Management of chronic leg ulcers by Dr. Kamalakkhannan
A wound near the ankle that weeps, keeps reopening, or has not healed in weeks is rarely just a wound. Most long-standing leg ulcers are caused by a circulation problem in the veins.
We treat the ulcer and the underlying venous disease together — because dressings alone rarely produce lasting healing.
Venous ulcers occur when the valves inside the leg veins stop working, so blood pools instead of returning to the heart. The sustained pressure damages the smallest blood vessels in the skin above the ankle, starving it of oxygen until it breaks down. That is why these ulcers appear in the same place, resist ordinary dressings, and return once healed — unless the vein problem itself is corrected.
Understanding the Condition
A venous ulcer, also called a venous leg ulcer or stasis ulcer, is an open wound that develops on the lower leg as a result of chronic venous insufficiency — the same underlying problem that causes varicose veins.
They typically form just above the ankle, most often on the inner side, and are usually shallow with irregular edges. The surrounding skin is often discoloured, hardened or itchy long before the ulcer itself appears.
Venous ulcers account for the majority of chronic leg ulcers. They are treatable, but they need the circulation problem addressed rather than the wound alone.
Warning Signs
The skin usually changes for months before an ulcer opens. Recognising those early signs is what prevents one forming.
Get seen promptly if the wound becomes more painful, smelly, or the surrounding skin turns hot and red — these suggest infection. Spreading redness with fever needs same-day medical care.
Why It Persists
Many patients arrive having had the same ulcer dressed for months. The wound sometimes closes, then opens again weeks later in the same spot.
The reason is that a dressing manages the surface while the cause continues underneath. As long as pressure inside the veins stays high, the skin over the ankle keeps being starved of oxygen — so healing stalls, and any healing that does occur is fragile.
Effective treatment therefore has two parts: getting the ulcer to close, and correcting the venous disease driving it. Treating the underlying vein is what substantially reduces the chance of the ulcer coming back.
Getting the Diagnosis Right
Leg ulcers have several causes, and the treatment for one can be harmful for another. Compression helps a venous ulcer but can be dangerous if the arterial supply is poor — which is why assessment comes before treatment.
| Venous ulcer | Arterial ulcer | Diabetic foot ulcer | |
|---|---|---|---|
| Usual location | Just above the ankle, inner side | Toes, heel, outer ankle, pressure points | Sole of the foot, under pressure points |
| Pain | Aching, eased by raising the leg | Severe, worse when the leg is raised | Often painless due to nerve damage |
| Appearance | Shallow with irregular edges, moist | Deep, "punched out", dry | Deep, surrounded by thickened skin |
| Surrounding skin | Brown staining, hardened, swollen | Pale, cool, shiny, hairless | Callus, may be warm and dry |
| Main treatment | Compression plus treating the vein | Restoring blood supply — compression may harm | Pressure offloading and glucose control |
Ulcers can have more than one cause at once, particularly in people with diabetes. Diabetic foot ulcer care →
Treatment
Treatment works on three fronts at once. Skipping any one of them is usually why an ulcer keeps returning.
The cornerstone of venous ulcer care. Graduated compression counteracts the raised pressure in the veins and helps the wound close.
The ulcer bed is prepared and dressed appropriately for its stage, with infection managed where present.
Where ultrasound shows a faulty vein feeding the problem, closing that vein addresses the cause rather than the symptom.
Treatment plans are individualised based on wound assessment, circulation studies and vein mapping.
Why It Matters
Long-standing ulcers become progressively harder to heal. Untreated, they may lead to:
Ulcers treated early heal faster and are less likely to return.
What to Expect
Examination of the wound and leg, plus a check of the arterial blood supply before any compression is applied.
A Doppler ultrasound identifies which veins have failed and whether they can be treated.
Compression and wound care to close the ulcer, with regular review as it improves.
Treating the underlying vein and continuing compression, so the ulcer does not return.
Your Surgeon
Dr. Kamalakkhannan is an experienced laser and laparoscopic surgeon with over 15 years of expertise in venous disease and chronic wound management.
Because venous ulcers sit at the meeting point of wound care and vein surgery, both are handled under one roof rather than split between clinics.
Patient Education
Understanding your condition helps you decide
A jargon-free explanation of leg ulcers and how they are treated.
Book a consultation if you experience any of the following.
Early assessment shortens healing time and reduces the chance of the ulcer returning.
Frequently Asked
They occur when valves in the leg veins fail, so blood pools and pressure inside the veins stays high. Over time this damages the skin above the ankle until it breaks down into an open wound.
With proper compression and wound care, many ulcers improve over a period of weeks to months. Healing time depends on the size and duration of the ulcer, circulation, infection and overall health.
Recurrence is common if only the wound is treated. Continuing compression and correcting the underlying vein problem substantially reduce the risk of the ulcer returning.
Not always. Compression and wound care come first. Where ultrasound shows a faulty vein driving the ulcer, a minimally invasive laser procedure may be recommended to prevent recurrence.
Compression is the cornerstone of venous ulcer treatment and is usually continued after healing. It is applied only after the arterial blood supply has been checked, as compression is not safe for every type of leg ulcer.
Yes, and it usually helps. Walking activates the calf muscle pump, which assists blood return. Prolonged standing or sitting still tends to make symptoms worse.
Eligible procedures may be covered under health insurance policies, depending on the terms of your plan. Our team assists with documentation and guidance on claims.
If you have a leg wound that will not heal, or one that keeps coming back in the same place, an assessment will identify what is causing it. Consult Dr. Kamalakkhannan at Lapser Multi Speciality Clinic, Chennai, for venous ulcer evaluation and treatment.
The information on this page is for general awareness and is not a substitute for professional medical advice, diagnosis or treatment. Leg ulcers have several possible causes, and treatment that helps one type can be harmful in another — compression should never be applied without a proper assessment of the circulation. Healing times and outcomes vary from person to person. Always consult a qualified doctor about your condition.
