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Venous ulcers

Definition
  • Chronic wounds that occur due to improper functioning of the venous valves, leading to increased pressure in the veins, primarily of the lower extremities.
Etiology/Risk Factors
  • Chronic venous insufficiency.
  • Deep vein thrombosis.
  • Varicose veins.
  • Obesity.
  • Previous leg injury.
  • Standing for long durations.
  • Advanced age.
Pathophysiology
  • Increased venous pressure leading to fluid leakage into the surrounding tissue.
  • Leaked red blood cells break down, causing skin discoloration and dermatitis.
  • Oxygen supply reduction and waste product accumulation lead to skin breakdown and ulceration.
Clinical Presentation
  • Ulcers are typically shallow with irregular shape, commonly found on the medial malleolus of the ankle.
  • Surrounding skin may be swollen, discoloured (haemosiderin staining), or hardened.
  • Associated with moderate to severe leg pain, especially when the leg is lowered.
  • Possible exudate or odour.
Investigations
  • Doppler ultrasound: Assess venous flow and valve function.
  • Ankle-brachial pressure index (ABPI): Differentiate between venous and arterial ulcers.
  • Wound swab if infection is suspected.
Management
  • Compression therapy: Multilayer bandaging or stockings to promote venous return.
  • Wound care: Regular cleaning, topical antimicrobials or silver sulfadiazine if infected, moisture-balancing dressings.
  • Pain management.
  • Elevate the leg when possible to reduce swelling.
  • Encourage regular movement and walking.
  • Consider surgical interventions (e.g., endovenous laser treatment, vein stripping) if underlying varicose veins are present.
Prognosis
  • Can take several weeks to months to heal. Some may become chronic and not heal.
  • Recurrence is common if underlying venous insufficiency is not addressed.

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