Varicose Ulcer Treatment

What is it?
A skin ulcer usually means a loss of a patch of skin due to several reasons. In your case, the reason is the veins just under the ulcer. Your veins are a little bigger than normal. These are called varicose veins because they look a bit like a wine bottle from ancient Greece (varix). A varicose vein is a superficial (close to the surface) vein lying under the skin. It gets swollen because of overspill of blood from veins running deep in the muscles of the legs.

This occurs when the leg veins don't return blood back toward the heart the way they should. The problems with your varicose veins are not their size, but the high pressure and sluggish flow of blood inside them. These results in aching, cramping, itching, staining of the skin, eczema and finally ulcers. The ulcers are often very painful. They can bleed and get infected. In the long term they can range from a minor handicap to possible serious illness. Most varicose ulcers will heal. The key to the treatment is to put continuous pressure on the underlying veins. One of the best ways of doing this is to squeeze the veins with bandaging.

The latest way of bandaging is to use four different types of bandage all at the same time. This is what you may have. The pressure dressing is far more important than any ointments, powders, granules, or dressings on the skin. Sometimes the blood supply is not good to the leg. The skin is starved of blood and gets damaged by the pressure. The doctors may need to do special tests and suggest other treatment for this.

You will not need to have any anesthetic. The aim is to get your ulcers healed. This means you wear a bandage on your leg for as long as it takes. Most people heal up inside 16 weeks. You need to have the bandages changed each week. Your ulcers are measured to make sure they are healing up. Once the ulcers have healed,the aim is to retain the recovery. This might mean injection treatment, or an operation for some people. For others, some type of support stocking may always be needed. When you see the surgeon, he will check you have straightforward varicose ulcers and nothing else. He will also look into any other surgical problems you may have.

The Surgery
Before surgery you will need a period of bed rest and elevation of the legs to reduce the swelling (oedema) of the legs. At the same time you will be given antibiotics to reduce the inflammation (cellulitis) of the skin around the ulcers.

The first step of the operation is for the ulcers to be measured. A probe test may be done to check the circulation. A specimen of the discharge is taken for the laboratory to examine for the presence of any bugs in the ulcers. This will guide the antibiotic treatment that you will need in the future. The ulcers are cleaned. A non-stick dressing is put on the ulcer. Four layers of special bandages are wrapped round your leg from the knee down to the base of your toes. The doctors arrange the OPD consultation weekly. You may need to take antibiotics when they have a report from the laboratory.

Any Alternatives
There are dozens of dressings, powders, sprays, etc. in the market, but of no use. You can get the ulcer to heal by getting rid of the excess pressure in the veins simply by going to bed with your feet up. This takes about three weeks. It may be best to do this in hospital. Skin grafting on its own is not very effective.

Before the operation
All your old dressings are taken off. You are given a general check over.