Venous stasis ulcers: a review

Venous stasis ulcers are one of the most common and perhaps the most costly of the vascular disorders. The etiology of venous ulcer formation has not been fully described; however, venous obstruction or valvular incompetence is almost always present. Manifestations of chronic venous insufficiency include mild to severe swelling, aching to frank leg pain, leg heaviness, dilated superficial veins and/or dilated tributaries of the saphenous vein system, skin changes and ultimately ulceration. The need for diagnostic testing may be minimal if the ulcer typifies the usual venous ulcer in persons recognized to be at high risk. Management includes both non-surgical and surgical management, wound debridement and electrical stimulation. Early management of venous stasis ulcers will improve outcomes. However, even with successful initial wound management, the recurrence rate approaches 70 percent. Much of this high recurrence rate can be related to the patient's inability to change life style and incorporate elastic bandage regimens and to poor tissue quality at the ulcer site. The management of venous ulcers should be regarded as a lifetime process.