Treatment of Venous Leg Ulcers in 2023

Doctor Name

Dr.Hossam Elmahdy

Ulcers are open skin sores that can affect any area of the skin but often occur on the legs due to blood flow problems and impaired circulation in the leg veins.

These 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 gets a cut or scratch, the body’s healing process begins to close the wound, and over time the wound heals. However, venous ulcers may not heal as spontaneously.

Symptoms of Venous Leg Ulcers:

enous leg ulcers are open sores that are often painful and take several weeks to heal. They usually develop on the inside of the leg, just above the ankle. If you have a venous leg ulcer, you may also experience:

Swelling of the ankles.
Darkening of the skin around the ulcer.
Hardening of the skin around the ulcer, which may make the leg feel stiff.
A feeling of heaviness in the leg.
Pain and swelling in the leg.
Red, scaly, and itchy skin on the leg.
Swollen and enlarged veins on the leg.
Foul-smelling discharge from the ulcer.

Causes of Venous Leg Ulcers:

Venous leg ulcers often form around the ankles, as mentioned, and are usually caused by damage to the valves inside the leg veins. These valves control blood pressure within the veins, allowing the pressure to decrease when walking. If the blood pressure inside the leg veins does not decrease while walking, the condition is called persistent venous hypertension. This high pressure leads to the formation of ulcers around the ankles. Venous ulcers can also occur due to other problems in the leg veins, including:

Varicose veins: Swollen veins in the leg due to malfunctioning valves, allowing blood to pool in the lower leg.
Chronic venous insufficiency: Similar to varicose veins, this condition occurs when the leg veins cannot pump blood back to the heart effectively. Blood then accumulates in the lower leg, causing it to swell. This severe swelling can exert extreme pressure on the skin, leading to the formation of venous ulcers.

Who is most at risk of developing venous leg ulcers?

There are several factors that can increase the risk of developing venous leg ulcers, including:

Obesity or being overweight: This increases pressure in the leg veins.
Difficulties in walking: This can affect circulation in the leg veins.
Previous deep vein thrombosis (DVT): Blood clots that develop in the leg can damage the valves in the veins.
Varicose veins: Swollen and enlarged veins resulting from valve dysfunction.
Previous leg injury: Such as a bone fracture, which can lead to DVT or impaired walking.
Previous leg surgery: Such as hip replacement or knee replacement, which can limit mobility.
Advancing age: Mobility issues become more common with age, especially in those with arthritis.

Treatment methods for venous leg ulcers:

Venous ulcers require proper care and treatment to prevent infection and accelerate the healing process. Treatment involves addressing circulatory or venous issues causing the ulcer, including the removal of some tissue around the wound, which Dr. Hossam El Mahdy, Professor of Vascular Surgery at Cairo University, always emphasizes through the following points:

• Regularly cleaning the wound and removing any dead tissue from the ulcer to provide optimal conditions for healing.

• Dressing the wound carefully.

• Avoiding products that cause skin sensitivities.

• Wearing compression stockings to prevent blood pooling in the legs and promote healing.

• Applying antibacterial ointment or any other topical medication to prevent or treat infection.

• Taking oral antibiotics to prevent or treat infection.

Treatment of accompanying symptoms

Swelling of the legs and ankles: Varicose leg ulcers are often accompanied by swelling in the feet and ankles, which occurs due to fluid accumulation. This can be managed by:

• Applying compression bandages.

• Keeping the leg elevated as much as possible to reduce swelling.

• Using a pillow to help keep the legs elevated during sleep.

• Maintaining activity as much as possible and continuing daily activities.

• Engaging in regular exercises, such as daily walking, to reduce leg swelling.

• Avoiding sitting or standing with the feet down, and ensuring they are elevated at least every hour.

Skin itching: Some individuals with varicose leg ulcers experience a skin rash accompanied by peeling and itching, which can be treated with a moisturizer and sometimes with a cream containing low levels of cortisone. It is important to avoid scratching the legs as this can damage the skin and may lead to further ulceration.

Tips to help varicose ulcers heal faster:

• Try to maintain moderate activity by walking regularly to prevent worsening varicose ulcers and swelling.
• When sitting or lying down, keep your affected leg elevated.
• Exercise your legs regularly by moving your feet up and down and 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.
• Quit smoking to help the ulcer heal faster.
• Be careful not to injure your affected leg, and wear comfortable and properly fitting shoes.

Small varicose ulcers in the leg usually heal after about 12 weeks of treatment. However, larger ulcers may take longer to heal, and in such cases, Professor Hossam El Mahdy may resort to skin grafting to provide a more conducive environment for healing.

Failure to treat varicose ulcers can lead to further complications such as immobility, bone inflammation, and blood poisoning.

Prevention of Varicose Ulcers in the Legs:

To prevent varicose ulcers, a person first needs to reduce the risk factors that increase the chances of developing them. This can be done by adopting healthy habits that promote blood flow in the legs. These changes can improve circulation and reduce the risk of varicose ulcers, including:

• Wearing compression stockings if the person has previously suffered from a varicose ulcer in the leg or is at risk of developing one, such as in cases of varicose veins. These stockings compress the leg and improve blood circulation. They are usually tighter around the ankle and less tight in the upper part of the leg. This encourages blood to flow upwards towards the heart. To be most effective, these stockings should be worn upon waking up and removed only at night.

• Following up with treatment if there has been a previous occurrence of varicose ulcers in the leg, as these individuals are more prone to developing ulcers again.

• Treating severe varicose veins helps prevent leg swelling or ulcers.

• Losing excess weight for those who are obese.

• Taking care of skin health.

• Quitting smoking.

• Engaging in regular exercise.

• Elevating the legs for short periods, especially when standing for long periods throughout the day.

Where can varicose ulcers on the legs be treated?

Dr. Hossam El Mahdy, Professor of Vascular Surgery and Varicose Vein Treatment at Cairo University, treats all cases of varicose ulcers on the legs with exceptional skill, acquired through years of outstanding experience.

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