5.2.1 Venous leg ulcers
Grading & Level of Importance: B
Prevalence of all leg ulcers: 1-2% in the general population, 4–5% of individuals older than 80 years. 60-70% occur due to CVI.
A chronic ulcer on the lower leg between knee and ankle joint resulting from improper functioning of venous valves and advanced chronic venous insufficiency (CVI).
Aetiology & Pathogenesis
The common denominator of vein ulcers is ischaemia of the upper dermis.
Signs & Symptoms
Moderate pain, which improves on elevation (unlike in arterial/mixed ulcers).
Irregular edges, associated oedema, atrophie blanche, pigmentation, associated superficial CVI.
Perimalleolar and almost always medial.
CEAP: Clinical class 5: inactive (healed) ulceration, clinical class 6: active ulceration.
CVI stage III by Widmer: Active or healed ulceration.
Biopsies from the edge of the wound should be considered if an ulcer does not respond or responds inadequately to therapy and has an atypical appearance.
Cellulitis (erysipelas) with an ulcer as the entry site. Recurrent cellulitis is often relatively asymptomatic.
Additional clinical findings: oedema, atrophie blanche, varicose vein(s).
Identification of CVI: duplex sonography.
Vascular, haematological diseases, infections, traumatic/physical, autoimmune, metabolic/endocrine, iatrogenic, neoplasia, congenital.
Prevention & Therapy
Improve general factors, nutrition and physical activity.
Compression therapy, stripping of varicosities, selective vein surgery.
Moist/semi-moist ulcer treatment.
Costs: Venous leg ulcers account for about 1% of health care budgets in western countries.
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