When an open sore on the leg fails to heal for a prolonged period of time, one might be looking at a venous ulcer. Venous ulcers, also referred by various synonyms like varicose ulcers or gravitational ulcers can occur when the veins in the legs do not drive the blood back up to the heart as well as they should. Blood pools up in the veins, building up pressure. This is known as chronic venous hypertension. If not treated, increased pressure and excess fluid in the affected area can cause an open sore to develop.
Most of the venous ulcers are preceded by a long-standing history of venous disease. Discomfort and tenderness of the skin, pigmentation and eczema may have existed for months, or even years before any ulceration can be spotted. This red, flaky, scaly, itchy skin rash (eczema) progressively turns into an open wound, either spontaneously or following some minor trauma. The ulcer is painful to begin with but once it settles down, it becomes painless and hence maybe easily neglected.
Venous ulcers are mainly found on the inner aspect of the lower part of the leg. They are never seen above the junction of the middle and upper thirds of the leg. Venous ulcers are usually shallow and flat and can be of any shape and size. The edge is sloping and pale purple-blue in color. The margin is thin and blue. The interior is formed by pale pink tissue. It might even be covered by dry, yellow tissue if it is not healing well. The base of the ulcer is fixed to deeper structures and cannot be moved easily from side to side or up and down. Watery discharge which might be occasionally blood tinged may also be present.
The surrounding skin may show changes like induration, pigmentation (dark red/ purple/ brown hard skin) or eczema which can get painful. Such skin changes are known as lipodermatosclerosis. Venous ulceration is usually associated with varicose veins. So, it is crucial to look for the presence of any enlarged, gnarled veins on the legs. Other symptoms include swelling of the legs, aching, cramping and it’s tiredness, especially towards the end of the day. The appearance of the swollen and pigmented leg in this case can be compared to that of an inverted champagne bottle.
Warning signs of an infection from Venous Ulcers:
- Aggravating pain
- Green, unpleasant discharge or frank pus oozing out of the ulcer.
- Redness and swelling of the skin around the ulcer
- High temperature (fever)
- Enlargement of inguinal lymph nodes which can be appreciated as masses in the groin region
Dreaded complications of Venous Ulcers:
- Deep vein thrombosis leading to pulmonary embolism – The venous ulcer may have been caused due to the presence of clot in the deep veins of the leg. This condition can either remain asymptomatic or cause pain and swelling in the leg. Upon it’s dislodgement, the clot or a part of it could potentially be carried upto the lungs where it gets stuck in the blood vessels supplying it, essentially choking the pulmonary circulation. The patient manifests with symptoms like intense chest pain, breathlessness and he maybe coughing up blood. This could escalate quickly and soon turn fatal
- Marjolin’s ulcer – Cancerous changes can occur in a long-standing venous ulcer. If it’s edge is raised and averted or somewhat different from what has been described above, it should arouse the suspicion of malignancy. The base becomes hard and indurated. This malignant ulcer is called Marjolin’s ulcer and warrants mandatory medical attention
Signs and symptoms of venous diseases must never be disregarded. Medical assistance should be sought after at the earliest to progress towards a full recovery and secure a healthy life.