This document defines and discusses venous ulcers. It begins by defining a venous ulcer as an ulcer caused by chronic venous hypertension, often due to issues with the saphenous or perforator veins. Risk factors include varicose veins, deep vein thrombosis history, age, gender, family history, obesity, and smoking. Venous ulcers form due to venous valve dysfunction causing backflow and increased pressure. Signs include painful or painless ulcers near the ankle with sloping edges and no granulation tissue. Treatment focuses on compression, elevation, education, and treating infection/causes while preventing recurrence. Complications can include pain, infection, malignancy, and amputation.

1. VENOUS ULCER
By Muweesi Ismail
Dip OPM UIAHMS

2. Outline
◦ Definition and introduction
◦ Risk factors
◦ Pathophysiology
◦ Signs and symptoms
◦ Diagnosis/investigations
◦ Treatment
◦ Complications

3. Defintion and introduction
◦ Venous ulcer is an ulcer due to ambulatory chronic venous hypertension
◦ Its due to varicose veins ie the long saphenous veins and short saphenous/perforators veins or a post
phlebitic limb
◦ Post phlebitic limb consists of veins that have been partially recanalised following a DVT which causes
increased venous pressure around the ankle through perforators
◦ Its common around the ankles(gaiter’s zone)
◦ Its most common in women with varicose veins

4. Risk factors
◦ Varicose veins
◦ History of DVT in the legs
◦ Old age, being tall, being female
◦ Family history of venous insufficiency
◦ Obesity
◦ Smokin

5. pathophysiology
o Venous ulcer arises from dysfunction of venous valves allowing back flow causing increases venous pressure.
The imbalance between arterial and venous pressures leads to pooling.
o Venous stretching allows extravasation of proteins, inflammatory exudates, occlusion with ischaemia and free
radical release hence contributing to ulceration and poor wound healing

6. Signs and symptoms
◦ Ulcer initially painful but later becomes painless
◦ Ulcer is often vertically oval with sloping edges
◦ Commonly located on medial side of ankle but not above the middle athird of leg
◦ Floor is covered with pale or often without any granulation tissue
◦ Tenderness is often seen at the base of the ulcer.
◦ It doesnt pentrate deep fascia
◦ Edema
◦ Presence of varicosities
◦ Venous dermatitis
◦ Inguinal lymph nodes are often enlarged.
◦ Ulcer heals but often reforms again. Scarring is common due to repeated healing and recurrent ulcer formation.
This unstable scaring of long duration may lead to squamous ceell carcinoma.(Marjolin ulcer)

8. Investigatins
Colour duplex Ultrasonography ( gold standard in venous disease)
Xray ( R/O osteomyelitis)
Biopsy and histology (suspected malignant)
General and systemic examination
Venogram

9. Geneneral principles of managing ulcers
1. Ensure adequate and balanced perfusion
2. Manage wound (debridement, dressing)
3. Treat associated infection
4. Ensure adequate nutrition
5. Find and treat cause
6. Find and treat associated and risk factors
7. Educate the patient
8. Follow up and protect from recurrence

10. Treatment of venous ulcers
Bisgaard regimen (4Es)
Education
Elevation
Elastic compression
Evaluation
◦ Artificial skin (may be combined c comp)
◦ Surgical correction of superficial venous reflux

11. Complications
◦ Chronic pain
◦ Impaired mobility(often due to pain)
◦ Infection eg osteomyelitis and septicemia
◦ Allergic contact dermatitis
◦ Malignancy leading to amputation and death
◦ cellulitis

12. Thank you for your attention………..