More Than a Skin Problem
When a Wound Will Not Heal
Venous ulcers are chronic wounds, typically just above the ankle, that develop when sustained venous pressure damages the skin and tissue around it.
They are the most advanced expression of chronic venous insufficiency, and they follow a frustrating pattern many patients know well: weeks or months of dressings and ointments, brief progress, then the wound opens again. The reason is not the wound care. It is that the circulation feeding the wound has not been corrected, and until it is, the tissue simply cannot repair itself the way it should.
A leg wound deserves a vascular evaluation when it shows any of these signs:
- It sits on the lower leg or above the inner ankle and has lasted more than a few weeks
- The surrounding skin has darkened, thickened, or hardened
- The leg is swollen, especially by the end of the day
- There is a history of varicose veins, blood clots, or leg heaviness
- The wound has healed before, only to return in the same area
None of these signs means the situation is beyond help. They mean the wound has a cause that can be found and, in most cases, treated.
Healing from the Inside Out
How Venous Ulcers Are Treated
Lasting healing starts with correcting the circulation, not just covering the wound.
The evaluation begins with a duplex ultrasound to map the venous insufficiency and locate the source of the pressure keeping the wound open. Every patient with a non-healing wound is also assessed for arterial disease, since the arteries deliver the oxygen that healing requires, and a simple in-office test can identify a problem that would otherwise undermine even excellent care. From there, treatment typically combines endovenous ablation to relieve the venous pressure, compression therapy to support the leg as it heals, and medications shown to reduce pain and speed the healing of venous ulcers.
Day-to-day wound management, including specialized dressings and debridement, continues with the region’s dedicated wound care centers, with whom Dr. Schmetterer works closely. In fact, many of his patients arrive referred by those same wound clinics, when a wound that should be healing is not and the team suspects an untreated vascular cause. Once the circulation is corrected, most venous ulcers heal, and treating the root cause is also what keeps them from coming back.
Care That Treats the Whole Picture
Dr. Schmetterer's Philosophy of Care
Few problems reveal the value of a complete vascular evaluation like a wound that refuses to heal.
Dr. Schmetterer spent decades performing limb salvage surgery, work devoted to restoring circulation when a leg was at risk. That experience shapes how he approaches every venous ulcer today: the wound is never viewed in isolation, the veins and arteries are both examined, and nothing is assumed. It also means he recognizes when a finding calls for another specialist, and he coordinates that care rather than leaving the patient to navigate it alone.
For the person living with a venous ulcer, the goal is bigger than closed skin. It is sleeping without the wound on your mind, walking without bandage routines dictating the day, and getting back to the ordinary life of the Valley that a chronic wound quietly takes away. Healing the wound and protecting the circulation behind it is how that life comes back.
FAQ
Frequently Asked Questions
Why won't my leg wound heal?
Wounds near the ankle that resist healing are most often caused by venous insufficiency, the elevated pressure in the leg veins that prevents normal tissue repair. Arterial disease can also play a role, particularly in patients with diabetes, a smoking history, or cardiovascular risk factors. Surface wound care alone is rarely enough, which is why a full vascular evaluation is the most important step toward lasting healing.
Can a venous ulcer be cured?
Yes, in most cases. When the underlying venous disease is treated and any arterial contribution is identified and addressed, the majority of venous ulcers heal and stay healed. The key is correcting the circulation that caused the wound rather than treating only its surface.
What is the difference between a venous ulcer and a diabetic ulcer?
Venous ulcers result from vein valve failure and elevated venous pressure, typically appear above the inner ankle, and are often surrounded by darkened or thickened skin. Diabetic ulcers stem from nerve damage and reduced arterial flow and usually develop on the foot. Both deserve specialist evaluation, and both can involve an arterial component that should be assessed before a treatment plan is set.
