Materiały źródłowe

• #1 Venous Leg Ulcer – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK567802/

  Venous leg ulcers are chronic wounds that result from prolonged venous insufficiency, primarily affecting older adults. […] These ulcers develop due to poor blood flow in the veins, leading to tissue breakdown, especially in the lower extremities. […] Although CVI is a well-known precipitant for VLU development, ulceration occurs rarely (5.1%) for unclear reasons. […] CVI may develop due to blood reflux, obstruction, or both mechanisms, causing macro- and micro-circulatory dysfunction. […] Most risk factors for the development of VLUs are non-modifiable, and patients often present with more than 1. […] Modifiable risk factors such as obesity and sedentarism are also associated with venous disease. […] Genetic traits may be an additional predisposing factor, presenting as an autosomal dominant trait with variable penetrance.

• #2 Leg Ulcers Treatment & Causes | Center for Vascular Medicine

  https://www.cvmus.com/vascular-treatment/leg-ulcer-treatment-common-causes

  Venous ulcers commonly occur near the ankles and are characterized by slow-healing, painful wounds. […] Faulty valves in the leg veins that disrupt blood flow, leading to venous insufficiency. […] Chronic leg ulcers often result from vascular conditions such as chronic venous insufficiency, arterial insufficiency, or a combination of both. […] Inadequate blood supply to the affected area hinders proper healing, making these ulcers resistant to treatment. […] Venous ulcers are the most common type of leg ulcers, accounting for approximately 70-90% of cases. […] They are typically a consequence of chronic venous insufficiency (CVI), which occurs when the valves in the leg veins are damaged or weakened, leading to impaired blood flow.

• #3 Venous leg ulcer | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/venous-leg-ulcer/

  A venous leg ulcer can develop after a minor injury if there’s a problem with the circulation of blood in your leg veins. If this happens, pressure inside the veins increases. […] This constant high pressure can gradually damage the tiny blood vessels in your skin and make it fragile. As a result, your skin can easily break and form an ulcer after a knock or scratch. […] Unless you have treatment to improve the circulation in your legs, the ulcer may not heal. […] Many factors can increase your risk of developing a venous leg ulcer, including: obesity or being overweight this increases the pressure in the leg veins […] previous deep vein thrombosis (DVT) blood clots that develop in the leg can damage valves in the veins […] varicose veins swollen and enlarged veins caused by malfunctioning valves

• #4 Venous leg ulcer | Mölnlycke Advantage

  https://www.molnlycke.ae/education/wound-areas/vlu/venous-leg-ulcer/

  The underlying cause of a venous leg ulcer (VLU) is venous disease. […] Venous leg ulcers are due to chronic venous insufficiency (CVI). […] The pathology can also include venous obstruction (e.g. from blood clotting). […] There are many risk factors for venous ulceration, including heredity, obesity, venous occlusion, and age. […] More than 95% of venous leg ulceration is in the leg below the knee, usually around the malleoli, and ulceration may be discrete or circumferential. […] In patients with chronic venous insufficiency, the inability of the calf muscles to pump venous blood contributes to the development and delayed healing of venous ulcers. […] Compression therapy is widely recognized as key to the management of venous leg ulcers, it increases healing rates in comparison with no compression therapy, and, after healing, reduces recurrence rates. […] It is essential that before treating a lower leg ulcer with compression therapy that the underlying aetiology has been established and arterial disease has been excluded. […] In 15-20% of venous leg ulcers an arterial impairment coexists, and the ulcers are known as mixed ulcers.

• #5 Venous Ulcer: Symptoms, Causes, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/23165-venous-ulcer

  A venous ulcer, also known as venous stasis ulcer, is a wound that takes longer than usual to heal. Its due to vein and blood flow issues and often occurs on your legs near your ankle. […] Venous ulcers occur when oxygen-poor blood cant flow from your extremities back to your heart. Instead, it pools, creating pressure in your veins. This damages skin tissue and leads to an ulcer. […] Your veins contain tiny valves that keep blood circulating throughout your body. These valves snap open and shut to move blood against the force of gravity back to your heart. In some people, venous diseases affect valve functioning. Other medical conditions, like diabetes, can also put you at risk for leg and foot ulcers. […] Chronic venous insufficiency is a common cause of valve dysfunction. It occurs when your valves are damaged or too weak to do their job.

• #6 Venous leg ulcer | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/venous-leg-ulcer/

  A venous leg ulcer can develop after a minor injury if there’s a problem with the circulation of blood in your leg veins. If this happens, pressure inside the veins increases. […] This constant high pressure can gradually damage the tiny blood vessels in your skin and make it fragile. As a result, your skin can easily break and form an ulcer after a knock or scratch. […] Unless you have treatment to improve the circulation in your legs, the ulcer may not heal. […] Many factors can increase your risk of developing a venous leg ulcer, including: obesity or being overweight this increases the pressure in the leg veins […] previous deep vein thrombosis (DVT) blood clots that develop in the leg can damage valves in the veins […] varicose veins swollen and enlarged veins caused by malfunctioning valves

• #7 Venous Ulcer: Symptoms, Causes, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/23165-venous-ulcer

  A venous ulcer, also known as venous stasis ulcer, is a wound that takes longer than usual to heal. Its due to vein and blood flow issues and often occurs on your legs near your ankle. […] Venous ulcers occur when oxygen-poor blood cant flow from your extremities back to your heart. Instead, it pools, creating pressure in your veins. This damages skin tissue and leads to an ulcer. […] Your veins contain tiny valves that keep blood circulating throughout your body. These valves snap open and shut to move blood against the force of gravity back to your heart. In some people, venous diseases affect valve functioning. Other medical conditions, like diabetes, can also put you at risk for leg and foot ulcers. […] Chronic venous insufficiency is a common cause of valve dysfunction. It occurs when your valves are damaged or too weak to do their job.

• #8 Venous ulcers – self-care: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/patientinstructions/000744.htm

  Venous ulcers (open sores) can occur when the veins in your legs do not push blood back up to your heart as well as they should. Blood backs up in the veins, building up pressure. If not treated, increased pressure and excess fluid in the affected area can cause an open sore to form. […] The cause of venous ulcers is high pressure in the veins of the lower leg. The veins have one-way valves that keep blood flowing up toward your heart. When these valves become weak or the veins become scarred and blocked, blood can flow backward and pool in your legs. This is called venous insufficiency. This leads to high pressure in the lower leg veins. The increase in pressure and buildup of fluid prevents nutrients and oxygen from getting to tissues. The lack of nutrients causes cells to die, damaging the tissue, and a wound can form.

• #9 Venous ulcer – Wikipedia

  https://en.wikipedia.org/wiki/Venous_ulcer

  Venous ulcers are wounds that are thought to occur due to improper functioning of venous valves, usually of the legs (hence leg ulcers). […] The exact cause of venous ulcers is not certain, but a common denominator is generally venous stasis, which may be caused by chronic venous insufficiency, and/or congestive heart failure. […] Venous stasis causes the pressure in veins to increase. […] Venous hypertension may also stretch veins and allow blood proteins to leak into the extravascular space, isolating extracellular matrix (ECM) molecules and growth factors, preventing them from helping to heal the wound. […] Venous insufficiency may also cause white blood cells (leukocytes) to accumulate in small blood vessels, releasing inflammatory factors and reactive oxygen species (ROS, free radicals) and further contributing to chronic wound formation.

• #10 Venous ulcers – self-care: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/patientinstructions/000744.htm

  Venous ulcers (open sores) can occur when the veins in your legs do not push blood back up to your heart as well as they should. Blood backs up in the veins, building up pressure. If not treated, increased pressure and excess fluid in the affected area can cause an open sore to form. […] The cause of venous ulcers is high pressure in the veins of the lower leg. The veins have one-way valves that keep blood flowing up toward your heart. When these valves become weak or the veins become scarred and blocked, blood can flow backward and pool in your legs. This is called venous insufficiency. This leads to high pressure in the lower leg veins. The increase in pressure and buildup of fluid prevents nutrients and oxygen from getting to tissues. The lack of nutrients causes cells to die, damaging the tissue, and a wound can form.

• #11 Why Venous Leg Ulcers Have Difficulty Healing: Overview on Pathophysiology, Clinical Consequences, and Treatment

  https://www.mdpi.com/2077-0383/10/1/29

  Venous leg ulcers (VLUs) are one of the most common ulcers of the lower extremity. VLU often occurs in association with post-thrombotic syndrome, advanced chronic venous disease, varicose veins, and venous hypertension. Several demographic, genetic, and environmental factors could trigger chronic venous disease with venous dilation, incompetent valves, venous reflux, and venous hypertension. Endothelial cell injury and changes in the glycocalyx, venous shear-stress, and adhesion molecules could be initiating events in VLU. Increased endothelial cell permeability and leukocyte infiltration, and increases in inflammatory cytokines, matrix metalloproteinases (MMPs), reactive oxygen and nitrogen species, iron deposition, and tissue metabolites also contribute to the pathogenesis of VLU. VLU can be defined as a full-thickness defect of the skin frequently seen in the ankle region that fails to heal spontaneously and is sustained by chronic venous disease (CVD, the spectrum of venous diseases affecting the lower limbs). The majority (70–80%) of patients with VLU have primary venous insufficiency (reflux) from varicose vein disease, and about 20–30% have secondary venous insufficiency from post thrombotic syndrome (PTS). Although there are many more patients with primary venous insufficiency, PTS has a much higher risk of developing VLU and is much more aggressive in its natural history, making treatment more challenging. It has been estimated that the venous origin impacts 50–75% of chronic leg ulcers, and this percentage heavily increases if foot ulcers are excluded. Chronic wounds of the lower extremities could be sustained by several local and systemic causative factors, leading to a broad comparison among ulcers. Misdiagnosis of a leg ulcer has a great impact both on patient’s suffering, due to delayed wound healing, and on economic costs. Chronic VLUs provide a fertile breeding ground for the onset of several complications, ranging from immobility and reduced quality of life to cellulitis, severe infections, osteomyelitis, and neoplastic transformation. Recalcitrant ulcers also show prolonged healing time and often occur in individuals with advanced age, higher body mass index, and nutritional deficiencies and in association with colder temperature, preexisting or underlying venous disease, deep venous thrombosis, venous outflow obstruction, and larger wound area. VLU has a high 50–70% recurrence rate possibly due to patient noncompliance with compression therapy, surgical procedure failure, mixed VLU disease with arterial component, incorrect diagnosis of ulcer, and progression of venous disease. Several predisposing demographic, genetic, and environmental factors could lead to CVD with extensive venous dilation, incompetent valves, venous reflux, and venous hypertension.

• #12 Venous leg ulcer | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/venous-leg-ulcer/

  A venous leg ulcer can develop after a minor injury if there’s a problem with the circulation of blood in your leg veins. If this happens, pressure inside the veins increases. […] This constant high pressure can gradually damage the tiny blood vessels in your skin and make it fragile. As a result, your skin can easily break and form an ulcer after a knock or scratch. […] Unless you have treatment to improve the circulation in your legs, the ulcer may not heal. […] Many factors can increase your risk of developing a venous leg ulcer, including: obesity or being overweight this increases the pressure in the leg veins […] previous deep vein thrombosis (DVT) blood clots that develop in the leg can damage valves in the veins […] varicose veins swollen and enlarged veins caused by malfunctioning valves

• #13 Venous Leg Ulcer – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK567802/

  Venous leg ulcers are chronic wounds that result from prolonged venous insufficiency, primarily affecting older adults. […] These ulcers develop due to poor blood flow in the veins, leading to tissue breakdown, especially in the lower extremities. […] Although CVI is a well-known precipitant for VLU development, ulceration occurs rarely (5.1%) for unclear reasons. […] CVI may develop due to blood reflux, obstruction, or both mechanisms, causing macro- and micro-circulatory dysfunction. […] Most risk factors for the development of VLUs are non-modifiable, and patients often present with more than 1. […] Modifiable risk factors such as obesity and sedentarism are also associated with venous disease. […] Genetic traits may be an additional predisposing factor, presenting as an autosomal dominant trait with variable penetrance.

• #14

  https://link.springer.com/article/10.1007/BF01658644

  Venous ulceration is caused by the disorganization of the microcirculation that is induced by prolonged venous hypertension. The most common cause of calf pump inefficiency that permits superficial venous hypertension during exercise is deep vein thrombosis. Venous hypertension causes venular dilatation and an increased capillary permeability. Fibrin is deposited around the capillaries and not removed because of a vein wall deficiency of the fibrinolytic activator. The fibrin acts as a diffusion barrier and the overlying dermis becomes anoxic. Any minor trauma then causes an ulcer. Ulcers can be cured by restoring calf pump function to normal. […] La ulceracin venosa es causada por desorganizacin de la microcirculacon que induce una prolongada hipertensin venosa. La causa ms comn de ineficiencia de la bomba muscular de la pantorrilla, la cual hace posible el desarrollo de hipertensin venosa superficial en el curso del ejercicio, es la trombosis de las venas profundas. La hipertensin venosa causa dilatacin de las vnulas y un aumento de la permeabilidad capilar. Esto resulta en depsitos de fibrina alrededor de los capilares, fibrina que no puede ser removida debido a una deficiencia del activador de fibrinolisis en la pared de la vena. La fibrina acta como una barrera para la difusin de oxgeno, con lo cual la dermis se hace anxica. Ahora cualquier trauma menor puede iniciar la ulceracin. Las lceras pueden ser curadas restaurando la funcin de bombeo de la pantorrilla a su estado normal.

• #15 Venous Leg Ulcer – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK567802/

  However, a specific gene or gene set has not been determined. […] Compared with healing VLUs, the gene expression profile of non-healing VLUs showed upregulation of secreted frizzled-related protein 4, branched-chain aminotransferase 1, dermatopontin, cytochrome P450, and 17 B hydroxysteroid dehydrogenase genes, which are involved in inflammation control, Wnt signaling, cell growth, extracellular matrix assembly, and steroidogenesis. […] Conversely, collagen differentiation and epidermal repair genes such as collagen type 131, collagen 271, keratin 14, keratin 16, and heparin-binding epidermal growth factor were notoriously downregulated. […] Besides these, single nucleotide polymorphisms of high iron, ferroportin 1, and matrix metalloproteinase 12 indicate venous ulcer development susceptibility.

• #16 Why Venous Leg Ulcers Have Difficulty Healing: Overview on Pathophysiology, Clinical Consequences, and Treatment

  https://www.mdpi.com/2077-0383/10/1/29

  Venous leg ulcers (VLUs) are one of the most common ulcers of the lower extremity. VLU often occurs in association with post-thrombotic syndrome, advanced chronic venous disease, varicose veins, and venous hypertension. Several demographic, genetic, and environmental factors could trigger chronic venous disease with venous dilation, incompetent valves, venous reflux, and venous hypertension. Endothelial cell injury and changes in the glycocalyx, venous shear-stress, and adhesion molecules could be initiating events in VLU. Increased endothelial cell permeability and leukocyte infiltration, and increases in inflammatory cytokines, matrix metalloproteinases (MMPs), reactive oxygen and nitrogen species, iron deposition, and tissue metabolites also contribute to the pathogenesis of VLU. VLU can be defined as a full-thickness defect of the skin frequently seen in the ankle region that fails to heal spontaneously and is sustained by chronic venous disease (CVD, the spectrum of venous diseases affecting the lower limbs). The majority (70–80%) of patients with VLU have primary venous insufficiency (reflux) from varicose vein disease, and about 20–30% have secondary venous insufficiency from post thrombotic syndrome (PTS). Although there are many more patients with primary venous insufficiency, PTS has a much higher risk of developing VLU and is much more aggressive in its natural history, making treatment more challenging. It has been estimated that the venous origin impacts 50–75% of chronic leg ulcers, and this percentage heavily increases if foot ulcers are excluded. Chronic wounds of the lower extremities could be sustained by several local and systemic causative factors, leading to a broad comparison among ulcers. Misdiagnosis of a leg ulcer has a great impact both on patient’s suffering, due to delayed wound healing, and on economic costs. Chronic VLUs provide a fertile breeding ground for the onset of several complications, ranging from immobility and reduced quality of life to cellulitis, severe infections, osteomyelitis, and neoplastic transformation. Recalcitrant ulcers also show prolonged healing time and often occur in individuals with advanced age, higher body mass index, and nutritional deficiencies and in association with colder temperature, preexisting or underlying venous disease, deep venous thrombosis, venous outflow obstruction, and larger wound area. VLU has a high 50–70% recurrence rate possibly due to patient noncompliance with compression therapy, surgical procedure failure, mixed VLU disease with arterial component, incorrect diagnosis of ulcer, and progression of venous disease. Several predisposing demographic, genetic, and environmental factors could lead to CVD with extensive venous dilation, incompetent valves, venous reflux, and venous hypertension.

• #17 Rationale for surgery in the treatment of venous ulcer of the leg – Servier – PhlebolymphologyServier – Phlebolymphology

  https://www.phlebolymphology.org/rationale-for-surgery-in-the-treatment-of-venous-ulcer-of-the-leg/

  Venous ulcer of the leg is the most severe clinical presentation of chronic venous insufficiency. […] In leg ulcer, the venous etiology is more frequent than an arterial, combined (arterial and venous) or nonvascular etiology. A venous etiology accounts for 70% to 80% of cases, depending on whether or not combined ulcers are included. […] A constant finding in patients presenting with chronic venous insufficiency (CVI) and, particularly, the severe form, VU, consists of elevated venous pressure in ambulatory settings. The increase in ambulatory venous pressure may be related to two pathophysiological factors: reflux and obstruction, or a combination of those two factors. […] Doppler ultrasound investigation of leg ulcers, if VU only are considered, shows that, in 40% to 50% of cases, the primary etiology is located in the superficial venous network (with or without the perforators), ie, primary varices.

• #18 Venous leg ulcer | Mölnlycke Advantage

  https://www.molnlycke.ae/education/wound-areas/vlu/venous-leg-ulcer/

  The underlying cause of a venous leg ulcer (VLU) is venous disease. […] Venous leg ulcers are due to chronic venous insufficiency (CVI). […] The pathology can also include venous obstruction (e.g. from blood clotting). […] There are many risk factors for venous ulceration, including heredity, obesity, venous occlusion, and age. […] More than 95% of venous leg ulceration is in the leg below the knee, usually around the malleoli, and ulceration may be discrete or circumferential. […] In patients with chronic venous insufficiency, the inability of the calf muscles to pump venous blood contributes to the development and delayed healing of venous ulcers. […] Compression therapy is widely recognized as key to the management of venous leg ulcers, it increases healing rates in comparison with no compression therapy, and, after healing, reduces recurrence rates. […] It is essential that before treating a lower leg ulcer with compression therapy that the underlying aetiology has been established and arterial disease has been excluded. […] In 15-20% of venous leg ulcers an arterial impairment coexists, and the ulcers are known as mixed ulcers.

• #19 Venous Ulcer: Symptoms, Causes, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/23165-venous-ulcer

  A venous ulcer, also known as venous stasis ulcer, is a wound that takes longer than usual to heal. Its due to vein and blood flow issues and often occurs on your legs near your ankle. […] Venous ulcers occur when oxygen-poor blood cant flow from your extremities back to your heart. Instead, it pools, creating pressure in your veins. This damages skin tissue and leads to an ulcer. […] Your veins contain tiny valves that keep blood circulating throughout your body. These valves snap open and shut to move blood against the force of gravity back to your heart. In some people, venous diseases affect valve functioning. Other medical conditions, like diabetes, can also put you at risk for leg and foot ulcers. […] Chronic venous insufficiency is a common cause of valve dysfunction. It occurs when your valves are damaged or too weak to do their job.

• #20 Venous Ulcer Causes, Symptoms, and Treatments

  https://www.upmc.com/services/heart-vascular/conditions/venous-ulcer

  Venous ulcers occur because of poor blood flow in the leg veins. […] Valves inside the leg veins control blood flow through the veins. But these valves can get damaged, altering blood flow and leading to ulcers. […] Venous ulcers often form because of an underlying issue that reduces wound healing or damages the skin, such as: Venous hypertension When you walk, usually your blood pressure drops in the legs. When that doesn’t happen, you have venous hypertension, which causes ulcers to form. […] Venous insufficiency When the leg veins cannot pump blood back to the heart, the blood pools in your legs, causing swelling. Over time, the swelling damages the skin and makes it hard for your body to heal. […] Varicose veins Problems in the leg vein valves lead to blood pooling in the lower leg. This pooling causes varicose veins and can lead to an ulcer.

• #21 Symptoms of a Venous leg ulcers – why is my leg ulcer not healing?

  https://legsmatter.org/information-and-support/types-of-ulcers/venous-leg-ulcers/

  A venous leg ulcer (VLU) is a break in the skin, between the knee and ankle joint, and is caused by damage to the vein(s) in the lower leg, which become weaker. The weakened vein walls prevent the valves in the veins from closing sufficiently. If the valves cannot close properly, some of the venous blood backflows when the heart beats and the pressure inside the vein increases, pushing small components of the venous blood across the vein wall into the surrounding flesh and skin. This damages the flesh and breaks the skin. Because the vein is weak and leaking, the skin cannot heal. […] Veins can become damaged due to a number of reasons, including; An injury, Previous fracture of the bones in the leg, ankle or foot, Previous operations, A clot (DVT), Increased abdominal weight (pregnancies or obesity), Because the veins get weaker as we get older. […] Venous ulcers can recur if the damaged vein is not supported or removed. Therefore, compression garments should be worn even when the ulcer has healed to stop it coming back.

• #22 Venous Leg Ulcers: Causes, Symptoms and Treatment – Michael Gaunt

  https://michaelgaunt.com/venous-leg-ulcers-causes-symptoms-and-top-tips/

  Venous ulcers are painful open sores that appear around the lower leg and ankles. Many sufferers do not realise that they can be caused by varicose veins and poor circulation. Damaged vein valves cause sustained venous hypertension when blood pressure inside your legs isnt regulated, toxins build up and poison the skin. […] Swelling and ulceration can be caused by venous abnormalities in the leg veins such as leaky valves Michael Gaunt […] High venous blood pressure causes inflammation and swelling. Persistent inflammation due to varicose veins weakens the skin making it vulnerable to injury. Venous ulcers appear as skin breaks open as a sore. […] What causes venous leg ulcers? […] Varicose Veins: Raised veins, bulging or twisted in appearance. […] Chronic venous insufficiency: Poor circulation allowing blood to collect in lower legs causing swelling and discomfort. […] High venous blood pressure in your legs: Skin becomes fragile and thin, breaking open to form a sore. […] Poor venous circulation: When damaged vein valves struggle to pump the blood back to your heart. […] Inactivity: Lack of movement promotes poor circulation and blood flow.

• #23

• #24 Venous leg ulcer | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/venous-leg-ulcer/

  A venous leg ulcer can develop after a minor injury if there’s a problem with the circulation of blood in your leg veins. If this happens, pressure inside the veins increases. […] This constant high pressure can gradually damage the tiny blood vessels in your skin and make it fragile. As a result, your skin can easily break and form an ulcer after a knock or scratch. […] Unless you have treatment to improve the circulation in your legs, the ulcer may not heal. […] Many factors can increase your risk of developing a venous leg ulcer, including: obesity or being overweight this increases the pressure in the leg veins […] previous deep vein thrombosis (DVT) blood clots that develop in the leg can damage valves in the veins […] varicose veins swollen and enlarged veins caused by malfunctioning valves

• #25

  https://link.springer.com/article/10.1007/BF01658644

  Venous ulceration is caused by the disorganization of the microcirculation that is induced by prolonged venous hypertension. The most common cause of calf pump inefficiency that permits superficial venous hypertension during exercise is deep vein thrombosis. Venous hypertension causes venular dilatation and an increased capillary permeability. Fibrin is deposited around the capillaries and not removed because of a vein wall deficiency of the fibrinolytic activator. The fibrin acts as a diffusion barrier and the overlying dermis becomes anoxic. Any minor trauma then causes an ulcer. Ulcers can be cured by restoring calf pump function to normal. […] La ulceracin venosa es causada por desorganizacin de la microcirculacon que induce una prolongada hipertensin venosa. La causa ms comn de ineficiencia de la bomba muscular de la pantorrilla, la cual hace posible el desarrollo de hipertensin venosa superficial en el curso del ejercicio, es la trombosis de las venas profundas. La hipertensin venosa causa dilatacin de las vnulas y un aumento de la permeabilidad capilar. Esto resulta en depsitos de fibrina alrededor de los capilares, fibrina que no puede ser removida debido a una deficiencia del activador de fibrinolisis en la pared de la vena. La fibrina acta como una barrera para la difusin de oxgeno, con lo cual la dermis se hace anxica. Ahora cualquier trauma menor puede iniciar la ulceracin. Las lceras pueden ser curadas restaurando la funcin de bombeo de la pantorrilla a su estado normal.

• #26 Why Venous Leg Ulcers Have Difficulty Healing: Overview on Pathophysiology, Clinical Consequences, and Treatment

  https://www.mdpi.com/2077-0383/10/1/29

  Venous leg ulcers (VLUs) are one of the most common ulcers of the lower extremity. VLU often occurs in association with post-thrombotic syndrome, advanced chronic venous disease, varicose veins, and venous hypertension. Several demographic, genetic, and environmental factors could trigger chronic venous disease with venous dilation, incompetent valves, venous reflux, and venous hypertension. Endothelial cell injury and changes in the glycocalyx, venous shear-stress, and adhesion molecules could be initiating events in VLU. Increased endothelial cell permeability and leukocyte infiltration, and increases in inflammatory cytokines, matrix metalloproteinases (MMPs), reactive oxygen and nitrogen species, iron deposition, and tissue metabolites also contribute to the pathogenesis of VLU. VLU can be defined as a full-thickness defect of the skin frequently seen in the ankle region that fails to heal spontaneously and is sustained by chronic venous disease (CVD, the spectrum of venous diseases affecting the lower limbs). The majority (70–80%) of patients with VLU have primary venous insufficiency (reflux) from varicose vein disease, and about 20–30% have secondary venous insufficiency from post thrombotic syndrome (PTS). Although there are many more patients with primary venous insufficiency, PTS has a much higher risk of developing VLU and is much more aggressive in its natural history, making treatment more challenging. It has been estimated that the venous origin impacts 50–75% of chronic leg ulcers, and this percentage heavily increases if foot ulcers are excluded. Chronic wounds of the lower extremities could be sustained by several local and systemic causative factors, leading to a broad comparison among ulcers. Misdiagnosis of a leg ulcer has a great impact both on patient’s suffering, due to delayed wound healing, and on economic costs. Chronic VLUs provide a fertile breeding ground for the onset of several complications, ranging from immobility and reduced quality of life to cellulitis, severe infections, osteomyelitis, and neoplastic transformation. Recalcitrant ulcers also show prolonged healing time and often occur in individuals with advanced age, higher body mass index, and nutritional deficiencies and in association with colder temperature, preexisting or underlying venous disease, deep venous thrombosis, venous outflow obstruction, and larger wound area. VLU has a high 50–70% recurrence rate possibly due to patient noncompliance with compression therapy, surgical procedure failure, mixed VLU disease with arterial component, incorrect diagnosis of ulcer, and progression of venous disease. Several predisposing demographic, genetic, and environmental factors could lead to CVD with extensive venous dilation, incompetent valves, venous reflux, and venous hypertension.

• #27

  https://www.nhs.uk/conditions/leg-ulcer/

  A venous leg ulcer is the most common type of leg ulcer, accounting for more than 60% of all cases. […] Venous leg ulcers can develop after a minor injury, if persistently high pressure in the veins of the legs has weakened the skin. […] You’re more at risk of developing one if you previously had deep vein thrombosis (DVT) or find it difficult to walk because of a problem such as: […] People with swollen and enlarged veins (varicose veins) also have a higher risk of developing venous leg ulcers. […] But unless the underlying cause of the ulcer is addressed, there’s a high risk of a venous leg ulcer coming back after treatment. […] Underlying causes could include immobility, obesity, previous DVT or varicose veins.

• #28 Venous leg ulcer | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/venous-leg-ulcer/

  A venous leg ulcer can develop after a minor injury if there’s a problem with the circulation of blood in your leg veins. If this happens, pressure inside the veins increases. […] This constant high pressure can gradually damage the tiny blood vessels in your skin and make it fragile. As a result, your skin can easily break and form an ulcer after a knock or scratch. […] Unless you have treatment to improve the circulation in your legs, the ulcer may not heal. […] Many factors can increase your risk of developing a venous leg ulcer, including: obesity or being overweight this increases the pressure in the leg veins […] previous deep vein thrombosis (DVT) blood clots that develop in the leg can damage valves in the veins […] varicose veins swollen and enlarged veins caused by malfunctioning valves

• #29 Venous leg ulcers – BAD Patient Hub

  https://www.skinhealthinfo.org.uk/condition/venous-leg-ulcers/

  A venous leg ulcer is an open wound in the skin of the lower leg due to high pressure of the blood in the leg veins. […] The main cause of venous leg ulcers is faulty valves inside the leg veins. These valves normally allow the blood to flow up the leg towards the heart, and they also prevent backward flow down the leg. If the valves are faulty, backward flow is not prevented and pressure builds up inside the veins. The persistent high pressure in the leg veins, caused by the faulty valves, damages tiny blood vessels in the skin. […] Some people are born with weak valves. In others, the valves are damaged after a venous thrombosis (a blood clot forming within a vein). Valves tend to weaken with age. Sometimes they are a result of faulty veins valves and narrow arteries in the limbs. […] Venous leg ulcers are not hereditary; however, some of the things that increase your chances of developing a venous leg ulcer do run in families – such as poor valves, a tendency to have a blood clot or to have abnormal veins and arteries in the lower limbs.

• #30 Varicose Leg Ulcers: Causes, Symptoms, and Risk Factors

  https://tinsleysurgical.com/understanding-varicose-leg-ulcers-causes-symptoms-and-risk-factors/

  A varicose leg ulcer is an open sore that typically forms near the ankle due to damaged veins and poor blood circulation. These venous ulcers arise when weakened vein walls and faulty valves cause blood to pool in the lower legs. This buildup increases venous pressure, making it difficult for your body to heal even minor injuries, leading to chronic, non-healing wounds. […] Understanding the root causes of venous leg ulcers is crucial for effective treatment and prevention. The primary cause is chronic venous insufficiency, a condition where the veins struggle to send blood back to the heart efficiently. Here are the main factors contributing to varicose leg ulcers: […] Varicose veins are enlarged, twisted veins that often appear on the legs. They occur when the valves within your veins fail to function correctly, allowing blood to flow backward and pool in the leg veins. This stagnation weakens the vein walls, leading to the formation of ulcers.

• #31 Arterial vs Venous Ulcers: Diagnosis, Treatment, Symptoms & More

  https://www.healthline.com/health/arterial-vs-venous-ulcers

  Venous ulcers are the most common type of leg ulcer. Theyre caused by damage to the veins. The veins are responsible for bringing blood from various parts of the body to the heart through one-way valves. These valves prevent blood from flowing away from the heart. […] If blood doesnt flow correctly, it could pool in one area of the body. This results in damage to the vein and leakage of fluid and blood cells, causing edema, or swelling. This is thought to prevent adequate blood flow to the tissue in the leg. As a result, this tissue will die, and ulcers will begin to form. […] Other potential causes of venous ulcers include: varicose veins, high blood pressure, trauma, fractures or injuries, obesity, blood clotting disorders, deep vein thrombosis, heart failure, pregnancy. […] Poor blood circulation often causes ulcers. When theres reduced blood flow, skin and tissues in the affected areas are deprived of oxygen and nutrients. These areas will become inflamed and form an open wound. […] Though ulcers can form anywhere on the body, arterial and venous ulcers are more commonly found on the legs and feet.

• #32 Leg Ulcers – Types & Causes

  https://thewhiteleyclinic.co.uk/conditions/leg-ulcers/

  Leg ulcers are open, non-healing wounds of the legs. They are usually on the lower legs or the feet. […] Since the 1990’s, research has shown that the real root cause of a leg ulcer appearing is abnormal blood supply to the skin. Occasionally it is blood supply taking nutrients to the skin. However, in most cases, this is due to varicose veins or “hidden varicose veins”. In these cases, the veins are failing to take the venous blood away from the leg. This causes inflammation and skin damage. […] There are 3 main causes of leg ulcers: Venous, Arterial, Other Causes. […] Venous leg ulcers are caused by veins not working properly – about 80-90% of leg ulcers. Most of these are due to the valves not working – varicose veins or “hidden varicose veins”. […] Other venous causes include obstruction where the vein is narrowed or blocked, or stasis. […] Research published in the 1990s showed that most venous leg ulcers were caused by superficial vein reflux. […] Most venous leg ulcers are curable by varicose vein surgery. […] Varicose veins are not cosmetic as they can go on to cause venous leg ulcers.

• #33 Leg Ulcers – Types & Causes

  https://thewhiteleyclinic.co.uk/conditions/leg-ulcers/

  Leg ulcers are open, non-healing wounds of the legs. They are usually on the lower legs or the feet. […] Since the 1990’s, research has shown that the real root cause of a leg ulcer appearing is abnormal blood supply to the skin. Occasionally it is blood supply taking nutrients to the skin. However, in most cases, this is due to varicose veins or “hidden varicose veins”. In these cases, the veins are failing to take the venous blood away from the leg. This causes inflammation and skin damage. […] There are 3 main causes of leg ulcers: Venous, Arterial, Other Causes. […] Venous leg ulcers are caused by veins not working properly – about 80-90% of leg ulcers. Most of these are due to the valves not working – varicose veins or “hidden varicose veins”. […] Other venous causes include obstruction where the vein is narrowed or blocked, or stasis. […] Research published in the 1990s showed that most venous leg ulcers were caused by superficial vein reflux. […] Most venous leg ulcers are curable by varicose vein surgery. […] Varicose veins are not cosmetic as they can go on to cause venous leg ulcers.

• #34

  https://www.nhs.uk/conditions/leg-ulcer/

  A venous leg ulcer is the most common type of leg ulcer, accounting for more than 60% of all cases. […] Venous leg ulcers can develop after a minor injury, if persistently high pressure in the veins of the legs has weakened the skin. […] You’re more at risk of developing one if you previously had deep vein thrombosis (DVT) or find it difficult to walk because of a problem such as: […] People with swollen and enlarged veins (varicose veins) also have a higher risk of developing venous leg ulcers. […] But unless the underlying cause of the ulcer is addressed, there’s a high risk of a venous leg ulcer coming back after treatment. […] Underlying causes could include immobility, obesity, previous DVT or varicose veins.

• #35 Venous leg ulcer | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/venous-leg-ulcer/

  A venous leg ulcer can develop after a minor injury if there’s a problem with the circulation of blood in your leg veins. If this happens, pressure inside the veins increases. […] This constant high pressure can gradually damage the tiny blood vessels in your skin and make it fragile. As a result, your skin can easily break and form an ulcer after a knock or scratch. […] Unless you have treatment to improve the circulation in your legs, the ulcer may not heal. […] Many factors can increase your risk of developing a venous leg ulcer, including: obesity or being overweight this increases the pressure in the leg veins […] previous deep vein thrombosis (DVT) blood clots that develop in the leg can damage valves in the veins […] varicose veins swollen and enlarged veins caused by malfunctioning valves

• #36 Causes of Venous Ulcers and How to Prevent Them?

  https://www.drsumitkapadia.com/blog/causes-of-venous-ulcers-and-how-to-prevent-venous-ulcers/

  Venous ulcers, or leg ulcers, result from issues with blood circulation in the veins of the legs. These ulcers develop when there’s a disruption to the normal flow of blood, often due to damage to the valves within the leg veins. This can lead to persistent wounds, as the compromised blood flow hinders the body’s natural healing process. […] Venous Hypertension […] This chronic high pressure in the veins of the legs can lead to the formation of ulcers. […] Venous Insufficiency […] The resulting swelling can damage the skin over time and inhibit the body’s healing ability, potentially leading to ulcers. […] Varicose Veins […] This pooling of blood can cause damage to the skin and underlying tissues, increasing the risk of ulcer formation. […] Blood Clots or Old Deep Vein Thrombosis (DVT)

• #37 Symptoms of a Venous leg ulcers – why is my leg ulcer not healing?

  https://legsmatter.org/information-and-support/types-of-ulcers/venous-leg-ulcers/

  A venous leg ulcer (VLU) is a break in the skin, between the knee and ankle joint, and is caused by damage to the vein(s) in the lower leg, which become weaker. The weakened vein walls prevent the valves in the veins from closing sufficiently. If the valves cannot close properly, some of the venous blood backflows when the heart beats and the pressure inside the vein increases, pushing small components of the venous blood across the vein wall into the surrounding flesh and skin. This damages the flesh and breaks the skin. Because the vein is weak and leaking, the skin cannot heal. […] Veins can become damaged due to a number of reasons, including; An injury, Previous fracture of the bones in the leg, ankle or foot, Previous operations, A clot (DVT), Increased abdominal weight (pregnancies or obesity), Because the veins get weaker as we get older. […] Venous ulcers can recur if the damaged vein is not supported or removed. Therefore, compression garments should be worn even when the ulcer has healed to stop it coming back.

• #38

  https://www.nsc.com.sg/patients-and-visitors/Health-Library/Conditions-And-Treatments/Pages/Chronic-Venous-Leg-Ulcers.aspx

  What causes venous leg ulcers? The blood supply of the leg consists of blood vessels called veins that return blood from the lower legs to the heart, assisted by valves that ensure that the one-way upward flow of blood. In many patients with venous leg ulcers, these valves are not working properly, causing blood to pool in the lower legs. This can lead to swelling and darkening of the skin, and eventually to venous leg ulcers. […] Some of the risk factors include patients with a past history of a blood clot in the leg veins (deep vein thrombosis), lower leg injury, varicose veins, obesity, smoking and prolonged standing. Patients who have difficulty moving or walking can also get venous leg ulcers because of loss of calf-muscle pump action which is important for venous blood circulation.

• #39 :: Journal of Wound Management and Research

  https://www.jwmr.org/m/journal/view.php?number=414

  Defined as an ulceration in a lower extremity caused by venous hypertension, venous ulcers are a common condition which are known to affect approximately 1% of the population. […] Risk factors include old age, obesity, previous trauma history, immobility and genetic thrombophilic conditions such as factor V Leiden mutation. […] Venous ulcers are open skin wounds occurring in regions of the leg or foot affected by venous hypertension. […] The pathophysiology of venous ulcers is a complex process with various associated signs such as varicose veins, chronic discharge, dermatitis, skin hyperpigmentation and fibrosis. […] Obstruction is an important factor in the pathogenesis of venous ulcers. […] Genetic mutation can be a predisposing factor for developing venous ulcers. […] The term postphlebitic syndrome was used to explain the etiology of venous ulcerations. […] Numerous theories have been proposed to explain the pathogenesis of venous hypertension causing ulceration from structural to molecular levels. […] Venous ulcers are a common condition caused by venous reflux and obstruction ultimately resulting in venous hypertension.

• #40 4 Risk Factors of Venous Ulcers You Should Know: Clement Banda, MD: Dermatologist

  https://www.mdveins.com/blog/4-risk-factors-of-venous-ulcers-you-should-know

  As you get older, you might find that simple cuts and scrapes on your lower legs take longer to heal. When this delayed healing happens because of increased blood pressure in leg veins, the open sore is called a venous stasis ulcer. Sometimes, the wound can form because of the elevated pressure in veins. […] People with deep vein thrombosis or a family history that includes deep vein thrombosis have an elevated risk for venous ulcers. […] Certain lifestyle factors can increase your chances of slow-healing ulcers. The use of tobacco products produces negative changes in blood vessels. Being overweight adds additional strain to the veins in your legs. People who need to sit or stand for long periods at work miss out on the vital pumping action that movement creates. This compromises blood circulation in the legs, making ulcers more likely.

• #41 :: Journal of Wound Management and Research

  https://www.jwmr.org/m/journal/view.php?number=414

  Defined as an ulceration in a lower extremity caused by venous hypertension, venous ulcers are a common condition which are known to affect approximately 1% of the population. […] Risk factors include old age, obesity, previous trauma history, immobility and genetic thrombophilic conditions such as factor V Leiden mutation. […] Venous ulcers are open skin wounds occurring in regions of the leg or foot affected by venous hypertension. […] The pathophysiology of venous ulcers is a complex process with various associated signs such as varicose veins, chronic discharge, dermatitis, skin hyperpigmentation and fibrosis. […] Obstruction is an important factor in the pathogenesis of venous ulcers. […] Genetic mutation can be a predisposing factor for developing venous ulcers. […] The term postphlebitic syndrome was used to explain the etiology of venous ulcerations. […] Numerous theories have been proposed to explain the pathogenesis of venous hypertension causing ulceration from structural to molecular levels. […] Venous ulcers are a common condition caused by venous reflux and obstruction ultimately resulting in venous hypertension.

• #42 Venous Leg Ulcer – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK567802/

  Venous leg ulcers are chronic wounds that result from prolonged venous insufficiency, primarily affecting older adults. […] These ulcers develop due to poor blood flow in the veins, leading to tissue breakdown, especially in the lower extremities. […] Although CVI is a well-known precipitant for VLU development, ulceration occurs rarely (5.1%) for unclear reasons. […] CVI may develop due to blood reflux, obstruction, or both mechanisms, causing macro- and micro-circulatory dysfunction. […] Most risk factors for the development of VLUs are non-modifiable, and patients often present with more than 1. […] Modifiable risk factors such as obesity and sedentarism are also associated with venous disease. […] Genetic traits may be an additional predisposing factor, presenting as an autosomal dominant trait with variable penetrance.

• #43 Venous leg ulcer | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/venous-leg-ulcer/

  A venous leg ulcer can develop after a minor injury if there’s a problem with the circulation of blood in your leg veins. If this happens, pressure inside the veins increases. […] This constant high pressure can gradually damage the tiny blood vessels in your skin and make it fragile. As a result, your skin can easily break and form an ulcer after a knock or scratch. […] Unless you have treatment to improve the circulation in your legs, the ulcer may not heal. […] Many factors can increase your risk of developing a venous leg ulcer, including: obesity or being overweight this increases the pressure in the leg veins […] previous deep vein thrombosis (DVT) blood clots that develop in the leg can damage valves in the veins […] varicose veins swollen and enlarged veins caused by malfunctioning valves

• #44 Venous leg ulcer | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/venous-leg-ulcer/

  previous injury to the leg, such as a broken or fractured bone, which may cause DVT or affect your walking […] previous surgery to the leg, such as a hip replacement or knee replacement, which can prevent you from moving about […] increasing age some people find it harder to move around as they get older, particularly if they suffer from arthritis. […] There are ways to help prevent venous leg ulcers. For example, you could: wear compression stockings this may be recommended by your GP […] manage your weight if you’re obese or overweight, losing weight can help treat and prevent venous leg ulcers.

• #45 Leg ulcers | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/leg-ulcers

  A number of different factors can increase a persons risk of chronic venous leg ulceration, including: Age peripheral circulation becomes less efficient with old age. […] Varicose veins the one-way valves that stop blood from travelling backwards in the vein stop working. […] Arterial disease vein problems are more likely if the person already has other diseases of the arteries. […] Medical treatment aims to improve blood flow to the area and promote healing of the ulcer. […] The type of treatment depends on whether the wound is caused by problems with veins or with arteries. […] Treatment for chronic venous leg ulceration includes: cleaning the wound using wet and dry dressings and ointments, or surgery to remove the dead tissue. […] Compression treatment boosts internal pressure, using either elasticised bandages or stockings. […] Hyperbaric oxygen this is now an accepted treatment for ulcers that resist other methods of healing, such as diabetic ulcers.

• #46 Venous Leg Ulcers: Causes, Treatments & Prevention – Dekalb Vein Center

  https://dekalbveincenter.com/blog/blog-venous-leg-ulcers-causes-treatments-prevention/

  Venous leg ulcers are caused by a condition called venous insufficiency. […] In patients with venous insufficiency, the valves have become weakened or damaged so that blood refluxes (flows backwards) and pools inside the vein. […] Over time, pooled blood increases pressure in the vein and fluid begins to seep out into surrounding tissues. […] This is known as fluid retention or edema. […] Excess fluid irritates the dermal (skin) tissue causing inflammation and eventual breakdown. […] Broken down tissue results in an ulcer. […] One of the biggest risk factors for developing a venous leg ulcer is having varicose veins; though, not everyone with varicose veins will develop leg ulcers nor does everyone with leg ulcers have visible varicose veins. […] Other risk factors for venous leg ulcers include: Being a woman over the age of 40, Leading a sedentary lifestyle, Having a history of smoking, Having a history of blood clots, Being overweight, Having high blood pressure, Being diabetic, Being pregnant. […] If you dont want your leg ulcers to come back, then the underlying venus insufficiency needs to be treated, as well. […] This is done with an outpatient procedure called venous closure. […] This helps existing ulcers heal and prevents future ulcers from forming.

• #47 Venous Leg Ulcer – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK567802/

  Venous leg ulcers are chronic wounds that result from prolonged venous insufficiency, primarily affecting older adults. […] These ulcers develop due to poor blood flow in the veins, leading to tissue breakdown, especially in the lower extremities. […] Although CVI is a well-known precipitant for VLU development, ulceration occurs rarely (5.1%) for unclear reasons. […] CVI may develop due to blood reflux, obstruction, or both mechanisms, causing macro- and micro-circulatory dysfunction. […] Most risk factors for the development of VLUs are non-modifiable, and patients often present with more than 1. […] Modifiable risk factors such as obesity and sedentarism are also associated with venous disease. […] Genetic traits may be an additional predisposing factor, presenting as an autosomal dominant trait with variable penetrance.

• #48 Venous leg ulcers – BAD Patient Hub

  https://www.skinhealthinfo.org.uk/condition/venous-leg-ulcers/

  A venous leg ulcer is an open wound in the skin of the lower leg due to high pressure of the blood in the leg veins. […] The main cause of venous leg ulcers is faulty valves inside the leg veins. These valves normally allow the blood to flow up the leg towards the heart, and they also prevent backward flow down the leg. If the valves are faulty, backward flow is not prevented and pressure builds up inside the veins. The persistent high pressure in the leg veins, caused by the faulty valves, damages tiny blood vessels in the skin. […] Some people are born with weak valves. In others, the valves are damaged after a venous thrombosis (a blood clot forming within a vein). Valves tend to weaken with age. Sometimes they are a result of faulty veins valves and narrow arteries in the limbs. […] Venous leg ulcers are not hereditary; however, some of the things that increase your chances of developing a venous leg ulcer do run in families – such as poor valves, a tendency to have a blood clot or to have abnormal veins and arteries in the lower limbs.

• #49 Venous Ulcer: Symptoms, Causes, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/23165-venous-ulcer

  Other venous ulcer causes include: High blood pressure (hypertension), which damages blood vessel walls. Venous obstruction, a vein blockage thats sometimes due to blood clots. Venous reflux, when blood flows backward through weak or damaged valves. […] A variety of factors can raise your risk of venous ulcers. They include: Deep vein thrombosis. Family history of venous disease. Obesity. Older age. Paralysis. Previous injury. Sedentary lifestyle with limited physical activity. Smoking. Surgery, such as a knee replacement. Varicose and spider veins.

• #50 Venous Leg Ulcer – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK567802/

  However, a specific gene or gene set has not been determined. […] Compared with healing VLUs, the gene expression profile of non-healing VLUs showed upregulation of secreted frizzled-related protein 4, branched-chain aminotransferase 1, dermatopontin, cytochrome P450, and 17 B hydroxysteroid dehydrogenase genes, which are involved in inflammation control, Wnt signaling, cell growth, extracellular matrix assembly, and steroidogenesis. […] Conversely, collagen differentiation and epidermal repair genes such as collagen type 131, collagen 271, keratin 14, keratin 16, and heparin-binding epidermal growth factor were notoriously downregulated. […] Besides these, single nucleotide polymorphisms of high iron, ferroportin 1, and matrix metalloproteinase 12 indicate venous ulcer development susceptibility.

• #51 Venous leg ulcer | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/venous-leg-ulcer/

  A venous leg ulcer can develop after a minor injury if there’s a problem with the circulation of blood in your leg veins. If this happens, pressure inside the veins increases. […] This constant high pressure can gradually damage the tiny blood vessels in your skin and make it fragile. As a result, your skin can easily break and form an ulcer after a knock or scratch. […] Unless you have treatment to improve the circulation in your legs, the ulcer may not heal. […] Many factors can increase your risk of developing a venous leg ulcer, including: obesity or being overweight this increases the pressure in the leg veins […] previous deep vein thrombosis (DVT) blood clots that develop in the leg can damage valves in the veins […] varicose veins swollen and enlarged veins caused by malfunctioning valves

• #52 Venous Ulcer: Symptoms, Causes, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/23165-venous-ulcer

  Other venous ulcer causes include: High blood pressure (hypertension), which damages blood vessel walls. Venous obstruction, a vein blockage thats sometimes due to blood clots. Venous reflux, when blood flows backward through weak or damaged valves. […] A variety of factors can raise your risk of venous ulcers. They include: Deep vein thrombosis. Family history of venous disease. Obesity. Older age. Paralysis. Previous injury. Sedentary lifestyle with limited physical activity. Smoking. Surgery, such as a knee replacement. Varicose and spider veins.

• #53 Venous leg ulcer | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/venous-leg-ulcer/

  A venous leg ulcer can develop after a minor injury if there’s a problem with the circulation of blood in your leg veins. If this happens, pressure inside the veins increases. […] This constant high pressure can gradually damage the tiny blood vessels in your skin and make it fragile. As a result, your skin can easily break and form an ulcer after a knock or scratch. […] Unless you have treatment to improve the circulation in your legs, the ulcer may not heal. […] Many factors can increase your risk of developing a venous leg ulcer, including: obesity or being overweight this increases the pressure in the leg veins […] previous deep vein thrombosis (DVT) blood clots that develop in the leg can damage valves in the veins […] varicose veins swollen and enlarged veins caused by malfunctioning valves

• #54 Venous Ulcer Causes, Symptoms, and Treatments

  https://www.upmc.com/services/heart-vascular/conditions/venous-ulcer

  Blood clots Blood clots block the vein, reducing blood flow to the lower leg. […] Poor circulation (peripheral artery disease). Reduced blood flow from poor circulation slows healing. […] Diabetes, kidney failure, or inflammatory diseases These conditions can slow healing or cause swelling. […] Certain medicines Some medications can suppress the immune system or cause swelling. That makes it harder for ulcers to heal. […] Infections Infections can spread or get into the bloodstream, reducing healing. […] Obesity Excess weight puts pressure on veins in the legs, so ulcers take longer to heal.

• #55 Venous Ulcer: Symptoms, Causes, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/23165-venous-ulcer

  Other venous ulcer causes include: High blood pressure (hypertension), which damages blood vessel walls. Venous obstruction, a vein blockage thats sometimes due to blood clots. Venous reflux, when blood flows backward through weak or damaged valves. […] A variety of factors can raise your risk of venous ulcers. They include: Deep vein thrombosis. Family history of venous disease. Obesity. Older age. Paralysis. Previous injury. Sedentary lifestyle with limited physical activity. Smoking. Surgery, such as a knee replacement. Varicose and spider veins.

• #56 Venous Leg Ulcer – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK567802/

  Venous leg ulcers are chronic wounds that result from prolonged venous insufficiency, primarily affecting older adults. […] These ulcers develop due to poor blood flow in the veins, leading to tissue breakdown, especially in the lower extremities. […] Although CVI is a well-known precipitant for VLU development, ulceration occurs rarely (5.1%) for unclear reasons. […] CVI may develop due to blood reflux, obstruction, or both mechanisms, causing macro- and micro-circulatory dysfunction. […] Most risk factors for the development of VLUs are non-modifiable, and patients often present with more than 1. […] Modifiable risk factors such as obesity and sedentarism are also associated with venous disease. […] Genetic traits may be an additional predisposing factor, presenting as an autosomal dominant trait with variable penetrance.

• #57 4 Risk Factors of Venous Ulcers You Should Know: Clement Banda, MD: Dermatologist

  https://www.mdveins.com/blog/4-risk-factors-of-venous-ulcers-you-should-know

  As you get older, you might find that simple cuts and scrapes on your lower legs take longer to heal. When this delayed healing happens because of increased blood pressure in leg veins, the open sore is called a venous stasis ulcer. Sometimes, the wound can form because of the elevated pressure in veins. […] People with deep vein thrombosis or a family history that includes deep vein thrombosis have an elevated risk for venous ulcers. […] Certain lifestyle factors can increase your chances of slow-healing ulcers. The use of tobacco products produces negative changes in blood vessels. Being overweight adds additional strain to the veins in your legs. People who need to sit or stand for long periods at work miss out on the vital pumping action that movement creates. This compromises blood circulation in the legs, making ulcers more likely.

• #58 Venous Ulcers – The Vein Institute

  https://veininstitutejax.com/conditions/venous-ulcers/

  Venous ulcers develop from chronic venous insufficiency, where damaged veins impede blood circulation. Increased vein pressure causes skin and tissue damage, with minor injuries potentially triggering ulcer formation due to compromised healing processes. […] Common contributing factors include: Chronic venous insufficiency or varicose veins, prolonged swelling in the lower legs, history of deep vein thrombosis (DVT), immobility or prolonged sitting or standing, obesity, which adds strain to leg veins.

• #59 Venous Ulcer: Symptoms, Causes, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/23165-venous-ulcer

  Other venous ulcer causes include: High blood pressure (hypertension), which damages blood vessel walls. Venous obstruction, a vein blockage thats sometimes due to blood clots. Venous reflux, when blood flows backward through weak or damaged valves. […] A variety of factors can raise your risk of venous ulcers. They include: Deep vein thrombosis. Family history of venous disease. Obesity. Older age. Paralysis. Previous injury. Sedentary lifestyle with limited physical activity. Smoking. Surgery, such as a knee replacement. Varicose and spider veins.

• #60 4 Risk Factors of Venous Ulcers You Should Know: Clement Banda, MD: Dermatologist

  https://www.mdveins.com/blog/4-risk-factors-of-venous-ulcers-you-should-know

  As you get older, you might find that simple cuts and scrapes on your lower legs take longer to heal. When this delayed healing happens because of increased blood pressure in leg veins, the open sore is called a venous stasis ulcer. Sometimes, the wound can form because of the elevated pressure in veins. […] People with deep vein thrombosis or a family history that includes deep vein thrombosis have an elevated risk for venous ulcers. […] Certain lifestyle factors can increase your chances of slow-healing ulcers. The use of tobacco products produces negative changes in blood vessels. Being overweight adds additional strain to the veins in your legs. People who need to sit or stand for long periods at work miss out on the vital pumping action that movement creates. This compromises blood circulation in the legs, making ulcers more likely.

• #61 Venous Ulcers Explained: Causes & Treatment

  https://www.tnveincenter.com/blog/everything-you-need-to-know-about-venous-ulcers

  Venous ulcers generally develop when damage has occurred to the valves inside the leg veins. This system of valves regulates the blood pressure throughout our entire body, and it is very noticeable when the system fails. […] There are many common conditions that can cause venous ulcers to develop or put a person at a higher risk. One of the most common conditions is obesity, which increases the amount of pressure and strain on leg veins. Varicose veins left untreated are often a precursor to venous ulcers since they are both caused by problematic valves. Bone injuries, surgeries and specific procedures can also increase your risk factor. […] The cause of a venous ulcer is poor blood flow and increased pressure on the vein. That pressure caused pain itself, but when the condition gets bad enough to create an open wound, patients are met with a double-edged source of pain. The poor blood flow puts increased pressure on the wound, making it much more tender and sensitive. […] Venous ulcers are highly susceptible to infection because of the location they develop on, the open wounds and their inability to heal themselves in many patients. Infection is perilous and needs to be handled immediately if not, it can spread and put someones life in danger.

• #62

  https://dermnetnz.org/topics/leg-ulcer

  Chronic leg ulceration affects about 1% of the middle-aged and elderly population. It most commonly occurs after a minor injury in association with: […] Venous insufficiency refers to improper functioning of the one-way valves in the veins. […] The increased venous pressure causes fibrin deposits around the capillaries, which then act as a barrier to the flow of oxygen and nutrients to muscle and skin tissue. The death of tissue cells leads to ulceration. […] Arterial insufficiency refers to poor blood circulation to the lower leg and foot and is most often due to atherosclerosis. […] Diabetic ulcers are caused by the combination of arterial occlusion and nerve damage. […] Certain conditions have been linked with the development of venous and arterial leg ulcers. […] A diabetic ulcer is more likely if diabetes is not well controlled by diet and/or medication. Ulceration is also more likely if there is poor care of the feet, badly fitting shoes, and continued smoking.

• #63 Venous leg ulcer | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/venous-leg-ulcer/

  A venous leg ulcer can develop after a minor injury if there’s a problem with the circulation of blood in your leg veins. If this happens, pressure inside the veins increases. […] This constant high pressure can gradually damage the tiny blood vessels in your skin and make it fragile. As a result, your skin can easily break and form an ulcer after a knock or scratch. […] Unless you have treatment to improve the circulation in your legs, the ulcer may not heal. […] Many factors can increase your risk of developing a venous leg ulcer, including: obesity or being overweight this increases the pressure in the leg veins […] previous deep vein thrombosis (DVT) blood clots that develop in the leg can damage valves in the veins […] varicose veins swollen and enlarged veins caused by malfunctioning valves

• #64 Venous leg ulcer | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/venous-leg-ulcer/

  previous injury to the leg, such as a broken or fractured bone, which may cause DVT or affect your walking […] previous surgery to the leg, such as a hip replacement or knee replacement, which can prevent you from moving about […] increasing age some people find it harder to move around as they get older, particularly if they suffer from arthritis. […] There are ways to help prevent venous leg ulcers. For example, you could: wear compression stockings this may be recommended by your GP […] manage your weight if you’re obese or overweight, losing weight can help treat and prevent venous leg ulcers.

• #65 Venous leg ulcer | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/venous-leg-ulcer/

  previous injury to the leg, such as a broken or fractured bone, which may cause DVT or affect your walking […] previous surgery to the leg, such as a hip replacement or knee replacement, which can prevent you from moving about […] increasing age some people find it harder to move around as they get older, particularly if they suffer from arthritis. […] There are ways to help prevent venous leg ulcers. For example, you could: wear compression stockings this may be recommended by your GP […] manage your weight if you’re obese or overweight, losing weight can help treat and prevent venous leg ulcers.

• #66 Symptoms of a Venous leg ulcers – why is my leg ulcer not healing?

  https://legsmatter.org/information-and-support/types-of-ulcers/venous-leg-ulcers/

  A venous leg ulcer (VLU) is a break in the skin, between the knee and ankle joint, and is caused by damage to the vein(s) in the lower leg, which become weaker. The weakened vein walls prevent the valves in the veins from closing sufficiently. If the valves cannot close properly, some of the venous blood backflows when the heart beats and the pressure inside the vein increases, pushing small components of the venous blood across the vein wall into the surrounding flesh and skin. This damages the flesh and breaks the skin. Because the vein is weak and leaking, the skin cannot heal. […] Veins can become damaged due to a number of reasons, including; An injury, Previous fracture of the bones in the leg, ankle or foot, Previous operations, A clot (DVT), Increased abdominal weight (pregnancies or obesity), Because the veins get weaker as we get older. […] Venous ulcers can recur if the damaged vein is not supported or removed. Therefore, compression garments should be worn even when the ulcer has healed to stop it coming back.

• #67 Venous leg ulcer | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/venous-leg-ulcer/

  previous injury to the leg, such as a broken or fractured bone, which may cause DVT or affect your walking […] previous surgery to the leg, such as a hip replacement or knee replacement, which can prevent you from moving about […] increasing age some people find it harder to move around as they get older, particularly if they suffer from arthritis. […] There are ways to help prevent venous leg ulcers. For example, you could: wear compression stockings this may be recommended by your GP […] manage your weight if you’re obese or overweight, losing weight can help treat and prevent venous leg ulcers.

• #68 Venous Leg Ulcers – North Tees and Hartlepool NHS Foundation Trust

  https://www.nth.nhs.uk/resources/venous-leg-ulcers/

  The doctor or nurse will want to rule out other conditions as possible causes of your symptoms. They may carry out a test known as an Ankle Brachial Pressure Index (ABPI) test. […] Leg ulcers caused by peripheral arterial disease are treated differently from venous leg ulcers. […] People most at risk of developing a venous leg ulcer are those who have previously had a leg ulcer.

• #69 Venous Leg Ulcers – North Tees and Hartlepool NHS Foundation Trust

  https://www.nth.nhs.uk/resources/venous-leg-ulcers/

  A venous leg ulcer can be defined as an open skin break between the knee and ankle joint that occurs in the presence of venous disease that takes more than two weeks to heal. […] A venous leg ulcer can develop after a minor injury where there is a problem with the flow of blood through the veins of your leg. If this happens, the pressure inside the veins increases and this can gradually damage the tiny blood vessels in your skin and make it fragile. If you then knock or scratch your skin, it can easily break and form an ulcer. Unless you have treatment to improve the blood flow in the veins in your legs, the ulcer may take a long time to heal. […] A number of things can increase your risk of developing a venous leg ulcer, including: Being overweight, Smoking, If you cannot move around very well, Sitting for a long period of time, If you have had a deep vein thrombosis (DVT), If you have varicose veins, If you have previously injured your leg, Previous surgery to your leg, A history of self-injecting drugs into the veins of your legs, Some medical conditions such as diabetes, rheumatoid arthritis and some skin conditions.

• #70 Venous Leg Ulcers – North Tees and Hartlepool NHS Foundation Trust

  https://www.nth.nhs.uk/resources/venous-leg-ulcers/

  A venous leg ulcer can be defined as an open skin break between the knee and ankle joint that occurs in the presence of venous disease that takes more than two weeks to heal. […] A venous leg ulcer can develop after a minor injury where there is a problem with the flow of blood through the veins of your leg. If this happens, the pressure inside the veins increases and this can gradually damage the tiny blood vessels in your skin and make it fragile. If you then knock or scratch your skin, it can easily break and form an ulcer. Unless you have treatment to improve the blood flow in the veins in your legs, the ulcer may take a long time to heal. […] A number of things can increase your risk of developing a venous leg ulcer, including: Being overweight, Smoking, If you cannot move around very well, Sitting for a long period of time, If you have had a deep vein thrombosis (DVT), If you have varicose veins, If you have previously injured your leg, Previous surgery to your leg, A history of self-injecting drugs into the veins of your legs, Some medical conditions such as diabetes, rheumatoid arthritis and some skin conditions.

• #71 Venous Ulcer Causes, Symptoms, and Treatments

  https://www.upmc.com/services/heart-vascular/conditions/venous-ulcer

  Blood clots Blood clots block the vein, reducing blood flow to the lower leg. […] Poor circulation (peripheral artery disease). Reduced blood flow from poor circulation slows healing. […] Diabetes, kidney failure, or inflammatory diseases These conditions can slow healing or cause swelling. […] Certain medicines Some medications can suppress the immune system or cause swelling. That makes it harder for ulcers to heal. […] Infections Infections can spread or get into the bloodstream, reducing healing. […] Obesity Excess weight puts pressure on veins in the legs, so ulcers take longer to heal.

• #72 Venous Ulcer: Symptoms, Causes, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/23165-venous-ulcer

  Other venous ulcer causes include: High blood pressure (hypertension), which damages blood vessel walls. Venous obstruction, a vein blockage thats sometimes due to blood clots. Venous reflux, when blood flows backward through weak or damaged valves. […] A variety of factors can raise your risk of venous ulcers. They include: Deep vein thrombosis. Family history of venous disease. Obesity. Older age. Paralysis. Previous injury. Sedentary lifestyle with limited physical activity. Smoking. Surgery, such as a knee replacement. Varicose and spider veins.

• #73 Vascular Ulcers: Practice Essentials, Epidemiology, Etiology

  https://emedicine.medscape.com/article/1298345-overview

  Ulceration due to vascular causes is often multifactorial and can be caused by both arterial and venous disease. Hypertension and atherosclerosis of the peripheral vessels lead to arterial disease associated with ischemic ulcers. Chronic venous insufficiency and the resulting venous hypertension cause venous ulcers. Vasculitis such as Buerger disease (thromboangiitis obliterans) or Takayasu disease can also be associated with ulceration. The former tends to manifest with arterial or ischemic-type ulcers, while the latter manifests with cutaneous disease such as pyoderma gangrenosum or erythema nodosum. […] In the aforementioned study by Garavello and colleagues, various comorbidities were identified as risk factors in the development of venous ulcers, including arterial hypertension, heart disease, and chronic obstructive pulmonary disease (COPD), which were found in 44.19%, 35.47%, and 16.28% of the studys patients, respectively. However, the investigators did not find the formation of venous leg ulcers to be directly influenced by diabetes, obesity, chronic renal insufficiency, or orthopedic disease.

• #74 Venous Leg Ulcers: Causes, Treatments & Prevention – Dekalb Vein Center

  https://dekalbveincenter.com/blog/blog-venous-leg-ulcers-causes-treatments-prevention/

  Venous leg ulcers are caused by a condition called venous insufficiency. […] In patients with venous insufficiency, the valves have become weakened or damaged so that blood refluxes (flows backwards) and pools inside the vein. […] Over time, pooled blood increases pressure in the vein and fluid begins to seep out into surrounding tissues. […] This is known as fluid retention or edema. […] Excess fluid irritates the dermal (skin) tissue causing inflammation and eventual breakdown. […] Broken down tissue results in an ulcer. […] One of the biggest risk factors for developing a venous leg ulcer is having varicose veins; though, not everyone with varicose veins will develop leg ulcers nor does everyone with leg ulcers have visible varicose veins. […] Other risk factors for venous leg ulcers include: Being a woman over the age of 40, Leading a sedentary lifestyle, Having a history of smoking, Having a history of blood clots, Being overweight, Having high blood pressure, Being diabetic, Being pregnant. […] If you dont want your leg ulcers to come back, then the underlying venus insufficiency needs to be treated, as well. […] This is done with an outpatient procedure called venous closure. […] This helps existing ulcers heal and prevents future ulcers from forming.

• #75 Venous Ulcer Causes, Symptoms, and Treatments

  https://www.upmc.com/services/heart-vascular/conditions/venous-ulcer

  Blood clots Blood clots block the vein, reducing blood flow to the lower leg. […] Poor circulation (peripheral artery disease). Reduced blood flow from poor circulation slows healing. […] Diabetes, kidney failure, or inflammatory diseases These conditions can slow healing or cause swelling. […] Certain medicines Some medications can suppress the immune system or cause swelling. That makes it harder for ulcers to heal. […] Infections Infections can spread or get into the bloodstream, reducing healing. […] Obesity Excess weight puts pressure on veins in the legs, so ulcers take longer to heal.

• #76 Vascular Ulcers: Practice Essentials, Epidemiology, Etiology

  https://emedicine.medscape.com/article/1298345-overview

  Ulceration due to vascular causes is often multifactorial and can be caused by both arterial and venous disease. Hypertension and atherosclerosis of the peripheral vessels lead to arterial disease associated with ischemic ulcers. Chronic venous insufficiency and the resulting venous hypertension cause venous ulcers. Vasculitis such as Buerger disease (thromboangiitis obliterans) or Takayasu disease can also be associated with ulceration. The former tends to manifest with arterial or ischemic-type ulcers, while the latter manifests with cutaneous disease such as pyoderma gangrenosum or erythema nodosum. […] In the aforementioned study by Garavello and colleagues, various comorbidities were identified as risk factors in the development of venous ulcers, including arterial hypertension, heart disease, and chronic obstructive pulmonary disease (COPD), which were found in 44.19%, 35.47%, and 16.28% of the studys patients, respectively. However, the investigators did not find the formation of venous leg ulcers to be directly influenced by diabetes, obesity, chronic renal insufficiency, or orthopedic disease.

• #77 Venous Ulcer Causes, Symptoms, and Treatments

  https://www.upmc.com/services/heart-vascular/conditions/venous-ulcer

  Blood clots Blood clots block the vein, reducing blood flow to the lower leg. […] Poor circulation (peripheral artery disease). Reduced blood flow from poor circulation slows healing. […] Diabetes, kidney failure, or inflammatory diseases These conditions can slow healing or cause swelling. […] Certain medicines Some medications can suppress the immune system or cause swelling. That makes it harder for ulcers to heal. […] Infections Infections can spread or get into the bloodstream, reducing healing. […] Obesity Excess weight puts pressure on veins in the legs, so ulcers take longer to heal.

• #78 Vascular Ulcers: Practice Essentials, Epidemiology, Etiology

  https://emedicine.medscape.com/article/1298345-overview

  Ulceration due to vascular causes is often multifactorial and can be caused by both arterial and venous disease. Hypertension and atherosclerosis of the peripheral vessels lead to arterial disease associated with ischemic ulcers. Chronic venous insufficiency and the resulting venous hypertension cause venous ulcers. Vasculitis such as Buerger disease (thromboangiitis obliterans) or Takayasu disease can also be associated with ulceration. The former tends to manifest with arterial or ischemic-type ulcers, while the latter manifests with cutaneous disease such as pyoderma gangrenosum or erythema nodosum. […] In the aforementioned study by Garavello and colleagues, various comorbidities were identified as risk factors in the development of venous ulcers, including arterial hypertension, heart disease, and chronic obstructive pulmonary disease (COPD), which were found in 44.19%, 35.47%, and 16.28% of the studys patients, respectively. However, the investigators did not find the formation of venous leg ulcers to be directly influenced by diabetes, obesity, chronic renal insufficiency, or orthopedic disease.

• #79 Venous Leg Ulcers – North Tees and Hartlepool NHS Foundation Trust

  https://www.nth.nhs.uk/resources/venous-leg-ulcers/

  A venous leg ulcer can be defined as an open skin break between the knee and ankle joint that occurs in the presence of venous disease that takes more than two weeks to heal. […] A venous leg ulcer can develop after a minor injury where there is a problem with the flow of blood through the veins of your leg. If this happens, the pressure inside the veins increases and this can gradually damage the tiny blood vessels in your skin and make it fragile. If you then knock or scratch your skin, it can easily break and form an ulcer. Unless you have treatment to improve the blood flow in the veins in your legs, the ulcer may take a long time to heal. […] A number of things can increase your risk of developing a venous leg ulcer, including: Being overweight, Smoking, If you cannot move around very well, Sitting for a long period of time, If you have had a deep vein thrombosis (DVT), If you have varicose veins, If you have previously injured your leg, Previous surgery to your leg, A history of self-injecting drugs into the veins of your legs, Some medical conditions such as diabetes, rheumatoid arthritis and some skin conditions.

• #80 Vascular Ulcers: Practice Essentials, Epidemiology, Etiology

  https://emedicine.medscape.com/article/1298345-overview

  Labropoulos et al showed that most of these uncommon ulcers were located in the medial lower calf (n = 19). Specific causes revealed in the histology included neoplasia (5 patients), chronic inflammation (3 patients), sickle cell disease (2 patients), vasculitis (2 patients), rheumatoid arthritis (1 patient), pyoderma gangrenosum (1 patient), and ulcer due to hydroxyurea (1 patient). In 6 patients with ulcers, the histology did not reveal any specific cause.

• #81 :: Journal of Wound Management and Research

  https://www.jwmr.org/m/journal/view.php?number=414

  Defined as an ulceration in a lower extremity caused by venous hypertension, venous ulcers are a common condition which are known to affect approximately 1% of the population. […] Risk factors include old age, obesity, previous trauma history, immobility and genetic thrombophilic conditions such as factor V Leiden mutation. […] Venous ulcers are open skin wounds occurring in regions of the leg or foot affected by venous hypertension. […] The pathophysiology of venous ulcers is a complex process with various associated signs such as varicose veins, chronic discharge, dermatitis, skin hyperpigmentation and fibrosis. […] Obstruction is an important factor in the pathogenesis of venous ulcers. […] Genetic mutation can be a predisposing factor for developing venous ulcers. […] The term postphlebitic syndrome was used to explain the etiology of venous ulcerations. […] Numerous theories have been proposed to explain the pathogenesis of venous hypertension causing ulceration from structural to molecular levels. […] Venous ulcers are a common condition caused by venous reflux and obstruction ultimately resulting in venous hypertension.

• #82 Vascular Ulcers: Practice Essentials, Epidemiology, Etiology

  https://emedicine.medscape.com/article/1298345-overview

  Ulceration due to vascular causes is often multifactorial and can be caused by both arterial and venous disease. Hypertension and atherosclerosis of the peripheral vessels lead to arterial disease associated with ischemic ulcers. Chronic venous insufficiency and the resulting venous hypertension cause venous ulcers. Vasculitis such as Buerger disease (thromboangiitis obliterans) or Takayasu disease can also be associated with ulceration. The former tends to manifest with arterial or ischemic-type ulcers, while the latter manifests with cutaneous disease such as pyoderma gangrenosum or erythema nodosum. […] In the aforementioned study by Garavello and colleagues, various comorbidities were identified as risk factors in the development of venous ulcers, including arterial hypertension, heart disease, and chronic obstructive pulmonary disease (COPD), which were found in 44.19%, 35.47%, and 16.28% of the studys patients, respectively. However, the investigators did not find the formation of venous leg ulcers to be directly influenced by diabetes, obesity, chronic renal insufficiency, or orthopedic disease.

• #83 Vascular Ulcers: Practice Essentials, Epidemiology, Etiology

  https://emedicine.medscape.com/article/1298345-overview

  Labropoulos et al showed that most of these uncommon ulcers were located in the medial lower calf (n = 19). Specific causes revealed in the histology included neoplasia (5 patients), chronic inflammation (3 patients), sickle cell disease (2 patients), vasculitis (2 patients), rheumatoid arthritis (1 patient), pyoderma gangrenosum (1 patient), and ulcer due to hydroxyurea (1 patient). In 6 patients with ulcers, the histology did not reveal any specific cause.

• #84 Causes, investigation and treatment of leg ulceration – PubMed

  https://pubmed.ncbi.nlm.nih.gov/12653729/

  Chronic ulceration of the lower leg is a frequent condition, with a prevalence of 3-5% in the population over 65 years of age. The incidence of ulceration is rising as a result of the ageing population and increased risk factors for atherosclerotic occlusion such as smoking, obesity and diabetes. […] The main causes are venous valve insufficiency, lower extremity arterial disease and diabetes. Less frequent conditions are infection, vasculitis, skin malignancies and ulcerating skin diseases such as pyoderma gangrenosum. But even rarer conditions exist, such as the recently discovered combination of vasculitis and hypercoagulability.

• #85 Vascular Ulcers: Practice Essentials, Epidemiology, Etiology

  https://emedicine.medscape.com/article/1298345-overview

  Labropoulos et al showed that most of these uncommon ulcers were located in the medial lower calf (n = 19). Specific causes revealed in the histology included neoplasia (5 patients), chronic inflammation (3 patients), sickle cell disease (2 patients), vasculitis (2 patients), rheumatoid arthritis (1 patient), pyoderma gangrenosum (1 patient), and ulcer due to hydroxyurea (1 patient). In 6 patients with ulcers, the histology did not reveal any specific cause.

• #86 Vascular Ulcers: Practice Essentials, Epidemiology, Etiology

  https://emedicine.medscape.com/article/1298345-overview

  Labropoulos et al showed that most of these uncommon ulcers were located in the medial lower calf (n = 19). Specific causes revealed in the histology included neoplasia (5 patients), chronic inflammation (3 patients), sickle cell disease (2 patients), vasculitis (2 patients), rheumatoid arthritis (1 patient), pyoderma gangrenosum (1 patient), and ulcer due to hydroxyurea (1 patient). In 6 patients with ulcers, the histology did not reveal any specific cause.

• #87 Wound Care Today | May 2025

  https://www.woundcare-today.com/journals/issue/wound-care-today/article/differential-diagnosis-leg-ulcers-focus-atypical-ulcers

  Patients presenting with venous leg ulcers may give a history of previous varicose veins, deep vein thrombosis (DVT), leg surgery and trauma. […] Leg ulcers that are venous in origin are often relatively easy to diagnose with tell-tale signs of varicose veins, haemosiderin staining, lipodermatosclerosis, atrophie blanche, ankle flare, and eczema. […] Venous leg ulcers are also commonly located around the malleolus or lower gaiter of the leg. […] Drug-induced ulcers may often be initially diagnosed as venous, but fail to respond to treatment.

• #88 Venous Ulcer: Symptoms, Causes, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/23165-venous-ulcer

  A venous ulcer, also known as venous stasis ulcer, is a wound that takes longer than usual to heal. Its due to vein and blood flow issues and often occurs on your legs near your ankle. […] Venous ulcers occur when oxygen-poor blood cant flow from your extremities back to your heart. Instead, it pools, creating pressure in your veins. This damages skin tissue and leads to an ulcer. […] Your veins contain tiny valves that keep blood circulating throughout your body. These valves snap open and shut to move blood against the force of gravity back to your heart. In some people, venous diseases affect valve functioning. Other medical conditions, like diabetes, can also put you at risk for leg and foot ulcers. […] Chronic venous insufficiency is a common cause of valve dysfunction. It occurs when your valves are damaged or too weak to do their job.

• #89 Why You Should Never Neglect a Leg Ulcer: Kishore K. Arcot , MD, FACC, FSCAI, FSVM, RPVI: Cardiology

  https://www.memphisvein.com/blog/why-you-should-never-neglect-a-leg-ulcer

  A leg ulcer is an open wound that develops when a disease affects circulation in the blood vessels serving your legs. The top three causes include: […] Peripheral artery disease (PAD) develops when cholesterol blocks a leg artery. As the plaque enlarges and limits blood flow, tissues die because they dont get enough oxygen. Thats when an arterial leg ulcer develops. […] When the valves inside your leg veins stop working, blood flows back down the leg and pools in the vein. This condition, chronic venous insufficiency (CVI), also raises blood pressure in the lower leg vein. High venous pressure forces fluids out of the vein, where they break down your skin and cause a venous leg ulcer. […] High blood sugar damages the small blood vessels in your feet and legs. As a result, a tiny sore can quickly turn into an ulcer because it lacks the blood supply and oxygen needed to heal. Diabetic ulcers often occur on your feet, but they may also appear on your lower legs.

• #90 Venous leg ulcer | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/venous-leg-ulcer/

  A venous leg ulcer can develop after a minor injury if there’s a problem with the circulation of blood in your leg veins. If this happens, pressure inside the veins increases. […] This constant high pressure can gradually damage the tiny blood vessels in your skin and make it fragile. As a result, your skin can easily break and form an ulcer after a knock or scratch. […] Unless you have treatment to improve the circulation in your legs, the ulcer may not heal. […] Many factors can increase your risk of developing a venous leg ulcer, including: obesity or being overweight this increases the pressure in the leg veins […] previous deep vein thrombosis (DVT) blood clots that develop in the leg can damage valves in the veins […] varicose veins swollen and enlarged veins caused by malfunctioning valves

• #91 Venous ulcers – self-care: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/patientinstructions/000744.htm

  Venous ulcers (open sores) can occur when the veins in your legs do not push blood back up to your heart as well as they should. Blood backs up in the veins, building up pressure. If not treated, increased pressure and excess fluid in the affected area can cause an open sore to form. […] The cause of venous ulcers is high pressure in the veins of the lower leg. The veins have one-way valves that keep blood flowing up toward your heart. When these valves become weak or the veins become scarred and blocked, blood can flow backward and pool in your legs. This is called venous insufficiency. This leads to high pressure in the lower leg veins. The increase in pressure and buildup of fluid prevents nutrients and oxygen from getting to tissues. The lack of nutrients causes cells to die, damaging the tissue, and a wound can form.

• #92 Why Venous Leg Ulcers Have Difficulty Healing: Overview on Pathophysiology, Clinical Consequences, and Treatment

  https://www.mdpi.com/2077-0383/10/1/29

  Venous leg ulcers (VLUs) are one of the most common ulcers of the lower extremity. VLU often occurs in association with post-thrombotic syndrome, advanced chronic venous disease, varicose veins, and venous hypertension. Several demographic, genetic, and environmental factors could trigger chronic venous disease with venous dilation, incompetent valves, venous reflux, and venous hypertension. Endothelial cell injury and changes in the glycocalyx, venous shear-stress, and adhesion molecules could be initiating events in VLU. Increased endothelial cell permeability and leukocyte infiltration, and increases in inflammatory cytokines, matrix metalloproteinases (MMPs), reactive oxygen and nitrogen species, iron deposition, and tissue metabolites also contribute to the pathogenesis of VLU. VLU can be defined as a full-thickness defect of the skin frequently seen in the ankle region that fails to heal spontaneously and is sustained by chronic venous disease (CVD, the spectrum of venous diseases affecting the lower limbs). The majority (70–80%) of patients with VLU have primary venous insufficiency (reflux) from varicose vein disease, and about 20–30% have secondary venous insufficiency from post thrombotic syndrome (PTS). Although there are many more patients with primary venous insufficiency, PTS has a much higher risk of developing VLU and is much more aggressive in its natural history, making treatment more challenging. It has been estimated that the venous origin impacts 50–75% of chronic leg ulcers, and this percentage heavily increases if foot ulcers are excluded. Chronic wounds of the lower extremities could be sustained by several local and systemic causative factors, leading to a broad comparison among ulcers. Misdiagnosis of a leg ulcer has a great impact both on patient’s suffering, due to delayed wound healing, and on economic costs. Chronic VLUs provide a fertile breeding ground for the onset of several complications, ranging from immobility and reduced quality of life to cellulitis, severe infections, osteomyelitis, and neoplastic transformation. Recalcitrant ulcers also show prolonged healing time and often occur in individuals with advanced age, higher body mass index, and nutritional deficiencies and in association with colder temperature, preexisting or underlying venous disease, deep venous thrombosis, venous outflow obstruction, and larger wound area. VLU has a high 50–70% recurrence rate possibly due to patient noncompliance with compression therapy, surgical procedure failure, mixed VLU disease with arterial component, incorrect diagnosis of ulcer, and progression of venous disease. Several predisposing demographic, genetic, and environmental factors could lead to CVD with extensive venous dilation, incompetent valves, venous reflux, and venous hypertension.

• #93 Why Venous Leg Ulcers Have Difficulty Healing: Overview on Pathophysiology, Clinical Consequences, and Treatment

  https://www.mdpi.com/2077-0383/10/1/29

  Venous leg ulcers (VLUs) are one of the most common ulcers of the lower extremity. VLU often occurs in association with post-thrombotic syndrome, advanced chronic venous disease, varicose veins, and venous hypertension. Several demographic, genetic, and environmental factors could trigger chronic venous disease with venous dilation, incompetent valves, venous reflux, and venous hypertension. Endothelial cell injury and changes in the glycocalyx, venous shear-stress, and adhesion molecules could be initiating events in VLU. Increased endothelial cell permeability and leukocyte infiltration, and increases in inflammatory cytokines, matrix metalloproteinases (MMPs), reactive oxygen and nitrogen species, iron deposition, and tissue metabolites also contribute to the pathogenesis of VLU. VLU can be defined as a full-thickness defect of the skin frequently seen in the ankle region that fails to heal spontaneously and is sustained by chronic venous disease (CVD, the spectrum of venous diseases affecting the lower limbs). The majority (70–80%) of patients with VLU have primary venous insufficiency (reflux) from varicose vein disease, and about 20–30% have secondary venous insufficiency from post thrombotic syndrome (PTS). Although there are many more patients with primary venous insufficiency, PTS has a much higher risk of developing VLU and is much more aggressive in its natural history, making treatment more challenging. It has been estimated that the venous origin impacts 50–75% of chronic leg ulcers, and this percentage heavily increases if foot ulcers are excluded. Chronic wounds of the lower extremities could be sustained by several local and systemic causative factors, leading to a broad comparison among ulcers. Misdiagnosis of a leg ulcer has a great impact both on patient’s suffering, due to delayed wound healing, and on economic costs. Chronic VLUs provide a fertile breeding ground for the onset of several complications, ranging from immobility and reduced quality of life to cellulitis, severe infections, osteomyelitis, and neoplastic transformation. Recalcitrant ulcers also show prolonged healing time and often occur in individuals with advanced age, higher body mass index, and nutritional deficiencies and in association with colder temperature, preexisting or underlying venous disease, deep venous thrombosis, venous outflow obstruction, and larger wound area. VLU has a high 50–70% recurrence rate possibly due to patient noncompliance with compression therapy, surgical procedure failure, mixed VLU disease with arterial component, incorrect diagnosis of ulcer, and progression of venous disease. Several predisposing demographic, genetic, and environmental factors could lead to CVD with extensive venous dilation, incompetent valves, venous reflux, and venous hypertension.

• #94

  https://link.springer.com/article/10.1007/BF01658644

  Venous ulceration is caused by the disorganization of the microcirculation that is induced by prolonged venous hypertension. The most common cause of calf pump inefficiency that permits superficial venous hypertension during exercise is deep vein thrombosis. Venous hypertension causes venular dilatation and an increased capillary permeability. Fibrin is deposited around the capillaries and not removed because of a vein wall deficiency of the fibrinolytic activator. The fibrin acts as a diffusion barrier and the overlying dermis becomes anoxic. Any minor trauma then causes an ulcer. Ulcers can be cured by restoring calf pump function to normal. […] La ulceracin venosa es causada por desorganizacin de la microcirculacon que induce una prolongada hipertensin venosa. La causa ms comn de ineficiencia de la bomba muscular de la pantorrilla, la cual hace posible el desarrollo de hipertensin venosa superficial en el curso del ejercicio, es la trombosis de las venas profundas. La hipertensin venosa causa dilatacin de las vnulas y un aumento de la permeabilidad capilar. Esto resulta en depsitos de fibrina alrededor de los capilares, fibrina que no puede ser removida debido a una deficiencia del activador de fibrinolisis en la pared de la vena. La fibrina acta como una barrera para la difusin de oxgeno, con lo cual la dermis se hace anxica. Ahora cualquier trauma menor puede iniciar la ulceracin. Las lceras pueden ser curadas restaurando la funcin de bombeo de la pantorrilla a su estado normal.

• #95

  https://dermnetnz.org/topics/leg-ulcer

  Chronic leg ulceration affects about 1% of the middle-aged and elderly population. It most commonly occurs after a minor injury in association with: […] Venous insufficiency refers to improper functioning of the one-way valves in the veins. […] The increased venous pressure causes fibrin deposits around the capillaries, which then act as a barrier to the flow of oxygen and nutrients to muscle and skin tissue. The death of tissue cells leads to ulceration. […] Arterial insufficiency refers to poor blood circulation to the lower leg and foot and is most often due to atherosclerosis. […] Diabetic ulcers are caused by the combination of arterial occlusion and nerve damage. […] Certain conditions have been linked with the development of venous and arterial leg ulcers. […] A diabetic ulcer is more likely if diabetes is not well controlled by diet and/or medication. Ulceration is also more likely if there is poor care of the feet, badly fitting shoes, and continued smoking.

• #96 Venous Ulcers Explained: Causes & Treatment

  https://www.tnveincenter.com/blog/everything-you-need-to-know-about-venous-ulcers

  Venous ulcers generally develop when damage has occurred to the valves inside the leg veins. This system of valves regulates the blood pressure throughout our entire body, and it is very noticeable when the system fails. […] There are many common conditions that can cause venous ulcers to develop or put a person at a higher risk. One of the most common conditions is obesity, which increases the amount of pressure and strain on leg veins. Varicose veins left untreated are often a precursor to venous ulcers since they are both caused by problematic valves. Bone injuries, surgeries and specific procedures can also increase your risk factor. […] The cause of a venous ulcer is poor blood flow and increased pressure on the vein. That pressure caused pain itself, but when the condition gets bad enough to create an open wound, patients are met with a double-edged source of pain. The poor blood flow puts increased pressure on the wound, making it much more tender and sensitive. […] Venous ulcers are highly susceptible to infection because of the location they develop on, the open wounds and their inability to heal themselves in many patients. Infection is perilous and needs to be handled immediately if not, it can spread and put someones life in danger.

• #97 The impact of venous leg ulcers on a patient’s quality of life: considerations for dressing selection – Wounds International

  https://woundsinternational.com/journal-articles/the-impact-of-venous-leg-ulcers-on-a-patients-quality-of-life-considerations-for-dressing-selection/

  VLUs are susceptible to microbial invasion and infection. The presence of infection can lead to increases in exudation, malodour and pain, therefore, adding unwanted complexity to the management of these sequelae. […] The longer a VLU is present, the greater its impact on the patient will be. […] Leakage may also increase the risk of infection by providing a portal of entry into the wound environment which is conducive to microbial colonisation and a nidus for potential infection.

• #98 The impact of venous leg ulcers on a patient’s quality of life: considerations for dressing selection – Wounds International

  https://woundsinternational.com/journal-articles/the-impact-of-venous-leg-ulcers-on-a-patients-quality-of-life-considerations-for-dressing-selection/

  A vast majority (70%) of lower-extremity ulcers are caused by chronic venous insufficiency (CVI). […] VLUs generally originate from minor traumatic injuries that do not follow the normal healing process as a consequence of CVI and the inflammatory status of the skin in the affected lower limbs. […] The main goals of VLU treatment are to reverse the underlying venous hypertension and the pro-inflammatory environment. […] Compression therapy remains the gold standard of the conservative treatment of CVI in all stages, because of its non-invasive nature, ease of use, and efficacy in reducing venous hypertension, which is a main pathophysiological mechanism of CVI. […] In the presence of venous hypertension, the increase in lymphatic flow can overwhelm the lymph transport capacity, leading to phlebolymphoedema.

• #99 Venous Ulcer Causes, Symptoms, and Treatments

  https://www.upmc.com/services/heart-vascular/conditions/venous-ulcer

  Blood clots Blood clots block the vein, reducing blood flow to the lower leg. […] Poor circulation (peripheral artery disease). Reduced blood flow from poor circulation slows healing. […] Diabetes, kidney failure, or inflammatory diseases These conditions can slow healing or cause swelling. […] Certain medicines Some medications can suppress the immune system or cause swelling. That makes it harder for ulcers to heal. […] Infections Infections can spread or get into the bloodstream, reducing healing. […] Obesity Excess weight puts pressure on veins in the legs, so ulcers take longer to heal.

• #100 Causes of Venous Ulcers and How to Prevent Them?

  https://www.drsumitkapadia.com/blog/causes-of-venous-ulcers-and-how-to-prevent-venous-ulcers/

  This disruption to the circulation can contribute to the development of venous ulcers. […] Peripheral Artery Disease […] Reduced blood flow due to peripheral artery disease can slow the healing of wounds, potentially leading to chronic ulcers. […] Chronic Conditions […] Conditions such as diabetes, kidney failure, and inflammatory diseases can slow down the healing process or cause swelling, increasing the risk of venous ulcers. […] Certain Medications […] Some drugs can suppress the immune system or cause swelling, making it harder for ulcers to heal. […] Infections […] Infections can reduce healing by spreading locally or entering the bloodstream. […] Obesity […] Being overweight can place extra pressure on the veins in the legs, which can impair blood flow and slow down the healing of ulcers.

• #101 Venous Ulcer: Symptoms, Causes, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/23165-venous-ulcer

  A venous ulcer, also known as venous stasis ulcer, is a wound that takes longer than usual to heal. Its due to vein and blood flow issues and often occurs on your legs near your ankle. […] Venous ulcers occur when oxygen-poor blood cant flow from your extremities back to your heart. Instead, it pools, creating pressure in your veins. This damages skin tissue and leads to an ulcer. […] Your veins contain tiny valves that keep blood circulating throughout your body. These valves snap open and shut to move blood against the force of gravity back to your heart. In some people, venous diseases affect valve functioning. Other medical conditions, like diabetes, can also put you at risk for leg and foot ulcers. […] Chronic venous insufficiency is a common cause of valve dysfunction. It occurs when your valves are damaged or too weak to do their job.

• #102 Venous leg ulcer | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/venous-leg-ulcer/

  A venous leg ulcer can develop after a minor injury if there’s a problem with the circulation of blood in your leg veins. If this happens, pressure inside the veins increases. […] This constant high pressure can gradually damage the tiny blood vessels in your skin and make it fragile. As a result, your skin can easily break and form an ulcer after a knock or scratch. […] Unless you have treatment to improve the circulation in your legs, the ulcer may not heal. […] Many factors can increase your risk of developing a venous leg ulcer, including: obesity or being overweight this increases the pressure in the leg veins […] previous deep vein thrombosis (DVT) blood clots that develop in the leg can damage valves in the veins […] varicose veins swollen and enlarged veins caused by malfunctioning valves

• #103 Diagnosis and Treatment of Venous Ulcers | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/0415/p989.html

  Venous ulcer, also known as stasis ulcer, is the most common etiology of lower extremity ulceration, affecting approximately 1 percent of the U.S. population. Possible causes of venous ulcers include inflammatory processes resulting in leukocyte activation, endothelial damage, platelet aggregation, and intracellular edema. The primary risk factors for venous ulcer development are older age, obesity, previous leg injuries, deep venous thrombosis, and phlebitis. […] Venous ulcers, or stasis ulcers, account for 80 percent of lower extremity ulcerations. Less common etiologies for lower extremity ulcerations include arterial insufficiency; prolonged pressure; diabetic neuropathy; and systemic illness such as rheumatoid arthritis, vasculitis, osteomyelitis, and skin malignancy. […] The pathophysiology of venous ulcers is not entirely clear. Venous incompetence and associated venous hypertension are thought to be the primary mechanisms for ulcer formation. Factors that may lead to venous incompetence include immobility; ineffective pumping of the calf muscle; and venous valve dysfunction from trauma, congenital absence, venous thrombosis, or phlebitis. Subsequently, chronic venous stasis causes pooling of blood in the venous circulatory system triggering further capillary damage and activation of inflammatory process. Leukocyte activation, endothelial damage, platelet aggregation, and intracellular edema contribute to venous ulcer development and impaired wound healing. […] Determining etiology is a critical step in the management of venous ulcers.

• #104 Why Venous Leg Ulcers Have Difficulty Healing: Overview on Pathophysiology, Clinical Consequences, and Treatment

  https://www.mdpi.com/2077-0383/10/1/29

  Venous leg ulcers (VLUs) are one of the most common ulcers of the lower extremity. VLU often occurs in association with post-thrombotic syndrome, advanced chronic venous disease, varicose veins, and venous hypertension. Several demographic, genetic, and environmental factors could trigger chronic venous disease with venous dilation, incompetent valves, venous reflux, and venous hypertension. Endothelial cell injury and changes in the glycocalyx, venous shear-stress, and adhesion molecules could be initiating events in VLU. Increased endothelial cell permeability and leukocyte infiltration, and increases in inflammatory cytokines, matrix metalloproteinases (MMPs), reactive oxygen and nitrogen species, iron deposition, and tissue metabolites also contribute to the pathogenesis of VLU. VLU can be defined as a full-thickness defect of the skin frequently seen in the ankle region that fails to heal spontaneously and is sustained by chronic venous disease (CVD, the spectrum of venous diseases affecting the lower limbs). The majority (70–80%) of patients with VLU have primary venous insufficiency (reflux) from varicose vein disease, and about 20–30% have secondary venous insufficiency from post thrombotic syndrome (PTS). Although there are many more patients with primary venous insufficiency, PTS has a much higher risk of developing VLU and is much more aggressive in its natural history, making treatment more challenging. It has been estimated that the venous origin impacts 50–75% of chronic leg ulcers, and this percentage heavily increases if foot ulcers are excluded. Chronic wounds of the lower extremities could be sustained by several local and systemic causative factors, leading to a broad comparison among ulcers. Misdiagnosis of a leg ulcer has a great impact both on patient’s suffering, due to delayed wound healing, and on economic costs. Chronic VLUs provide a fertile breeding ground for the onset of several complications, ranging from immobility and reduced quality of life to cellulitis, severe infections, osteomyelitis, and neoplastic transformation. Recalcitrant ulcers also show prolonged healing time and often occur in individuals with advanced age, higher body mass index, and nutritional deficiencies and in association with colder temperature, preexisting or underlying venous disease, deep venous thrombosis, venous outflow obstruction, and larger wound area. VLU has a high 50–70% recurrence rate possibly due to patient noncompliance with compression therapy, surgical procedure failure, mixed VLU disease with arterial component, incorrect diagnosis of ulcer, and progression of venous disease. Several predisposing demographic, genetic, and environmental factors could lead to CVD with extensive venous dilation, incompetent valves, venous reflux, and venous hypertension.

• #105 Venous Leg Ulcer – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK567802/

  Venous leg ulcers are chronic wounds that result from prolonged venous insufficiency, primarily affecting older adults. […] These ulcers develop due to poor blood flow in the veins, leading to tissue breakdown, especially in the lower extremities. […] Although CVI is a well-known precipitant for VLU development, ulceration occurs rarely (5.1%) for unclear reasons. […] CVI may develop due to blood reflux, obstruction, or both mechanisms, causing macro- and micro-circulatory dysfunction. […] Most risk factors for the development of VLUs are non-modifiable, and patients often present with more than 1. […] Modifiable risk factors such as obesity and sedentarism are also associated with venous disease. […] Genetic traits may be an additional predisposing factor, presenting as an autosomal dominant trait with variable penetrance.

• #106 Venous leg ulcer | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/venous-leg-ulcer/

  A venous leg ulcer can develop after a minor injury if there’s a problem with the circulation of blood in your leg veins. If this happens, pressure inside the veins increases. […] This constant high pressure can gradually damage the tiny blood vessels in your skin and make it fragile. As a result, your skin can easily break and form an ulcer after a knock or scratch. […] Unless you have treatment to improve the circulation in your legs, the ulcer may not heal. […] Many factors can increase your risk of developing a venous leg ulcer, including: obesity or being overweight this increases the pressure in the leg veins […] previous deep vein thrombosis (DVT) blood clots that develop in the leg can damage valves in the veins […] varicose veins swollen and enlarged veins caused by malfunctioning valves

• #107 Why Venous Leg Ulcers Have Difficulty Healing: Overview on Pathophysiology, Clinical Consequences, and Treatment

  https://www.mdpi.com/2077-0383/10/1/29

  Venous leg ulcers (VLUs) are one of the most common ulcers of the lower extremity. VLU often occurs in association with post-thrombotic syndrome, advanced chronic venous disease, varicose veins, and venous hypertension. Several demographic, genetic, and environmental factors could trigger chronic venous disease with venous dilation, incompetent valves, venous reflux, and venous hypertension. Endothelial cell injury and changes in the glycocalyx, venous shear-stress, and adhesion molecules could be initiating events in VLU. Increased endothelial cell permeability and leukocyte infiltration, and increases in inflammatory cytokines, matrix metalloproteinases (MMPs), reactive oxygen and nitrogen species, iron deposition, and tissue metabolites also contribute to the pathogenesis of VLU. VLU can be defined as a full-thickness defect of the skin frequently seen in the ankle region that fails to heal spontaneously and is sustained by chronic venous disease (CVD, the spectrum of venous diseases affecting the lower limbs). The majority (70–80%) of patients with VLU have primary venous insufficiency (reflux) from varicose vein disease, and about 20–30% have secondary venous insufficiency from post thrombotic syndrome (PTS). Although there are many more patients with primary venous insufficiency, PTS has a much higher risk of developing VLU and is much more aggressive in its natural history, making treatment more challenging. It has been estimated that the venous origin impacts 50–75% of chronic leg ulcers, and this percentage heavily increases if foot ulcers are excluded. Chronic wounds of the lower extremities could be sustained by several local and systemic causative factors, leading to a broad comparison among ulcers. Misdiagnosis of a leg ulcer has a great impact both on patient’s suffering, due to delayed wound healing, and on economic costs. Chronic VLUs provide a fertile breeding ground for the onset of several complications, ranging from immobility and reduced quality of life to cellulitis, severe infections, osteomyelitis, and neoplastic transformation. Recalcitrant ulcers also show prolonged healing time and often occur in individuals with advanced age, higher body mass index, and nutritional deficiencies and in association with colder temperature, preexisting or underlying venous disease, deep venous thrombosis, venous outflow obstruction, and larger wound area. VLU has a high 50–70% recurrence rate possibly due to patient noncompliance with compression therapy, surgical procedure failure, mixed VLU disease with arterial component, incorrect diagnosis of ulcer, and progression of venous disease. Several predisposing demographic, genetic, and environmental factors could lead to CVD with extensive venous dilation, incompetent valves, venous reflux, and venous hypertension.

• #108 Symptoms of a Venous leg ulcers – why is my leg ulcer not healing?

  https://legsmatter.org/information-and-support/types-of-ulcers/venous-leg-ulcers/

  A venous leg ulcer (VLU) is a break in the skin, between the knee and ankle joint, and is caused by damage to the vein(s) in the lower leg, which become weaker. The weakened vein walls prevent the valves in the veins from closing sufficiently. If the valves cannot close properly, some of the venous blood backflows when the heart beats and the pressure inside the vein increases, pushing small components of the venous blood across the vein wall into the surrounding flesh and skin. This damages the flesh and breaks the skin. Because the vein is weak and leaking, the skin cannot heal. […] Veins can become damaged due to a number of reasons, including; An injury, Previous fracture of the bones in the leg, ankle or foot, Previous operations, A clot (DVT), Increased abdominal weight (pregnancies or obesity), Because the veins get weaker as we get older. […] Venous ulcers can recur if the damaged vein is not supported or removed. Therefore, compression garments should be worn even when the ulcer has healed to stop it coming back.

• #109 The impact of venous leg ulcers on a patient’s quality of life: considerations for dressing selection – Wounds International

  https://woundsinternational.com/journal-articles/the-impact-of-venous-leg-ulcers-on-a-patients-quality-of-life-considerations-for-dressing-selection/

  A vast majority (70%) of lower-extremity ulcers are caused by chronic venous insufficiency (CVI). […] VLUs generally originate from minor traumatic injuries that do not follow the normal healing process as a consequence of CVI and the inflammatory status of the skin in the affected lower limbs. […] The main goals of VLU treatment are to reverse the underlying venous hypertension and the pro-inflammatory environment. […] Compression therapy remains the gold standard of the conservative treatment of CVI in all stages, because of its non-invasive nature, ease of use, and efficacy in reducing venous hypertension, which is a main pathophysiological mechanism of CVI. […] In the presence of venous hypertension, the increase in lymphatic flow can overwhelm the lymph transport capacity, leading to phlebolymphoedema.

• #110 Venous Ulcers Treatment Yuma | The Vein Center of Arizona

  https://www.veincenterofarizona.com/chronic-venous-insufficiency/venous-ulcers/

  A venous ulcer, also called a stasis ulcer, is a shallow wound that usually develops on the legs as a result of advanced vein disease. Venous ulcers are common in patients who have a history of leg swelling, varicose veins, venous insufficiency, certain health conditions or blood clots in either the superficial or deep veins of the legs. […] Vein disease is the root cause of a venous ulcer. Vein disease develops when the one-way valves inside of a vein stop functioning correctly. The one-way valves are designed to push blood toward the heart; however, sometimes the valves weaken and are unable to adequately return the blood to the heart. As a result, excess blood remains in the vein, which creates increased pressure on the vein wall. Further, the excess blood has nowhere to go, so it pools in the lower extremities. The pooled blood may seep out of the vein and into surrounding tissue, causing the skin to become discolored and tender. If left untreated, the excess blood and pressure can break down the skin from the inside out and create open, painful sores on the surface of the skin. […] Addressing and treating the root cause of the ulcer will improve circulation, help the wound heal and prevent future ulcers from developing.

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