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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. This is called venous insufficiency. See a picture of abnormal blood flow caused by venous insufficiency.
These ulcers usually form on the sides of the lower leg, above the ankle and below the calf. See a picture of areas affected by venous skin ulcers.
Venous skin ulcers are slow to heal and often come back if you don't take steps to prevent them.
A venous skin ulcer is also called a stasis leg ulcer.
Venous skin ulcers are caused by poor blood circulation from the legs, such as from venous insufficiency. Your veins have one-way valves that keep blood flowing toward the heart. In venous insufficiency, the valves are damaged, and blood backs up and pools in the vein. Fluid may leak out of the vein and into the surrounding tissue. This can lead to a breakdown of the tissue and an ulcer.
Veins that become blocked also may cause fluid to pool, leading to these ulcers.
Some things can increase your risk of venous skin ulcers. These include:
There are two other types of skin ulcers that can happen on the lower leg or feet. They are different from venous skin ulcers.
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 odor, and pus may drain from the wound. The area around the wound also may be more tender and red.
Call your doctor when you first notice the signs of a venous skin ulcer, because you may be able to prevent the ulcer from forming. If an ulcer has formed, get treatment right away, because new and smaller ulcers tend to heal faster than larger ones.
Your doctor will diagnose venous skin ulcers by asking questions about your health and looking at your legs. Your doctor may also use duplex Doppler ultrasound to find out what is causing the ulcer. This test shows how well blood is moving through the lower leg.
Your doctor may use other tests to check for problems related to venous skin ulcers or to recheck the ulcer if it does not heal within a few weeks after the start of treatment.
The first step involves improving blood circulation. To do this, you can:
To help your ulcer heal, your doctor may also remove dead tissue from the wound (debridement).
After your ulcer has healed, continue to wear compression stockings. Take them off only when you bathe and sleep. Compression therapy helps your blood circulate and helps prevent other ulcers from forming.
If your ulcer doesn't heal within a few months, your doctor may advise other treatment, such as:
Other Works Consulted
Burkhart CN, et al. (2012). Cutaneous changes in peripheral venous and lymphatic insufficiency. In LA Goldman et al., eds., Fitzpatrick's Dermatology in General Medicine, 8th ed., vol. 2, pp. 2110-2120. New York: McGraw-Hill.
Habif TP (2010). Eczema and hand dermatitis. In Clinical Dermatology: A Color Guide to Diagnosis and Therapy, 5th ed., pp. 91-129. Edinburgh: Mosby.
Katz DL, Friedman RSC (2008). Diet and wound healing. In Nutrition in Clinical Practice, 2nd ed., pp. 271-274. Philadelphia: Lippincott Williams and Wilkins.
Nelson EA (2011). Venous leg ulcers, search date June 2011. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.
Nelson EA, Adderley U (2016). Venous leg ulcers. BMJ Clinical Evidence. http://clinicalevidence.bmj.com/x/systematic-review/1902/overview.html. Accessed April 14, 2016.
Raju S, Neglen P (2009). Chronic venous insufficiency and varicose veins. New England Journal of Medicine, 360(22): 2319-2327.
ByHealthwise StaffPrimary Medical ReviewerE. Gregory Thompson, MD - Internal MedicineAdam Husney, MD - Family MedicineSpecialist Medical ReviewerMargaret M. Doucette, DO - Physical Medicine and Rehabilitation, Wound Care, Hyperbaric Medicine
Current as ofNovember 21, 2017
Current as of:
November 21, 2017
E. Gregory Thompson, MD - Internal Medicine
& Adam Husney, MD - Family Medicine & Margaret M. Doucette, DO - Physical Medicine and Rehabilitation, Wound Care, Hyperbaric Medicine
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