Venous Insufficiency and Leg Wounds (Venous Ulcers) Treatment

Untreated varicose veins and venous insufficiency can, over the years, lead to wounds on the leg that heal only with great difficulty (venous ulcers). In this article I will explain this advanced stage of chronic venous insufficiency and its treatment.

What Is Chronic Venous Insufficiency?

When the venous valves function inadequately over a long period, blood continues to pool in the leg; over time this leads to thickening of the skin, a dark brown change in colour (stasis dermatitis/pigmentation) and impaired nourishment of the tissues. As this process advances, tissue nourishment becomes so impaired that even the slightest trauma can turn into a wound that will not heal.

Why Do Ankle Wounds Heal with Difficulty?

Venous ulcers typically develop around the inner ankle; the venous pressure that accumulates in this area and the tissue damage it causes slow the normal wound-healing process considerably. Carrying out wound care alone, without correcting the underlying venous pressure problem, usually provides temporary relief but does not prevent the wound from recurring.

Wound Care and Treatment Approach

In the treatment of venous ulcers we carry out two steps together: care of the wound site with appropriate dressings and a compression bandage, and elimination of the source of the underlying venous reflux (usually insufficiency of a major vein) with methods such as EVLA. While the recurrence rate remains high when only wound care is carried out without correcting the source, when we combine the two approaches healing is both faster and lasting.

Frequently Asked Questions

Why is the wound on my leg taking so long to heal? Without correcting the underlying venous pressure problem, wound care alone may not be sufficient; a venous assessment is therefore essential.

Does a venous ulcer always require surgery? No; in many patients the source vein is sealed with a minimally invasive procedure such as EVLA, and open surgery is rarely necessary.

Does it recur after the wound has healed? If the underlying venous reflux is not corrected, the risk of recurrence is high; when we treat the source, this risk decreases markedly.

Conclusion

A venous ulcer is the most advanced and most challenging consequence of untreated venous insufficiency. Combining wound care with a treatment that corrects the source of the underlying venous problem is the most effective approach for lasting healing.

If you have a wound on your leg that has not healed for a long time, you can make an appointment for a detailed venous assessment.

References

1. Kakkos SK, Gohel M, Baekgaard N, et al. Editor’s Choice – European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease. Eur J Vasc Endovasc Surg. 2022;63(2):184-267.