1. What is a venous leg ulcer?
This is a skin defect, in most cases located above the ankle, formed as a result of varicose veins of the lower extremities and chronic venous insufficiency. They occur and recur frequently, healing is difficult, and sometimes impossible.
2. What venous diseases cause varicose ulcers?
Varicose veins of the lower extremities and chronic venous insufficiency (read more in the section on varicose disease, anatomy of veins and their disorders).
3. How are varicose leg ulcers diagnosed?
They have certain features:
- Often located above the ankle.
- Usually surrounded by dark brown skin.
- Varicose veins of the lower extremities are often noted.
- The rest of the leg and foot appear normal.
Most leg ulcers with this characteristic are varicose.
Diagnosis requires duplex scanning of the veins of the lower extremities.
A patient with a leg ulcer should be referred to a surgeon or a phlebologist surgeon immediately when visiting a general practitioner.
4. What happens if I have a venous trophic ulcer and I do not treat it?
Until recently, venous trophic ulcers were considered difficult to treat, or not treatable at all. Patients began to believe that trying to treat them was a waste of time and money. This would be correct if the ulcer did not expand, become infected and deepen, leading to life-threatening venous bleeding, often occurring suddenly, and sometimes in sleep (preceded by nocturnal itching).
5. What to do then?
Fortunately for patients, foam sclerotherapy, which has recently appeared, leads to the healing of more than 98% of venous leg ulcers in an extremely short time, on average from two weeks to three months, depending on the depth, area, age and infection of the ulcers.
6. What should you never do under any circumstances?
- Make endless dressings and wear compression hosiery without the advice of a specialist.
- Give patients with trophic changes in the ankle area hormonal creams until venous insufficiency is ruled out.
- Tell patients with varicose veins that this problem is cosmetic in nature and that they should consult a specialist when problems arise.
- Prescribe long-term supportive compression hosiery to patients with trophic changes in the ankles or with varicose veins without determining the cause and without eliminating it.
7. How do you treat venous trophic ulcers?
There are four important principles underlying the effective treatment of varicose leg ulcers:
- A detailed examination and duplex scanning to determine the cause of ulceration.
- Foam sclerotherapy of varicose veins leading to ulceration.
- Keep the ulcer clean and change dressings regularly to treat and prevent infection.
- Preventive measures and, first of all, wearing compression stockings as often as possible. (See the section on varicose veins - prevention of varicose veins).
8. How long does it take for a leg ulcer to heal?
It lasts from two weeks to three months, depending on the depth, area, age and infection of the ulcers.
9. What can I do to reduce the recurrence of venous leg ulcers?
- Wearing compression hosiery;
- Walking and exercises aimed at eliminating congestion in the veins of the lower extremities;
- Proper care of the ulcer and regular dressings;
- Losing weight (if it is excess);
- Fighting constipation (if any).
10. Is Hospitalization Necessary?
Hospitalization is not necessary, even if there are large, deep and multiple ulcers on both shins. Treatment is carried out on an outpatient basis.
11. How long does the course of treatment last and how often will I visit the doctor?
The course lasts from 2 weeks to 4 months, i.e. as much time as it takes for healing. During this time, you visit your doctor once every 5-7 days for a month, and then once every 2-3 weeks until the ulcers are completely healed.
12. Will the ulcers reopen?
Since varicose veins progress over the years, there is a possibility of calf ulcers appearing with a relapse of varicose veins.
Based on my 13 years of experience in treating varicose ulcers of the calves, I can say that, despite the relapse of varicose veins to varying degrees in different patients, no relapse of ulcers was observed. The appearance of varicose veins on the other calf was not observed for the reason that during treatment we initially treated varicose veins on both lower extremities.
13. Who is suitable for foam sclerotherapy?
Foam sclerotherapy can be used to treat almost all patients: with varicose veins of any diameter, including those complicated by ulcers, primary or recurrent, of any duration.
14. What is injected into the veins and how does it work?
Sclerosing foam is injected into the vein lumen under ultrasound control. The foam repels blood, replacing it in the lumen of the vein and interacts with the vessel wall, causing the latter to sclerose, i.e. shrink, and then become clogged. The vein is excluded from the bloodstream, and venous congestion is eliminated, which helps normalize blood flow and thereby speed up the healing of ulcers.