In short. Why venous leg ulcers form, why compression therapy is the treatment with the best evidence behind it, and how adherence decides whether the ulcer heals.

Key points

  • Compression heals more venous ulcers, and heals them faster, than dressings alone.
  • The choice of dressing has far less effect on healing than whether adequate compression is worn.
  • Recurrence is common — frequently around a third or more within a year — and the strongest predictor of recurrence is not wearing compression consistently after the ulcer has healed.

A venous leg ulcer is the most common chronic leg wound. It usually sits above the ankle on the inner side, in skin that has been stained brown and thickened over years. It is caused by faulty valves in the veins rather than by weak skin, which is why treating the skin alone never works.

Why the ulcer forms

Normally, the calf muscles pump blood upward and valves prevent it from falling back. When valves fail, blood pools under pressure in the lower leg. That pressure pushes fluid and large molecules into the tissues, causing swelling, pigment staining, and hardening, and finally a break in the skin that cannot heal while the pressure remains. Standing still and hot weather make it worse; walking and elevation help.

Compression is the treatment

Compression bandages or stockings apply graduated pressure that reverses the pooling and supports the return of blood. It is the only treatment with strong evidence that it heals venous ulcers and prevents recurrence, and it works best at adequate, correctly applied pressures under supervision. Multilayer bandage systems and graduated stockings are the main options. Compression must be applied by someone trained to do it and reassessed as swelling changes, because a bandage that has become loose stops working and one that is too tight is dangerous.

What the evidence shows

Compression heals more venous ulcers, and heals them faster, than dressings alone. The choice of dressing has far less effect on healing than whether adequate compression is worn. Recurrence is common — frequently around a third or more within a year — and the strongest predictor of recurrence is not wearing compression consistently after the ulcer has healed. For that reason compression usually continues lifelong, supported by supervised exercise and leg elevation.

Adherence decides the outcome

Compression is hot, awkward, and difficult to put on. That is why many venous ulcers persist for months. Practical support matters: correct measurement and fitting, help with application if dexterity or eyesight is limited, and a frank conversation about what will actually be worn. An honest plan that a patient can keep to beats an ideal one abandoned within a week.

Other treatment

Debridement removes slough so healing can advance. Dressings keep the wound moist under the bandage, and antibiotics are used only when infection is present rather than routinely. Surgery on the veins themselves — ablation, stripping, or stenting where indicated — reduces recurrence for some patients, and a vascular assessment identifies them. Skin grafting can close a large ulcer that has stopped shrinking, but only once compression and the wound bed are right.

Seek urgent review if

  • The leg becomes much more painful, swollen, red, and hot, or you feel feverish.
  • The ulcer bleeds heavily, deepens, or exposes tendon or bone.
  • Toes or the forefoot turn pale, cold, or blue, or pain occurs at rest.

Related reading

Frequently asked questions

Why is compression the main treatment for a venous leg ulcer?

It is the only treatment with strong evidence that it heals venous ulcers and prevents recurrence. Compression reverses the pooling of blood in the lower leg and supports its return. Dressing choice has far less effect on healing than whether adequate compression is actually worn.

How long does compression need to be worn?

Usually lifelong. Recurrence is common, frequently around a third or more within a year, and the strongest predictor of recurrence is not wearing compression consistently after the ulcer has healed. Garments are replaced roughly every four to six months.

Can a venous leg ulcer be treated with surgery?

Surgery on the veins themselves, such as ablation, stripping or stenting where indicated, reduces recurrence for some patients, and a vascular assessment identifies them. Skin grafting can close a large ulcer that has stopped shrinking, but only once compression and the wound bed are right.

Risks & Limitations

  • Chronic wounds heal over months, not weeks. A wound that closes in three to six months of consistent care is a good result.
  • Recurrence is common. Both diabetic foot wounds and venous leg ulcers frequently return, which is why protective footwear and compression continue after healing.
  • Partial or complete failure of a skin graft or flap, which may require further surgery.
  • Infection and biofilm, which delay healing by weeks and can spread deeply or into bone.
  • Amputation risk in diabetes and vascular disease, which is reduced but never abolished by treatment.
  • Prolonged dressings and repeated clinic visits. Offloading, compression, and follow-up are demanding and take months.
  • Donor-site scarring and discomfort where a graft or flap was taken.
  • Reduced or absent sensation in grafted and flap tissue, and around a healed diabetic foot wound.

When to Seek Care

  • A wound that is enlarging or deepening, or that begins to expose bone, tendon, or joint.
  • Black, grey, or dead tissue appearing in or around the wound.
  • Spreading redness, warmth, or swelling around the wound.
  • Fever, shivering, or feeling generally very unwell.
  • Foul odour or pus from the wound.
  • New or severe pain, including pain in the leg or foot at rest or at night.
  • A toe or foot that turns black, cold, or blue.
  • Loss of sensation in a foot or toe, or a new wound or blister you cannot feel.

References & Further Reading

  • World Health Organization (WHO) — chronic wound and diabetes care resources
  • NICE (National Institute for Health and Care Excellence) — guidance on wound care, diabetic foot problems, and pressure ulcers
  • Wounds International — international consensus documents on wound infection, biofilm, and compression therapy
  • American Society of Plastic Surgeons (ASPS) — plastic surgery guidance on wound closure
  • Cochrane Library — systematic reviews in wound care and wound closure

Medically reviewed by Shaoliang Wang, MD (王韶亮), Center Director, Plastic Surgery & Aesthetics Medical Center. Last reviewed: 18 September 2026.

This page is patient education, not medical advice, and it does not cite individual studies. Discuss your own case with a qualified clinician. To arrange an assessment at Chongqing West District Hospital, see Contact & Consultation.