The Clinical Presentation of Venous-Insufficiency Ulcers

Venous-insufficiency ulcers are usually located on the medial aspect of the lower leg or medial malleolus. It is also common to find venous ulcers in areas exposed to trauma, such as the anterior shin. Venous ulcerations do not occur on the plantar aspect of the foot and rarely occur above the knee.

Venous-insufficiency ulcers are generally superficial, irregular in shape, and have moderate- to- high amounts of drainage. If the dressing does not absorb enough wound drainage, the wound edges will be white and fragile due to maceration. The wound bed contains beefy, red granulation tissue but may take on a ruddy appearance. A thin, yellow fibrous coating may cover the wound bed, giving it a glossy look.

Venous insufficiency is often associated with many skin changes. Cellulitis, Dermatitis and dry, scaling skin” which may cause intense itching are common. Superficial varicosities and evidence of previous ulceration may be present. Lower- extremity edema is usually always present. In cases of long-standing venous insufficiency, the edema may become firm or indurated. Initially, skin changes may include a subtle erythema. With chronic venous insufficiency, the skin becomes stained and more darkly pigmented, due to hemosiderin deposition. Hemosiderin is a by-product of the breakdown of red blood cells, which have been forced into the interstitium by venous hypertension. The term lipodermatosclerosis is used to describe the hyperpigmentation and accompanying erythema, induration, and plaque-like structural changes that occur due to long-standing venous insufficiency. The skin and subcutaneous tissues are more fibrotic and less elastic than healthy tissue.

To learn more about these dressings and others, you may wish to consider becoming certified as a wound care specialist. The benefits of wound certification are immeasurable, both to your own career and to the standard of care that you can offer your patients. And, because Medicare and other organizations are now holding health-care professionals responsible for outcomes in wound care, there has never been a better time to become a wound care specialist.

For more information about venous ulcers refer to the following articles:

Learn More About Our Wound Care Education Options

Interested in learning more about wound care and certification? Browse through our wound care certification courses for information on our comprehensive range of education options to suit healthcare professionals across the full spectrum of qualifications and experience.

Editors Note:  This post was originally published in December 2007 and has been revamped and updated for accuracy and comprehensiveness.


Myers, B. (2007). Wound Management; Principles and Practice. Upper Saddle River, Prentice Hall, PA., Page 259.


    1. Hi Theresa,

      Thank you for your interest in

      LPNs can absolutely become wound care certified!!!

      There are no eligibility requirements to take our course. To sit for the certification exam, you will need to show three years of clinical experience. The ABWM defines three years of clinical experience as follows: 
      “Three years of wound care experience can be acquired over the course of your career. It does not necessarily have to be a consecutive three years. Wound care does not have to be your primary responsibility during that time, as long as you can demonstrate you have had roles related to wound care throughout your career.” 

      If you do not have the required clinical experience at this time, please contact us so that we can provide you with alternative options.

      As an LPN we recommend our 50-hour LPN Wound Certification Course.

  1. I have Venous-insufficiency ulcers on the tops of my shins my dog scratched this sensitive area open and it has been draining water for 3 weeks. My Dr is monitoring it and put me on antibiotics but there is no pain odor or redness just draining continuously large amounts of Water. 30 minutes soaks a towel completely. Bandages are soaked in 10 minutes or less. Any suggestions

  2. Hello Dr. Swezey, I learned that my problem is psuedomonas, not sure of a certain type, my skin issue is statis dermatitis, affecting my lower right leg. I went to a dermatologist and he told me it was not cellulitis and he said I should see a vein doctor. I have started wearing compression stockings and I am still experiencing a lot of pain and burning and now that I understand how serious psuedomonas is I am wondering if I would be better off not wearing compression stockings until I get this bacteria taken care of before I wear them again. Thanks for any advice.

  3. some alteration in food habits can assist with the appearance of varicose and spider veins. There are numerous aromatic plants, which will help in keep blood thin and flowing easily. Also take care of the nutrients essential to keep capillaries and veins tough. Rising your eating of saturated and monounsaturated fats may assist you in the process. All cells substitute themselves on a habitual basis; containing the cells in your circulatory structure.

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