Why a lower-leg wound may not heal for months, when home care may be appropriate and when treatment of the affected vein is needed.
What is a venous leg ulcer?
A venous leg ulcer is a break in the skin and deeper tissue that remains inflamed and does not heal for a prolonged period. It most often develops on the inner lower leg. Tissue damage progresses over time and may leave scarring after healing.
Why does it not heal?
The underlying problem is impaired venous drainage. Blood pools in the lower-leg tissues, reducing their oxygen and nutrient supply. The skin darkens and hardens, and even minor damage can develop into a wound that the body struggles to heal. Local immune defences are also affected.
The main principle
Treat the cause, not only the wound. When normal venous drainage is restored, the tissues receive a better blood supply and the ulcer can begin to heal.
When home treatment may be appropriate
At an early stage, while the wound is small and shows no signs of infection, the doctor may prescribe conservative treatment and careful wound care:
- Local wound care and dressings as prescribed by the doctor.
- Compression therapy to reduce venous congestion.
- Medicines prescribed to support venous circulation and microcirculation.
- Regular follow-up with a phlebologist.
This supports wound healing but does not remove the underlying cause. The doctor therefore also plans how to close the affected vein.
When intervention is needed
If the ulcer is large, persistent, recurrent or infected, do not delay assessment. Modern minimally invasive techniques can close the underlying vein even when a wound is open. Restoring venous drainage can substantially improve healing.
How it works in practice
First, an ultrasound scan identifies the vein causing venous congestion. The vein is then closed through a needle puncture using laser or radiofrequency ablation, while the wound is managed at the same time. This treats the underlying cause rather than relying on repeated dressings alone.
Conclusion
A venous leg ulcer is a sign of advanced venous disease, but the cause can still be treated. Do not focus on the wound surface alone: see a phlebologist, have an ultrasound scan and address the underlying vein problem. Earlier treatment gives the leg a better opportunity to heal.