Chronic venous ulcer (Ulcus cruris)

Ulcers can be

1. Arterial – if they are a consequence of the diseases of arteries
2. Venous – terminal state of chronic venous insufficiency
3. Gravitational – a consequence of age, lymphedema, arthrosis of large joints, immobility.

Chronic venous ulcer (according to CEAP classification – stage C5 and C6) are terminal state of chronic venous insufficiency – weakening. They cause constant pain. The pain can be eased by lifting your leg.

Unlike arterial ulcers – where patients feel ease by lowering his leg.

Causes and mechanisms of occurance

1. primary venous insufficiency – cause of the disease of surface vein valves in 90% cases

– In case the groin valve (SF confluence or saphenofemoral valve) has weakened, the flow of large superficial vein is weakened as well. It becomes curved across the inner part of the upper leg and lower leg (stage C2).

If the disease – vein insufficiency – lasts longer, the leg starts swelling as well (C3); then, hyperpigmentation – brown spots and stains, appear on the lower leg, above the ankle (C4).

Long term presence of blood return causes wounds that still sometimes heal (C4); until, at the end, there is a chronic wound that cannot heal anymore (C6). It is all a consequence of the continuous vein blood return, blood that is rich in carbon dioxide, into the lower leg. Skin cells and subcutaneous cells are no longer provided with oxygen that is the main energy source for tissue, so they decay. A wound opens that cannot heal anymore. Ulcers whose cause is a groin valve, are usually placed at the inner side of the lower leg.

– In case the valve around the knee crease (SP confluence or saphenopopliteal valve) has weakened, there is a similar progress of the disease. With this insufficiency, leg swelling appears very early, and often the vein conglomerates in legs are completely invisible. With the disease of the valve mentioned, wounds open at the outer side of the lower leg.

– Weakening of perforating or communicating veins – perforators: those veins cause so-called gravitational ulcers and they are a consequence of the disorder in posture. They accompany knee arthrosis, difficult mobility, prolonged sitting. If being overweight adds up to that, a wound opening occurs even without previously visible varicose veins. It often happens in older age, and it is a consequence of a vicious circle in which the patients find themselves: because of their joints, they cannot walk, they sit, eat, gain weight, walk even less… It all leads to opening of a wound that is painful and impairs the quality of life.

2. secondary venous insufficiency – in 10% cases

It is a consequence of clogged deep veins or a consequence of damage of deep venous valves – it appears after healed deep vein thrombosis (DVT) which rechanneled, but deep venous valves do not ‘breathe’. Such people have constant swelling of one leg, and their medical history shows data on recovering from DVT.