Venous Leg Ulcers

Chronic venous insufficiency is the most common cause of ulcers affecting the legs. Venous leg ulcers occur mainly just above the ankle. They can lead to disability that inevitably leads to significantly diminished quality of life.

Venous leg ulcers typically start as areas of dark, reddish-brown skin pigmentation. The high pressure in the leg veins due to valve malfunctioning leads to chronic inflammation. There may also be discolored or hardened skin around the ulcer, and the sore may produce a foul-smelling discharge. These areas may be very painful and sensitive to touch. White scar tissue may also develop in these areas.

Venous leg ulcers can lead to serious issues if they are not treated appropriately.

The source of the development of venous leg ulcers is deep vein disease, superficial vein disease, perforator vein disease, or a combination of these. With these problems venous blood refluxes or pools in the legs.

Visible spider veins or varicose veins may be the first symptom.


Venous leg ulcers develop as a result of reflux that allows venous blood to accumulate in your leg. This reflux may be the result of various causes such as:

  • Saphenous vein
  • Perforator vein
  • Non-saphenous vein reflux

Over time, fluid begins to leak from dilated veins and seeps into surrounding tissues causing swelling to occur. This swelling disrupts the natural flow & movement of oxygen and nutrients into these tissues, which also prevents the removal of waste products which ultimately results in inflammation, tissue damage, and venous ulcer formation.


Most venous leg ulcers heal within three to four months if they are treated by an experienced healthcare professional trained in venous disease. However, some ulcers may take longer to heal, and a very small number never heal.

Treatment usually involves:

  • Standard wound care
  • Using compression therapy, such as bandages or stockings, to improve the flow of blood in the legs
  • Advanced wound care, such as bio-engineered skin substitutes, negative pressure wound therapy or skin grafts
  • Definitive management of chronic venous insufficiency leading to venous ulcers with the use of laser or radiofrequency ablation to eliminate incompetent veins. Unless the underlying cause of the ulcer is addressed, there is a high risk of a venous leg ulcer recurring after treatment. Diagnostic venous ultrasound will help determine the diseased vein segments causing the problem. Depending upon the duplex ultrasound results, definitive treatment for the management of chronic venous insufficiency should be undertaken to prevent future recurrence of venous leg ulcers.

Good Wound Care is Important for Treatment

If the ulcer does not heal with good wound care, additional duplex testing is needed to evaluate for any persistent reflux in incompetent perforators or branch varicose veins. If persistent perforator vein reflux or additional refluxing varicose veins are noted it is corrected appropriately. Many patients report that their ulcers heal quickly after correction of the underlying venous reflux.


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