The insufficiency of the veins in the legs that carry the blood to the heart is described as chronic venous insufficiency – popularly known as varicose veins. In patients with varicose veins that have been neglected and untreated for a long time, wounds may occur around the ankle and in the lower part of the leg below the knee due to the insufficiency of these veins. These wounds may occur as a result of trauma or they may open spontaneously. This condition, called a venous ulcer or varicose ulcer, usually heals very poorly and may recur.
Although its incidence in the general population varies between 1 and 4 in 1000, the incidence increases in older individuals. Although it is seen equally in men and women at young ages, it is more common in women at older ages.
In the leg veins, the flow is in the opposite direction of gravity from the wrist to the groin. The flow in these veins occurs with the propulsion of the blood in the arteries and the suction power of the heart. Apart from these two factors, there is no contraction or pumping system that directly supports the flow. The backflow of blood with the effect of gravity is provided by valves located at regular intervals in the veins. Deterioration in the structure and function of these valves primarily causes venous insufficiency and varicose disease. With the development of the disease, enlargement of the leg veins and blood pooling begin. This circulatory disorder, increased pressure in the leg veins, the liquid part of the blood passing under the skin and causing edema start to cause various problems in the leg skin. Varicose scars occur after processes such as darkening and thinning of the skin.
Who is at higher risk of developing venous ulcers?
In the elderly; in obese; It is more likely to be seen in patients with chronic diseases such as heart failure, kidney failure, hypertension and diabetes, and those with previous venous thrombosis. However, it is more common in patients with known but untreated venous insufficiency and those who have had leg trauma.
The first symptom of the disease is usually swelling on the inside of the ankle and the front of the leg. Itching is a common complaint in most patients. In the following periods, thinning and darkening of the skin are observed. The wounds that develop in the final stage usually occur on the inside of the leg, in the area of 20 cm above the ankle. Wound inflammation, on the other hand, is red-pink in color and the surrounding skin tissue is thickened. Complaints such as swelling and pain in these wounds, which can be painful, increase later in the day.
In order to reveal the characteristics of the underlying venous insufficiency in these wounds diagnosed by physical examination, it is necessary to evaluate with venous Doppler ultrasonography. Deep venous structures, superficial venous structures and connecting (perforating) venous structures should be examined in detail in venous Doppler USG.
There are two purposes of treatment in varicose scars. The first of these is to heal the wound, and the second is to heal the venous insufficiency, that is, the varicose veins. In wound treatment, multiple bandage or multiple stocking systems are used simultaneously with wound care. Patients should have wound care at the intervals prescribed by their physicians and use multiple bandage systems. Varicose scars are one of the most obvious indications for surgery or intervention in varicose disease. Interventional methods or surgery can be applied before the wound is healed (during the wound care period) or after the wound healing is completed, depending on the characteristics of the patient and the condition of the wound.
It is important to take the necessary precautions and change the life habits after the varicose scar is healed and the varicose treatment is completed. The recurrence rate reaches 70% in patients who do not comply with the precautions and do not use stockings. Not sitting or standing still for long periods of time, losing weight, not smoking, walking and moving intermittently during the day, avoiding tight-fitting clothes and high-heeled shoes, applying varicose veins exercises, using the necessary drugs and compression stockings recommended by the doctor are the rules that must be followed to prevent recurrence of the wound.