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Venous ulcers - self-care

Description

Venous ulcers (open sores) can occur when the veins in your legs do not push blood back up to your heart as well as they should. Blood backs up in the veins, building up pressure. If not treated, increased pressure and excess fluid in the affected area can cause an open sore to form.

Most venous ulcers occur on the leg, above the ankle. This type of wound can be slow to heal.

Alternative Names

Venous leg ulcers - self-care; Venous insufficiency ulcers - self-care; Stasis leg ulcers - self-care; Varicose veins - venous ulcers - self-care; Stasis dermatitis - venous ulcer

Causes

The veins in your legs have one-way valves that keep blood flowing up toward your heart. When these valves become weak, blood can flow backward and pool in your legs. This is called venous insufficiency. The excess fluid causes the blood pressure to build up in your legs. The increase in pressure and buildup of fluid prevents nutrients and oxygen from getting to tissues. The lack of nutrients causes cells to die, damaging the tissue, and a wound can form.

Signs and Symptoms

When blood pools in the veins of the lower leg, fluid and blood cells leak out into the skin and other tissues. This can cause itchy, thin skin and lead to skin changes called stasis dermatitis. This is an early sign of venous insufficiency.

Other early signs include:

  • Leg swelling, heaviness, and cramping
  • Dark red, purple, brown, hardened skin (this is a sign that blood is pooling)
  • Itching and tingling

Signs and symptoms of venous ulcers include:

  • Shallow sore with a red base, sometimes covered by yellow tissue
  • Unevenly shaped borders
  • Surrounding skin may be shiny, tight, warm or hot, and discolored
  • Leg pain
  • If the sore becomes infected, it may have a bad odor and pus may drain from the wound

Who is At Risk?

Risk factors for venous ulcers include:

  • Varicose veins
  • History of blood clots in the legs (deep vein thrombosis)
  • Blockage of the lymph vessels, which causes fluid to build up in the legs
  • Older age, being female, or being tall
  • Family history of venous insufficiency
  • Obesity
  • Pregnancy
  • Smoking
  • Sitting or standing for a long periods (usually for work)
  • Fracture of a long bone in the leg or other serious injuries, such as burns or muscle damage

Wound Care

Your health care provider will show you how to care for your wound. The basic instructions are:

  • Always keep the wound clean and bandaged to prevent infection.
  • Your provider will tell you how often you need to change the dressing.
  • Keep the dressing and the skin around it dry. Try not to get healthy tissue around the wound too wet. This can soften the health tissue, causing the wound to get bigger.
  • Before applying a dressing, cleanse the wound thoroughly according to your provider's instructions.
  • Protect the skin around the wound by keeping it clean and moisturized.
  • You will wear a compression stocking or bandages over the dressing. Your provider will show you how to apply the bandages.

To help treat a venous ulcer, blood flow to your legs needs to be improved.

  • Wear compression stockings or bandages every day as instructed. They help prevent blood from pooling, reduce swelling, help with healing, and reduce pain.
  • Put your feet above your heart as often as possible. For example, you can lie down with your feet propped up on pillows.
  • Take a walk or exercise every day. Being active helps improve blood flow.
  • Take medicines as directed to help with healing.

If ulcers DO NOT heal well, your provider may recommend certain procedures or surgery to improve blood flow through your veins.

Prevention

If you are at risk for venous ulcers, take the steps listed above under Wound Care. Also, check your feet and legs every day: the tops and bottoms, ankles, and heels. Look for cracks and changes in skin color.

Lifestyle changes can help prevent venous ulcers. The following measures may help improve blood flow and aid healing.

  • Quit smoking. Smoking is bad for your blood vessels.
  • If you have diabetes, keep your blood sugar level under control. This will help you heal faster.
  • Exercise as much as you can. Staying active helps with blood flow.
  • Eat healthy foods and get plenty of sleep at night.
  • Lose weight if you are overweight.
  • Manage your blood pressure and cholesterol levels.

When to Call the Doctor

Call your provider if there are any signs of infection, such as:

  • Redness, increased warmth, or swelling around the wound
  • More drainage than before or drainage that is yellowish or cloudy
  • Bleeding
  • Odor
  • Fever or chills
  • Increased pain

References

Fukaya E, Margolis DJ. Leg ulcers. In: Lebwohl MG, Heymann WR, Berth-Jones J, Coulson I, eds. Treatment of Skin Disease: Comprehensive Therapeutic Strategies. 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 120.

Leong M, Phillips LG. Wound healing. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 20th ed. Philadelphia, PA: Elsevier; 2017:chap 6.

Perry AG, Potter PA, Ostendorf V. Wound care and irrigations. In: Perry AG, Potter PA, Ostendorf V. Clinical Nursing Skills and Techniques. 8th ed. Philadelphia, PA: Elsevier Mosby; 2013:chap 38.

Review Date:5/24/2016
Reviewed By:Mary C. Mancini, MD, PhD, Department of Surgery, Louisiana State University Health Sciences Center, Shreveport, LA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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