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Therapeutics in Dermatology
A reference textbook in dermatology
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Venous and mixed predominantly venous leg ulcers

8 February 2016, by CHABY G.

1 - INTRODUCTION

Venous or mixed arterial and venous but predominantly venous ulcers account for the majority of leg ulcers, being diagnosed in an estimated 70 to 80% of leg ulcer cases. Their prevalence is estimated at between 1 and 1.5% and they amount to a significant public health expense, requiring around 1 to 2% of the annual healthcare budget in Western European countries [1].

Venous ulcers are the final clinical expression of the venous hypertension that is still known as chronic venous insufficiency. This venous hypertension can have a number of causes: valvular incompetence in the superficial and/or communicating veins, which can be either congenital or acquired; valvular incompetence in the deep veins, which can be congenital or post-thrombotic; an obstruction in the deep venous system; calf muscle pump dysfunction secondary to ankle ankylosis, myopathy or neuropathy.

The risk factors for venous ulcer are the same as those for chronic venous insufficiency: old age (peaks between the ages of 60 and 80), female (female to male ratio of 1.5:1 to 10:1), a history of deep vein thrombosis, a family history of leg ulcer, a personal history of obesity, leg trauma or surgery, number of pregnancies, and prolonged standing up. 

Treatment consists of correcting venous insufficiency, which must involve wearing venous compression garments, and in some cases this will be combined with surgery to the superficial venous system. The choice of dressing will be made based on the healing stage and the whether certain factors are present (infection, unpleasant odour or actively bleeding wound). Negative pressure wound therapy and skin grafts are the alternatives to the most commonly used dressings.

Educating the patient about the illness and the importance of venous compression for healing and later for the prevention of recurrence is a key factor.

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