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Stop leg wounds that don't heal

Harvard Health Letter

9:30 AM EDT, September 30, 2013

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The easy fix that millions of people may be ignoring.

Each year millions of people struggle with painful, debilitating venous leg ulcers and the stages leading up to the condition. But prevention is simple. That's why doctors are now campaigning to reduce venous ulcers by 50%. "This is a longstanding problem that needs our attention," says Dr. Sherry Scovell, a vascular surgeon and instructor in surgery at Harvard Medical School.

Venous leg ulcers

Venous leg ulcers—open skin wounds that don't go away—usually occur on the inner side of the leg between the ankle and mid-calf. It takes a long time for them to develop, because they are the final stage in the progression of venous disease.

It starts with a varicose vein, a vein with broken valves that causes blood to pool. The pooled blood may cause your ankles to swell, and the swelling can lead to skin changes characterized by a brown discoloration called hyperpigmentation. "The ulcer happens when the skin layer breaks down, and a tiny nick or scratch causes the skin to open," says Dr. Scovell. "The open wound may leak fluid, due to the ankle swelling. The skin continues to break down, revealing a beefy red sore that's very painful."

Treatment

Venous leg ulcers typically don't go away on their own. In fact, they may get bigger until you seek treatment. The first step is confirming venous disease. Doctors use ultrasound imaging to look at the deep and superficial veins and confirm the vein problem.

Once the problem is identified, the mainstay of ulcer treatment is reducing the swelling by using either bandages or compression stockings with dressings on top of the broken skin. "That compresses the fluid out of the leg, which makes it easier for oxygen and nutrients to get to the ulcer so it will heal," says Dr. Scovell. Adding therapy with either aspirin or pentoxifylline may also be effective for treatment, as is elevation of the leg when you're sitting. Dr. Scovell recommends periodic check-ups after treatment, as venous disease may recur.

Anatomy of a varicose vein



Normally, blood moves through veins toward the heart by one-way valves, which prevent blood from flowing backward. In a varicose vein, the valves don't close properly, allowing the blood to pool and enlarge the vein, which can lead to painful skin ulcers.

Prevention

You can prevent venous leg ulcers at any stage. "The varicose veins, the swelling, the skin changes—at each step you have a chance to catch it for prevention. If you catch it, you still have time to make a difference and stop an ulcer from developing," says Dr. Scovell. Rest and elevation are also helpful for prevention, especially if you have a job or do an activity that requires long periods of standing.

But ultimately you must treat the underlying venous disease to prevent the ulcers from occurring and recurring. This is usually done in the doctor's office, using a catheter procedure to collapse the faulty vein from the inside. Wearing compression stockings may also be an acceptable alternative to surgery. "The ulcers are completely preventable if you seek treatment for your varicose veins," says Dr. Scovell.