A Case Of Varicose Veins Ulcers

A Case of Varicose Vein Ulcers: Understanding Chronic Venous Ulcers and Their Management

Varicose vein ulcers, also known as venous leg ulcers, are one of the most serious complications of chronic venous insufficiency. They not only affect a person's mobility and quality of life but also require long-term management and care.

In this blog, we’ll share a real-world case of a varicose ulcer, discuss it sunderlying pathology, and highlight best practices for diagnosis, treatment,and prevention.

Case Summary

Patient:60 Year-old male

MedicalHistory: poliomyelitis

SurgicalHistory: plastic surgery (2018 and 2022) laser therapy (2024)

Occupation:Farmer (includes strainer activity)

Complaint:Non-healing ulcer on the dorsal surface of both the legs for 12 years,associated with pain, itching and regular oozing.

Clinical Background

The patient presented with:

A shallow, irregular ulcer located on the dorsal surface of the ankle covering the whole ankle of the right lower and two shallow ulcers on the ankle of left lower limb.

Surrounding hyperpigmentation, lipodermatosclerosis, and bulging veins visible along the course of the medial aspect of the leg.

Complaints of pain, heaviness, itching, and dull aching pain, oozing of blood from the ulcer

Pedalpulses present, ruling out arterial involvement

Hehad tried over-the-counter creams and dressings but saw no significantimprovement.

Healso underwent plastic surgeries of the ankle to cure the ulcer butunfortunately went unsuccessful.

He alsowent for radio frequency ablation treatment for the right leg to cure varicosebut no improvement was seen.‍

Diagnosis

The condition was diagnosed as a venous ulcer secondary to varicose veins based on:

Clinical examination

Doppler ultrasound, which confirmed incompetent perforators and reflux in the sapheno-femoral junction, great saphenous vein, sapheno-popliteal junction.

No evidence of arterial insufficiency or deep vein thrombosis (DVT)

Treatment Approach

1.Local Wound Care

Gentlecleaning with betadine

Applicationof absorbent hydrophilic foam silver pad and non-adherent dressing.

Avoidanceof irritant antiseptics

2.Compression Therapy

Two-layercompression bandaging initially, later switching to graduated compressionstockings

Compression is the gold standard for healing venous ulcers, as it helps improve venousreturn and reduces oedema

3.Medical Management

Antibiotic sprescribed only for signs of secondary infection

Vein needgel for itching due to varicose veins.

4.Definitive Treatment of Varicose Veins

Once the ulcer showed signs of healing, Endovenous thermal ablation (EVLT) wasperformed to correct venous reflux and prevent recurrence. Sclerotherapy wasused for residual varicosities.

Outcome

Theulcer showed complete healing within 10 -12 weeks of initiating compressiontherapy, wound care and EVLT procedure. The patient’s symptoms of pain,heaviness and itching improved, disappearance of bulging veins seen within afew weeks after the procedure  and he wascounseled on long-term preventive measures.

Key Takeaways

Venousulcers are often chronic and can take weeks or months to heal without propertreatment.

Compressiontherapy is essential and should be continued even after ulcer healing toprevent recurrence.

Early treatment of underlying venous insufficiency (e.g., VENASEAL GLUE IMPLANTATION,ENDOVENOUS THERMAL ABLATION, or sclerotherapy) significantly reduces recurrencerates.

Patient education, leg elevation, exercise, and avoidance of prolonged standing are crucial for long-term success.

What Happens If Left Untreated?

Untreated varicose vein ulcers can lead to:

Chronic infection

Cellulitis

Reduced mobility

Social isolation and psychological distress

Prevention Tips for At-Risk Patients

Wear compression stockings regularly

Keep legs elevated when sitting

Stay active; avoid standing or sitting for long periods

Maintaina healthy weight

Seek early treatment for varicose veins

Final Thoughts

This case reminds us of the importance of early intervention in chronic venous disease. Venous ulcers are preventable, manageable, and often curable with a multidisciplinary approach.

If you or someone you know is struggling with a chronic leg ulcer or visible varicose veins, don’t wait—seek medical advice. Healing begins with the right diagnosis and consistent care