Venous Skin Ulcer

Treatment Overview

The key to treating venous skin ulcers is using compression stockings and elevating your legs. Compression reverses the underlying circulation problem in the legs and helps control painful swelling from fluid buildup (edema). People who stick to a long-term compression treatment regimen have much greater treatment success than those who do not. Also, continuing compression after healing prevents ulcers from coming back.¹

See an illustration of how to put on compression stockings.

Prevention

If you are at risk of developing a venous skin ulcer or have had one before, wear compression stockings during your waking hours and try to elevate your legs as often as possible.

Compression stockings are also important if you have had a deep vein thrombosis, or blood clot. Studies show that below-the-knee compression stockings lower the risk of postthrombotic syndrome, including venous skin ulcers.²

For more information, see:

Venous skin ulcers: Using compression stockings.

If you have poor blood circulation (reflux) just below the skin, simple vein surgery and compression treatment may prevent ulcers from coming back.³

Treatment

If you have developed a venous skin ulcer, your treatment may include:

• Compression bandages and elevation. If an ulcer has formed, a dressing may be placed over the wound before the compression is put on. The dressing may contain medicine to help heal the ulcer.
• Debridement, or removal, of any dead tissue on the wound. Debridement is often used to help a skin ulcer heal properly.
• A balanced diet, dietary supplements, and exercise. For more information, see the Home Treatment section of this topic.

If your skin ulcer does not heal within 3 to 6 months of standard compression treatment, your doctor may recommend additional treatment. A number of options are available, including:

• Pentoxifylline, an oral medicine that speeds healing when used with compression.⁴
• Antibiotics, used only when an infection is present. They do not improve ulcer healing.
• Intermittent pneumatic compression (IPC) pump. These devices alternately inflate and deflate knee-high boots, which results in decreased pooling of blood in the legs. IPC pumps can be used at home for ulcers that have not healed with conventional compression therapy.
• Skin grafting, an effective treatment for deep or long-standing and difficult-to-heal skin ulcers.
• Vein surgery, which does not improve healing but may help prevent recurring ulcers. This treatment is rarely done, because it is only useful for specific vein problems.⁵ For more information on vein surgery, see the topic Varicose Veins.

Other treatment options that show promise include:

• Injections of growth factors at the ulcer site. Early studies show that one factor, granulocyte-macrophage colony-stimulating factor (GM-CSF), increases the likelihood that chronic leg ulcers heal completely.¹
• Mesoglycan. One large study found that injections of mesoglycan, which is found naturally in many tissues in the body, significantly increased healing when compression bandages were used for 6 months.⁶

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Author:	Maria G. Essig, MS, ELS	Last Updated: September 17, 2007
Medical Review:	Kathleen Romito, MD - Family Medicine Randall D. Burr, MD - Dermatology
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