Venous ulcers

Venous ulcers are wounds that appear between the ankle and the knee as a result of an insufficient blood supply to the lower limbs. They are quite common and generally affect the elderly, especially women and obese people. They are generally associated with a state of venous hypertension due to chronic venous insufficiency, or thrombosis of the saphenous vein with obstruction of the return of venous blood. They start as brownish discolorations that are followed by thinning of the skin and finally by a breakage of the skin forming ulcers of different depths. These ulcers can then also get infected.

They are classified in the following order depending on the underlying venous insufficiency:

  • C0: No visible or palpable signs of venous insufficiency
  • C1: Telangiectasia or venous reticulum
  • C2: Varicose veins
  • C3: Leg oedema
  • C4a: Skin alterations due to diseases of the veins (pigmentation, eczema)
  • C4b: Severe skin alterations due to diseases of the veins (dermatosclerosis, white atrophy)
  • C5: C4 + ulcers healed
  • C6: Skin changes with active ulcers

There are different types of therapy for venous ulcers and their underlying problems. First of all, it is important to identify the type of vascular disease that is causing it. If possible, once the disease is cured, a compression dressing is applied to the ulcers and changed until the wounds have healed. The compression phase of the dressing once was carried out with pinstriped boots (Unna boot); currently it is carried out with graduated elastic compression stockings. These ulcers easily reopen once the compression is removed. Sometimes these ulcers require grafting with medium-thick skin grafts. Healing with compression, in uncomplicated cases, takes about 40 days.

Compression therapy is considered the standard of treatment for venous ulcers.

Negative pressure therapy can be used for venous ulcers, although its superiority over other types of conventional therapies, with dressings and compression, has not been fully demonstrated. There is one particular study that shows that cutaneous healing with negative pressure therapy takes less time than with compression dressings.

In cases in which it is necessary to cleanse the ulcer, such as in preparation for a skin graft, negative pressure therapy is definitely more useful than the compression dressing.

In general, negative pressure therapy requires less frequent medications, is often self-managed by the patient or caregivers and is recently preferred by doctors and patients for its provision of greater patient comfort.