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Varicose Vein Ulcer A Dreaded Complication

“A varicose vein ulcer?  My mother had one.  It was awful.  I don’t want to go there!”

If you have had a family member with an ulcer from their varicose veins you will empathise with these words.  They are not pretty. 

Varicose vein ulcer a large open tissue wound in the lower legLarge varicose ulcer

They take an inordinate amount of time to heal.

Without good treatment they will continue to get worse.

Small Beginnings

Nearly always varicose ulcers begin with some minor problem. 

A bite that was scratched.  A minor graze or cut.

Because the skin nutrition is so poor, as noted in varicose eczema, the wound heals poorly.

In fact it deteriorates.

Age Correlations

The skin health needs to be compromised for this sequence to occur. 

Therefore usually it appears in older people who have had varicose veins for years.

But they can occur in even young people.

I had two men in their mid twenties in the same year who both had a varicose vein ulcer.

Problems In Care

Like any open wound they are a nuisance for the person with them.  They need to be managed effectively.

Without this they will persist and become larger.  As bare tissue they are an open route for infection to enter the body. 

Untreated for years, they will at times present with a skin cancer in the wound.

Scarring after healing of varicose vein ulcerScar left after healing

Taking so long to heal they will leave a scar once healed. 

Most often the surrounding skin shows other changes of long-term varicose veins problems. 

Pigmentation, skin and deeper tissue thickening are often present.

Other Causes Of Ulcers

There are other causes of skin ulcers. 

Arterial disease can present this way. 

As can some rarer skin conditions. 

Less than optimal management of deep vein clots can also predispose people to vein-related leg ulcers.  

Usually the appearance and location of the ulcer gives a good indication of the underlying cause.  Not always though.

A varicose vein ulcer most commonly occurs on the inner aspect of the lower leg, near the ankle.

Varied Treatment

Research into treatments bring used in varicose ulcers frequently reveals widely varying approaches.

As it is an area that requires repeated dressings in managing the acute problem, many companies are vying for their share of the medical revenue.  It is a large pie.

Increasingly exotic applications are recommended.  Which progressively cost more.

Ideal Management Of Varicose Vein Ulcer

Agreed management for varicose vein ulcer has changed over the years.

There was a time when everyone with such an ulcer was put on bed rest with their leg elevated until it was healed.

Modern treatment totally reverses this approach.  Daily active walking through causing the muscles to pump the deep venous blood efficiently actively supports and increases healing.

Smaller managed varicose vein ulcerSmaller scar from earlier healing

You do need to wear compression stockings though. 

This reproduces the normal circulation which optimises your skin’s health.

Simple dressings are all that are needed. 

Normal saline soaked gauzes without any topical creams are best. 

Any medicated gauze and especially the use of topical antibiotics is not recommended. 

The open wound increases the risk of directly exposing your cells to these agents, which is far more likely to produce allergies to them.


As the ulcer is effectively an open wound it leaves you at risk of infection.  The skin barrier has been lost. 

Frequently ulcers are swabbed looking for bacteria. 

Just as with skin swabs some bacteria often show in cultures.  Usually low grade, non-pathogenic ones. 

Treating the ulcer for these does not accelerate healing and risks inducing an allergic reaction to the agent.

Definitive Management

When surgery was so popular the operation was usually delayed until after the ulcer had healed.  To avoid risks of wound infections.

Newer options allow for treatment while the ulcer is present. 

This can halve the time it takes for a varicose vein ulcer to heal.

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