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What is a Venous Stasis Ulcer? How Can Your Treat It?

My name is Ken Seifert, M.D. I work at Optima vein care and I will be publishing in this blog to help inform the public about the work we do and the help we can provide you with your varicose and spider veins.

One of the worst problems caused by valvular incompetence is the development of venous stasis ulcers. In the presence of valvular incompetence, the pressure in the venous system is high when the person is standing and that reduces blood flow from the arteries to the veins through the capillaries and reduces nutrient the oxygen supply to the skin, particularly at the level of the ankles. Over a time period of several months, the skin dies and an ulcer develops. Here is a picture of a venous stasis ulcer.

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Many of these venous stasis ulcers are a result of valvular incompetence in the superficial vein system. If that is the case then ablation of the incompetent superficial veins, along with good wound care, will allow these ulcers to heal. In the photograph above, notice the varicose vein above the ulcer. Also, notice the black rim of skin around the ulcer. These features are common with venous stasis ulcers. This particular ulcer is somewhat unusual in it’s location on the outside of the leg. Most venous stasis ulcers are located on the inside of the leg at or just above the ankle bones. The location of the ulcer on the outside of the leg is a hint that the incompetent vein in this case is the small saphenous vein going down the back of the calf. And that turned out to be true by ultrasound.

When I see patients with venous stasis ulcers, the patient has often had an ulcer for many months. Sometimes there is hope that the ulcer will heal on it’s own, and often there is a some misconceptions by patients and even by primary care physicians that this is a skin condition. Or, there may be a misconception that the problem inevitably is in the deep venous system and therefore beyond repair. In fact, problems in the deep system are much less common than incompetence in the superficial system.

It is particularly discouraging to see that the ulcer has been biopsied. I can usually diagnose a venous stasis ulcer by it’s appearance and location. I understand that I see these frequently and that other physicians are not as familiar with this problem, but still, a biopsy is not necessary and usually makes the problem worse.

The patient shown above had had the ulcer for months. It was painful. It had been biopsied. The black center was the biopsy scar, which of course had not healed and caused more pain.

Duplex Doppler ultrasound demonstrated incompetence of the short saphenous vein and a large branch from that vein to the large varicose vein above the ulcer and then to the ulcer itself. The patient worked at a job that required standing all day long.

First, I started some would care to clean up the ulcer to make it less likely that bacteria from the ulcer would infect the procedures that he needed done. Then he had a laser closure of the small saphenous vein and a microphlebectomy of the varicose veins in his calf. The photograph below shows the ulcer one week later:

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Three weeks later the ulcer in almost healed:

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And three more weeks later. It is healed and he is pain free:

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He had to take 2 days off work after the procedure, but otherwise was not limited in his life.

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