• Venous stasis ulcers are lesions (sores) that form on the lower part of the legs because of poor circulation (chronic venous insufficiency). Ulcers are open wounds in the skin that sometimes become infected.

• Usually begins with swelling of the leg.
  
• Over time, the leg may become itchy and red. Sometimes, the skin breaks down or becomes thick and hard.
  
• Eventually an ulcer will form. It may start as a small opening in the skin, and slowly get bigger. It is usually round, and most often occurs on the inside part of the lower leg, just above the ankle.
  
• Sometimes the ulcer can become infected and lead to Cellulitis (skin infection).

• Venous stasis ulcers result from poor circulation in the leg, caused by any process that prevents blood and fluid from draining out.
  
• Those at high risk are patients with Varicose Veins or previous Blood Clots in the Legs, and patients who do not get to move much, such as paraplegics or the bedridden.

• Diagnosis is made by observing the appearance and location of the ulcer.
  
• Next, a full examination is needed of the patient's blood vessels and circulation, checking pulses and pressures in the arms and legs. Rarely, an angiogram (dye injection and X-Rays of blood flow) may be needed.
  
• If the diagnosis is still not clear, a biopsy may be done.

• Once an ulcer forms, treatment needs to be started immediately to keep it from enlarging and to prevent infection.
  
• First, the swelling should be reduced, as mentioned above.
  
• Next, the ulcer should be cleaned with sterile saline or with a wound cleanser such as Cara-klenz. If there is any dead skin, it needs to be cut out.
  
• An antibiotic ointment can then be used to keep the ulcer clean.
  
• If the skin is red and inflamed, a steroid cream can be used to help reduce itching and redness.
  
• The ulcer is then covered with a special dressing, such as Duoderm, Cutinova, or Allevyn.
  
• An Unna boot, a special boot that helps the ulcer heal and protects the wound, is worn over the dressing. It will need to be changed once a week until the ulcer is completely healed.
  
• If this regime does not work, a new medicine called Regranex is often used to help heal the ulcer, especially in diabetics.
  
• Whirlpools, Ultrasound therapy, and physical therapy may be prescribed in some cases.
  
• Most people heal with good wound care. Occasionally, some do not and may need skin-grafting surgery.
  
• A diet rich in protein, vitamins, minerals, and adequate hydration is advised.

• The goal is to prevent the formation of the ulcer.
  
• Stockings can be used to reduce swelling in the legs -- not be used in people with poor arterial circulation.
  
• Keeping the legs elevated as much as possible can also help with decreasing fluid buildup.
  
• The lower the swelling, the better.

• Vasculitis
  
• Pyoderma gangrenosum
  
• Arterial ulcerations
  
• Insect bite
  
• Injury
  
• Sickle cell disease
  
• Infection

• Special Information

- These ulcers have to be watched carefully. They can become infected and cause Cellulitis (infection of the skin). If this happens, antibiotics such as Ciprofloxacin, Dicloxacillin, or Cefazolin will be needed.