Venous leg ulcer

A venous ulcer is a complication, the most advanced stage of chronic venous disease. It is a wound that struggles to heal as long as the venous cause sustaining it is not addressed.

The mechanism

A venous ulcer results from long-standing venous hypertension. High pressure in the venous network affects the cutaneous microcirculation and the tissues. The skin, poorly perfused and weakened, eventually breaks down, most often on the inner side of the leg, above the malleolus.

Unlike other wounds, a venous ulcer does not heal durably as long as venous hypertension persists. Its management combines local treatment of the wound, compression, and, when reflux is identified, treatment of that reflux at its origin.

Stage C6 of the CEAP

The CEAP classification grades chronic venous disease from C0 to C6. An open venous ulcer corresponds to stage C6, the most advanced on the clinical axis. Stage C5 designates a healed ulcer, C4 the skin changes that often precede ulceration.

This terminal position places the ulcer within the continuum of the disease. It does not appear in isolation, but at the end of a course in which venous hypertension has progressively damaged the skin. Preventing it means addressing reflux before this stage.

The underlying perforator reflux

Perforating veins connect the superficial network to the deep network. Their incompetence can sustain local venous hypertension beneath an ulcer, by feeding a reflux that is difficult to correct. This perforator reflux is one of the mechanisms that explain why a venous ulcer resists healing as long as its cause is not addressed.

The identification and management of reflux, superficial or perforator, are a specialized medical decision, based on the patient's full workup. The choice of the modality for treating reflux is not addressed on this page; it is covered in the dedicated concept.