Conditions – Venous Ulcers, Georgia
The development of venous ulcers is a costly and painful late complication of vein disease. Venous ulcers lead to disability including lost days of work and expenses of wound care. The source of the development of venous or stasis ulcers is deep vein disease, superficial vein disease, perforator vein disease, or a combination of these. With these problems venous blood refluxes or pools in the legs.
Venous reflux creates a pooling of protein rich fluid in the skin and subcutaneous tissue of the legs with diminished nutrition to the skin and accumulation of waste products. Left untreated this leads to stasis skin changes and ulcers, which are avoidable with early intervention. Tissue changes may first be noticed as dark red, purple, or brown skin discoloration of the lower legs. If you have symptoms, visible spider or varicose veins, or skin changes seek care to avoid painful and costly venous ulcers.
At the ulcer stage, you may experience painful and swollen legs. With good wound care and the use of compression, most ulcers will heal. However, without compression and good skin care, within a year more than half of patients will have recurrence of their ulcer. With compression, good skin care and correction of the underlying vein disease, the incidence of recurrence is less than 20% in a year.
Contributing Factors for Venous Ulcers
Venous ulcers develop as reflux allows venous blood to pool in your leg. This reflux may be the result of saphenous vein, perforator vein, or non-saphenous vein reflux. As fluid leaks out of the dilated veins into the surrounding tissues, swelling interferes with the movement of oxygen and nutrients into these tissues and the removal of waste products, resulting in inflammation, tissue damage, and venous ulcer formation.
Treatment for Venous Ulcers
The key to successful treatment of venous ulcers is a detailed duplex ultrasound mapping study. Once a map is created Dr. Kenneth Harper uses the most effective methods to treat the underlying venous reflux including Endovenous Therapy, Ambulatory Phlebectomy, ligation of perforator veins, and Sclerotherapy.
The principle of the treatment of venous ulcers starts with correction of saphenous vein reflux first if present. In some cases, the only finding may be deep vein reflux or damage to the deep veins from deep vein thrombosis. In this case the treatment of choice is wound care to heal the ulcer and compression for the deep vein disease.
In most cases of venous ulcers there is truncal reflux or reversal of venous flow in the Great or Small Saphenous veins with or without deep vein disease or incompetent perforator veins.
Unless there is complete deep vein obstruction, correction of the saphenous vein or truncal reflux is the first step after wound care to heal the ulcer. The bulging varicose veins may be treated with ambulatory phlebectomy or sclerotherapy for varicose veins.
If the ulcer does not heal with good wound care, additional duplex testing is needed to evaluate for any persistent reflux in incompetent perforators or branch varicose veins. If persistent perforator vein reflux or additional refluxing varicose veins are noted it is corrected appropriately.
Many patients report that their ulcers heal quickly after correction of the underlying venous reflux. It is rewarding to see a patient’s quality of life improve.
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