Vascular Leg Ulcers - Causes, Symptoms, and Treatment

Introduction

Vascular leg ulcers result from chronic venous insufficiency (a medical condition characterized by the inadequate functioning of the veins, particularly in the legs, resulting in poor blood flow back to the heart). They can lead to disability and severe consequences. Older individuals are more frequently impacted. With the aging of the global population, there has been a noticeable increase in the prevalence of the condition worldwide.

Common manifestations of a vascular leg ulcer encompass discomfort, pruritus (itchiness), and edema (swelling caused by an accumulation of fluid in the body's tissues) in the affected lower limb. The ulcer may also exhibit skin discoloration or hardening, releasing a malodorous fluid.

What Are the Various Signs and Symptoms of Vascular Leg Ulcers?

Vascular leg ulcers are non-healing, open wounds in the skin that can be accompanied by pain and typically require more than two weeks to heal fully. Typically, they form on the inner side of the leg, namely between the knee and the ankle. Individuals with a vascular leg ulcer may also exhibit the following symptoms:

• Ankle edema.

• The ulcer may cause skin discoloration or darkening in the surrounding area. Additionally, the skin around the ulcer may become stiff, resulting in a firm sensation in the leg.

• The sensation of weightiness in the lower limbs.

• Leg pain or edema.

• Varicose eczema manifests as flaky, scaly, and itchy skin on the legs.

• Varicose veins refer to the condition of having swollen and bulging veins on the legs.

• Indicators of an infection.

• Bacterial infection.

Indications of a contaminated leg ulcer may encompass:

• Aggravating discomfort.

• An ulcer may exhibit a green or unpleasant discharge, whereas the redness may be less discernible on darker skin tones.

• Erythema and edema of the cutaneous tissue surrounding the ulcer.

• Pyrexia (fever) is malodorous, emitting or radiating from the ulcer.

What Are the Causes of the Condition?

Vascular ulcers can be categorized based on their underlying cause. Multiple circumstances can commonly contribute to the development of an ulcer.

• Ulcers Caused by Stasis - Vascular ulcers are primarily caused by vein issues. These typically occur in the legs and feet as getting older due to the valves in leg veins malfunctioning. The accumulation of surplus blood in your legs and feet causes excessive pressure on the blood vessels, leading to leakage and rupture.

• Arterial Ulcers - These are also known as ischemic ulcers. These occur because of restricted blood supply to a specific location, a condition known as ischemia. The afflicted body part, typically a limb, gradually perishes due to insufficient blood circulation.

Which Individuals Are Most Vulnerable to Vascular Leg Ulcers?

Several factors can elevate susceptibility to getting a venous leg ulcer, including:

• Excess Weight - Obesity or excess weight can increase pressure in the leg veins. Difficulties with walking can weaken the calf muscles, impacting circulation in the leg veins.

• Leg Injury - A previous leg injury, such as a broken or fractured bone, can cause deep vein thrombosis (DVT) or impact the ability to walk. Prior leg surgeries, such as hip or knee replacements, can restrict mobility. Additionally, advancing age is a contributing factor to those with arthritis, experiencing increased difficulty in mobility.

• Peripheral Vascular Diseases - These include peripheral artery disease and peripheral venous disease.

• Others - Diabetes, cardiovascular illness, hypertension, smoking and tobacco use.

What Are the Various Diagnostic Methods?

The diagnosis primarily relies on the symptoms experienced and the examination of the affected limb; however, supplementary testing may be necessary.

Medical Records and Physical Assessment: During a consultation with the general practitioner or practice nurse, they will inquire about any additional symptoms that may be linked to vascular leg ulcers, such as:

• Ankle edema.

• Skin discoloration or induration.

• The medical professionals will endeavor to ascertain the etiology of the ulcer by inquiring about any pre-existing diseases or prior traumas, such as diabetes (a medical condition characterized by high blood sugar levels), deep vein thrombosis (DVT) (the formation of blood clots in the body's deep veins, typically in the legs), injury or surgery in the affected leg and a history of a previous leg ulcer are additional factors that might contribute to the development of DVT. Additionally, they will assess the leg upright and when reclining. Varicose veins are more pronounced in an upright position, while the ulcer is more visible in a supine position.

Doppler Test: To eliminate the possibility of peripheral artery disease, a disorder that affects the arteries, a GP or nurse will conduct a doppler test.

• This procedure entails the assessment of arterial blood pressure in the ankles and its subsequent comparison with the pressure in the arms.

• Individuals with peripheral vascular disease typically exhibit lower blood pressure in their ankles than in their arms.

• Conducting this test is crucial, as the primary therapy for vascular ulcers involves using compression bandages or stockings to enhance blood flow in the leg veins.

What Are the Treatment Methods for Vascular Leg Ulcers?

Treatment for vascular ulcers varies based on their severity and underlying etiology.

Possible medications include:

• Antibiotics - These can cure an infection. Antibiotics may be administered in some situations, such as post-surgery, to prevent the onset of an infection.

• Topical Gels and Ointments - These tools aid in the removal of dead or contaminated tissue, enhance circulation to the affected area, prevent infection, and accelerate wound healing.

• Treat the Root Cause With Medications - Managing blood pressure, cholesterol, tobacco use, and blood sugar can aid in wound healing.

• Analgesics or Anesthetics- Vascular ulcers and their therapies might cause discomfort. Anesthetics are frequently administered during your therapy to alleviate pain or numbness.

• Wearable Objects - Bandages and various wearable objects are frequently utilized in the treatment of vascular ulcers. These should be used only as directed by the healthcare provider. Improper use of these can worsen the vascular ulcer rather than improve it.

• Applying Bandages - Applying a protective bandage over the ulcer can prevent infection. Some bandages are medicated and can accelerate the process of wound healing.

• Compression Garments - It comprises of socks, stockings, and several additional items. Applying pressure to the entire leg can help reduce or prevent swelling. This is frequently utilized for venous ulcers to prevent blood from accumulating in the lower extremities.

• Specialized Orthotic Devices - Vascular ulcers are often the result of mechanical stress and strain. Typically, experiencing discomfort in this situation would prompt to alter the walking pattern to reduce harm to the injured area.

Sophisticated techniques for managing vascular ulcers, particularly those that are bigger or have a delayed healing process, can be employed.

• Revascularization - Vascular ulcers can occur due to obstructions in important blood arteries. Revascularization therapies aim to eliminate blockages to aid in healing existing wounds and prevent the occurrence of new ones.

• Surgery - Surgery may be necessary for infected or big wounds that are difficult to heal. A surgeon can debride a vascular ulcer to eliminate infected tissue and conduct surgical procedures to facilitate wound healing. This may involve skin transplants and various restorative techniques. For advanced or severe vascular ulcers, amputation (surgical removal) of a portion of the foot or leg may be required. This method aims to preserve lives and prevent further difficulties.

• Physical Exercise - Engaging in physical exercise under medical supervision can enhance circulation and aid in the prevention of developing vascular ulcers.

• Hyperbaric Oxygen Treatment - Hyperbaric oxygen therapy involves being placed in a chamber with 100 percent oxygen concentration and increased atmospheric pressure. These circumstances can accelerate the process of wound healing, particularly for vascular ulcers.

• Debridement - Decaying and contaminated tissue near a vascular ulcer can delay healing and result in gangrene and other serious problems. Debriding the area eliminates dead or contaminated tissue, leaving only healthy tissue behind.

What Is Long-Term Care for the Condition?

• At the beginning of treatment, one will have regular weekly appointments to change the dressings and compression bandages. In addition, they will observe the ulcer to assess its healing progress.

• After the ulcer has made significant progress in healing, the frequency of nurse visits will be reduced.

Once the ulcer has fully healed:

• After experiencing a vascular leg ulcer, the possibility of developing another ulcer within a few months or years exists.

• The nurse will assist in selecting an appropriately sized stocking that can be independently handled.

• Several accessories can assist in the process of putting on and removing them.

Conclusion

Managing vascular leg ulcers can present significant challenges, imposing a substantial socioeconomic burden and a high recurrence rate. A systematic approach to managing vascular leg ulcers allows physicians to enhance the healing process results and decrease the likelihood of recurrence. Treating clinicians must provide patients with education concerning the necessity of everlasting compression therapy.