Chronic venous ulceration - Hypertension and vascular diseases

Chronic venous ulceration

Definition

Ulceration of the gaiter area (lower leg and ankle) due to venous disease.

Incidence

4% over 60 years of age. It is a major cause of morbidity in the elderly.

Age

Increases with age.

Sex

3F : 1M

Aetiology

Two-thirds are attributable to chronic venous insuffi-ciency. Aggravating factors include old age, obesity, re-current trauma, immobility and joint problems.

Pathophysiology

Chronic venous ulceration is the last stage of lipo-dermatosclerosis(the skin changes of oedema, fibrosis around veins and eczema, which occurs in venous sta-sis).

Clinical features

Distinguishable from arterial ulcers by clinical features and a history of chronic venous insufficiency (see Table 2.11).

Investigations

Phlebography is performed to assess the underlying state of the veins.

Management

Healing often takes weeks, possibly months. Conserva-tive treatment consists of application of an absorbent nonadherent dressing, preferably under a compression bandage, which reduces venous stasis. Local antibiotics are contraindicated as they do not prevent colonisation and are often irritant and reduce healing rates.

Skin grafts may speed healing, but only if venous pressure is reduced, e.g. by leg elevation. Surgery to remove incompetent veins before ulceration occurs.