Treatment to Heal Leg Ulcers

For a few seconds in September 1977, David Obermier saw his life flash before his eyes. A quick maneuver on his bike tempered the severity of a definite collision with an oncoming car. Still, he sustained significant injuries. One impacted his life for years afterward.

Through his Ulcer Center at JVAI, Douglas Joyce, DO, at Joyce Vein & Aesthetic Institute in Punta Gorda treated David Obermier for venous disease and a skin ulcer that resulted from it.

David has no pain in his leg and can walk unassisted.

“I was on a motorcycle, and a drunk driver was going to hit me head on,” relates David. “I swerved, and he hit the side of me instead. I ended up with four compound fractures of my left leg. The doctor at that time was able to save my leg, and my life.

“As I got older, however, the blood flow in my leg became less efficient from complications of that trauma. I eventually developed an open ulcer on the inside of my ankle that wouldn’t heal.”

Not only was the ulcer on David’s leg unattractive, it was also painful. Over time, the pain in his leg began to affect David in his daily routines. He started having difficulty with his mobility.

“It was so painful, I almost needed to use crutches for walking,” he says. “Most of the time, I just limped around, but when the pain was very bad, I would use a crutch. Sometimes, I used a cane.

“I went to work, but I had to wear a special shoe so I didn’t put pressure on my left ankle. I also had to keep my foot elevated whenever I could to help keep the pressure off of it. The gentleman I work for was nice enough to let me put my foot up while I worked.”

All these steps, however, weren’t helping to heal the wound. At a health fair, David learned a person’s veins could contribute to ulcers on the skin.

The physician who spoke at the health fair was Douglas H. Joyce, DO, of Joyce Vein & Aesthetic Institute in Punta Gorda. David realized Dr. Joyce was the best choice for expertise in vein care. He decided to have his veins evaluated, so he called Dr. Joyce and scheduled an appointment.

During that first appointment, Dr. Joyce explained to David he had varicose veins on his left leg as well as the ulcer. Dr. Joyce described how there are two systems of veins in the legs. There are the high-pressure, deep veins in the middle of the leg, and the low-pressure, superficial veins near the surface of the skin.

“The superficial veins collect the blood from the skin and transport it through connecting veins called perforators to the deep veins,” educates Dr. Joyce. “The deep veins create pressure by using leg muscles when a person walks to move the blood all the way up to the heart.

“The valves in the deep veins are designed to close tightly to keep blood flowing toward the heart. When the valves are not working properly, which is called venous disease, pressure eventually builds up in the superficial veins.”

This pressure can lead to a host of symptoms, such as swelling, varicose veins and a feeling that the legs are getting progressively heavier. Over time, venous disease slowly worsens. Left untreated, it can lead to skin discoloration, thickening and, ultimately, ulceration.

“At our appointment, Dr. Joyce told me if he performed a procedure to close off some of my leaking veins, it would take the pressure away from where the ulcer was,” states David. “This would allow the ulcer to heal.”

Rungs of a Ladder

“When David came in, we identified his problem as too much pressure in the veins under the skin in the area of the ulcer,” explains Dr. Joyce. “I corrected that with procedures in two primary areas. First, I closed off the blood flow in the long vein in the leg, called the saphenous vein, and then I addressed the perforator veins.”

Leg veins are like a ladder, describes Dr. Joyce, with one side being the high-pressure deep veins and the other the low-pressure superficial veins. The perforator veins are the rungs in between. The perforators have valves that keep blood flowing from the low-pressure veins to the high-pressure veins.

“If those valves aren’t working properly, the blood goes from the high-pressure side over to the low-pressure side,” he notes. “When it does, it hits the veins under the skin at one point, so the pressure at that spot becomes extremely high.

“Because of this high pressure, the arteries can’t get fresh blood to the area, and they can’t take waste products out. The cells begin to die, and a wound is created. The ulcer may be small at first, but it can get larger over time.”

At Joyce Vein & Aesthetic Institute, Dr. Joyce concentrates the treatment of leg ulcers from venous disease in his Ulcer Center at JVAI. Treating patients with ulcers was the reason Dr. Joyce focused his practice on vein disorders.

“In the late Nineties, I was doing heart surgery and noticed many people with what we determined were venous ulcers,” he recalls. “I became intrigued and decided to learn more about them. We came up with a procedure to put titanium clips on the perforator veins, and it was very successful. The ulcers started healing.

“People heard about this and started coming from all over the country to be treated. That’s when I stopped doing heart surgery to concentrate on leg veins.”

Dr. Joyce is a pioneer in treating all of the causes of venous disease of the leg. Since that initial procedure, he has developed new techniques to treat venous disease. One is single-needle laser ablation, a noninvasive method of treating the diseased veins responsible for advanced venous conditions. He uses this procedure to close the perforator veins causing ulcers.

“At the Ulcer Center at JVAI, we concentrate on the subset of patients with venous ulcers,” notes Dr. Joyce. “We use specific protocols for their diagnosis and treatment. We specialize in fixing the causes of the misery on patients’ legs.

“Patients with non-healing ulcers are often told that nothing can be done. When they come to us, we’re optimistic. Our cure rate is in the high ninety percent range.”Through his Ulcer Center at JVAI, Douglas Joyce, DO, at Joyce Vein & Aesthetic Institute in Punta Gorda treated David Obermier for venous disease and a skin ulcer that resulted from it.

Mobility Returned

In David’s case, two procedures were needed to address his stubborn condition, and he’s finally experiencing significant improvement in his left leg. The ulcer has healed, and David’s mobility has returned to his previous level of function.

“The wound is closed, and my leg is a lot better than it was,” he confirms. “I have no pain in my leg anymore, and I’m getting around just fine, walking normally and wearing regular shoes.”

David is convinced anyone who develops open wounds on the skin should have his or her leg veins evaluated. He urges sufferers to consult with Dr. Joyce and be treated through his Ulcer Center at JVAI.

“Dr. Joyce is very good about sitting down with his patients, going over what needs to be done and explaining what he is able to do for them,” says David. “I absolutely recommend Dr. Joyce and Joyce Vein and Aesthetic Institute!”

FHCN article by Patti DiPanfilo. Photo by Fred Bellet. Before and after images courtesy of Joyce Vein & Aesthetic Institute. Graphic from mkb
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