Venous disease: how to heal and prevent chronic leg ulcers.

Venous disease accounts for up to 90% of all cases of chronic leg ulcers. Patients with venous disease have relatively unhealthy, ischemic tissue in the lower legs, and slight trauma often initiates an ulcer. Symptoms include leg swelling, which is often unilateral and persistent, and a dull ache that worsens with standing, walking, or sitting with the legs down. Approximately 50% of patients have a history of deep vein thrombosis. A careful history and examination can rule out other causes and guide appropriate therapy as well as prophylaxis against progressive disease. Elevation, compression, occlusion, and debridement are the mainstays of treatment. Ulcer healing is gradual, often requiring weeks to months of therapy. Preventing recurrence requires careful attention to compression; surgery may be indicated.