Stasis ulcers, also known as varicose ulcers or venous leg ulcers are chronic wounds that usually develop on the lower legs due to poor blood circulation. These ulcers are a common complication of venous insufficiency, a condition in which veins struggle to bring blood back from legs to heart.

What are leg ulcers, how do they develop and what their stages are, understanding is important for effective management and treatment. This article explores various stages of stasis ulcers, their causes and available treatment for venous stasis ulcers.

What Are Leg Ulcers?

The ulcers of the legs are open sores or wounds that are formed on the lower legs, which often take weeks or months to fix (heal). In various types, a varicose ulcer is the most common, responsible for about 70-90% of cases of leg ulcers. These ulcers are generated from CVI, where damaged veins or valves fail to circulate blood efficiently and thereby pooling blood in the lower extremities. This blood pooling increases the pressure in the veins, thereby becoming fluid leakage in the surrounding tissues, damage to the skin and ultimately ulcers.

Other types of leg ulcers include arterial ulcers (caused by poor arterial blood flow) and diabetes ulcers (related to nerve damage and poor wound healing). However, stasis ulcers are different due to their venous origin, which often appear on the inner ankle or the lower calf.

How Do Leg Ulcers Begin?

This process starts with venous insufficiency, often starting with factors like standing/sitting for a long time, obesity, pregnancy or a history of deep vein thrombosis (DVT). When the nerves fail to pump the blood effectively, pressures in the lower legs occur, thereby causing edema (inflammation), skin changes and ultimately breakdown. The skin becomes delicate, discolored and likely to hurt. Minor injury like scratches or bump can also trigger the open wound that cannot heal properly, forming a stasis ulcer.

Risk factors include:

• Age: Older people are more sensitive to it due to weak vein functionality.
• Obesity: Overweight increases the pressure on the leg veins.
• Sedentary lifestyle: Lack of movement impairs circulation.
• Previous injuries: Trauma or surgeries affecting veins can contribute.
• Genetics: Family history of CVI increases risk.

Stages of Stasis Ulcers

Stasis ulcers progress through different stages, each of which has specific symptoms and skin changes. Understanding these stages aids early intervention and effective management.

Stage 1: Pre-Ulcerative Skin Changes

At the initial state, there is no open wound, but early symptoms of venous insufficiency on the skin appear. The affected area, usually near ankle, may appear the following:

• Discolored: Reddish, brownish, or purplish hue due to blood pooling (hemosiderin staining).
• Swollen: Edema (swelling) causes the legs to feel heavy or tight.
• Itchy or tight: Skin irritation or stretch can be felt.

At this stage, the skin remains intact, but it is delicate and there is likely to be harm. Prevention measures, such as compression therapy and lifestyle changes, are important to prevent progression.

Stage 2: Early Ulcer Formation

A shallow open wound develops. The ulcer is superficial, which only affects outer layers of the skin (epidermis and possibly dermis). Features include:

• Small, shallow wound: The ulcer may ooze clear or slightly bloody fluid.
• Mild pain: Discomfort may worsen with standing or walking.
• Surrounding skin changes: The skin around the ulcer may be red, inflamed or hardened.

Prompt treatment at this condition can prevent the ulcers from deepening or spreading.

Stage 3: Deep Ulceration

If not treated, the ulcer increases to stage 3, where it becomes deeper and more severe. The wound spreads to deep layers of the skin, sometimes reaching the subcutaneous tissues. This includes the following features:

• Larger, deeper sore: The ulcer edges can be irregular and the base can be moist, yellowish.
• Increased pain: The pain becomes more acute, especially if the infection occurs.
• Infection risk: Open wound is sensitive to the bacterial infection, leading to foul odor, pus or increased redness.

Stage 4: Chronic or Complicated Ulcer

In the final stage, the ulcer becomes chronic, with significant tissue damage and complications. Characteristics include:

• Extensive tissue loss: The wound may extend to muscles, tendons, or bone in severe cases.
• Chronic infection: Recurrent or persistent infections complicate healing.
• Severe pain and swelling: Edema and discomfort may limit mobility.

Treatment for Venous Stasis Ulcers

Effective treatment for venous stasis ulcers focuses on addressing the underlying venous insufficiency, promoting wound healing, and preventing recurrence. Treatment plans are tailored to the ulcer’s stage and the patient’s overall health.

Compression Therapy

Compression therapy is the cornerstone of stasis ulcer treatment. It involves applying external pressure to the legs using:

• Compression stockings: Elastic stockings improve blood flow and reduce swelling.
• Compression bandages: Multi-layer bandages provide targeted pressure for severe cases.

Compression reduces venous pressure, minimizes edema, and supports wound healing. Patients must wear compression garments consistently, as prescribed by a healthcare provider.

Wound Care

Proper wound care is critical to prevent infection and promote healing. Steps include:

• Cleansing: Gently clean the ulcer with saline or mild soap to remove debris.
• Dressings: Use moisture-retentive dressings (e.g., hydrocolloids or foams) to keep the wound moist but not overly wet.
• Debridement: Remove dead tissue surgically or with enzymatic agents to encourage healthy tissue growth.

Medications

Medications may be prescribed to manage symptoms or complications:

• Antibiotics: Used for infected ulcers, either topically or orally.
• Pain relievers: Over-the-counter or prescription medications alleviate discomfort.
• Pentoxifylline: This drug improves blood flow and may enhance healing.

Lifestyle Changes

Lifestyle modifications can prevent worsening and recurrence:

• Exercise: Regular walking or leg exercises improve circulation.
• Weight management: Losing excess weight reduces pressure on veins.
• Elevating legs: Raising legs above heart level several times daily reduces swelling.

Advanced Treatments

Advanced medical (therapies) may be necessary for severe or non-healing ulcers:

• Skin grafts: Implant healthy skin to cover large or old (chronic) ulcers.
• Venous surgery: Procedures like vein ablation or valve repair address built-in venous problems.
• Hyperbaric oxygen therapy: Increases the supply of oxygen to promote the therapy of tissues (tissue healing).

Preventing Recurrence

Once healed, it’s important to stop repetition of the disease. Patients should:

• Continue compression therapy as recommended
• Keep an eye on the initial symptoms of skin breakdown
• Adopt a healthy lifestyle to improve blood circulation

Complications of Untreated Stasis Ulcers

Stasis ulcer can lead to serious complications if not treated, including:

• Chronic infections: Constant infection can spread to deep tissues or bones (osteomyelitis).
• Cellulitis: Bacterial skin infections that cause redness and swelling.
• Amputation: In rare, severe cases, extensive tissue damage may necessitate amputation.

When to Seek Medical Attention

Consult a healthcare provider if you notice:

• Persistent leg swelling or skin discoloration
• An open sore that does not heal within two weeks
• Signs of infection, such as increased pain, redness, or pus
• Severe pain or difficulty walking

Conclusion

Stasis ulcers, or varicose ulcers, are a serious complication of venous insufficiency that progress through distinct stages, from skin changes to chronic wounds. Understanding what are leg ulcers and how do leg ulcers begin empowers individuals to recognize early signs and seek timely treatment. Treatment for venous stasis ulcers involves compression therapy, wound care, medications, and lifestyle changes, with advanced options for severe cases. By addressing risk factors and adhering to treatment, patients can manage stasis ulcers effectively, promote healing, and prevent recurrence. Awareness and proactive care are key to maintaining leg health and improving quality of life.