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Patient Education - Venous Leg Ulcers

Patient Education - Venous Leg Ulcers

Patient Education - Venous Leg Ulcers

Summary

A venous leg ulcer is a wound or opening in the skin on the lower leg, ankle, or foot in someone with vein disease. Venous leg ulcers appear in persons with a condition caused "chronic venous insufficiency", in which blood in the legs cannot easily return to the heart because the venous wall and/or valves are not working properly.   

    Treatment and Prevention

    Compression therapy with wraps, bandages, or medical stockings is the main form of treatment and prevention. 

    When to contact your healthcare provider?

    If you have a new ulcer, if you already have an ulcer and it is getting bigger or infected, or if you are wearing compression wraps and you have:

      • Wet or soiled wraps
      • Wound drainage on the outside of the wrap
      • Wraps that fall down or bunch on the foot
      • Toes that seem dark or turn blue
      • Toes that are more swollen than usual
      • Worsening pain in the legs, feet, or toes
      • Sudden shortness of breath


        Patient Handout (download)

      WHAT is a venous leg ulcer?

      • A venous leg ulcer is a wound or opening in the skin on the lower leg, ankle, or foot in someone with vein disease (Figure 1).
      • Before the skin opens, you may see skin color changes, have swollen legs and feet, and/or experience a burning or itching sensation. 
      • After the skin opens, the wound may be wet or leak fluid (weep), be covered with yellow film, and be painful. Dry, crusty scabs may form and the skin around the wound may be swollen, change colors, or feel warm.

      Figure 1. Leg appearance before the skin opens to form an ulcer and after the skin opens

      WHAT causes a venous leg ulcer?

      Venous leg ulcer appears in persons with a condition called "chronic venous insufficiency". Figure 2 illustrates the difference between normal veins and veins with chronic venous insufficiency. 

      Figure 2. Normal leg veins and damaged leg veins and their valves in people with chronic venous insufficiency

      You can be born with this condition (chronic venous insufficiency) or you can get it over time due to:

      • Standing or sitting for long periods
      • Pregnancy or excessive weight
      • History of a blood clot in the leg
      • Surgery, infection, or injury in the leg

      HOW do I care for my leg ulcer?

      Venous leg ulcers need proper care and treatment to prevent infection and to help the ulcer close.

      Follow your healthcare provider’s recommendations for wound care which may include:

      • Cleaning the wound
      • Applying medicine or other treatment to the wound and the surrounding skin
      • Covering the wound
      • Wearing compression garments or special leg bandages that prevent blood from settling in the lower legs

      WHAT are compression wraps?

      • Compression Wraps or Compression Therapy is when the lower legs are “wrapped” with one or more layers of bandages.  
      • Compression wraps come in several different types.  Some are washable and reusable and others are used one time only and are changed on a routine basis.
      • Compression wraps are used until the ulcer closes.  When the ulcer closes, wearing compression stockings/hose lifelong helps prevent the ulcer from returning.

      WHY do I have to have my legs “wrapped”?

      Venous leg ulcers take time to heal and diuretics or medications that reduce swelling minimally help with this condition. Compression therapy helps venous leg ulcers heal faster. Figure 3 shows how compression acts. 
      Figure 3. Veins and blood flow in a leg "wrapped" with compression and in a leg without compression

      WHEN should I call my healthcare provider?

      Don’t wait or hesitate:

      Contact your healthcare provider when you see a wound or opening along your lower legs, ankles, or feet.

      See signs of infection:

      Leg, foot, or wound redness, warmth, swelling, pain, or a change in wound drainage, odor, or color.

      During compression therapy for:

      • Wet or soiled wraps
      • Wound drainage on the outside of the wrap
      • Wraps that fall down or bunch on the foot
      • Toes that seem dark or turn blue
      • Toes that are more swollen than usual
      • Worsening pain in the legs, feet, or toes
      • Sudden shortness of breath

      HOW can I prevent a venous leg ulcer? 

      Do

      • Wear compression stockings/hose: To decrease leg swelling and help push the blood in the legs back to the heart.
      • Exercise: Walking helps move blood in the lower legs back to the heart and improves blood circulation.
      • Elevate your feet: Above the level of the heart once a day or after standing or sitting with your feet on the floor for long periods, to reduce leg swelling.
      • Take care of your skin: Check the skin along legs and feet for cuts or sores. Clean and moisturize skin every day.
      • Maintain a healthy weight: A healthy weight supports vein health and reduces strain on the leg veins.

      Don’t

      • Smoke: Smoking slows wound healing and reduces blood circulation.
      • Injure your legs: Protect legs and feet from scratches, rubbing, pressure, and burns.
      • Expose legs to extreme temperatures: Very hot or cold temperatures could injure the skin.
      • Remove scabs or dry skin: Picking at scabs or dry skin may damage new skin growth.

      For more information:

      For more information about venous leg ulcers, contact your healthcare team. Online resources include:

      • Gradient Compression Stockings for Patients
      • Venous Ulcers - Overview
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      NOTE: This is a controlled document. This document is not a substitute for proper training, experience, and exercising of professional judgment. While every effort has been made to ensure the accuracy of the contents, neither the authors nor the Wound Reference, Inc. give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of the work.
      Topic 1219 Version