Venous ulcer is a chronic wound on the lower leg caused by pooling of venous blood or poor blood circulation in the lower limbs. The worlds 1% population suffers from venous ulcer.
Causes of Venous Ulcers:
- Weak or damaged vein valves: The valves in the veins prevent blood from flowing backward. When they weaken or are damaged, blood can pool in the lower extremities, increasing venous pressure.
- Deep vein thrombosis (DVT): A history of DVT can lead to venous damage and scarring, which impairs blood flow.
- Varicose veins: Enlarged, twisted veins near the surface of the skin are less effective at returning blood to the heart, which can lead to venous insufficiency.
- Prolonged standing or sitting: These activities can reduce venous return and contribute to venous hypertension.
Risk Factors:
Several factors can increase the likelihood of developing venous ulcers:
- Age: Old age.
- Obesity: Over weight puts pressure on the veins, leading to venous insufficiency.
- Sedentary lifestyle: Lack of movement can impair venous circulation( Software Industry, Clerical work, CA’s and other sedentary jobs).
- Smoking: Damage blood vessels and impede circulation.
- Pregnancy: The increased blood volume during pregnancy can stress the venous system.
- Injuries or surgeries: Injuries or surgeries also in the legs may impair venous function.
Symptoms of Venous Ulcers:
- Pain: Long standing may case pain or discomfort in venous ulcer.
- Swelling: The affected leg may be swollen, especially around the ankle.
- Discoloration: brownish or reddish due to the buildup of iron deposits around the ulcer.
- Itching or burning: The skin may feel itchy or irritated.
- Ulcer appearance: Venous ulcers typically occur specially near the ankle.
Diagnosis:
Diagnosing venous ulcers usually involves:
- Physical examination: The doctor will inspect the affected area, noting the location, appearance, and signs of venous insufficiency.
- Ankle-brachial index (ABI): This test measures the blood pressure in the ankle compared to the arm, ruling out arterial insufficiency.
- Duplex ultrasound: An ultrasound may be used to assess blood flow and identify any blockages or valve dysfunction in the veins.
Treatment:
Treatment of venous ulcers purpose to improve blood circulation, help healing, and prevent repetition. Key strategies include:
1. Compression Therapy:
- Compression bandages or stockings: Multi-layer bandages or Grade III stocking are recommended to improve venous return by applying pressure to the legs, reducing swelling and preventing blood pooling.
2. Wound Care:
- Cleansing: The ulcer should be gently cleaned to remove dead tissue and bacteria.
- Dressings: Special dressings like hydrocolloid or foam dressings help maintain a moist environment conducive to healing.
- Debridement: Removing dead or infected tissue is essential to promote healing. This can be done surgically, mechanically, or with specialized dressings.
3. Medications:
- Topical antibiotics or antiseptics: These may be used to treat or prevent infection.
- Pentoxifylline: This medication improves blood flow.
4. Lifestyle Changes:
- Exercise: Physical activity like walking can improve blood circulation in the legs.
- Elevating the legs: Raising the legs above the level of the heart can help reduce swelling.
5. Surgical Interventions:
In severe or persistent cases, surgery may be needed to improve blood flow. These options include:
- Vein stripping: Removal of damaged veins.
- Skin grafting: In extreme cases, a skin graft may be applied to cover large ulcers.
Laser Treatment Procedure for Venous Ulcer:
Laser for Venous ulcer is a time-tested gold standard treatment in medical field which is being used from last 25 years and because of its high success rate, cost effectiveness, minimally invasive procedure, laser is being used world wide and is the first choice among doctors. The primary goal is to close the diseased veins that cause blood pooling leading to improved blood circulation and faster healing of the ulcer.
Why Laser (EVLA Endo venous laser ablation) is the Choice of Treatment for Venous Ulcer:
- Minimally invasive: A small incision is made to insert the laser fiber.
- Outpatient procedure: The treatment typically takes 30-60 minutes, and patients can return home the same day.
- Effective in healing ulcers: EVLA addresses the root cause of venous ulcers by correcting the venous insufficiency. Studies have shown that it significantly improves ulcer healing rates and reduces recurrence.
- Recovery: Patients may resume normal activities from next day.
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