Venous Leg Ulcer Treatment: Why These Wounds Develop and How They Heal

A wound on the lower leg that refuses to close is exhausting. The dressings, the weeping, the disturbed sleep, the quiet worry that it will never heal. If that describes you or a parent you care for, take heart from one fact I share with every ulcer patient in my clinic: with correct venous leg ulcer treatment, the great majority of these wounds do heal, and modern vein procedures can stop them coming back. What most patients have never been told is why the ulcer formed in the first place, and that is where healing begins.

Venous Leg Ulcer

What Is a Venous Leg Ulcer?

A venous leg ulcer is an open, slow-healing wound, usually near the inner ankle, caused by persistently high pressure in the leg veins. According to the Cleveland Clinic, venous disease accounts for around 80 percent of all lower leg ulcers, making it by far the most common cause. These wounds affect roughly 1 in 100 adults at some point, with risk rising steeply after 60.

The chain of events runs like this. One-way valves inside the leg veins fail, a problem called chronic venous insufficiency. Blood pools in the lower leg instead of returning to the heart, and the sustained pressure damages the skin from within. The skin darkens, thickens and becomes fragile, until a minor knock or scratch opens a wound that the waterlogged, poorly nourished tissue cannot repair.

Why does this matter so much? Because an ulcer treated only with dressings, while the venous pressure underneath stays high, is a wound being asked to heal underwater. Address the pressure and the biology changes completely.

Why Venous Ulcers Develop

Failed vein valves. Previous deep vein thrombosis, longstanding varicose veins, obesity, multiple pregnancies and simple family predisposition all damage venous valves. If you have had a DVT in the past, your risk of a later ulcer is significantly increased, which is why leg swelling after a clot should never be ignored.

Prolonged standing and immobility. The calf muscle is the leg's second heart, pumping blood upwards with every step. Jobs that involve standing still for hours, common in Dubai's retail, security and hospitality sectors, defeat that pump. So does a sedentary routine in an air-conditioned office through the long summer months.

Skin changes that go unheeded. Most ulcers announce themselves years in advance: ankle swelling by evening, itching, brown staining around the ankle, hardening of the skin. Patients often dismiss these signs. In my clinic, the story "this patch has been dark for years, then a small scratch would not heal" is one I hear almost weekly.

Diagnosis: The Scan Before the Dressing

Every leg ulcer deserves two checks before a treatment plan is set. First, a duplex ultrasound maps the veins and confirms where the pressure is coming from, whether superficial reflux, deep vein damage or both. Second, an arterial check (ankle-brachial pressure measurement) confirms the arteries can safely tolerate compression. This step is not optional: applying strong compression to a leg with significant peripheral arterial disease is dangerous, so arterial status must be confirmed first.

How Venous Leg Ulcers Are Treated

Compression therapy is the foundation. Graduated compression, applied as multi-layer bandaging or strong medical hosiery, counteracts the venous pressure and is the first-line, evidence-based treatment that heals most venous ulcers. Full compression delivering around 40 mmHg at the ankle is the recognised standard. Healing rates are good: the majority of venous ulcers close within three to six months under proper compression, with dressings chosen to manage fluid and protect new tissue.

Treating the leaking veins stops the cycle. Compression heals the wound, but it does not fix the valves. The landmark EVRA randomised trial published in the New England Journal of Medicine showed that early endovenous ablation of superficial reflux, performed within two weeks, shortened ulcer healing time and increased the ulcer-free period compared with deferred treatment. In practical terms: closing the faulty vein with a minimally invasive procedure such as laser ablation or foam sclerotherapy helps the current ulcer heal faster and roughly halves the risk of recurrence.

Skin care, elevation and movement complete the plan. Elevating the legs above heart level for periods during the day, regular walking to work the calf pump, protein-rich nutrition and careful skin care all support healing. None of these replaces compression; they multiply its effect.

What Happens if a Venous Ulcer Is Left Untreated?

These wounds do not heal on their own. An untreated venous ulcer typically enlarges, becomes colonised by bacteria, and may cause surrounding skin infection (cellulitis). Pain and odour erode quality of life, and the longer an ulcer remains open, the greater the likelihood of permanent tissue damage and the harder healing becomes. Recurrence is the other trap: even after healing, ulcers return in well over half of patients whose underlying vein problem is never treated. Prevention after healing rests on two pillars, continued compression hosiery and definitive treatment of the refluxing veins.

When to See a Specialist in Dubai

See a vascular specialist promptly if you have a leg wound that has not healed within two weeks, brown or hardened skin around the ankle, worsening swelling, or a previous ulcer and fear it is returning. Bring a list of your medications and any previous scan reports. If you have diabetes, be doubly cautious, because diabetic foot problems and venous disease can coexist and need coordinated care.

Dr. Soroush Sohrabi is a UK-trained Consultant Vascular and Endovascular Surgeon (FRCS, CCT) practising in Dubai, with a Cleveland Clinic Advanced Endovascular Fellowship and 77 peer-reviewed publications.

Why Choose Dr. Soroush Sohrabi for Leg Ulcer Care in Dubai

An ulcer service should offer four things under one roof: duplex ultrasound performed by the treating specialist, arterial assessment before compression, modern wound care, and the minimally invasive vein procedures proven to speed healing and prevent recurrence. Dr. Soroush Sohrabi provides all four in Dubai, holding the FRCS in Vascular Surgery from the Royal College of Surgeons of England with advanced endovascular training from the Cleveland Clinic, USA.

His practice follows the approach validated by the EVRA trial: heal the wound with correct compression while treating the underlying reflux early rather than waiting. During more than a decade of NHS vascular practice, including service as Clinical Director of Vascular Surgery Services in North Wales, leg ulcer pathways were a core part of his workload, and he brings the same protocol-driven care to Dubai. Patients referred with complex, long-standing wounds frequently find that the missing step was never the dressing, it was the scan that no one had done.

Frequently Asked Questions

How long does a venous leg ulcer take to heal?

With correct graduated compression therapy, most venous leg ulcers heal within three to six months, and smaller recent ulcers often close faster. Wounds that have been open longer than a year, or that sit on legs with untreated deep and superficial reflux, take longer. Early treatment of the underlying veins, as shown in the EVRA trial, shortens healing time.

Can a venous ulcer heal without compression?

Rarely, and far more slowly. Compression is the single most effective evidence-based treatment because it directly counteracts the venous pressure that caused the wound. Dressings alone treat the surface while the cause continues underneath. Compression must only be applied after an arterial check confirms it is safe for your circulation.

Do I need surgery for a venous leg ulcer?

Not surgery in the traditional sense. Modern treatment of the underlying veins is minimally invasive: endovenous laser ablation or foam sclerotherapy performed under local anaesthetic, walking out the same day. The EVRA trial showed early ablation speeds ulcer healing and extends ulcer-free time, so vein treatment is now recommended alongside compression rather than after it.

Why do venous ulcers keep coming back?

Because healing the skin does not repair the faulty vein valves underneath. If venous pressure remains high, the skin breaks down again, and recurrence affects more than half of patients without vein treatment. Definitive ablation of refluxing veins plus long-term compression hosiery reduces recurrence dramatically.

Are venous leg ulcers painful?

Many are, particularly when swollen or infected, though some cause surprisingly little pain. Pain that worsens sharply, spreading redness, heat or fever suggests infection and needs urgent review. Elevation and correct compression usually improve day-to-day discomfort as the swelling settles.

Is an ulcer near my ankle definitely venous?

Not automatically, and this is why assessment matters. Around 80 percent of leg ulcers are venous according to Cleveland Clinic figures, but arterial disease, diabetes, pressure and rarer causes account for the rest, and mixed disease is common. A duplex scan plus ankle pressure measurement identifies the cause before treatment starts.

Key Takeaways

• Venous disease causes approximately 80 percent of all lower leg ulcers according to Cleveland Clinic, making failed vein valves the leading reason a leg wound will not heal.

• Graduated compression therapy delivering around 40 mmHg at the ankle is the first-line, evidence-based treatment for venous leg ulcers and heals the majority within three to six months.

• The EVRA randomised trial in the New England Journal of Medicine showed early endovenous ablation of superficial reflux shortens ulcer healing time and increases ulcer-free time compared with deferred treatment.

• An arterial assessment must precede compression therapy because strong compression is unsafe in significant peripheral arterial disease.

• Venous ulcers recur in more than half of patients when the underlying refluxing veins are left untreated, so definitive vein treatment plus maintenance hosiery is the standard of care.

• Dr. Soroush Sohrabi in Dubai combines duplex-guided diagnosis, compression care and same-day minimally invasive vein ablation in a single leg ulcer pathway.

A leg wound that will not close needs a cause, not just a dressing. Book an assessment with Dr. Soroush Sohrabi in Dubai.

About the Author

Dr. Soroush Sohrabi MD, PhD, FRCS, CCT is a Consultant Vascular and Endovascular Surgeon in Dubai. He trained in the United Kingdom and holds a Fellowship of the Royal College of Surgeons of England (FRCS) in Vascular Surgery and a Certificate of Completion of Training (CCT). He completed an advanced endovascular fellowship at the Cleveland Clinic, USA, and further fellowships in Australia. He has published 77 peer-reviewed papers with over 1,183 academic citations and is a member of the European Society of Vascular Surgery (ESVS) and the Vascular Society of Great Britain and Ireland (VSGBI). He is licensed by the UK General Medical Council (GMC No. 5207627) and the Dubai Health Authority (DHA No. 48905551).

Medically reviewed by Dr. Soroush Sohrabi MD, PhD, FRCS, CCT, Consultant Vascular Surgeon | August 2026

References

1. Cleveland Clinic, Venous Ulcer: Symptoms, Causes, Treatment and Prevention. https://my.clevelandclinic.org/health/diseases/23165-venous-ulcer

2. Gohel MS et al., A Randomized Trial of Early Endovenous Ablation in Venous Ulceration (EVRA), New England Journal of Medicine. https://www.nejm.org/doi/full/10.1056/NEJMoa1801214