Chronic disturbances of venous blood flow are associated with vein dilation, functional impairment of vascular walls and surrounding tissues as well as local inflammation. Minor trauma to affected tissues may result in poor wound healing and venous stasis ulcer.
Venous stasis primarily occurs in body regions situated below the heart. Granulation tissue is often visible at the base of the ulcer. For physical reasons, the lower legs are most frequently affected. Ulcers are commonly situated over bony prominences because these sites are more prone to trauma. Still, patients may not associate a VSU with any traumatic event. They are irregularly shaped, shallow cutaneous lesions of varying size. Edematous swelling, erythema and shiny skin consistent with stasis dermatitis may be noted in close proximity to VSU . Lipodermatosclerosis and atrophie blanche are commonly observed . Patients may claim tenderness and dull aching pain in regions affected by VSU. In the case of systemic disorders, symptoms occur bilaterally. In contrast, post-traumatic VSU and similar conditions are generally limited to one leg.
Entire Body System
Clinicians can determine the appropriate type of dressing for ulcers by the appearance of tissue type on the ulcer base (see “How To Select The Optimal Dressing For Venous Ulcers” at left).11 Depending on the wound type and drainage amount, there are a plethora [podiatrytoday.com]
Foul Smelling Discharge
Venous stasis ulcers may: Be painful and itchy Be discolored, darkened, and scaly skin around the edges Have foul-smelling discharge from the wound if an infection is present You will be asked about your symptoms and health history. [health.cvs.com]
The symptoms of stasis dermatitis include: skin discoloration itching scaling ulcers You may also experience symptoms of venous insufficiency, including: leg swelling calf pain calf tenderness a dull ache or heaviness in your legs that gets worse when [healthline.com]
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Venous skin ulcers, or venous stasis ulcers, are often caused by a venous reflux disorder, a chronic condition that prevents toxic venous blood from being pumped back to the heart. [goldmanveininstitute.com]
Venous skin ulcers are shallow wounds that develop when the leg veins do not circulate blood back to the heart normally. In such cases, blood tends to pool near the ankle as gravity pulls fluid and blood downward. [mmcoakridge.com]
There are a variety of skin ulcers. Most people are somewhat familiar with decubitus ulcers, more commonly known as pressure sores (and also sometimes called bedsores). [excelas1.com]
Venous stasis (purplish skin) ulcers are common in patients who have a history of leg swelling, varicose veins or a history of blood clots in either the superficial or deep veins of the legs. [premierveincenter.com]
Leg ulcers are very common and are diagnosed clinically. Anamnestic data generally support the diagnosis of VSU. Because these ulcers occur in patients suffering from chronic disease, affected individuals typically have a medical history of venous insufficiency, varicose veins, phlebitis and/or eczematous dermatitis. Complaints associated with these pathologies subside when the legs are elevated.
In case of doubt, further measures are required to distinguish VSU from ulcers resulting from arterial disorders and vasculitis :
- Duplex ultrasonography may be employed to assess blood flow and vascular anomalies , and this method has largely replaced invasive angiography and venography.
- Air plethysmography is a non-invasive technique that allows for an evaluation of venous reflux and calf muscle function .
It is important to note that malignancies may develop from chronic wounds like VSU . In this context, biopsy specimens should be obtained for histopathological and immunohistochemical analyses.
Venous blood flow depends on the activity of the surrounding musculature as well as cardiac function :
- On the one hand, leg muscles literally pump venous blood up the lower limbs against gravity while venous valves impede the blood to sink back to lower body regions. In patients suffering from venous insufficiency, however, these valves don't close properly.
- On the other hand, cardiovascular disorders associated with functional impairment of the right heart and venous congestion may hinder the undisturbed return of venous blood to the heart. Such pathologies may thus impose disproportionate burdens on venous valves and walls.
Both venous insufficiency and cardiovascular disease - often occurring concomitantly - may thus result in venous hypertension and blood stasis. Moreover, venous stasis may be related to a mechanical obstruction of veins, as is the case in patients suffering from vein thrombosis. Less common causes of venous stasis include phlebitis, malignancy , post-traumatic formation of an arteriovenous fistula , and congenital malformations , among others.
Venous stasis may affect superficial veins, a common condition known as varicose veins, or deep veins. In any case, chronic venous stasis leads to structural changes in venous walls and surrounding tissues. It has been suggested that fibrin leakage may result in the development of perivascular fibrinogen cuffs that hinder the passage of oxygen, nutrients and a variety of other molecules to dependent tissues. In the case of a traumatic lesion, this condition would largely impair wound healing and predispose for the onset of venous stasis ulcer (VSU). Of note, other hypotheses have been proposed regarding the pathogenesis of VSU .
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