Definition

Venous stasis ulcers are wounds on the skin of the lower legs which develop as a result of significant venous reflux.  They are the most common type of ulcers on the lower legs, affecting 500,000 to 600,000 Americans annually.   Venous stasis ulcers can be shallow or deep and typically develop below the knee on the sides of the legs near the ankle area.

Symptoms

Some venous ulcers are quite painful while others are virtually painless.  The borders of the ulcer are generally irregularly shaped and often surrounded by discolored and swollen skin.  Fluid drainage from the ulcer is also common and may or may not indicate infection.  Darkening of the skin near the ankles, itching, chronic pain and swelling, or a burning sensation may develop near the area of the ulcer prior to the onset of the open wound.  Special attention should be given to this condition before the skin breaks down into an open ulcer.

Causes

Fluid accumulation in the legs, due to venous insufficiency, makes it difficult for the cells in that area to obtain the necessary nutrients or effectively remove the waste products.   Gradually the skin in the legs becomes malnourished and fragile. If left untreated, venous stasis ulcers may ultimately develop.  Although not everyone who develops varicose veins will develop a venous stasis ulcer, varicose veins are an indication of a venous insufficiency disorder which increases the risk of developing venous stasis ulcers.

Diagnosis

A visual examination and thorough history are used to diagnose a venous stasis ulcer.  A venous duplex ultrasound is also completed to help direct treatment of the underlying cause of the venous insufficiency disorder.

Risk Factors for Venous Stasis Ulcers

• History of varicose veins
• Inherited blood-clotting disorder
• Prolonged bed rest
• Injury or surgery
• Cancer
• Heart Failure
• Smoking
• Obesity
• History of prior DVT or PE
• Family history of DVT or PE
• Birth control pills or hormone replacement therapy

Treatment

Treatment of a venous stasis ulcer is twofold: healing the existing ulcer and preventing a recurrence of the ulcer once it is healed.  Reducing the amount of swelling and fluid accumulation in the legs, with prescription strength compression stockings, periodic leg elevation, and activities such as walking can all help heal the ulcer.  Identification and treatment of the underlying venous disease will speed the healing process and prevent the venous stasis ulcer from returning once it is healed.  Venous stasis ulcers may be prevented all together by treating venous insufficiency before an ulcer develops.