Venous ulcers are the most common leg ulcers. It results in the appearance of a wound that does not heal. Venous leg ulcers are a complication of circulatory disorders such as varicose veins and phlebitis.

Definition of venous ulcer

An ulcer refers to a chronic loss of substance from the skin or a mucous membrane: a wound forms, develops and has the particularity of not healing spontaneously. There are different types of ulcers including venous ulcer.

By definition, a venous ulcer is related to a disorder in the venous system. As a reminder, the veins are the blood vessels that bring blood back to the heart. A venous ulcer occurs in the event of poor venous return (venous insufficiency). Blood stagnates in the veins, which puts great strain on the lining of the veins. Blood may leak out and damage surrounding tissue. This damage can lead to the formation of an ulcer spontaneously or as a result of even minimal injury.

Venous ulcers are the most common leg ulcers. A sore forms, hollows out the skin and can spread to the bone. The venous ulcer usually appears in the lower part of the leg, and more generally in the ankle.

Causes of venous ulcer

Venous ulcer is a complication of circulatory disorders. The venous insufficiency becomes too important: the veins struggle to bring blood back to the heart and the blood stagnates in the veins.

A leg ulcer can be a serious complication of:

• varicose veins which correspond to abnormal and permanent dilations of the veins;
• phlebitis, or venous thrombosis, which is the formation of a blood clot in a vein.

Persons concerned

Like the risk of circulatory disorders, the risk of venous ulcers increases with age. The risk was also found to be higher in women.

Risk factors

Besides aging, other factors are known to increase the risk of circulatory disorders:

• family history;
• pregnancies which can lead to venous circulation disorders;
• physical inactivity ;
• trampling and prolonged standing;
• trauma.

Diagnosis of venous ulcer

A clinical examination allows the diagnosis to be made. This is generally confirmed by performing a Doppler ultrasound (Echo-Doppler) which makes it possible to observe and analyze the blood circulation.

Persistent wound

Venous ulcer is characterized by the appearance of a persistent wound. This does not heal and does not heal spontaneously. The typical venous leg ulcer is usually single, large, and oozing. It can be painful.

Associated lesions

Around the wound, the skin can show different lesions. In particular, it is possible to observe:

• dermo-epidermal lesions, also called varicose eczema, which are reddish-brown patches or sheets that tend to flake;
• ocher dermatitis manifested by brown spots;
• white atrophy which is characterized by the presence of a whitish area around the wound;
• acute hypodermitis which is responsible for a big red leg.

Wound treatment

Treating a venous ulcer involves cleaning the wound and initiating the healing process. If the wound is infected, antiseptics can be used to kill pathogens. Specific dressings are applied to the wound to promote healing. In more severe cases, a skin graft can be done to speed up the healing process. 

Treatment of circulatory disorder

Treatment of the wound must be accompanied by treatment of the underlying cause. It should improve circulation within the venous network and thus limit the risk of recurrence.

Several therapeutic approaches can be considered depending on the type of circulatory disorder and its severity:

• elastic venous compression with the wearing of compression socks, stockings or tights;
• sclerotherapy which consists of injecting a sclerosing substance to induce retraction and hardening of the veins involved;
• the use of venotonics to stimulate venous circulation;
• surgery when previous treatments have not been effective.

These treatments must also be accompanied by preventive measures to avoid recurrence.

Prevention of venous ulcer is to prevent varicose veins and phlebitis. To do this, it is particularly advisable to:

• engage in regular physical activity;
• avoid staying in a still position for several hours;
• avoid keeping your legs crossed for too long;
• drink regularly without waiting to be thirsty;
• wear clothing that does not obstruct circulation.

Preventing a venous ulcer also means treating circulatory problems as early as possible. It is therefore advisable to seek medical advice if signs of venous insufficiency are felt (pain in the legs, feeling of heavy legs, etc.). Early detection and appropriate management reduce the risk of developing a venous ulcer.