Facing the global challenge of Venous leg ulcers

Venous leg ulcers – Prevention and treatment

Leg ulcers are a major health and healthcare problem, affecting people throughout the world. Venous leg ulcers could account for 80 percent of all leg ulcers1. Also they pose a significant financial burden on healthcare resources.

The number of leg ulcers has the potential to increase significantly in the coming years due to factors such as an aging population, obesity, concurrent illness, intravenous drug misuse and social deprivation.

Assessment, management and prevention of Venous Leg Ulcers

A guide that examines the assessment, management and prevention of venous leg ulcers. ...

About Venous leg ulcers

Venous leg ulcers
Venous leg ulcers are the most common cause of leg ulceration with estimates ranging from 37 – 81 percent 2,3,4 Venous leg ulcers have an immense socio economic impact.
Venous hypertension leads to a myriad of microangiopathological changes. In the most severe cases skin breaks down and an ulcer develops.
The primary cause of venous leg ulceration is venous hypertension resulting from venous disease.

There are other theories that contribute to the development of lower leg venous ulceration:

  •  Microcirculatory disturbances
  •  Fibrin cuff theory
  •  The trap hypothesis
  •  Hypoxia to the gaiter region
  •  White cell trapping
  •  The role of tissue proteinases
  •  Fibroblasts in chronic venous insufficiency


There are more than 40 perforators connecting the deep and superficial veins.
The venous pumping system consists of muscle in the distal calf and the foot pumps. Muscular contraction is the main activator of the pump system.
In the normal lower leg in the supine position, blood flows slowly through the veins and the pressure in the ankle is 70 – 100mmHg falling to 10 – 20mmHg during walking and 55mmHg while sitting.
If the valves of the superficial and perforator veins are incompetent blood oscillates up and down in the segments. This results in venous reflux, leading to ambulatory venous hypertension and oedema during exercise.
The more extensive and distal the venous reflux the greater the risk of ulcer formation. 

Other solutions

Safetac

The Diabetic Foot - prevention and treatment of ulcers

Pressure ulcer prevention and treatment

References

1. Agnew MS, Gottrup F (2007) Causation of venous leg ulcers, cited in Marson MJ et al Leg ulcers a problem based learning approach. Mosby London

2. Adam DJ, Naik J, Hartshorn ET (2003) The diagnosis and management of 689 chronic leg ulcers in a single visit assessment clinic. European Journal of Vascular and Endovascular surgery 25:462 – 468

3. Briggs M, Closs SJ (2003) The prevalence of leg ulceration: a review of the literature. EUMA Journal 3 (2): 14 – 18, 20

4. Valencia IC, Falabella A, Kirsner RS (2001) Chronic venous insufficiency of venous leg ulceration Journal of American Academy of Dermatology 44:401 – 421.

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