Venous leg ulcers Information for patients

Information for patients

                Venous leg ulcers

                           Northern General Hospital

You have been diagnosed as having a Venous Leg Ulcer.
This leaflet explains more about venous leg ulcers and
answers some of the most frequently asked questions.
If, after reading it, you have any more questions or
concerns, you should write them down and discuss them
at your next appointment.

Where will my hospital appointments take
place?
Your appointments will usually be at the Sheffield Vascular
Institute at the Northern General Hospital. We also run
local outpatient clinics at the Royal Hallamshire Hospital,
Rotherham and Barnsley District General.
The Sheffield Vascular Institute is one of the largest
vascular centres in Europe. We specialise in the treatment
of all circulatory conditions affecting the arteries, veins and
lymphatics. If you wish to find out more about the
Sheffield Vascular Institute then look under the Guide to
Services of the Sheffield Teaching Hospitals NHS
Foundation Trust website ( http://www.sth.nhs.uk ).

What is a leg ulcer?
A leg ulcer is a wound on the lower part of the leg that
takes longer than six weeks to heal. It is usually caused by
a minor injury that breaks the skin. In most people, such
an injury will heal up without difficulty within a week or
two. However, if there is an underlying circulation
problem then the skin may not heal. Leg ulcers can
develop quickly and, if untreated, can last for years.
It is important that they are properly diagnosed so that the
correct treatment can be given.

                               1

What causes leg ulcers?
Leg ulcers are usually due to a problem with your veins
(venous) or arteries (arterial). There are less common
causes for leg ulcers, such as diabetes or rheumatoid
arthritis.

               Normal               Leaking
               valves                valves

Veins are the blood vessels that carry blood back to the
heart. When your leg muscles move they help squeeze
blood back to the heart and the valves in the veins stop
the blood from flowing backwards. If these valves leak,
blood flows back down the legs and pressure builds up at
the ankle. This high pressure causes inflammation of the
skin (cellulitis) and causes swelling due to leakage of fluid
(pitting oedema). If untreated, this damage can result in
the development of a venous ulcer.
The leaky valves may be familial (run in the family) or may
be due to damage from a previous DVT (deep vein
thrombosis). Poor mobility can also cause the same
problem if the blood is not pumped out of the leg by the
muscles.
                              2

How can my ulcer be treated?
The majority of venous ulcers are treated by compression
therapy, which improves the blood flow up the leg. This
usually requires several layers of bandages around your
lower leg and foot. These are changed by your district or
practice nurse once or twice a week. If the ulcer is small
enough, it may be managed by a compression stocking
over a dressing. These are changed by your district or
practice nurse once or twice a week, but may need to be
changed more often if your ulcers are very leaky.

You can safely bathe or shower with your ulcer exposed
before having your legs redressed. This also helps to
remove any dry skin.

You should rest with your legs elevated whenever possible.
Try to exercise regularly. If you are unable to walk try
moving your feet up and down whilst sitting or lying.
Avoid long-distance travel until your ulcer has healed.

How long will it take for my ulcer to heal?
It has usually taken many years for the venous disease to
cause the ulcers, so it is not surprising that the ulcers may
take a long time to heal. Although many venous ulcers
will heal in 3 - 4 months, a small proportion can take
considerably longer. Ulcers which have been present for
months or years are slower to heal, and a stage may be
reached where healing is difficult without a period of bed
rest in hospital.

                              3

Will I need an operation?
If your ulcer is due to varicose veins, then these may be
treated when your ulcer has healed to reduce the risk of
further ulceration.

How can I stop the ulcer from coming back?
Once the ulcer has healed, you will need to wear
compression stockings to stop the ulcer from returning.
The hospital will give you a pair and then your GP will put
them on repeat prescription for you. Please keep the box
that your stockings came in as it can be used to ensure
that you get the correct stockings from your GP.
Depending upon the make of the stockings, you will need
new pairs every 3 or 6 months. Your specialist will advise
you on this. To avoid confusion, when you receive your
new stockings please throw your old supplies away.

If you required ‘made to measure’ stockings from the
hospital, you will need to attend the outpatient clinic every
6 months so we can arrange your next supply.

How do I use the stockings?
You should put on the stocking before you get out of bed
in a morning and only remove it before going to bed. If
you are unable to re-apply the stockings daily they can be
left in place overnight and changed every few days or even
weekly by a relative or nursing staff. You may also find it
useful to get an applicator specially made to help you put
the stockings on. This is also available on prescription.

                              4

Compression
                increases

You will usually be given below knee stockings unless the
venous damage is very extensive, and then you will need
thigh length stockings.

Compression stockings are available in 3 strengths: Class 1,
2 and 3. Class 2 is usually sufficient to control the swelling.
Open toe stockings can be worn under socks or tights.
Closed toe stockings can be worn by themselves like pop-
socks. There are many different makes of compression
stocking - if one kind doesn't suit you, try another.

How can I help myself?
There are other things which you can do to reduce the risk
of the ulcer returning:

• Eat a healthy balanced diet with plenty of fresh fruit
  and vegetables.

• Try to lose weight if you are overweight, as increased
  weight puts more strain on the veins.

                              5

• Exercise regularly, as this helps the calf muscle to
  pump blood up the veins. If you are unable to walk, try
  moving your feet up and down while you are sitting or
  lying. Consider an exercise bike.

• When sitting, elevate your leg on another chair or on
  the end of the sofa.

• Stop smoking; this damages the arteries that supply
  blood and oxygen to your legs and smoking delays the
  process of wound healing.

• Wear correctly fitting shoes with a low heel, and
  elevate you legs whenever possible.

• Wash and cream your legs regularly, and avoid dry
  skin which is more easily damaged.

• Seek immediate medical or nursing advice if you
  damage your skin. Never try to heal the wound yourself.

For futher advice or queries:
Vascular Nurse Specialists        (0114) 271 4688
                                         226 9311

The Circulation Foundation:
                    www.circulationfoundation.org.uk

                             6

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        © Sheffield Teaching Hospitals NHS Foundation Trust 2010.
        Re-use of all or any part of this document is governed by copyright and the “Re-use of Public Sector
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PD4735-PIL1352 V2
Issue date: September 2010. Review date: September 2012