Venous Ulcers

Venous ulcers, as with all superficial ulcers, are a breakdown of the cutaneous and sub-cutaneous tissues. The venous part of the title indicates the aetiology of the ulcer. With increased venous pressure from venous insufficiency, there is also increased pressure in the microvasculature, resulting in oedema. As such, there is decreased perfusion of tissues, with absence of nutrition and build-up of toxic metabolites. These factors reduce the resistance of the tissues, rendering them susceptible to breakdown from minor trauma (Baele, 1992).

The most common site for a venous ulcer is just proximal to the medial malleoli, as this is where the ankle vessels perforate, locally increasing the venous pressure (Baele, 1992).

Venous ulcers usually present as shallow, irregular to oval in shape, with macerated borders. Size varies from pinhead to extensively covering the disto-medial aspect of the leg. The base may be granulated, however it is usually covered in slough and a serous or haemoserous exudate (Lorimer, 1999; PM331).

Pain may be present as a burning, throbbing ache, but will generally not be as severe as ischaemic ulcers. There may also be a venous part to combination ulcers.
A good test to differentiate between venous and ischaemic ulcers is to elevate and lower the leg. Pain will decrease with elevation if the ulcer has a venous aetiology due to the assistance of gravity, and vice-versa. For this reason, pain is usually worse during walking, standing or sitting.
Two other differentials are presence of other venous indicators such as varicosities, oedema, telangiactasia and haemosiderin; and location in that ischaemic ulcers don’t develop in these areas unless caused by major trauma.

A venous ulcer in a atypical location on the leg - the lateral leg rather than the medial leg (near perforating veins).

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Last Updated: October 24th, 2001