Leg Ulcer Treatment

Leg Ulcers

Leg ulcers develop when an area of skin breaks down to reveal the underlying flesh. Venous ulcers are the most common type of leg ulcer, with around 80%  of leg ulcers being venous, according to NHS statistics. It is estimated that they affect around 1 in 50 older age adults. They usually occur just above the ankle and can also carry with them pain and other symptoms such as:

• Varicose eczema
• Discolouration or hardening of the skin
• Heavy legs
• Swollen ankles and heavy legs
• Active ulcers may also have discharge

Leg Ulcers Treatment

At Veincentre, we have over 20 years’ experience in treating venous leg ulcers via EVLA and foam sclerotherapy. We find that these methods lead to quicker healing and longer-lasting results than traditional approaches (see below). In our experience, leg ulcers tend to remain healed following this treatment pathway.

Step 1 – Consultation

The consultation will include a discussion with your consultant about your ulcers and medical history, they will ask for photos of the ulcer and current management and ulcer dressing plan. We require a copy of a recent ABPI test if you’ve already had one, however your consultant can perform this at the consultation. The results of the colour duplex ultrasound scan will be discussed there and then, along with a tailored treatment plan.

Step 2 – Primary Treatment

The most common primary treatment required is Endovenous Laser Ablation (EVLA) to treat the underlying cause of venous insufficiency, and/or sclerotherapy. By fixing the underlying cause of your venous ulcers, this will allow the ulcers to start healing.

Step – Follow up

At follow-up for a patient with a venous leg ulcer we scan to check all the reflux has closed with ablation and often will perform further sclerotherapy for localised refluxing veins underlying the area of the ulcer which is recommended to maximise chances of healing.

The follow-up is usually around 6-8 weeks post EVLA.

We were delighted to see the results of the landmark UK-based EVRA randomised control trial published in the prestigious New England Journal of Medicine1 , which clearly supports our strategy. (EVRA is the acronym for the trial “Early Venous Reflux Ablation” .)

As the article itself states, this trial was the first to demonstrate that “early endovenous ablation of superficial venous reflux resulted in faster healing of venous leg ulcers and more time free from ulcers than deferred endovenous ablation”.

This followed an earlier study2 that had shown that traditional surgical correction of superficial venous reflux in addition to compression bandaging does not improve ulcer healing but reduces the recurrence of ulcers at four years and results in a greater proportion of ulcer-free time.

Although this earlier study had shown that surgical correction of venous insufficiency reduced recurrence, the fact that it also showed no improvement in ulcer healing held back the most effective treatment of venous leg ulcers by many years.

Our Approach Vs. the Traditional Approach

The first-stage of the NHS treating leg ulcers is with a process of cleaning and dressing the affected area, committing you to a lengthy period in compression bandages to theoretically help improve circulation and to treat swelling.

This process is usually undertaken weekly by a district nurse, and is very time-consuming. It has been estimated that treating leg ulcers takes up 50% of district nurses’ time.

Whilst compression therapy is an essential part of leg ulcer management, it needs to be augmented with eliminating any superficial vein reflux after careful assessment by a vascular specialist and early EVLA if required. Access to this type of treatment on the NHS is however not always available in a timely manner due to limited funding for venous services and underdeveloped patient pathways in many areas of the country…

Leg Ulcer Treatment – Before & After

Venous leg ulcers appear as an open wound usually on the lower leg or ankle. The area around the wound will be red and there are likely to be skin changes such as venous eczema visible. If the ulcer is active, there may be discharge oozing from the wound, there may also be scabbed areas.

Following treatment for venous ulcers, the area will heal quite quickly. The wound will close up and the redness will fade, any eczema will begin to clear up. There may however be some pigmentation or scarring left from the ulcer, depending on the severity of it.

Leg Ulcer Treatment Prices

EVLA as Primary Treatment

Foam Sclerotherapy as Primary Treatment (e.g. if EVLA not required)

If EVLA is not required, Foam Sclerotherapy is often the first-line treatment.

Home Remedies

If you believe that you are at risk of developing venous ulcers, you can make changes to your lifestyle to potentially help prevent their onset. Getting regular exercise, eating healthily, and getting enough sleep to feel rested, perhaps to aid losing weight, may help improve blood flow in both arteries and veins. If you are a smoker, quitting will take some of the strain off your cardiovascular system, which in turn can help the circulation.

If you develop leg ulcers, seek a medical opinion.  If your ulcers prove to be venous, you will need compression bandages and referral for a venous scan to address any superficial venous reflux.

Once the ulcer heals, you would benefit from wearing compression stockings, as they help reduce leg swelling by helping blood flow back to the heart. Try to keep your legs elevated while sitting, keeping your legs above your heart, to help blood flow out of your leg and prevent pooling. Propping your legs up on a pillow or cushion is perhaps the simplest way to achieve the appropriate elevation.

Leg Ulcer Treatment Aftercare

We would advise you to continue with your simple dressing and wearing the compression stocking provided by Veincentre for a week following EVLA and then to continue with dressings/bandaging provided from your GP surgery following this until the ulcer is fully healed.

Treatment Risks

With all medical treatments it’s important to weigh up the benefits versus the risks. With that in mind, we have provided you with a full outline of the known vein treatment risks.

Video FAQs

References

1. A Randomized Trial of Early Endovenous Ablation in Venous Ulceration. May 31, 2018
N Engl J Med 2018; 378:2105-2114. DOI: 10.1056/NEJMoa1801214
(https://www.nejm.org/doi/full/10.1056/nejmoa1801214)
2. “Long term results of compression therapy alone versus compression plus surgery in chronic venous ulceration (ESCHAR): randomised controlled trial. BMJ. 2007 Jul 14;335(7610):83. doi: 10.1136/bmj.39216.542442.BE. Epub 2007 Jun 1.”
(https://www.bmj.com/content/335/7610/83)