Treating Venous Stasis Ulcers In The Lower Extremity

By Mark Beylin, DPM

Chronic venous insufficiency is a significant disease that affects as much as 25 percent of the population in the United States. It is also a condition commonly treated by podiatric physicians. The condition results in blood pooling in the venous system of the lower extremities (see “A Guide To Normal Venous Anatomy And Physiology below). Venous stasis ulcers are the end stage of chronic venous insufficiency.
In order to treat venous stasis ulceration, one must have a clear understanding of the pathophysiology of venous disease. Most of the vein problems that occur are due to increased pressure in the venous system. Venous insufficiency and subsequent hypertension are caused by valvular incompetence in the high-pressure deep venous system, low-pressure superficial venous system or both. Dilation of the veins is the primary problem. When the veins dilate, the valves are separated from each other. This causes a back flow of blood.

When veins lose their functional capacity, gravity works against the flow of venous blood in the lower extremity. When one is walking, the blood flow is generally normal even through the incompetent veins and muscle contracture circulates blood out of the leg. On the contrary, when one stands, there is a reverse flow in the incompetent vein and a back flow occurs. This gets in the way of venous drainage and eventually results in an elevation of venous pressure.
When valves of the perforating veins become incompetent, high-pressure blood from the deep venous system flows towards the skin, producing hypertension in the superficial veins.2 This process leads to the leaking of fluid from small veins makes into the surrounding tissues. This causes edema and characteristic discoloration. This is subsequently followed by an impaired exchange of nutrients and wastes between the arterial and venous systems.

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