The root cause of recurrent venous ulcers

Many patients with lower extremity ulcers have similar experiences: the wound heals slowly after dressing changes, only to reopen in the same spot a few months later, repeating this cycle for years without real improvement. Superficially, it appears to be a case of poorly healing broken skin, but the root cause often lies in the venous system of the lower leg. Venous ulcers are a late-stage manifestation of chronic venous insufficiency; the wound is merely the result, while vascular problems are the persistent driving factor.

Why do wounds reopen even after they've healed?

The healing of a venous ulcer only signifies the temporary closure of the skin defect; it does not indicate the relief of venous hypertension. When deep vein valves are damaged or superficial venous reflux persists, blood flows backward during standing and walking, increasing pressure in the calf veins. Prolonged high pressure in the capillaries leads to increased fluid exudation, tissue edema, and obstructed oxygen and nutrient transport, causing gradual hardening of the skin and subcutaneous tissue. Even a minor friction, scratching, insect bite, or eczema flare-up can cause the already fragile skin to break down again. Without addressing venous hypertension, recurrence is highly probable.

What exactly does venous hypertension do to the tissues of the lower leg?

Normally, the calf muscles compress the deep veins during walking, propelling blood back to the heart. With valvular insufficiency, blood flows backward, and the efficiency of the muscle pump decreases. Venous blood stasis increases capillary hydrostatic pressure, causing fluid to seep into the interstitial spaces, leading to edema. Red blood cells and fibrinogen leak out, and their breakdown products stimulate an inflammatory response. White blood cells aggregate and release proteases and reactive oxygen species, damaging local tissues. The skin gradually develops pigmentation, hardening, white atrophy, and eczema-like changes. These areas have poor resistance to damage, and even minor trauma can lead to ulceration. The morphological changes of the skin around the ulcer are a direct reflection of venous hypertension on the body surface.

What happens if we only change the medication without addressing the venous hypertension?

Simply changing dressings, cleaning, and administering antibiotics can temporarily control the wound, but venous hypertension immediately returns when standing or walking, and the surrounding tissues remain edematous and hypoxic. Healing is slow, the risk of infection is high, and recurrence is rapid. Many patients experience repeated hospitalizations for years, with their wounds healing and deteriorating intermittently, because the treatment only targets the wound and not the veins.

Why is stress therapy a core measure?

Compression therapy supports the veins in the lower leg with external pressure, reducing blood backflow and pooling, and lowering venous hypertension. Elastic bandages and medical compression stockings are commonly used, with pressure decreasing from the ankle down the lower leg. During the acute phase with significant effusion, multiple layers of elastic bandages are used under professional guidance. Compression stockings are worn during the stable phase, worn during the day and removed at night. Compression therapy requires long-term adherence and should not be stopped once the wound has healed. The recurrence rate increases significantly after stopping compression therapy. Arterial blood supply must be assessed before compression therapy; those with a low ankle-brachial index should not be subjected to excessive compression.

In what situations is surgery or intervention necessary?

If venous Doppler ultrasound reveals severe reflux in the great or small saphenous vein, or obstructive lesions in the deep veins, pressure therapy alone may have limited effectiveness, requiring vascular surgical evaluation. Common methods include endovenous laser or radiofrequency ablation, sclerotherapy, vein stripping, and stent implantation. After treating the refluxed veins, venous hypertension is reduced, and ulcer healing and recurrence rates can improve. Surgery is not a replacement for pressure therapy; long-term compression stockings and follow-up are still necessary post-operatively.

How to prevent recurrence in daily life?

Maintain long-term use of compression stockings, wearing them during daytime activities and changing them regularly. Elevate the affected limb above heart level when resting. Avoid prolonged standing or sitting; move your ankle and calf muscles periodically. Protect the skin around the ulcer with a moisturizer, avoiding scratching and injury. Control your weight and walk moderately. Seek medical attention promptly if you notice redness, broken skin, or oozing; do not repeatedly irritate the area with disinfectants. Venous ulcer management is a long-term process; wound healing is only one stage. Managing venous function is key to preventing recurrence. For more information on Innomed® Silicone Foam Dressing, refer to the Previous Articles. If you have customized needs, you are welcome to contact us; You Wholeheartedly. At long-term medical, we transform this data by Innovating and Developing Products that Make Life easier for those who need loving care.

Editor: kiki Jia