Typical venous VU are located in the lower leg, preferentially in the lower calves. Ulcers may be rather extensive, but are usually not too deep. Moist granulation tissue that oozes blood upon manipulation may be visible at their base. Borders are irregular. The surrounding, not ulcered skin may show signs of chronic ischemia and dermatitis. Patients with venous VU often report mild pain that can, however, be alleviated by elevating the affected legs.

Of note, there are other types of ulcers that are sometimes deemed VU. In detail, these are arterial, neurotrophic and diabetic ulcers. They differ from venous VU in location and appearance.

• Arterial ulcers usually affect the dorsum of feet and toes. Grayish granulation tissue may be observed at their base. Their borders may be more regular than those of venous VU. Patients report pain to aggravate at night and to subside when the leg is loaded. The surrounding skin is often pale and hairless.
• Neurotrophic ulcers are often observed at the plantar surface the patient's feet, most frequently in close proximity to calluses formed under pressured joints. They have clearly defined borders and are rather deep. Any manipulation provokes bleeding. Adjacent tissues typically show signs of chronic inflammation, but these ulcers are not painful. This apparent contradiction may be explained by the fact that neurotrophic ulcers are developed by patients who suffer from neuropathy and hypesthesia.
• Diabetic ulcers may occur as a combination of any of the aforementioned types of ulcers. Their pathogenesis is not completely understood, but neuropathy and hypesthesia seem to play an important role.

• Pain

  The approach to venous ulcer pain must include an assessment of the cause of pain and the pain characteristics (constant or intermittent). [o-wm.com]

  With regard to pain intensity, the mean VAS pain score was 6.70 at baseline, corresponding to severe pain and 0 (no pain) at 8 and 12 months of treatment. [omicsonline.org]

  As pain increases to mild or moderate levels, the second step on the pain ladder adds a mild opioid such as codeine. The third step calls for a stronger opioid such as morphine as pain becomes moderate or severe. [woundsresearch.com]

  The ulcers are open wounds that can be painful and, if not treated, can become infected. Herbs may help relieve the pain and heal the wound naturally. Consult your health care provider before starting herbal treatment for venous leg ulcer pain. [livestrong.com]

  When the compression bandage is first applied to a venous leg ulcer, the patient will usually experience some pain. The vein specialist may prescribe a mild pain medication to keep the patient comfortable. [empirevein.com]

• Inflammation

  It is an ingredient in commercial creams and ointments used for relieving pain and inflammation, and it also helps prevent scars. [livestrong.com]

  Non-adherence may be the principal cause of these poor results, but presence of inflammation in people with CVI may be another factor, so a treatment that suppresses inflammation (healing ulcers more quickly) and reduces the frequency of ulcer recurrence [cochrane.org]

  A varicose ulcer is a deep lesion of the skin that results from impaired vein function, blood stasis and tissue inflammation. Typical venous VU are located in the lower leg, preferentially in the lower calves. [symptoma.com]

  Venous stasis ulcer of lower limb Venous stasis ulcer with edema and inflammation Venous stasis ulcer with edema of lower leg ICD-10-CM L97.909 is grouped within Diagnostic Related Group(s) (MS-DRG v 36.0): 573 Skin graft for skin ulcer or cellulitis [icd10data.com]

  These soft cast like dressings help blood flow return to the heart by narrowing the veins, stopping backflow of blood into the legs, and reducing both swelling and inflammation. [schulmanveincenter.com]

• Fever

  When to Seek Medical Care If you have pain, swelling, spreading red areas, fever, or any open wound that does not heal after a few days of self-care, seek medical advice. [skinsight.com]

  Debridement - Debridement is often done when a venous ulcer shows signs of infection such as when there is fever, elevated white blood count, and persistent or increased drainage. [vascular.surgery.ucsf.edu]

  If that happens, you might notice: A redness or swelling of the surrounding skin Worsening pain A fever Pus Continued Diagnosis If you have a wound that isn’t healing or you think is infected, you should see your doctor. [webmd.com]

  Progressive signs and symptoms of infection associated with fever and other toxicity symptoms warrant broad-spectrum I.V. antibiotics. [woundcareadvisor.com]

  Symptoms may include: Swelling Itchy or burning sensation A rash or dry skin Brownish discoloration A foul-smelling fluid oozing from the sore If an ulcer becomes infected: A redness or swelling of the surrounding skin Worsening pain A fever Pus How are [veincenterofarizona.com]

• Severe Pain

  Bandage Removal The patient may have to cut the bandage off in following conditions: Severe pain is experienced at the front of the ankle Severe pain is experienced on the top of the foot The toes appear swollen and blue Once the bandage has been removed [empirevein.com]

  Symptoms of Varicose Ulcer Varicose ulcers are severe painful ulcers that are formed on the skin where varicose veins are, specifically near the ankle area. [ehealthhall.com]

  With regard to pain intensity, the mean VAS pain score was 6.70 at baseline, corresponding to severe pain and 0 (no pain) at 8 and 12 months of treatment. [omicsonline.org]

  However, you'll need to cut the bandage off if: you get severe pain at the front of your ankle you get severe pain on the top of your foot your toes become blue and swollen Once you remove the bandage, make sure you keep your leg highly elevated and contact [nhsdirect.wales.nhs.uk]

• Collapse

  […] a Message Share a File Directory Events Upcoming Events Mentoring About Mentor Match Mentor Match FAQs Browse Discussion Posts Library Entries Help How To Guide Help/FAQs Community Home Discussion 18.3K Library 224 Events 0 Members 7.7K Expand all | Collapse [engage.ahima.org]

  During walking, as the foot is dorsal flexed, the contraction of the calf muscle compresses the deep veins and soleal sinuses to the point at which they become almost totally collapsed, producing internal pressures of up to 250 mmHg and emptying them [worldwidewounds.com]

  Collapse all Expand all Antecedentes Las úlceras venosas de las piernas son heridas abiertas en la piel de las piernas que pueden cicatrizar lentamente y son dolorosas y costosas. [cochranelibrary.com]

• Diarrhea

  Herbalists use the leaves and bark to treat diarrhea, gum inflammation, wounds, venous disorders, hemorrhage, skin problems and sore throat. The plant is rich in tannins, which have astringent, anti-inflammatory, hemostatic and antiseptic actions. [livestrong.com]

  […] for venous ulcers when added to compression therapy. 31, 40 Pentoxifylline may also be useful as monotherapy in patients who are unable to tolerate compression bandaging. 31 The most common adverse effects are gastrointestinal (e.g., nausea, vomiting, diarrhea [aafp.org]

  The main side effects reported were gastrointestinal disturbances such as nausea, indigestion, and diarrhea [ 89, 92, 93 ]. In studies, pentoxifylline has shown to be an effective adjuvant to compression therapy in venous leg ulcers. [intechopen.com]

• Venous Insufficiency

  As the condition progresses, people with venous insufficiency develop brown patches and deteriorating (flaking or hardening) skin around the ankles. If venous insufficiency is not treated, venous ulcers may develop on the lower legs. [bcm.edu]

  About Venous Insufficiency Blood from your legs moves toward your heart through one-way valves in the veins, against the pull of gravity. [advocatehealth.com]

  Often they are caused by venous insufficiency. Your veins have one-way valves that keep blood flowing toward the heart. In venous insufficiency, the valves are damaged, and blood backs up and pools in the vein. [vanishingveins.net]

  Venous ulcers primarily develop on the lower leg as a complication of long-term untreated venous insufficiency, and can result in pain, odor, pus, tenderness and redness. [gittervein.com]

• Thrombosis

  Venous/Lymphatic Disorders Deep Vein Thrombosis Deep vein thrombosis is a serious condition that occurs when a blood clot, also known as a thrombus, forms in a vein deep within the body. [cliftonveincarecenter.com]

  […] names separated by a space and hit enter Links Authors Source MeSH Anti-Bacterial Agents Anti-Infective Agents Anti-Infective Agents, Local Antibiotics, Antitubercular Bandages Dermatologic Agents Diet Humans Ointments Phenylbutazone Powders Thiamine Thrombosis [unboundmedicine.com]

  Thrombophlebitis and trauma with long-term immobilization predisposing to deep venous thrombosis are important risk factors for CVI and venous ulcer. [ncbi.nlm.nih.gov]

  If any of these underlying diseases account for blood stasis or vein thrombosis, the respective patient will suffer from secondary varicose veins. [symptoma.com]

  Figure 1: Venous ulcer with obesity as cofactor Figure 2: Large superficial venous ulcer Etiology Any condition that causes blood to pool in the veins of the leg is a potential cause of venous ulcers, including varicose veins, deep vein thrombosis, or [woundsource.com]

• Hypertension

  In this line, obesity, hypercholesterolemia, hypertension, heart insufficiency and diabetes mellitus as well as other predisposing conditions should be prevented or accordingly treated. [symptoma.com]

  Hypertensive leg ulcer (Ulcus Cruris Hypertonicum Martorell) Hypertensive leg ulcers are extremely painful and commonly located on the distal portion of the lower leg above the lateral malleolus. [intechopen.com]

  Skin changes and skin breakdown that result in venous ulcers are triggered by inflammatory mediators when venous hypertension is present. [tnveincenter.com]

  Venous leg ulcers develop when persistently high blood pressure in the veins of the legs (venous hypertension) causes damage to the skin, which eventually breaks down and forms an ulcer. 2. [slideshare.net]

  The leaking and venous hypertension can cause pain, skin changes (lipodermatosclerosis) and swelling that could lead to open sores, called ulcers, on your legs. [advocatehealth.com]

• Venous Insufficiency of Leg

  Eaglstein, “Chronic Venous Insufficiency and Venous Leg Ulceration,” Journal of the American Academy of Dermatology, Vol. 44, No. 3, 2001, pp. 401-421. doi:10.1067/mjd.2001.111633 [ 14 ] C. N. Etufugh and T. J. [scirp.org]

  Pathophysiology Venous hypertension Deep vein thrombosis, perforator insufficiency, superficial and deep vein insufficiencies, arteriovenous fistulas and calf muscle pump insufficiencies lead to increased pressure in the distal veins of the leg and finally [idoj.in]

  Chronic venous insufficiency and venous leg ulceration. J Am Acad Dermatol. 2001;44(3):401–421. 14. Etufugh CN, Phillips TJ. Venous ulcers. Clin Dermatol. 2007;25(1):121–130. 15. Phillips TJ, Dover JS. Leg ulcers. [aafp.org]

• Leg Pain

  Chronic Wounds can be dangerous, inviting infection and causing pain. When a venous leg ulcer or chronic wounds occur on the legs, it may not heal due to problems with the arteries or veins. [usaveinclinics.com]

  Symptoms Aching pain at ulcer site Sensation of limb heaviness Leg Pain increases late in the day Pain relieved with elevating legs VI. [fpnotebook.com]

  MRV is useful in some cases because it can help detect causes of leg pain other than vein problems. [bcm.edu]

  To help treat a venous ulcer, the high pressure in the leg veins needs to be relieved. Wear compression stockings or bandages every day as instructed. They help prevent blood from pooling, reduce swelling, help with healing, and reduce pain. [medlineplus.gov]

  It typically begins with pain, numbness, tingling, burning or weakness in the feet, legs and/or hands, and may progress to more serious conditions such as ulcers, pain and loss of sensation. [cliftonveincarecenter.com]

• Muscle Cramp

  cramps, and other complaints attributable to venous dysfunction A = Asymptomatic Etiological classification Anatomical classification Pathophysiology Ec: congenital As: superficial veins Pr: reflux Ep: primary Ap: perforating veins Po: obstruction Es [sigvaris.com]

  If you experience any of these symptoms, ask your doctor whether you should be treated for venous insufficiency: Swelling in the lower legs Muscle cramping, especially at night Aching or stabbing pain or a feeling of burning in the legs Numbness, tingling [advocatehealth.com]

  But improving your circulation and muscle tone may reduce your risk of developing varicose veins or getting additional ones. [mayoclinic.org]

  Symptoms include aching, pain, skin irritation, tightness, heaviness, muscle cramps, and other complaints. [intechopen.com]

• Ankle Pain

  […] usually found on the inside of the leg, just above the ankle -painful, particularly when infected -pitting oedema - lipodermatosclerosis - atrophie blanche SYMPTOMS 5. [slideshare.net]

• Ulcer

  […] had been present (ulcer duration, also known as ulcer chronicity), and the size of the ulcers. [nejm.org]

  Of note, there are other types of ulcers that are sometimes deemed VU. In detail, these are arterial, neurotrophic and diabetic ulcers. They differ from venous VU in location and appearance. [symptoma.com]

  […] of peptic ulcer. gastric ulcer an ulcer of the inner wall of the stomach, one of the two most common kinds of peptic ulcer. [medical-dictionary.thefreedictionary.com]

  […] in infected ulcers. [physiotherapy-treatment.com]

• Skin Ulcer

  There are two other types of skin ulcers that can happen on the lower leg or feet. They are different from venous skin ulcers. Arterial skin ulcers are less common than venous skin ulcers. [northshore.org]

  Compression Compression therapy is the main treatment for venous skin ulcers. If you have a venous skin ulcer, your doctor may first want to reduce the buildup of fluid in your lower leg. [cigna.com]

  Venous skin ulcer is a wound that develops on the skin because the leg veins cannot carry blood effectively back to the heart. [gittervein.com]

  Usually, all it takes is a quick examination of the sore and the skin around it to figure out whether you have a venous skin ulcer. [webmd.com]

  Skin inflammation (dermatitis) sometimes develops around a venous ulcer. Non-venous skin ulcers are less common. [patient.info]

• Skin Discoloration

  This back-up of blood leads to skin discoloration, skin thickening, swelling, and possible ulceration. Venous ulcers are located below the knee and are primarily found on the inner part of the leg, just above the ankle. [premierveincenter.com]

  Signs Medial malleolus most often affected Irregular, flat border Associated findings Dependent Edema Varicose Vein s Purpura Red-brown Skin Discoloration Venous dermatitis ( Eczema tous changes) VII. Differential Diagnosis VIII. [fpnotebook.com]

  Venous Ulcer Veins Clear fluid drainage in lower leg or ankle Dry, scaly, itchy or thickened skin Leg swelling Open sore Pain when standing Skin discoloration Damaged veins Pooling blood Overview When the vein valves or the calf muscle pump in the leg [nm.org]

  Painful ulcers may form on the skin near varicose veins, particularly near the ankles. A discolored spot on the skin usually begins before an ulcer forms. See your doctor immediately if you suspect you've developed an ulcer. Blood clots. [mayoclinic.org]

• Pruritus

  These dressings are also believed to provide symptomatic relief, such as decreased pain and pruritus. Dressings that deliver substances active in the healing process, such as growth factors, have been the subject of much recent investigation. [emedicine.medscape.com]

  Periulcer area Capillary leaking causing edema leading to maceration, pruritus and scaling. Associated warmth and pruritus. [idoj.in]

• Kidney Failure

  Leg ulcers may be caused by medical conditions such as: Poor circulation Venous insufficiency (a failure of the valves in the veins of the leg that causes congestion and slowing of blood circulation in the veins) Diabetes Renal (kidney) failure Hypertension [premierveincenter.com]

  Causes of Venous Ulcers Some issues that can cause venous ulcers include: Venous hypertension Venous insufficiency Varicose veins Blood clots or poor circulation Diabetes, kidney failure, or inflammatory diseases Certain medicines Infections Obesity Symptoms [upmc.com]

• Irritability

  Anti-inflammatory herbs will soothe irritated and damaged tissue, relieving pain. Some herbs will help heal the underlying problem — venous insufficiency — that leads to painful leg ulcers. [livestrong.com]

  […] vein specialist may also recommend a nonsurgical treatment such as fitting you with compression stockings, recommending an exercise program to stimulate proper blood flow in the legs, or recommend a topical steroid cream to relieve the swelling and irritation [veinsofhouston.com]

  […] venous disease C1 Telangiectasies or reticular veins C2 Varicose veins C3 Edema C4a Pigmentation or eczema C4b Lipodermatosclerosis or athrophie blanche C5 Healed venous ulcer C6 Active venous ulcer S = Symptomatic, including ache, pain, tightness, skin irritation [sigvaris.com]

  Bacteria may invade the area or the dead cells may irritate the normal tissues, causing inflammation and the ulcer spreads. [physiotherapy-treatment.com]

  A change in the type of pain or discomfort that a patient experiences in association with eczematous changes on the skin would suggest a diagnosis of either irritant contact or allergic contact dermatitis.22 Atrophie blanche. [o-wm.com]

While VU may be diagnosed after clinical examination, a thorough workup is necessary to identify the underlying disease and to evaluate tissue perfusion.

With regards to the former, many VU patients have already been diagnosed with heart insufficiency, diabetes mellitus or any of the afore mentioned diseases that may provoke varicose veins and ulcers. If this is not the case, laboratory analyses of blood samples and possibly imaging techniques may reveal the cause of VU.

There are different diagnostic measures to assess tissue perfusion. Doppler sonography may be applied to detect venous reflex [5]. Sensitivity has been estimated to be > 75%. Ascending venography may provide detailed information regarding vein valve function and potential vessel occlusion.

Furthermore, contrast agents may be used to establish femoral arteriograms that display perfusion of the leg, even of distal parts if deemed necessary. Angiographic images may be obtained using X-rays, computed tomography or magnetic resonance imaging. Magnetic resonance angiography has been found particularly sensitive [6] [7].

Ulcer healing may be supported by interactive wound dressings, e.g. interactive hydrocolloid dressings. Other than conventional, passive dressings, these products release growth and migration factors and thus directly promote the healing cascade. Application of platelet-derived growth factor, epidermal growth factor or fibroblast growth factor, among others, aim at enabling the development of healthy granulation tissue and enhanced epithelial cell migration. This may be very valuable in VU patients whose healing process is delayed due to low tissue perfusion. Furthermore, in such a humid environment, formation of rigid eschar is significantly reduced. Of note, interactive hydrocolloid dressings may only be used to accelerate healing of uninfected wounds. Infected wounds require topical if not systemic antibiotic therapy. Silver sulfadiazine is often used to this end. Regular changes of wound dressings decrease the risk for infection [8].

Other therapeutic measures need to be adjusted to the overall condition of the patient and the disease that triggered varicose vein formation. In this context, compression dressings are usually applied to patients suffering from VU due to hypertension [9]. Recently, it has been reported that compression hosiery yields better long-term effects than bandages [10]. Moreover, it has been proposed to treat patients suffering from VU due to lymphedema with intermittent pneumatic compression [11]. It has yet to be shown whether this technique may replace traditional compression methods.

Alternative therapeutic options for VU include low-intensity pulsed ultrasound and hyperbaric oxygen therapy. It could be proven that wound healing improves under ultrasonic stimulation. It has been speculated that ultrasound waves stimulate growth factor production and angiogenesis [12]. According to current knowledge, hyperbaric oxygen therapy only improves wound healing in the short term [13].

Surgical treatment of varicose veins may become necessary if the patient does not respond to wound care and supportive drug therapy.

Etiology of VU, overall condition of the patient and applicable treatment determine prognosis. If adequate treatment can be provided in a timely manner, prognosis for preservation of the affected leg and leg function is good. Prognosis is less favorable if the underlying disease is not curable. VU that are left untreated are likely to become infected and gangrenous. This stage of disease requires amputation.

Relapses are frequent. It has been estimated that half of all VU patients will suffer from recurrences within five years after termination of initial VU treatment.

In general, varicose veins develop due to venous insufficiency. This pathological condition, however, may result from a variety of factors and underlying diseases.

There is a genetic component that may predispose certain individuals for varicose veins. Thus, a family history of varicose veins or deep vein thrombosis augments the risk for varicose veins and subsequently VU. If no precise cause for varicose vein development can be identified, primary varicose veins are diagnosed. Moreover, genetic factors may also contribute to systemic diseases like hypercholesterolemia, hypertension, heart insufficiency and diabetes mellitus that render patients more prone to varicose veins. Furthermore, vascular and dermatological disorders, e.g., vasculitis, lupus erythematodes and scleroderma, may accelerate pathophysiological events leading to varicose veins or ulcers. Similar to blood stasis, lymphedema is associated with skin remodelling and susceptibility to injury. In isolated cases, other rare causes have been described [2]. If any of these underlying diseases account for blood stasis or vein thrombosis, the respective patient will suffer from secondary varicose veins.

Patients that are maintained for prolonged periods of time in a lying position may also develop varicose veins and ulcers. Lack of physical activity not only facilitates formation of thrombi, venous blood flow from the legs back to the heart also depends directly on leg muscle activity. Thus, blood pools in leg veins and this condition, unfortunately, makes vein thrombosis even more likely.

Neoplasms are sometimes associated with VU.

Smoking has repeatedly been related to the individual risk for VU.

Although there are no reliable data regarding the worldwide overall incidence of VU, this is not a rare condition. Approximately 2.5% of patients admitted to long-term care facilities in the United States show VU. In Northern Europe, almost 10% of people aged 70 years and older have suffered from VU at least once in their lives. In Europe and Australia, incidence of leg ulcers in general has been estimated to be around 1% and the vast majority of leg ulcers results from functional impairment of veins [3].

In large parts of the Western world, obesity is a major health problem. Overweight and obesity, in turn, are associated with a series of pathological conditions that facilitate VU development [4]. This applies to hypercholesterolemia, hypertension, heart insufficiency and diabetes mellitus, for instance. Direct intra-abdominal vein compression may further aggravate venous pressure increase in obese patients. It would therefore be expected for VU incidence to diminish if these underlying diseases could be controlled better.

VU result from venous insufficiency and varicose veins that may either develop without any identifiable cause or subsequent to underlying, mainly cardiovascular diseases. Independent of their etiology, primary and secondary varicose veins are associated with blood stasis and increased venous pressure. There are different hypotheses regarding pathophysiological events that lead from augmented venous pressure to VU.

It has been shown that dilated veins are unable to prevent fluids from leaking into the surrounding tissue. Even molecules like fibrinogen may pass the damaged vascular wall and reach subcutis and dermis. Fibrinogen may be converted to fibrin and deposit around skin capillaries. This pericapillary cuff literally isolates dependent tissues from nutrient and oxygen supply. Hypoxic injury may then lead to ulceration. Any external lesion would accelerate this process because healing is severely delayed.

Elsewhere, it has been stated that venous wall damage triggers leukocyte activation and release of reactive oxygen species and proteolytic enzymes. These may then pass into the surrounding skin layers, trigger DNA damage and degrade structure proteins. Similar to the above described scenario, internal damage may lead to ulceration and may be exacerbated by external injuries.

Prevention of varicose veins and ulcers consists in avoiding risk factors and maintaining an active lifestyle. In this line, obesity, hypercholesterolemia, hypertension, heart insufficiency and diabetes mellitus as well as other predisposing conditions should be prevented or accordingly treated. Regular exercise contributes to weight control and avoids blood stasis. Prolonged periods of siting or standing should be interrupted by small breaks of exercise.

Patients who suffer from varicose veins should carefully avoid skin injuries.

Venous blood flow largely depends on muscle activity and gravity; venous valves impede reflux inside the veins. However, if these valves do not close correctly due to venous insufficiency, blood will tend to follow gravity and flow back to lower body regions, particularly to feet and legs. The resulting blood stasis evokes elevated pressure on venous walls and triggers remodelling processes. Varicose veins develop.

Varicose veins are superficial and visible as dilated, protruding vessels. Patients suffering from varicose veins often report that minimal skin lesions result in poorly healing, painful ulcers [1]. These varicose ulcers (VU) most commonly affect ankles and calves and are caused by extensive tissue inflammation and reduced oxygen supply to the skin surrounding varicose veins.

Blood is pumped throughout the body by the heart and, to a lesser extent, by arteries. However, reflux to the heart is largely dependent on the pumping action of muscles surrounding veins. In order to avoid blood pooling in the lower parts of the body, particularly in feet and legs, veins possess valves that impede backflow of blood once certain sections have been covered. If these valves do not close correctly, blood will tend to follow gravity and will accumulate in feet and legs. This blood stasis is associated with an increased venous pressure and favors development of varicose veins. Here, fluids are leaking from the intravascular space into the surrounding tissue. Pressure, fluids and its constituents may trigger skin remodelling processes. The latter reduce nutrient and oxygen supply to the skin which thus becomes much more susceptible to injury. Because the skin is deprived of its essential provisions, the healing process is severely slowed down and small lesions may rapidly develop into deep skin defects. These are called varicose ulcers (VU).

Causes

While genetic components play an important role in varicose vein and subsequent ulcer development, comorbidities and lifestyle decisions may further increase the individual risk. In this context, obesity, hypercholesterolemia, hypertension, heart insufficiency and diabetes mellitus as well as vascular and dermatological disorders, smoking and a sedentary lifestyle render patients more susceptible to VU.

Symptoms

Due to gravity, venous varicose veins typically develop in the lower parts of the leg, especially in the lower half of the calf. Here, they become visible as superficial, protruding vessels. The skin surrounding these vessels may turn bluish. Skin injuries take a very long time to heal or do not heal at all and turn into VU. These are extended, but not very deep skin defects. If manipulated, they may start to bleed. Patients often experience mild pain and find relief in elevating their legs.

Diagnosis

Although VU may be diagnosed by means of clinical examinations, additional diagnostic measures will usually be applied to assess the extent of perfusion disturbances and to identify the underlying disease.

In order to visualize tissue perfusion, contrast agents may be injected into veins or arteries before magnetic resonance images are taken. This procedure is called angiography. In some cases, other techniques than magnetic resonance imaging will be utilized.

Analysis of blood samples may reveal valuable information concerning the underlying disease.

Treatment

Intensive wound care is the mainstay of VU therapy. Patients suffering from certain pathological conditions, e.g., hypertension and lymphedema, may benefit from calf compression. Additionally, newer techniques such as low-intensity pulsed ultrasound and hyperbaric oxygen therapy may be applied.

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