Chronic venous insufficiency (CVI) or bad veins is the condition that causes venous leg ulcers. Arteries are the blood vessels that bring blood away from the heart, to the rest of the body, including the legs. Veins are the blood vessels that bring blood back to the heart. They have one-way valves that help to prevent the backflow of blood when pumping against gravity. Many factors contribute to the development of CVI and venous leg ulcers, including deep vein thrombosis, varicosities, decreased mobility, obesity, trauma, family history, or traumatic injury. These conditions can cause damage to the veins and the valves, complicating their ability to pump blood out of the veins. As a result, blood pools and causes the veins to swell.
With CVI, the veins become swollen and blood cells begin to leak out of the veins and into the skin of the legs. At this point, some of the signs and symptoms of CVI appear. An early sign is the brown or reddish-brown discoloration of the skin in the calf area. Swelling in the legs is common, and the skin on the legs may feel tough or leathery. If significant swelling is present in the legs, the skin can become red and fluid may begin to drip from the skin. Patients may describe this skin as "weepy". When CVI is present, oxygen and nutrients can have trouble reaching the skin. As a result of CVI, venous leg ulcers can form.
Venous leg ulcers tend to be shallow in depth, but can vary in surface area from small to large. The skin around the ulcer has brown staining. Venous leg ulcers generally produce moderate to heavy amounts of fluid.
An integral part of treating venous leg ulcers involves improving venous return to the heart and treating the underlying cause of chronic venous insufficiency, which physicians accomplish with a combination of compression therapy, and rest. Compression therapy is essential to help eliminate the edema or swelling and to help the veins work more efficiently to pump the blood from the legs back to the heart. By decreasing edema, compression therapy allows more oxygen to reach the ulcer, helps to decrease ulcer drainage, and protects the ulcer to allow for healing.
Patients can improve their venous health by elevating their feet and legs above the level of the heart for a portion of the day, and exercising. Routine exercise can help in two ways: it encourages blood flow, and promotes weight loss, both of which help to control chronic venous insufficiency. Walking is the best excercise for the legs, but when walking is not possible, simple excercises can be beneficial. These include wiggling the toes, flexing the foot back and forth, extending and flexing the leg, and standing flat-footed and rising tot he balls of the feet. Patients should repeat these excercises several times an hour to improve venous return.
Compression therapy exists in a variety of forms, ranging from rigid compression therapy to two-layer and four-layer compression bandages, and finally, elastic compression stockings. The type of compression therapy a doctor recommends depends upon the presence and location of ulcers, the severity of ulceration, the patient’s lifestyle, available caregivers, and the patient’s overall health.
Clinicians use a variety of wound care products to treat the ulcers themselves, depending upon the amount of fluid in the wound, and the presence or absence of infection. Treatment for the ulcers will consider any underlying problems. Without treating CVI, ulcers will have a difficult time healing and it may take longer without compression therapy. CVI requires long term treatment, and reoccurence of ulcers is fairly common. The most important thing to help maintain healthy legs and prevent reoccurrence is to wear compression stockings.
