Pathophysiology of venous ulcers: Surgical implications, review, and update

BACKGROUND. Ambulatory Venous hypertension has long been accepted as the principal and sole factor underlying the development of venous ulcers of the leg. This concept is now being seriously challenged as other factors emerge as important in the pathophysiology of venous ulcers. OBJECTIVE. This study was undertaken in order to review and update the current thinking concerning the pathophysiology of venous ulcers of the leg. METHOD. A review of the current medical literature. RESULTS. The prevailing current thinking about the pathophysiology of venous ulcers of the leg reveals that ambulatory venous pressure is the initiating factor. Over time this causes endothelial damage by the activation of leukocytes with subsequent release of proteolytic enzymes along with free oxygen radicals, leading to tissue damage which over time may cause ulceration. CONCLUSIONS. The production of venous ulcers of the leg is more complex than what was first thought. Although it is most likely that inflammatory factors are involved in its production, the cascade of inflammatory events postulated to occur need further investigation and clarification.