medial malleolus (inside ankle bone). This normally affects elderly people with several underlying diseases. The onset of venous leg ulcers is also common with people who have diabetes or a weak heart. Women suffer from venous leg ulcers more often than men. The main cause is usually venous insufficiency over several years.

How a venous leg ulcer develops

Due to the chronically dysfunctional veins (in medical terminology, chronic venous insufficiency), the veins are no longer in the position to transport blood quickly from the legs to the heart. The valves that stop the flow of blood back into the veins decrease in efficiency. The blood pools and widens the veins. This so-called stasis ultimately damages the smallest blood vessels (capillaries). These supply the cells with oxygen and nutrients and transport metabolic breakdown products away from the tissues. The damaged capillaries can no longer fulfill their function satisfactorily. This backflow of blood means increased pressure in the end of the limb. The skin in the affected areas becomes sensitive, loses its elasticity and grows hard. When that happens, the weakened skin makes it harder for a cut or scrape to heal. Eventually the skin dies off and even the slightest, barely noticed injury can turn into an open, weeping wound.

The open wound is very painful and can feel itchy or will burn. A rash can occur, and the skin becomes dry, with brownish discoloration. Micro-organisms that colonize the wound and its surroundings can cause unpleasant odors. In many cases, those affected are afraid to go out and avoid contact with other people. The patients often take on a protective posture due to the pain. They may barely move the affected leg at all. This lack of mobility, in turn, switches off the pump mechanism that transports the blood back in the direction of the heart and starts a vicious cycle.

Healing prognosis

Some people suffer from venous leg ulcers for many years, but the healing prospects are also good - around 90% percent of all venous leg ulcers can be healed using some of the treatment procedures available today.

Preconditions for wound therapy

Efficient treatment of chronic wounds is based on the two underlying principles, wound debridement and treatment of the underlying condition. These principles describe the two main points of medi's wound care concept. medi also offers versatile solutions for preventing relapse. Besides the tried-and-tested dual-component, below-knee compression stocking system, the mediven ulcer kit, medi also offers a completely new approach in compression therapy: juxtacures

Efficient treatment of venous leg ulcers comprises:

Cleaning of the wound and care of the surrounding skin.
Compression treatment is an element of wound care, even if many people believe that wound care is restricted to cleaning and wound dressings.
Treatment of the underlying disease, which means that the venous disease has to be treated. Medical compression stockings and inelastic compression wraps are used as disease-modifying treatment. The pressure should improve the blood circulation in your leg, boosting your body’s ability to heal the sore.
Solutions to effectively prevent recurrence

Besides pain control and compression, wound management plays an important role in venous leg ulcers and should be carried out by clinicians or trained professionals only. You should never try to treat the wound yourself with ointments and bandages. Open wounds must be cleaned, and dead tissues removed. Special dressings make sure that the wound does not dry out and promote the healing process.

Phases of treatment and healing

Phase 1: wound debridement

As a result of the chronic insufficiency of the leg veins, venous leg ulcers are usually surrounded by hardened connective tissue that must be removed. Dressings with silver particles are used to disinfect inflamed wounds that are infected by bacteria.

Phase 2: formation of new connective tissues

During the second phase of wound healing, the body refills the gap in the skin. In order to promote the growth of the connective tissue, flat dressings (hydrocolloid and hydropolymer dressings) are applied that stimulate the production of connective tissue and keep the wound moist.

Phase 3: growth of new skin

During the third phase of wound healing, the wound contracts and skin cells grow inward from the wound margin to close the wound. Since phases 1 and 2 of wound healing are severely impaired in chronic insufficiency of the leg veins, most venous leg ulcers do not reach the third phase without supportive wound treatment. In this last phase, too, the wound must have a balanced level of moisture and the dressing must not be allowed to adhere to the tender, young skin. Thin, flat dressings (hydrocolloid or hydropolymer dressings) are usually used for this purpose.