Venous Ulcers

Our Services-Venous Ulcers

Treating Venous Ulcers

Venous ulcers, also known as venous leg ulcers (VLUs), are chronic wounds typically occurring on the lower legs due to chronic venous insufficiency (CVI), where faulty vein valves cause blood pooling, hypertension, and tissue damage. Representing 70–90% of leg ulcers, they affect up to 1% of adults over 65, leading to significant morbidity, reduced quality of life, and healthcare costs exceeding $14 billion annually in the U.S. This scaled guide, aligned with 2025 Pan Pacific and Best Practice Recommendations, details identification, severity-based management, and prevention. Emphasizing compression therapy as the cornerstone, it promotes multidisciplinary care involving vascular specialists, wound nurses, and therapists to achieve healing rates of 60–80% within 12–24 weeks.

Understanding Venous Ulcers

Understanding Venous Ulcers: Types and Severity Scales

VLUs arise from venous hypertension, often in the gaiter region (medial malleolus to mid-calf), presenting as shallow, irregular wounds with moderate exudate, haemosiderin staining (brownish pigmentation), and surrounding edema or lipodermatosclerosis (hardened, inverted champagne-bottle leg shape).

Types include:

  • Primary VLUs: From superficial/deep vein reflux or obstruction without prior thrombosis.
  • Secondary VLUs: Post-deep vein thrombosis (DVT) or trauma, with post-thrombotic syndrome.
  • Mixed Etiology: Overlapping arterial disease (25% of cases), requiring vascular differentiation.

The Clinical-Etiological-Anatomic-Pathophysiologic (CEAP) classification standardizes severity, with C5 (healed ulcer) and C6 (active ulcer) denoting advanced disease. Additional scales like Venous Clinical Severity Score (VCSS; 0–30, higher = worse) and Wound, Ischemia, foot Infection (WIfI) guide prognosis.

Severity is scaled by size, depth, infection, and healing trajectory for tailored intervention:

  • Mild (CEAP C5–C6a; Small/Superficial): <5 cm², shallow (partial-thickness), clean base with granulation; minimal exudate/edema. Heals in 4–12 weeks.
  • Moderate (CEAP C6b; Larger/Partial-Thickness): 5–20 cm², extends to dermis/subcutis, moderate exudate, mild colonization or lipodermatosclerosis. 12–24 weeks.
  • Severe (CEAP C6c; Extensive/Full-Thickness): >20 cm², to fascia/muscle, heavy exudate, overt infection or non-healing (>4 weeks no 25–40% reduction). >24 weeks; high recurrence/amputation risk.

Symptoms: Aching/heaviness (worse with dependency), pruritus, edema; severe adds pain, odor, or cellulitis.