Normally, when you get a scrape or cut in your skin, your body’s natural healing system quickly starts working to close the wound. The repair process takes place over several stages. A clot forms to stop blood loss. Red and white blood cells flood the area to help clean and restore the damaged tissues. Collagen, which acts as a type of scaffolding, builds and strengthens the area, sometimes resulting in a scar. Over time, the new tissue grows stronger, and within several months, the wounded area is nearly as strong as it was before the trauma.
But the healing process does not always go smoothly. A venous ulcer is a type of open skin sore that’s very slow to heal. In fact, a venous ulcer may not heal at all without proper treatment. Chronic venous ulcers have a significant impact on quality of life. The sooner you receive treatment for an ulcer, the lower the risk of infection and other complications.
Dr. James Jimenez of The Vein Center of Florida & South Baldwin is known for superior care in the diagnosis, management and treatment of the underlying cause of venous ulcers. Dr. J specializes in minimally-invasive, office-based vein treatments and is proud to be a leading vein expert on the Emerald Coast. Please contact us today at 1-800-910-VEIN (8346) to request a consultation with Dr. J.
How Do Venous Ulcers Form?
Venous ulcers account for a majority of chronic lower extremity ulcers. The problem begins with poor blood circulation in the legs, often due to damaged valves inside the leg veins. When they’re healthy, these valves help control blood pressure inside the veins. If they weaken due to injury or aging, they allow blood to pool inside the veins and cause an excessive build-up of pressure. The growing pressure causes the vein to expand and prevents essential nutrients and oxygen from getting to tissues.
Eventually, the vein may protrude from the skin and form a varicose vein, and the skin may become fragile. This is the start of venous ulcer development. In the first stage, the skin becomes red and inflamed. Persistent inflammation leads to damage of the local tissues.
Due to the increased pressure and poor circulation in the area, the delivery of nutrients and oxygen to the wound site is inadequate. This environment is not conducive to the normal healing process, and as a result, the formation of new, healthy tissue is compromised. The skin may begin leaking a small amount of fluid.
As the condition progresses, the affected area of skin starts to die and a non-healing wound develops. In the final stage, the open wound is clearly visible and unlikely to disappear without medical intervention.
Who Is At Risk of Developing Venous Ulcers?
Approximately 1 percent of Americans may develop venous ulcers. Certain groups and individuals with specific risk factors are more susceptible to developing these chronic wounds:
Age and Gender
- Older Adults: The risk of venous ulcers increases with age due to the natural weakening of vein walls and a decrease in the efficiency of the venous valves
- Women: Women, especially those who have been pregnant, are at a higher risk due to hormonal changes that can affect the elasticity of veins and the pressure exerted on leg veins during pregnancy
Lifestyle
- Smoking: Nicotine and other chemicals in cigarettes can damage the structure of blood vessels, impair blood flow and decrease oxygen delivery to tissues, all of which can delay wound healing and increase the risk of ulcer formation
- Physical Inactivity: Lack of exercise can lead to poor circulation and venous insufficiency, as regular movement is required to help pump blood back to the heart from the lower extremities
- Obesity: Excess weight significantly increases the pressure on leg veins, which can lead to valve dysfunction and venous hypertension, a primary contributor to ulcer development
- Poor Nutrition: Deficiencies in vitamins and minerals, particularly vitamin C and zinc, can impair wound healing and the body’s ability to repair damaged tissues
Health
- Diabetes: High blood sugar levels can lead to damaged blood vessels and nerves, which can impair circulation and the normal wound healing process, increasing the risk of ulceration
- Prior Leg Injuries: Previous trauma to the leg can damage the veins and lead to chronic venous insufficiency, predisposing individuals to ulcer formation
- Varicose Veins: These are often a sign of underlying venous insufficiency and can increase the risk of skin changes and ulceration due to the associated chronic venous hypertension
- Other Circulation Problems: Conditions such as deep vein thrombosis (DVT) can also contribute to the development of venous ulcers by affecting blood flow
Even with a healthy lifestyle, it’s possible to develop vein disease and venous ulcers. This is partially due to a strong genetic influence. Individuals who have a close relative with vein disease are more likely to develop venous issues. If this describes your circumstances, you may wish to be monitored closely by a vein specialist to minimize your risk of future complications.
What Is the Progression of Vein Disease?
Vein disease is a progressive condition that affects many adults, particularly as they approach older age.
The initial stage of vein disease in many often manifests as spider veins. These small, web-like networks of visible veins may indicate that the valves in your veins are beginning to fail, leading to blood pooling and vein enlargement.
If vein disease advances, you may develop varicose veins. These are larger, swollen blood vessels that are visible on the skin’s surface and may cause symptoms like pain or a heavy feeling in your legs.
Further progression can lead to edema, characterized by swelling in your lower legs, ankles, and feet. The swelling usually worsens throughout the day or after prolonged periods of standing.
If vein disease continues to progress without intervention, permanent changes can occur, such as skin discoloration around the affected veins. Your skin may become red or brown and develop a thick, leathery texture. At this stage, your skin also becomes thinner and more prone to injury.
Ulcers form in the most advanced stage of vein disease. Healing these ulcers can be a lengthy process, and they are prone to recurrence if the underlying venous insufficiency isn’t properly addressed.
What Health Issues Can Be Related to Venous Ulcers?
Symptoms which may be seen in conjunction with venous ulcers include:
- Swollen and achy legs
- Tired or heavy legs
- Patches of dark red or purple skin
- Areas of skin that are thick, dry, itchy or hardened
- Restlessness, especially at night
- A shallow, red sore with irregular edges
- Clear, yellow or bloody drainage from the sore
- Random bleeding
- Unpleasant smell
If you notice any of these symptoms, the best thing to do is to see a vein specialist to assess the situation. Accurate diagnosis is the first step of proper treatment.
Severe complications of chronic venous ulcers may include infection and malignant change, such as the skin cancer squamous cell carcinoma. Venous ulcers can also have a major economic and personal impact. They are linked with loss of productivity, missed workdays, discomfort, increased disability, frequent visits to health care facilities, need for dressing changes, recurrent hospitalizations and high medical costs.
Can I Treat Venous Ulcers at Home?
Venous ulcers require proper care to prevent infection and heal. Visit an experienced vein specialist like Dr. J who can help assess the situation and provide advice to advance your vein health. Treatment options for venous ulcers may include conservative management, medications, mechanical modalities, advanced wound therapy and surgical intervention. The main goal of treatment is healing the ulcer and treating its underlying cause. Secondary goals include the reduction of swelling and prevention of recurrence.
Below are some steps you may be advised to take to care for your ulcer at home:
- Apply a dressing to the ulcer
- Clean the wound regularly
- Apply topical medicine to prevent or treat an infection
- Take oral antibiotic medication to prevent or treat an infection
- Avoid products and treatments that cause skin sensitivity
- Protect the skin around the wound by keeping it clean, dry and moisturized
In addition to the guidelines above, you may be given instructions to alleviate pressure in your leg veins and promote healthy circulation:
- Wear compression stockings or bandages to prevent blood from pooling, reduce swelling and pain, and speed healing
- Raise your leg for set lengths of times each day
- Take a walk or exercise daily to improve blood flow
- Aim for weight reduction if you are overweight
If your ulcer does not improve within several weeks of conservative wound care, then you will likely need to consider adjunctive treatment options. There are two components to venous ulcer treatment. The first is addressing the wound. The second is addressing the cause. Treatment of underlying venous insufficiency will usually facilitate healing and decrease the incidence of recurrence.
Will Insurance Cover the Treatment of Venous Ulcers?
Most health insurance providers, including Medicare, will cover the cost of vein treatment when it is medically necessary. A treatment is considered medically necessary when it is required to protect or maintain your health, ability to function in daily life or overall comfort.
In the case of venous ulcer treatment, your procedure will likely be medically necessary and covered by your insurance. Your insurer may request documentation of the severity of the venous ulcer and may require a period of conservative treatment before approving more advanced procedures.
We recommend contacting your insurance provider directly to learn about your specific coverage, limitations and any required documentation. Our team will also help you understand what treatments are covered under your insurance plan and any potential out-of-pocket costs.
How Are Venous Ulcers Treated?
Proper care of the ulcer site involves cleaning the wound, removing dead tissue (debridement) and applying dressings that promote healing and prevent infection. The wound should be cleaned regularly. Oral or topical antibiotics may be needed to prevent or treat infection.
Compression therapy is a cornerstone of venous ulcer treatment. This can include compression stockings or multilayer compression bandages, which help reduce edema, improve venous return and promote healing of the ulcer. It can be painful when compression is first applied to an unhealthy ulcer; over-the-counter or prescription pain relievers can help manage discomfort, and it will lessen as the ulcer starts to heal.
Addressing the underlying venous insufficiency is another critical component of treating venous ulcers. At The Vein Center of Florida & South Baldwin, we offer several options for treating venous insufficiency.
Vein Treatments Offered at The Vein Center of Florida & South Baldwin
Our state-of-the-art, minimally-invasive treatments resolve problem veins quickly, easily and with minimal downtime. Dr. Jimenez will recommend appropriate treatment options after examining your legs and evaluating your venous health during an initial consultation.
Endovenous Laser Treatment
Endovenous Laser Treatment (EVLT™) is a 30-minute procedure in which a small catheter is guided into a compromised vein using ultrasound. Once it’s in place, the catheter emits laser energy that weakens the vein walls, eventually causing the vein to collapse in on itself. The ablated vein gradually disappears and blood reroutes to healthier veins.
Ambulatory Phlebectomy
In an ambulatory phlebectomy, tiny incisions are made along the targeted vein. The vein is then precisely removed in sections using a specialized hook tool. Dr. Jimenez may use this microsurgical technique to treat surface varicose veins that are too large to treat with sclerotherapy or too small to treat with EVLT™.
Ultrasound-Guided Foam Sclerotherapy
Foam sclerotherapy treats incompetent veins with little to no downtime. During the procedure, microinjections of a “foamed” sclerosing agent (also called a “sclerosant”) are administered into a vein using ultrasound to guide proper placement. Multiple treatments, scheduled four to six weeks apart, may be needed for optimal results.
Scleroablative Therapy
Patients who have had past vein surgery or procedures, such as vein stripping, may achieve the best results with scleroablative therapy. Scleroablative therapy involves injecting a sclerosant into the targeted vein in combination with laser ablative therapy. Dr. J may recommend this approach for recurrent or residual bulging veins and complex varicose vein cases.
What Happens After Venous Ulcer Treatment?
After treating the underlying cause of a venous ulcer, the focus shifts to healing, monitoring for complications, and preventing ulcer recurrence. Dr. Jimenez will schedule periodic check-ups allow him to assess the effectiveness of the treatment, as well as make any necessary adjustments to your care plan.
Venous ulcers can take weeks to months to heal. Dedicated wound clinics are often of significant benefit in ulcer care. Your healing timeline will depend on the size and severity of the ulcer, your overall health and your adherence to a tailored treatment plan. You will gradually notice reductions in symptoms such as pain and swelling and the formation of new tissue to close the wound.
How Can I Prevent Venous Ulcers?
The final step in venous ulcer treatment is reducing the risk of recurrence. Unfortunately, venous ulcers may reoccur, and some can persist for years. To prevent venous ulcers, you must first prevent vein problems. Finding ways to improve your vein health with positive lifestyle changes and healthy habits is an important management task that may require daily attention.
You may be instructed to elevate your legs above your heart several times a day. Long-term use of compression stockings may be recommended to prevent blood pooling in your legs. If you are overweight or obese, losing weight and then maintaining a healthy weight can lower the pressure placed on your venous system. Avoid smoking, prolonged standing or sitting, extremes of temperature and overly tight shoes and socks. Finally, regular exercise and walking are essential for continuing to improve calf muscle pump function and promote good circulation.
What Are Vein Screenings So Important?
Much like routine bloodwork, vein screenings allow for the early detection of venous diseases. By assessing the health of your venous system, Dr. J can identify any early signs of conditions that could lead to more serious complications if left unchecked.
If you experience symptoms such as leg pain, swelling, aching or restlessness, a vein screening can help determine the cause and the best course of treatment to alleviate your discomfort. Early intervention can prevent these conditions from worsening.
Before any vein treatment, a thorough screening, including imaging, is essential. This ensures that the treatment plan is tailored to your specific condition, avoiding assumptions and focusing on the actual problem.
Contact The Vein Center of Florida & South Baldwin for Venous Evaluation and Treatment With Dr. Jimenez
To find lasting solutions for venous ulcers or vein disease, visit The Vein Center of Florida & South Baldwin. We offer highly-effective, minimally-invasive treatments that provide symptom relief while addressing the underlying causes of venous ulcers, varicose veins and other conditions. Appropriate vein treatment can greatly improve your quality of life and doesn’t have to involve painful, invasive surgery. We promise to go beyond the surface to treat the underlying cause of vein disease, using treatments thoughtfully designed to give you the results you’re really looking for.
Call The Vein Center of Florida today at 1-800-910-VEIN (8346), or visit our contact page to request a free vein screening. We serve The Emerald Coast and beyond from offices conveniently located in Pensacola and Destin, Florida, and Foley, Alabama.