Do you also have wounds on your legs that don't heal? Let's learn about this 'Vascular Ulcer'!

Have you ever noticed that sometimes wounds appear on your legs, especially in the groin or ankle area, and take a long time to heal? You may have experienced this too. These are not ordinary wounds. We call these 'Vascular Ulcers', which in Sinhala means 'vein ulcers '. Simply put, these are wounds that occur on the skin due to poor blood circulation in our body. Let's talk about this in a little more detail today, because this is something that can affect many people.

What are vascular ulcers?

Simply put, venous ulcers are wounds that occur on our skin. But these are not just any wounds. They are caused by problems with the blood flow in our body, that is, the circulatory system. Most often, these wounds are seen on our limbs, especially the lower legs and feet. But they can also occur in other places. These wounds take a long time to heal, and sometimes special treatments such as surgery may be required.

There are two main reasons why these venous ulcers occur.

1. One is the weakening of blood circulation in our arteries . The arteries are where the body gets the nutrients and oxygen it needs. So when there is a problem with these, wounds form.

2. The other reason is the poor blood circulation in our veins . It is through the veins that blood, along with the waste products in the body, is carried back to the heart. If there is a problem with these, injuries occur.

The most common of these are wounds that occur in the veins, which we also call venous ulcers .

How common are these injuries?

In fact, these venous ulcers are more common than you might think, especially as you get older. On average, about 1% of adults may have this condition. Among people over 65, this percentage can be between 3% and 5%. So this is not something to be taken lightly.

How do these venous ulcers affect our bodies?

These injuries can have various negative effects on your life. Just think...

• Increased risk of infections: Our skin is like a shield that protects us from germs. So a wound like this is a breach in that shield, allowing germs to easily enter the body.
• Sepsis: If an infection is not treated properly, it can spread throughout the body and lead to a very dangerous condition called sepsis . This is when our immune system overreacts to a major infection and starts damaging various parts of the body.
• Gangrene: Either due to infection or lack of blood flow to the wound, the cells around the wound begin to die. This can lead to a condition called gangrene . If left untreated, it can spread and even lead to death.
• Pain and difficulty walking: These venous ulcers can be very painful. Depending on the location of the ulcer, you may not be able to work, sleep, or perform daily activities. Since physical activity improves blood circulation, if you are unable to walk due to a painful ulcer, the ulcer may become worse.

Very important: Do not ignore these injuries because they are minor. It is very important to seek medical advice immediately.

What are the symptoms?

The symptoms of a venous ulcer depend on the cause, and sometimes there may be several causes at once.

Symptoms of Venous Ulcers / Stasis Ulcers

These symptoms often appear before venous ulcers develop:

• The flesh on the legs is turning red and swollen.
• The skin thickens, hardens, and turns a dark color (usually red, purple, or brown).
• There may be numbness and itching in the affected area (we call this 'stasis dermatitis' ).
• Varicose veins are a common sign of developing vein problems.

Stasis ulcers typically have the following characteristics:

• Injuries often occur around the ankle.
• The wounds are not deep and may be covered with a red to yellow coating.
• The shape of the lesions is irregular, with uneven edges.
• The skin around the wound may be shiny and may appear stretched.
• That area may feel warmer than other places.
• The sores are painful and may ooze a fluid, such as blood or water. If infected, they may have a foul odor and pus.

Symptoms of Arterial Ulcers

These symptoms may appear before arterial ulcers develop:

• The skin around the wound becomes shiny and dry. It may also appear tight and flaky.
• Hair loss occurs on the affected arm/leg or near the wound due to poor blood circulation.
• Blood flow can be restricted when you lie down or elevate your legs. This can make your legs feel pale and cold. Your legs may hurt when you elevate your legs or lie down. (This pain may be relieved by letting your legs hang down. Your legs may also turn red as blood flow returns to normal.)

Arterial ulcers typically have the following symptoms:

• Sores begin to form in the parts of the body furthest from the heart, especially on the toes and between the toes.
• The lesions appear dark in color (especially red, yellow, gray, black).
• The wounds are deep, sometimes even exposing muscles or tendons.
• The edges around the wound look like they've been pushed out.
• The wounds may not bleed, and there may be no pain.

Who is affected the most by this situation?

Venous ulcers are more common in older people or those with certain health problems, especially those with heart and circulatory problems. Conditions associated with this include:

• Diabetes (Diabetes Mellitus)
• Obesity
• Peripheral Vascular Diseases - that is, Peripheral Artery Disease (PAD) or Peripheral Venous Disease (PVD)
• Cardiovascular disease
• High blood pressure (Hypertension)
• Smoking and use of tobacco products

Even in the absence of disease, venous ulcers can develop if blood flow is disrupted for other reasons. For example:

• Injuries: Fractures, burns, and muscle injuries can damage nearby blood vessels and cause problems with blood circulation.
• Standing for long periods of time: People who stand for long periods of time without moving (such as cashiers, bakery workers, hotel workers) can develop blood pooling in the veins of their legs. When the valves in the veins do not work properly, the blood does not flow properly back to the heart. This puts too much pressure on the veins and causes them to enlarge, causing 'Varicose Veins'. Fluid then leaks from the veins into the surrounding tissues, causing them to swell. This fluid, along with blood and proteins, can cause brown spots on the legs, especially on the inside of the groin area. This can be itchy, and the skin can become dry and cracked. Bacteria can enter these cracks and cause a skin infection called 'Cellulitis' or a wound related to the veins.
• Family history: If someone in your family has had these types of injuries, you may be at risk for developing them too.

Why do these types of injuries occur? What are the causes?

Venous ulcers can usually be classified according to their underlying causes. However, a single ulcer can have multiple causes. A good example of this is the development of venous ulcers due to diabetes.

• Stasis Ulcers: These are caused by problems with the veins. The majority of venous ulcers fall into this category. They are more common in the legs and feet as you get older. This occurs when the valves in the veins in the legs fail to do their job properly. This means that the blood that should be going up to the heart cannot be stopped from flowing down due to gravity. As a result, more blood accumulates in the legs and feet, putting more pressure on the blood vessels. This pressure can cause the veins to leak fluid and even burst. Over time, this can lead to ulcers.
• Arterial Ulcers: These are also called 'Ischemic Ulcers' . These are caused by a lack of blood flow to the affected area. We also call this 'Ischemia' . Due to the lack of blood flow, the affected body part (usually an arm or leg) gradually begins to die.

How do you recognize this? How do doctors diagnose it?

A doctor can quickly identify a venous ulcer by examining it. He or she will look closely at the wound, perhaps palpating the area around it, and checking for any special symptoms.

However, the doctor also needs to find out what caused the injury. The information obtained during the examination of the injury will also help in this. However, some tests will also be ordered to understand the exact cause. This is because there can be several causes that affect venous injuries, and these causes can be related to each other.

What tests are being done?

Your doctor or specialist may perform these tests:

• Blood pressure measurement: The doctor will measure the blood pressure in your arm. He will also measure the blood pressure in your legs to see if there is a difference between the two. This test is called the Ankle-Brachial Index (ABI) test .
• Listening to your heart and checking your pulse: By listening to your heart and breathing, your doctor can look for evidence of underlying heart disease that could be contributing to the venous lesions. They can also feel the pulses (peripheral pulses) in your lower legs and feet. The strength of these pulses — or if no pulse is felt — can help your doctor make a more definitive diagnosis.
• Blood testing: Blood tests can help your doctor make a diagnosis and decide how to treat your injury. One specific test is the A1C hemoglobin test . This can help determine whether you have diabetes and, if so, how severe it is.
• Imaging: Your doctor may order imaging tests to look not only at the injury but also at the blood flow around it. They may also order imaging tests of major arteries and veins elsewhere in the body, as these can also show problems related to a vascular injury. These tests may include X-rays, MRIs, CT scans , and ultrasounds .

Can these wounds be healed? What are the treatments?

In most cases, a venous ulcer can be healed. However, the likelihood of the wound healing depends on how severe it is. Therefore, treating venous ulcers quickly is very important for a good outcome.

It is also important to address the underlying problem that caused the injury. Your doctor will treat the injury and recommend treatments for any underlying health problems you may have. Some of his recommendations will involve making changes to your lifestyle. These changes can help reduce your risk of developing another injury and improve your overall quality of life.

Treatment methods

Different treatments are used depending on how severe the venous ulcers are and what caused them.

Medications

• Antibiotics: These can treat infections and, in some cases (such as after surgery), are also given to prevent infection.
• Topical gels and ointments: These help remove dead or infected tissue, improve blood flow to the affected area, prevent infection, and help the wound heal faster.
• Medications to treat the underlying problem: Things like controlling your blood pressure and cholesterol, quitting smoking, and controlling your blood sugar levels can help wounds heal.
• Painkillers or numbing medications: Venous ulcers and some of their treatments can be painful. It is common to use painkillers or numbing medications during treatment.

Bandages and dressings

Bandages and various types of wearable items are commonly used to treat venous ulcers. These should only be used as directed by your doctor. If used incorrectly, a venous ulcer can become worse instead of better.

• Bandaging: Covering the wound with a protective bandage can help protect against infection. Some bandages may also contain medications, which can help the wound heal faster.
• Compression garments: These include socks, stockings, and other items. They apply pressure to the entire leg, helping to limit or stop swelling. They are commonly used for venous ulcers. They help prevent blood from pooling in the legs and feet.
• Specialized shoes, socks or orthotic devices: Many venous ulcers, especially diabetic ulcers, are caused by simple friction and pressure. Usually, when you feel pain, you change the way you walk and reduce the damage to the affected area. However, this is not the case with diabetic ulcers. They are often caused by a complete or partial loss of sensation in the feet.

Advanced methods

These advanced treatments can be used for large, or venous wounds that take a long time to heal.

• Revascularization: Blockages in important blood vessels can cause venous ulcers. Revascularization treatments attempt to remove these blockages, heal existing ulcers, and prevent new ulcers from forming.
• Surgery: Surgery may be performed for infected or large, difficult-to-heal wounds. A surgeon may perform surgery to remove dead or infected parts of a deep wound ( debridement ), making it easier for the wound to heal. This may include skin grafts and other repair methods. (However, in cases of very severe gangrene or a very severe deep wound, sometimes amputation of a part of the foot or leg is necessary. This is done to save lives and prevent even more serious complications. Unfortunately, people with diabetes are 30 times more likely to develop gangrene in their feet than the general population.)
• Prescribed walking: Physical activity, especially when done with medical advice, helps improve blood circulation and prevent the formation of new venous ulcers.
• Hyperbaric oxygen therapy: The normal oxygen level around us is 21%. In 'Hyperbaric oxygen therapy', you are placed in a chamber with 100% oxygen concentration and increased atmospheric pressure. Under these conditions, wounds, especially venous wounds, can heal faster.
• Debridement: Dead and infected tissue in and around a deep wound can delay healing and lead to dangerous complications such as gangrene. Debridement involves removing this dead or infected tissue, leaving only healthy tissue.

How to manage symptoms and reduce risk?

If you are at risk for developing a venous ulcer, there are things you can do to protect your health and prevent an ulcer from developing. This is especially important if you have diabetes or another condition that reduces sensation in your feet.

• Check yourself: Check your feet daily. Pay special attention to between the toes, around the ankles, and on the soles of the feet.
• Protect your feet: Protect your feet from injuries by wearing properly fitting shoes and socks.
• Get proper foot care: If you have diabetes, you should see a podiatrist regularly to check your feet for signs of ulcers. He or she will advise you on the best way to care for your feet.
• Control underlying medical conditions: Taking care of things like your blood pressure, cholesterol, blood sugar levels, and weight can help prevent injuries.

If you already have a venous ulcer, your doctor will guide you on how to care for it. He or she will often advise you on the following:

• Keep the wound clean: Use bandages and change them as directed by the doctor.
• Rest as advised: If you have a venous ulcer, your doctor will tell you to keep your legs elevated to prevent swelling.
• Take your medications correctly: Take your medications on time, especially antibiotics, blood pressure, diabetes, and high cholesterol medications.

What can you expect while living with this injury?

If you have a venous ulcer, or have had one before, you are at higher risk of developing another one. Taking care of your health is the best way to delay the development of a new ulcer. If you manage your health, you are more likely to live longer overall and with fewer health problems.

On the other hand, if you don't take care of your health, the venous ulcer – and your overall health – is more likely to get worse. In the worst cases, if you neglect the ulcer and your health, it can lead to amputation, and even death.

When should you see a doctor?

See your family doctor at least once a year for a complete physical checkup. This is important to identify health problems, including those that can lead to vascular lesions, even if they don't show symptoms.

Also, talk to your doctor if you have any of the following:

• If a wound on your leg or foot is taking longer than expected to heal.
• If you have symptoms that suggest you have problems with blood circulation in your legs (especially swelling, pain, discoloration, or pain that changes depending on how you hold your leg).
• If you have pain in your legs that gets better with rest.

When should you go to the Emergency Room?

If you have a venous wound, it becomes infected and you develop these symptoms, you should go to the emergency room:

• If the skin around the affected area turns dark brown or black, especially on the fingers.
• If you have a fever or chills and are shivering.
• If there is a bad smell coming from the venous wound.
• If the venous wound is oozing more fluid or blood than usual, especially if the fluid coming out is cloudy or yellow.
• If the wound and the area around it are swollen, red, and feel warm to the touch.

In summary, take-home message:

Vascular ulcers are usually a sign of an underlying chronic health condition. Although these conditions are serious, they can be managed and you can enjoy your life. Don't be afraid or panic.

Your doctor can guide you, provide you with the necessary resources, and provide other support. All of this will help you prevent chronic conditions from interfering with your life and live the life you want. It's important to seek medical advice early. Take care of your feet, take care of your health.

` Venous wounds, circulatory problems, foot wounds, venous wounds, arterial wounds, diabetic wounds, non-healing wounds