Venous leg ulcers in Cairns

A shallow wound just above the ankle, usually on the inner side, that weeps, sits in discoloured skin and has not healed in six weeks. That is what a venous leg ulcer looks like, and it is the most common cause of a chronic wound on the lower leg.

Ulcers of this kind heal when the pressure in the veins is brought down. Dressings alone treat the surface of the problem. Finding and correcting the venous cause is what changes the trajectory.

Why they form

Venous ulcers are the end point of long-standing venous hypertension — sustained high pressure in the leg veins, caused either by failed valves in the superficial veins, damage to the deep veins after a previous clot, or both.

That pressure is transmitted to the smallest vessels in the skin. Over years, fluid and red cells leak into the tissue. The iron released as those cells break down stains the skin brown. The tissue becomes inflamed and then fibrotic, so the skin above the ankle thickens and tightens. Skin in that state has a poor blood supply at the capillary level and is fragile. A minor knock, an insect bite, or a scratch is enough to break it, and once broken it struggles to close.

The warning signs arrive long before the ulcer does:

Anyone with those changes should have a venous assessment, whether or not the skin has broken. That is the point at which the sequence can most readily be interrupted.

Not every leg ulcer is venous

This matters, because the treatments differ and one of them can cause harm if applied to the wrong ulcer.

Arterial ulcers occur when the arterial supply to the leg is inadequate. They tend to sit lower — on the toes, the heel, the outer ankle or over a bony point — look punched out, and are often painful, particularly at night and when the leg is elevated. Compression bandaging on a leg with poor arterial supply can worsen the situation.

Diabetic foot ulcers typically occur under a pressure point on the sole and are frequently painless because of neuropathy. They need a specific multidisciplinary approach.

Mixed ulcers — with both venous and arterial disease — are common in older patients and need the arterial supply assessed before any compression is applied.

Ulcers that are unusual in appearance, in an atypical site, or that fail to progress despite correct treatment need a different line of enquiry, which may include biopsy.

Establishing which kind of ulcer you have is the first job of the assessment, not an afterthought.

The assessment

Duplex ultrasound of the leg veins identifies where the reflux is, whether the deep veins are patent and normal, and whether there is a treatable superficial vein driving the pressure. Scans are performed on site at Lake Street by our sonographer, Jovin.

Arterial assessment — pulses, ankle-brachial index and, where indicated, arterial duplex — is done in parallel to establish whether the blood supply will support healing and whether compression is appropriate.

Wound swabs are taken only where infection is suspected clinically. All chronic wounds carry bacteria; the presence of organisms on a swab is not by itself a reason for antibiotics.

If you wear a bandage or dressing over the ulcer, it will be removed for the scan, so bring a spare dressing if you have one.

Treatment

Compression is the foundation. Graduated compression opposes the venous pressure that caused the ulcer and is the single most effective measure for healing. It is applied only once the arterial supply has been shown to be adequate. Compression is uncomfortable at first for many people, and getting through that period is the main determinant of whether an ulcer heals.

Treating the underlying reflux. Where duplex shows superficial venous reflux, closing the refluxing vein — by endovenous ablation, glue closure or surgery — addresses the cause rather than the wound. Current evidence supports treating superficial reflux early in venous ulceration, both to speed healing and to reduce the chance of the ulcer returning.

Wound care. Dressings keep the wound at an appropriate moisture level and protect the surrounding skin. They support healing; they do not drive it. Simple, non-adherent dressings under effective compression usually outperform expensive products under inadequate compression. Wound management is generally shared with your GP practice nurse or a community nursing service.

Skin care. Emollients for the surrounding skin, and treatment of venous eczema where present. Many people with venous ulcers develop contact sensitivity to dressing components over time, which is worth considering when a wound suddenly deteriorates.

Elevation and walking. Elevating the leg above hip level for periods during the day reduces swelling. Walking uses the calf muscle pump and helps venous return. Long periods of motionless standing or sitting work against both.

After the ulcer heals

Healing is not the end of it. Once venous skin damage has occurred, the leg remains at risk, and recurrence rates without ongoing management are substantial.

Long-term graduated compression stockings, continued skin care, and correction of any remaining venous reflux are what keep the skin intact. In this climate, compression through summer is the part people find hardest and the part that matters most — lighter-weight garments and having more than one pair in rotation both help.

Common questions

How long will it take to heal?

It depends on the size and duration of the ulcer and on how well compression is tolerated. Many uncomplicated venous ulcers heal within twelve to twenty-four weeks under effective compression. Ulcers present for a long time, or larger than a few centimetres across, generally take longer. An ulcer that is not measurably smaller after four to six weeks of correct treatment should prompt a review of the diagnosis.

Should I be on antibiotics?

Only if there is clinical evidence of infection — spreading redness, increasing pain, fever, a sudden change in the wound. Routine antibiotics for a chronic wound do not accelerate healing and contribute to resistance.

Can I shower with an ulcer?

Generally yes, and washing the leg is good for the skin. The specific advice depends on your dressing and bandaging system, so confirm it with the nurse managing the wound.

Is it worth treating my veins at my age?

Age alone is not the deciding factor. Vein closure for ulceration is usually performed under local anaesthetic and the aim is to keep the skin intact and avoid repeated ulcer episodes. Whether it is appropriate depends on the duplex findings, the arterial supply and your general health.

My ulcer keeps coming back in the same place.

That pattern usually means the underlying venous pressure has not been corrected, or compression has lapsed. It is a reason for a full reassessment rather than another course of dressings.

Does the heat here make it worse?

Swelling is typically worse in heat and humidity, and compression is harder to tolerate through the wet season. It is a real problem rather than an excuse, and it is worth planning around — including timing elective vein treatment for the cooler months.

Referral and appointments

GPs, practice nurses and community nurses: a leg ulcer that has not reduced in size after six weeks of appropriate care, or any ulcer where the arterial supply is uncertain, warrants a vascular opinion. Please include the duration of the ulcer, current dressing and compression regimen, palpable pulses or ABI if available, diabetic status and relevant history.

Patients: phone the rooms on (07) 4254 5006. Suite 9, Level 1, 193 Lake Street, Cairns.