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Concept
Venous ulcer
Summary
Venous ulcer is defined by the American Venous Forum as "a full-thickness defect of skin, most frequently in the ankle region, that fails to heal spontaneously and is sustained by chronic venous disease, based on venous duplex ultrasound testing." Venous ulcers are wounds that are thought to occur due to improper functioning of venous valves, usually of the legs (hence leg ulcers). They are an important cause of chronic wounds, affecting 1% of the population. Venous ulcers develop mostly along the medial distal leg, and can be painful with negative effects on quality of life.
Exercise, together with compression stockings, increases healing. The NICE guideline recommends that everyone with a venous leg ulcer, even if healed, should be referred to a vascular specialist for venous duplex ultrasound and assessment for endovenous surgery.
Signs and symptoms of venous ulcers include:
Moderate pain, which improves on elevation (unlike arterial ulcers which worsen with elevation)
Irregular, sloping edges
Associated oedema, due to increased hydrostatic pressure, which contributes to 'atrophie blanche'
'Atrophie blanche', localised loss of skin pigmentation due to death of erythrocytes and scarring
Lipodermatosclerosis, a hardening of the skin which can lead to an "inverted champagne bottle" appearance to the leg
Associated superficial varicose veins or "ankle flare", a collection of small, dark, engorged superficial veins
File:Úlceras antes da cirurgia.JPG|Venous ulcer before surgery
File:WIRA-Wiki-GH-012-de-Ulkus-Verlauf-unter-wIRA.png|Healing process of a chronic venous stasis ulcer of the lower leg
File:Venous ulcer Wound healed in one month - Varicose Vein.jpg|Healing venous ulcer after one month
The exact cause of venous ulcers is not certain, but a common denominator is generally venous stasis, which may be caused by chronic venous insufficiency, and/or congestive heart failure. Venous stasis causes the pressure in veins to increase. The body needs the pressure gradient between arteries and veins in order for the heart to pump blood forward through arteries and into veins.
Official source
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