Treatment of Venous Ulcers in the Legs 2023

Venous Ulcers Treatment in the legs

Ulcers are open skin ulcers that can affect any area of ​​the skin, but they often occur in the legs and are caused by problems with blood flow and poor circulation in the leg veins.

Ulcers are chronic wounds that cause pain, itching and swelling in the affected leg, along with skin discoloration or hardening around the ulcer area.

Usually when a person has a cut or scrape, the body's healing process begins to work to close the wound and over time the wound will heal, but venous ulcers may not heal that automatically.

Symptoms of venous ulcers in the legs:
Venous leg ulcers are open, often painful, and take several weeks to heal. It usually develops on the inside of the leg, just above the ankle.
If you have a venous leg ulcer, you may also have:
• Swollen ankles.
• The color of the skin around the ulcer has changed to darker.
• Hardening of the skin around the ulcer; Which may make the leg stiff.
• A feeling of heaviness in the leg.
• Pain and swelling in the leg.
• Red, scaly, itchy skin on the leg.
• Swollen and enlarged veins on the leg.
• Foul-smelling secretions from ulcers.

Causes of venous ulcers in the legs:
As mentioned above, venous ulcers are often formed around the ankles, and they are usually caused by damage to the valves within the leg veins. These valves control the pressure of the blood inside the veins; This allows for a decrease in pressure when walking. If the blood pressure within the leg veins does not decrease while walking, the condition is called Persistent Venous Hypertension. This elevation leads to ulcers on the ankles. Venous ulcers may also be caused by other problems in the leg veins, including:
• Dilation of veins: swollen leg veins due to the valves not working well, allowing blood to accumulate in the lower leg.
• Chronic venous insufficiency: Like varicose veins, this condition occurs when the leg veins cannot pump blood back to the heart. Then the blood is accumulated in the lower leg; causing it to swell. This severe swelling can put very high pressure on the skin; Which leads to the formation of venous ulcers.

Who is most at risk of developing venous leg ulcers?
There are a number of factors that can increase your risk of developing a venous leg ulcer, including:
• Obesity or being overweight; Which increases pressure in the leg veins.
• Difficulties walking, may affect the blood circulation in the leg veins.
• Previous deep vein thrombosis, as blood clots that develop in the leg can damage valves in the veins.
• Varicose veins, which are swollen and enlarged veins, caused by a defect in the valves.
• Previous injury to the leg, such as a broken bone, which may cause Deep vein thrombosis or impaired walking.
• Previous leg surgery, such as a hip or knee replacement, which can prevent the person from moving.
• Aging. People find it difficult in movement around as they age, especially if they suffer from arthritis.

Methods for treating venous ulcers in the legs:
Venous ulcers need proper care and treatment to prevent infection and speed up the healing process. Treatment requires focusing on the circulatory problems or the veins that cause the ulcer and also includes removing some tissue around the wound, and this is what Dr. Hossam El-Mahdy, Professor of Vascular Surgery at Cairo University is always keen on, the following points:
• Clean the wound regularly and remove any dead tissue from the ulcer, in order to provide the best conditions for healing of the ulcer.
• Bandage the wound carefully.
• Avoid products that cause skin sensitivity.
• Wearing compression socks to prevent blood from accumulation in the legs and to speed up healing.
• Apply an antibacterial ointment or other topical medication to prevent or treat the infection.
• Take oral antibiotics to prevent or treat infection.

Treatment of accompanying symptoms:
Swelling of the legs and ankles: Venous leg ulcers are often accompanied by swelling in the feet and ankles, which is caused by fluid accumulation. This can be controlled by:
• Applying pressure bandages.
• Keeping the leg as high as possible to reduce swelling.
• Putting a pillow to help keep the legs elevated while sleeping.
• Maintaining activity as much as possible and continuing daily activities.
• Regular exercise, such as daily walking, to reduce leg swelling.
• Avoid sitting or standing with the foot down, and be sure to raise it at least every hour.

Skin itching: Some people with venous leg ulcers develop a rash accompanied by scaly and itchy skin, and it can be treated with a moisturizer and sometimes an ointment that contains small percentages of cortisone. It is important to avoid scratching the leg as this damages the skin and may lead to more ulcers.

Tips to help venous ulcers heal more quickly:
• Try to maintain your moderate activity by walking regularly, so venous leg ulcers and swelling do not worsen.
• When you sit or lie down, keep your affected leg up.
• Regularly exercise your legs by moving your feet up and down, rotating them at the ankles. This can improve blood circulation.
• If you are overweight, try to reduce your weight by following a healthy diet and exercising regularly.
• Stop smoking to help the ulcer heal faster.
• Be careful not to injure your leg, wear comfortable and well-fitting shoes.

Small venous ulcers in the leg heal after about 12 weeks of treatment. However, large ulcers need more time to heal, and Prof. Dr. Hossam El-Mahdy may go for skin grafting in such cases, in order to provide a more suitable environment for healing.

Untreated venous ulcers can cause further complications, such as immobility, bone inflammation and septicemia.

Prevention of venous ulcers in the legs:
To prevent venous ulcers, a person first needs to reduce the risk factors that increase the chances of infection. This can be done by following healthy habits that help blood flow in the legs. These changes can improve circulation and reduce the risk of developing venous ulcers, including:
• Wearing compression socks if the person has had a venous ulcer in the leg before, or is at risk of developing one of them, as in the case of varicose veins.
These socks compress the leg and improve circulation. They are usually narrower at the ankle and less narrow at the top of the leg. This encourages blood to flow upward toward the heart. To be most effective, these socks should be worn when you get up and only taken off during the night.
• Follow-up treatment in the case of the previous infection with venous leg ulcers, because these people are most likely to have ulcers again.
• Treating severe varicose veins helps prevent leg swelling or ulcers.
• Losing excess weight for cases that suffer from obesity.
• Attention to skin health.
• Stop smoking.
• Doing a lot of regular exercise.
• Lifting the leg for a short time, especially when standing all day.

Where can venous ulcers be treated legs?
Dr. Hossam El-Mahdy, Professor of Vascular Surgery and Varicose Treatment at Cairo University, treats all cases of venous ulcers in the legs with great skill, which he gained from his distinguished years of experience.