Chronic Wounds
Chronic Venous insufficiency, Superficial venous reflux and the resultant visible
varicose veins is the underlying cause of many chronic wounds in the legs.  The
abnormally high pressures that result from either venous reflux (80%) or venous
obstruction (20%) decreases the ability of the body to heal itself, either through
decreased oxygen in the blood, decreased blood flow or due to toxins from the
breakdown products of blood (blood that has been forced out of the vessels due to
the high pressures).
Common patterns of ulceration
It is important to differentiate between a supply problem (Arterial blockage or
decreased flow) and a problem with the venous system.  Physical examination can
provide clues to the probable cause and a thorough ultrasound examination can
demonstrate the specific abnormal vessels.  As always, skill with the ultrasound
examination is essential.
Different vessels produce ulcerations and pain in different locations of the leg.  For
instance, the most common cause of an ulceration in the medial (inside) side of the
ankle is the Greater Saphenous Vein (also referred to as the Long Saphenous
Vein).  Familiarity with the different patterns can lead to more rapid diagnosis and
more accurate and predictable treatment results.
CEAP Classification is used to determine
severity of venous reflux.
Class 0    No signs of venous disease
Class 1    Spider veins or reticular veins
Class 2    Varicose veins
Class 3    Edema
Class 4    Skin changes
Class 5    Healed ulceration
Class 6    Active ulceration
In CEAP classifications 4-6, treatment is performed to promote
wound healing and provide symptomatic relief.  With successful
treatment of the underlying reflux including significant perforators,
healing for at least 3 years is seen in 70-90% of patients.  Without
successful treatment, 50-100% of patients have repeat ulcerations.
We have included images of some of the chronic wounds that we
have treated at The Vein Center on the linked page below.  Please
note that some of the images are fairly graphic, please use good
judgement on appropriate locations to view them.
The Vein Center
11219 Financial Centre Parkway
Suite 215
Little Rock, Arkansas  72211
(501) 225-8346  (225-VEIN)
Fax  (501) 217-9819