Surgical Science, 2013, 4, 144-150 http://dx.doi.org/10.4236/ss.2013.42028 Published Online February 2013 (http://www.scirp.org/journal/ss) Venous Ulcer: Review Article Shashi Prakash, Satyendra Kumar Tiwary, Manjaree Mishra, Ajay Kumar Khanna * Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India Email: sprakashsurgery@gmail.com, drsktiwary1@gmail.com, drmanjareemd@gmail.com, * akhannabhu@gmail.com Received December 4, 2012; revised January 2, 2013; accepted January 11, 2013 ABSTRACT Venous ulceration is the most severe and debilitating outcome of chronic venous insufficiency in the lower limbs and accounts for 80 percent of lower extremity ulcerations. The morbidity caused by them has a serious impact on the qual- ity of life. Sustained venous hypertension, caused by venous insufficiency leads to venous ulceration. The diagnosis is mainly clinical but needs to be differentiated from other causes of lower limb ulcers. Doppler ultrasound is the diagnos- tic investigation. Treatment options for venous ulcers include conservative management, mechanical treatment, medica- tions, and surgical options. The goals of treatment are to reduce edema, improve ulcer healing, and prevent recurrence. The achievement of good long term results depends on continuous care, ulcer care clinics, home health nursing and regular evaluation by the doctor. They have a crucial role to play for the amelioration of this common and morbid con- dition. Keywords: Venous Ulcer; Chronic Venous Insufficiency 1. Introduction Venous ulceration (stasis ulcer) is the most severe and debilitating outcome of chronic venous insufficiency in the lower limbs and accounts for 80 percent of lower extremity ulcerations [1]. Various other causes for lower extremity ulcerations could be arterial insufficiency, pro- longed pressure, diabetic neuropathy and systemic illness such as rheumatoid arthritis, vasculitis, osteomyelitis, and skin malignancy [2]. In the United States overall prevalence of venous ulcers is approximately 1 percent [1]. Venous ulcers are more prevalent in women and older persons and the risk factors primarily include older age, obesity, previous leg injuries, deep venous thrombo- sis and phlebitis [3-7]. They are often recurrent and may sometimes persist from weeks to years, giving rise to the complications in form of cellulitis, osteomyelitis and at times malignant change [3,8-10]. In spite of low overall prevalence, the refractory nature of these ulcers causes an increased risk of morbidity, mortality and a significant impact on quality of life [11,12]. The financial burden of venous ulcers is estimated to be $2 billion per year in the United States [13,14]. 2. Aim and Objective The aim of this review article is to elaborate the various aspects related with pathophysiology, diagnosis and treat- ment of venous ulcers. 2.1. Pathophysiology The circulatory system of the body is a complex network of blood vessels, if they become diseased or damaged then skin breakdown can occur, or an existing wound could fail to heal. Veins usually carry deoxygenated blood towards the heart and are often closer to the skin than arteries. Most veins have one-way flaps or valves that prevent backflow of blood and pooling in the lower legs. These valves may become diseased or damaged, hence incompetent, causing blood to flow back. This leads to an increase in pressure within the deep venous system causing the vein walls to stretch, opening up the valves and allowing even more blood to fill the veins. Veins are classified as superficial and deep. Superficial veins are close to the body surface having no corre- sponding arteries. The long saphenous vein is the most important superficial vein in the lower limb, running from the dorsal vein at the big toe to join the femoral vein at the sapheno-femoral junction at the top of the thigh. Deep veins are found much deeper within the leg and all have corresponding arteries, with similar names, running alongside them. Examples are the perineal and femoral veins. It is within the deep veins where blood clots form, causing a deep vein thrombosis (DVT), which is one of the main causes of venous hypertension. Perforator veins connect the deep and superficial venous systems and have one way valves. * Corresponding author. Copyright © 2013 SciRes. SS