Introduction
Skin is the intact protective covering that shields the internal structures from exposure to the external environment, thereby hindering various pathogens from gaining access to the body. A break in the skin integrity, which can be in the form of sores or skin breaks, acts as a potential access point for pathogens. Ulcers are skin areas with sores that are open and resistant to normal healing. Normally, when a skin break or abrasion develops, it heals within a few days. Skin ulcers develop when the body fails to heal the sores by normal physiological processes. Anatomical and structural parameters make the legs prone to developing open sores.
What Are Venous Leg Ulcers?
Venous leg ulcers, as the name suggests, develop exclusively on the legs. Almost 60 percent of the leg ulcers are identified to be venous leg ulcers. These ulcers are seen in and around the ankle region, more precisely below the knees. Unlike other sores or cuts, venous leg ulcers may not heal or close by themselves; they often necessitate medical assistance. It is routinely encountered in elderly patients. Over 60 groups are more susceptible to venous leg ulcers, and it can even give rise to complications. Venous leg ulcers are associated with circulatory insufficiencies in the leg. Females have a slight preference for venous leg ulcers when compared with males.
What Leads to the Development of Venous Leg Ulcers?
Venous leg ulcers develop due to blood pooling in the leg veins. The veins are the blood vessels that bring back the oxygen-deficient blood from various parts to the heart. The leg veins house the oxygen-deficient blood from the legs and carry it to the heart. Certain valves regulate the blood flow through the leg veins, which permit only a unidirectional stream in the upward direction. These valves check the blood pooling in the leg veins by ensuring constant upward flow. Valve blockage, scarring, damage, or weakness can impair the functional status of the valve. Once the leg vein valves become nonfunctional, the blood in the veins tends to gather in the leg itself instead of moving to the heart, which is medically known by the condition venous insufficiency.
The gathering of the venous blood in the leg exerts added pressure on the veins, which in turn limit and restrict the leg’s arterial blood flow. Arterial blood delivers oxygen and other essential nutrients. In this way, venous insufficiency curbs the delivery of vital elements to the leg cells. The nutrient-deprived cells fail to thrive and undergo destruction, giving rise to open sores in the leg, called venous leg ulcers. Varicose veins (ballooning of leg veins) are also reported to be a causative factor for venous leg ulcers. Certain studies have exposed a familial association of venous leg ulcers, where those with a positive family association are more likely to have the condition in the long run. However, no specific gene has been identified to be associated with venous leg ulcers.
What Are the Manifestations Associated With Venous Leg Ulcers?
Open and tender sore in the leg, specifically in the ankle region, lasting for a few weeks, suggests venous leg ulcers. These are irregularly bordered wounds that are often coated with yellow tissue. In addition to ulcers, there are specific other manifestations elicited by venous leg ulcers. Some of the routinely reported manifestations include the following:
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The ankle regions elicit puffiness, and the patients experience heaviness and soreness in the leg.
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The skin that encircles the ulcer exhibits alteration in color and texture, appearing darker and feeling harder than normal skin.
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Certain patients exhibit puffy (varicose) veins, often accompanied by itching and peeling of the leg skin.
Venous leg ulcers can house bacterial pathogens, making them vulnerable to infections. When venous leg ulcers acquire infections, there will be enhanced pain and smelly, pus-like discharge from the sore. There will be an associated hike in body temperature, which indicates undergoing infection in the body.
What Are the Risk Factors Associated With Venous Leg Ulcers?
Certain conditions may enhance the likelihood of venous leg ulcers and are considered risk factors. Some of the known risk factors include the following:
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Leg Injury: External injury or trauma to the leg resulting in an open wound can facilitate the development of venous leg ulcers. Not all leg wounds turn into venous leg ulcers. If the wound develops in an individual with compromised venous blood flow, it can precipitate as venous leg ulcers.
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Overweight: Individuals who are overweight, possessing more than the necessary body weight, are more susceptible to venous leg ulcers.
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Osteoarthritis: Osteoarthritis is a medical condition that explicitly restricts the person's joint functioning. It potentially limits one’s ability for movement and enhances the risk of venous leg ulcers.
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Smoking: Smoking can impair the blood vessels and deteriorate circulatory functions.
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Deep Vein Thrombosis: A condition where the venous blood develops a clot within the vein. Deep vein thrombosis, when developed in the legs, can occlude the venous blood flow, potentially giving rise to venous leg ulcers.
How Are Venous Leg Ulcers Managed?
The treatment intervention for venous leg ulcers is aimed at leg ulcer healing and wound closure. It is necessary to alleviate the leg swelling to facilitate the healing process. Compression therapy is advised to curb the leg swelling and enhanced venous blood pressure. Compression bandages, which are applied over the involved leg, are employed for compression therapy. Compression bandages force the venous blood to move upward and check venous blood gathering in the leg. However, the cardiac health status and other underlying medical conditions need to be assessed beforehand to ensure the safety of the intervention.
Wound protection and proper management also facilitate the healing process. Leg sores are open to contamination, and care should be taken to keep the wound clean and germ-free. Cleansing with antimicrobial solutions is often followed by debridement, during which the dead and damaged cells are excavated. Debridement is carried out after anesthetizing (numb and pain-free) the area locally. Wound-protective dressings and antimicrobial cream application are also recommended to check bacterial contamination and subsequent infection.
Conclusion
Venous leg ulcers are a specific category with a remarkable prevalence rate. Understanding the etiology and treating the underlying causative factor warrant the success of the treatment. Healthy eating, a healthy lifestyle, and maintaining physical activity are the key parameters to keep the legs active and viable. The earlier the treatment interventions are initiated, the higher the prognosis. The compression therapy needs to be followed for an extended period to ensure no return of the leg ulcers.
