What is a leg ulcer?
A leg ulcer is simply a break in the skin of the leg, which allows air and bacteria to get into the underlying tissue. This is usually caused by an injury, often a minor one that breaks the skin.
In most people such an injury will heal up without difficulty within a week or two. However, when there is an underlying problem the skin does not heal and the area of breakdown can increase in size. This is a chronic leg ulcer.
What causes leg ulcers?
The most common underlying problem causing chronic leg ulcers is disease of the veins of the leg. Venous disease is the main reason for over two thirds of all leg ulcers.
Venous Disease (caused by veins not working) - about 80% of leg ulcers
Arterial Disease (caused by the arteries not working) - about 15% of leg ulcers
Other causes (includes diabetes and rheumatoid arthritis as well as some rare conditions) - about 5% of leg ulcers
In some cases two or more conditions may be causing damage at the same time. Your doctor will examine you and do some tests to see what sort of ulcer you have. The following advice applies to venous ulcers and may not be appropriate for other sorts of ulcers.
How does venous disease cause ulcers?
The veins in your leg are tubes that carry the blood back from the foot towards your heart. The veins in your legs have one-way valves that make sure the blood flows up the leg and not back down. In some people, these valves are not very effective or can be damaged by thrombosis (clots) in the veins. If the valves are damaged, blood can flow the wrong way down the veins, which results in a very high pressure in the veins when standing up. This abnormally high pressure in the veins damages the skin and leads to the ulcers.
How will I be treated?
Treatment of a venous leg ulcer happens in two ways:
Controlling the high pressure in the leg veins
Treatment of the ulcer
The mainstays of treatment are elevation of the leg, compression bandaging or stockings and vein interventions:
Elevation of the leg
The higher the leg, the lower the pressure in the leg veins. If the foot is elevated above the heart then the pressure in the foot drops to a normal level. Put your legs up whenever you can and as high as you are able-the arm of the sofa is good. Elevate the lower end of your bed (6 inches or so) so that when in bed your feet are a little higher than your head. You can use some old books for this.
Compression bandaging or stockings
In order to keep the pressure in the leg veins at the ankle low when you are standing up, you will be treated with compression bandaging or stockings. Several layers of bandages may be required to get the necessary pressure to control the veins. Once the ulcer is healed, compression stockings are usually necessary to prevent the ulcer from returning. These stockings need to be specially fitted and are much stronger than ordinary "support tights". If you have difficulty putting on your stockings then you can buy a special stocking applicator.
Intervention to the Veins
The leg veins should be assessed with a duplex scan to look at function. If there is a lot of incompetence in the surface veins of the leg (allows flow in the wrong direction down the leg) then there is evidence that treating these veins can help with ulcer healing and prevent recurrence. Common procedures for the veins are endovenous ablation using heat (laser ablation or radiofrequency ablation) or chemical (foam sclerotherapy) injury to cause the faulty vein to scar up and block. See procedures section.
The nurse will use a number of different dressings under the bandages depending on the state of the ulcer itself. These dressings may well change as the ulcer progresses
How long will it take the venous ulcer to heal?
Most ulcers can be helaed in 3-4 months, some take 6 months. A small proporation wil be resistant and not heal but overall the above treatments are usually successful.
Information about Arterial Ulcers can be found here
More information about leg ulcers HERE