- Venous insufficiency of lower limbs
- Venous leg ulcer
- Pelvic venous insufficiency
- Venous pathologies during pregnacy
- Venous thrombosis
- Postthrombotic syndrome
- Venous malformations
- Haemorrhoidal disease
dr hab. n. med. Tomasz Grzela
Neglected varicose veins on the legs are often the cause of hard to heal wounds, ie. venous leg ulcers
Venous ulcer of lower limb is a lesion which appears most commonly in the region of ankle. It does not show a tendency to heal. Usually, it appears in patients who have problems with veins earlier – vein inflammation, thrombosis or just large varicose veins…
May varicose veins be serious?
We should say it directly. Chronic venous disease is not only a cosmetic problem. Neglected varicose veins may become a hard-to-heal wound on leg – venous ulcer of lower limb. Such condition is very unpleasant and unusually burdensome for patient and his/her close contacts.
Most frequently, the wound is located on the anterior surface of leg, just above the ankle. Usually, it is quit painful. Often, it is also a source of massive exudate. A large exudate is a serious hygienic problem for patient. After short period of time, dressing becomes wet. It smells unpleasant and should be changed. We should not forgotten about serious health-related aspect – massive exudates leads to a substantial loss of protein and electrolytes from patient’s organism which additionally hinders the healing process of wound.
May venous ulcer be effectively treated?
Absolutely. Most preferably, it should be treated under the guidance of center specializing in treatment of chronic wounds. Fortunately, there are more such centers in our country. The majority of such wounds may be treated using specialist dressings (to a large extent, they are reimbursed by the National Healthcare Fund) and compression band which are adequately placed on affected leg. Unfortunately, treatment requires patience and determination from patient as well as physician or nurse. The lack of determination is the most frequent reason of failure in treatment.
It is worth to know that the larger and older the wound, the treatment is longer and cosmetic effect is worse. Analogically, the earlier the treatment, the better and faster its effects are.
Is skin graft helpful in the treatment of ulcers?
In some patients, we may shorten the time of treatment via skin graft. Wound, however, must be adequately prepared earlier. It should not be forgotten that e.g. if we want to collect skin fragment for the purpose of graft for one wound, we have to make another wound in other location. Unfortunately, there are situations in which some of the grafts are not accepted. Then, two wounds have to be treated…
Is surgical procedure required to heal the ulcers?
In the majority of cases, specialist dressings and compression bands are sufficient. In some cases, however, patients may require to undergo surgical procedure to heal the wound. Usually, it refers to patients with large wounds and massive exudates.
In the past, surgical procedure consists in surgical removal of insufficient superficial vein (great saphenous vein and small saphenous vein). Currently, minimally invasive procedures are applied – intravascular laser therapy or chemical obliteration, i.e. sclerotherapy. In our Clinic, we also perform procedures of closure of insufficient veins with special glue. Having used the latter method, we successfully treated problematic wounds in several patients who were earlier disqualified for the surgical treatment with other methods. Fortunately, such cases are rare …
New possibilities of treating patients with recurrent ulcers, who have postthrombotic lesions in deep veins of thigh and/or pelvis should be mentioned. At least in case of some of such patients, better healing or decrease of the chances of ulcer recurrence may be achieved due to insertion of a special stent to the affected vein. Success of such procedure, however, mainly depends on adequate qualification of patient to the procedure. Most preferably, it should be conducted following precise imaging, e.g. using magnetic resonance imaging, i.e. angio-MRI.
May treated ulcers recur?
Unfortunately, it is the case. Healing of wound does not mean that the leg is entirely healthy. In the majority of patients, as the successive phase of treatment, sometimes before the healing of wound, we adopt surgical procedure (usually minimally invasive) in case of insufficient superficial veins. Frequently, however, the problem of insufficient deep veins is still to be solved. Thus, patients should still use specialist compression materials. In the majority of cases, wounds most commonly recur as the patient stops to wear compression materials.
- 1. Venous ulcers may be effectively treated, however, time, patience and determination are required from patient, his closest contacts and team taking care of patient.
- 2. Compression therapy, i.e. adequate application of compression band on the affected leg, is the most important element of treatment of venous ulcers of lower limb.
- 3. Effective treatment means adequate caring and use of adequately adjusted specialist bands. Band should be changed as frequently as it is required, however, as rare as it is possible. .