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Trinity Mother Frances
Neuroscience Institute

Venous Ulcerations

Venous ulcerations are open sores, usually on the legs. These sores occur as a complication of poor blood circulation from the legs to the heart.

Who gets it?

The chances of developing venous ulcerations increase with age. Those with a history of venous insufficiency, a condition where damage to the veins causes blood to pool in the veins of the lower legs, are most likely to develop venous ulcerations. Paraplegics are also more likely to develop venous ulcerations because the calf muscle is immobile.

What causes it?

The most common cause of venous ulcerations is venous insufficiency. Venous insufficiency occurs when the valves in the veins become damaged and allow the blood to leak backward, instead of upward to the heart. Varicose veins can damage the valves. Or, damage can occur when there is a problem with the calf muscle, so the blood isn't being pushed upward. Chronic venous insufficiency can also be caused by a blockage in a vein, such as a blood clot. As the blood begins to pool in the veins, it creates pressure and swelling in the legs. Eventually, the capillaries burst under the high pressure, releasing red blood cells and giving that area of the skin a reddish-brown discoloration. The discolored skin is easily broken by a scratch or bump. This open skin then becomes an ulcer.

What are the symptoms?

Venous ulcerations are often preceded by red, itchy patches on the skin. These patches are easily broken open, and the ulcers that result can become infected. An infected venous ulcer will ooze pus and have a foul-smelling discharge. If the infection spreads to the surrounding tissue, the patient develops a condition called cellulitis.

How is it diagnosed?

To diagnose venous ulcerations, your doctor will take your medical history, paying careful attention to any history of varicose veins, thrombophlebitis, or any other condition that causes venous insufficiency. He or she will carefully examine your legs for swelling (edema), varicose veins, patches of red and scaly skin, and areas of reddish-brown discoloration. The doctor may also order a procedure called duplex scanning, which is a painless ultrasound examination of the leg veins.

What is the treatment?

To treat venous ulcerations, you must treat the underlying cause, which is venous insufficiency. An important way to prevent ulcerations is to wear compression stockings, which squeeze the veins and keep blood flowing so it is more difficult for blood clots to form and swelling to occur. It is extremely important to keep the area clean and dry. Venous ulcers are usually treated with a metronidazole gel to help prevent bacterial growth and reduce odor. A steroid ointment may also be used to treat itching. The ulcers are covered with special dressings, which need to be changed regularly. With this treatment, the ulcers usually heal within weeks or months. Infected ulcers and cellulitis must be treated with oral antibiotics.

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