What is venous ulcer? Is it seen frequent? 

Venous ulcer is a wound which usually occurs in the area of ankle and leg because of the failure in leg veins. It is also commonly known as varix wound. Usually, these kind of wounds rarely heals and may occur again.

The frequency of the occurance of this disease ranges from 1 to 4 out of 1000 but this frequency increases with age. Although it can be seen in young women and men equally, it frequently occurs in women older than 40 years old.

Why these wounds occur?
Veins are the vessels which takes blood low on oxygen back to the heart. However, there is no active spasm and pumping system. For this reason, there are valves in vessels to prevent blood from backing away with the effect of gravity. It is thought that venous ulcer is developed because of the defect in these valves.

Sometimes, these valves defect because of the various reasons including aging. Return of the blood to the heart defects and it ponds in the vessels of the leg. This causes to increase in pressure in vein. Because of the continuous high pressure, defect, various varixes, swelling in tissues and finally wounds (venous ulcer) in legs are formed.

Who has the higher risk of development of venous ulcer?
In some cases, the frequency of venous ulcer increases. These are:
– Advanced age
– Obesity
– Hypertension
– Diabetes
– Heart failure
– Kidney failure
– Low socioeconomical status
– Previous leg traumas
– Previously experienced venous thrombosis.

What are the features and symptoms of venous ulcers?
Usually, the first symptoms of the disease is the swelling (edema) on inside of the ankle and front of the leg. If we pressure the area where the swelling is with our finger it goes deep inside and a hole forms. This hole remains there even after we put off our finger. In that same area, there would be itching and varicos vessel expansions. Usually, wounds occur under the knee and especially on ankles (also known as leggings part) where the venous pressure is highest in legs. Usually, the wound is in color of pink/red and has flow and irregular sides. The wound is surrounded by hardened skin and there would be dandruff as well. Usually, the feet and heel of the patient is normal. It may cause slight pain and immobility. Pain and swelling can be decreased by keeping the feet high. Ulcers may leave a mark and occur again while healing.

IMAGES: Venous ulcer wounds

How is venous ulcer diagnosed?
Firstly, the physical examination is done. It is investigated if the patient previously has clot, varix surgery or attempt in veins and a similar situation in family tree. If venous ulcer is suspected with the information gathered, it is supported with diagnostic imaging methods.

What are these imaging methods?
The most frequently preferred method is doppler ultrasonographics. With this method, the veins in legs are reviewed in terms of congestion and leakage. Especially, it is checked if there is leakage in veins in wound base and surrounding area.
In rare cases, the detailed imaging methods such as MR, BT can be used.

How the wounds are treated?
There are two aims in treatment. First one is to heal the existing wound, and second one is to prevent a new wound from forming.

Wound management and multi layered compression bandage are significant for healing of wound. Wound management should be done on regular occasions in the accordance with the suggestion of the doctor. Compression bandage should be applied by an educated and experienced medical professional with the frequencies suggested by the doctor.

Treatment of the underlying cause is possible by eliminating the vein problem that has occurred.

An operation would be suggested to the suitable patients. Varix socks are suggested to some patients as well.

Images: Multi layered bandage and application of it

What happens if the patient with venous ulcer doesn’t receive treatment?

Venous ulcer is a progressing disease if not treated. If not treated, the wound may expand and be infected. As a result, the wound may progress towards deeper tissues, even bone.
What to do to prevent reopening of the wound after it is healed?

Varix socks should be used. The risk for those who does not wear it is 69% whereas those who does it is 32%. These patients should have the habit of wearing varix socks.
Also, in daily life, there are some situations which should be taken into account. These may increase the quality of life of the patient and protect the patient from a new wound:
-Smoking should be given up.
-The overweight patients should lose some weight.
-Standing still should be avoided; walks should be made.
-After a day which includes standing for a long time, legs should be raised for 10 to 15 minutes, leaned to the wall etc. and lie down.
-Dressing loose should be preferred in order to ease the blood circulation.
-It should be careful to sock tires not straining leg and feet. (Wound may be formed in these areas.)
-At home (watching TV etc.), sitting while legs are extended should be preferred rather than sitting while dangling legs.
-Varix socks should be used with the suggestion of the doctor.
-Varix socks is used incorrectly by a lot of people. Varix socks should be put on when the veins of the patient are at the emptiest. First of all, the patient should lie down to the bed and raise his or her leg up for about 5 to 10 minutes. Then, the varix socks should be put on. Varix socks should be keep put on while standing up in the day. The socks do NOT have to be put on while preparing for sleep.
-The exercises which strenghtens leg muscles should be done.
-The drugs prescribed by the doctor should be used regularly.

What are the exercises the patients with venous failure can do?

These exercises are the movements which increase the return of the blood in veins to heart by using muscle pump in leg and calf. These moves prevents the formation of varix as well.
1.Lie down backwards to a place comfortable and soft and place your hands behind your neck. Stretch your feet and bend your knees towards your stomach. When you are in this position, stretch your legs up and slowly return to your starting position. Repeat this exercise 5 to 20 times.

2. Lie down backwards while your legs are on mat. Fold your toes and open it all the way by forcing. Do this exercise for one minute while opening and closing your toes. 

3. If you are sitting or on travel stand up on both toes and bring them back to the same position. Do this position for at least 5 minutes daily.

4. Again, from a seated position, extend your legs forward and bring them to the same or higher level with your hips and then return to the same position. Again, do this position for at least 5 minutes during the day.