Venous Skin Ulcer

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Topic Overview

What is a venous skin ulcer?

A venous skin ulcer, also called a stasis leg ulcer, is a shallow wound that develops when the leg veins do not move blood back toward the heart normally (venous insufficiency).

Venous skin ulcers typically develop on either side of the lower leg, above the ankle and below the calf. See a picture of areas affected by venous skin ulcers .

What causes venous skin ulcers?

The veins in the body have valves that keep blood flowing toward the heart. In a condition called venous insufficiency, the valves are damaged and allow some blood to back up in the vein. The slowed circulation causes fluid to seep out of the overfilled veins into surrounding tissues, causing tissue breakdown and ulcers. See a picture of abnormal blood flow caused by venous insufficiency .

Less frequently, blocked veins are a contributing factor in the development of venous skin ulcers.

What are the symptoms?

The first sign of a venous skin ulcer is the appearance of dark red or purple skin over the affected area. The skin may also become thickened and dry and itchy. Contact your doctor when you first notice the signs of a venous ulcer because you may be able to prevent an open wound (ulcer) from forming.

Without treatment, an ulcer may form. The wound may be painful, and you may also have swollen and achy legs. You may get rashes, such as contact dermatitis, on the skin around the ulcer.

Because venous skin ulcers are a result of poor blood circulation, these wounds are often slow to heal. If an ulcer becomes infected, there may be an odor, pus draining from the wound, and increased tenderness and redness.

How are venous skin ulcers diagnosed?

Venous skin ulcers can usually be diagnosed with a health history and physical exam. Your doctor may also use duplex Doppler ultrasound. This shows how well your blood is moving up through the lower leg.

How are they treated?

Improving circulation is critical in the treatment of venous skin ulcers. You can accomplish this by elevating your legs above the level of your heart when you can and, during your waking hours, using specially fitted stockings called compression stockings, designed to help prevent blood from pooling in your legs. See a picture of how to put on compression stockings .

More aggressive medical treatments, such as skin grafting and vein surgery, are available for venous skin ulcers that take longer than 6 months of treatment to heal or that become infected.

What increases your risk for venous skin ulcers?

Factors that contribute to venous insufficiency and increase your risk of developing venous skin ulcers include:

• Deep vein thrombosis, which can result from a severe leg injury (such as a broken or crushed bone) or leg surgery (including knee replacement and varicose vein procedures). Deep vein thrombosis can also develop when you don't move around for long periods (for example, if you are paralyzed or bedridden).
• Obesity.
• Pregnancies, which may aggravate an existing venous problem.
• A family history of varicose veins, especially if you also have reverse blood flow in a saphenous vein, which runs up the inner thigh.
• A blood-clotting disorder.

Your risk of developing a venous skin ulcer is further increased by smoking, lack of physical activity, excessive alcohol use, aging, poor nutrition (especially insufficient protein), and work that requires many hours of standing.

Frequently Asked Questions

Last updated:	September 17, 2007
Author:	Maria G. Essig, MS, ELS
Reviewed By:	Kathleen Romito, MD - Family Medicine, Randall D. Burr, MD - Dermatology
Editors:	Susan Van Houten, RN, BSN, MBA, Terrina Vail