Venous stasis ulcers are crater-like wounds that develop (typically) in the leg when venous blood flow is insufficient. (They are also referred to as venous insufficiency ulcers. The term stasis is a Greek word meaning “the posture for standing”.) They form when venous valves cease to function efficiently, or when veins become damaged by trauma, blood clots, or disease. The damaged vein cannot help the heart send blood back to it effectively, and thus the blood begins to pool at the lower extremities. As the vein swells to accommodate the extra blood, it begins to leech into the surrounding tissue, damaging it. This is called edema.
Over time, the conditions in the leg worsen, making healing impossible. Any small wound or scar will not have adequate blood flow to supply the nutrients and protein necessary for it to heal. The cells in the area slowly die off, causing the surrounding skin to erode, and then the subcutaneous tissue beneath it, causing the wound to change color. Eventually, the muscle and bone can become exposed. And although the wound is open to the air, because of the lack of circulation, it does not bleed.
As a venous stasis ulcer forms, the tiny blood vessels in the affected area that supply the skin with blood become damaged by pressure as the blood begins to pool, and thus the skin cannot receive proper nourishment from them. Layers of the skin begin to die and shed. This is called scaling. The skin also becomes inflamed; producing a reddish color. This is known as erythema. Other parts of the skin may turn purple or dark red due to edema. Other areas may turn brown or yellow due to hemosiderin (iron) staining.
As the wound develops, it begins as a shallow yet wide crater, with irregular edges, usually on the ankle or lower leg. The exposed area is typically red, and may exude fluid, depending on the level of infection. In many cases, edema will result in the entire leg becoming swollen, and the skin hardening, turning reddish brown in color. Typically, the wound is not painful, although infection or edema may cause some discomfort.
Any degenerative condition affecting the veins can result in an insufficiency ulcer. Varicose veins, deep vein thrombosis, or even heart failure can result in poor venous return, and thus pooling of blood in the leg. Again, the key element is that the valves that help the heart pump blood stop working properly, and thus the blood begins to back up, or even flow backwards. Also, anything that causes leg muscle to weaken can result in poor circulation from the legs, and thus contribute to the condition.
A number of factors can contribute to venous insufficiency ulcers. Here are a few:
A few of the complications that may develop from venous stasis ulcers include:
There are a number of different options for treating venous stasis ulcers. Knowing which options are right for you will require the attention and insight of a seasoned healthcare provider who specializes in wound care. Such a provider will know how to account for the specific risk profile that you bring to the examination. For example, treatment for a diabetic woman at age 65 may look very different from treatment offered to an 85-year-old woman with varicose veins.
The following is a partial list of treatment options for venous insufficiency ulcers.
Radiofrequency ablation, endovenous laser therapy, and sclerotherapy are three options for outpatient treatment for venous stasis ulcers. Rather than address the ulcers themselves, they target the cause of the conditions that create them: poor venous circulation. By redirecting the flow of blood into veins that are healthy and effective, the older veins will eventually shrink and disappear. This gives the heart considerable relief, as the veins carrying the blood back to it function much more effectively.
Debridement is a process in which a surgeon cuts away all of the dead or decaying tissue from the affected area, thus enabling the remaining tissue to heal more efficiently. Dead tissue carries a risk of infection, and can cause septicemia. Once it is gone, the wound is treated going forward, and circulation can resume more easily. If for whatever reason necrosis has affected too much of the leg, amputation may be necessary.
If you or someone you know is suffering from any kind of ulcer that appears as a result of poor circulation, give our office a call. In Orange County, Woundcare OC specializes in treatment of all kinds of ulcers. The professionals here will help you identify all the risks associated with your specific situation and deliver the best possible prognosis. We guide you through the difficult aspects of treatment to ensure success. Wound care is a serious health matter, so you need a specialist. We understand that, and we help people with your condition all the time. We look forward to hearing from you.
Other Wound Care Treatment Options: