Author: Amy Dendale, Medical Student, University of Auckland, New Zealand. DermNet NZ Editor in Chief: A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. December 2016.
A venous ulcer or venous leg ulcer is the most common cause of chronic full-thickness skin loss on the lower leg. The name implies that the veins are incompetent so that venous blood doesn’t flow properly from the leg back towards the heart. A venous ulcer is also called a stasis ulcer, a gravitational ulcer and varicose ulcer (although the latter is an inappropriate name when varicose veins are not present).
Venous ulcers affect 1% of the population. A variety of medical problems and lifestyle factors have been linked to their development. These include:
Venous ulcers account for at least 40–50% of chronic lower limb ulcers, and contribute to a further 20% of mixed arterial and venous ulcers.
Venous ulcers are caused by:
Factors leading to venous insufficiency include:
When blood is unable to be efficiently returned to the heart:
The result is in eventual skin breakdown, especially after an acute injury (which might be quite minor).
Characteristics of venous ulcers include:
Accompanying features confirming venous disease include:
The main complication of venous leg ulcers is infection. Wound infection can impair the healing process. Bacteria colonise nearly all leg ulcers, but systemic antibiotics are not required unless clinical signs of infection are present. Signs that a venous ulcer may require treatment with antibiotics include:
Topical antibiotics are not recommended because they slow the rate of wound healing, despite their bactericidal properties.
Venous ulceration is usually a clinical diagnosis, made on the basis of the patient's history and examination findings, and includes the presence of risk factors for venous stasis, that is, congestion and slowing of venous circulation, and the characteristic features of the wound and surrounding tissues.
Other investigations to evaluate venous insufficiency and provide haemodynamic information may include:
The treatment for venous ulcers aims to address the underlying cause, provide symptomatic relief, and promote wound healing.
Compression is a mainstay of treatment for venous ulcers.
Adequate wound care involves keeping the wound clean and moist with regular dressing changes.
Oral medications that affect blood flow, particularly aspirin, provide some benefit in promoting the healing of venous ulcers.
Surgical interventions may help venous leg ulcers heal and prevent their recurrence.
In cases of resistant venous ulcer, other therapies may be tried, including:
Venous leg ulcers are chronic and may persist for a few months to many years. Once they have healed, there is a high likelihood that venous ulceration will recur, unless the underlying venous insufficiency is treated.
Investigation of Chronic Venous Insufficiency. A. N. Nicolaides. Circulation. 2000;102:e126-e163, originally published November 14, 2000
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