What Are Leg Ulcers and How Are They Treated?
Leg ulcers are open wounds that develop on the lower legs due to poor blood circulation, often causing pain and discomfort. They can persist over long periods and may take weeks, months, or even years to heal, which classifies them as chronic leg ulcers. Most commonly found in adults, leg ulcers can significantly impact quality of life, requiring careful management to heal and prevent recurrence.
CAUSES
Leg ulcers are typically classified by their underlying causes:
- Venous Leg Ulcers: These are the most common type and result from poor blood flow in the veins of the legs. When vein valves don’t function properly, blood pools in the lower legs, leading to swelling, skin breakdown, and eventually open sores.
- Arterial Leg Ulcers: These ulcers develop due to poor blood supply in the arteries. When arteries are blocked or narrowed, it restricts oxygenated blood flow to the tissues in the leg, causing tissue damage.
- Diabetic and Neuropathic Ulcers: People with diabetes or nerve damage in their feet and legs are at higher risk of developing leg ulcers. Diabetic ulcers often appear due to poor sensation in the feet, making it difficult to notice injuries.
Trauma, prolonged pressure, certain skin conditions, obesity, history of blood clots, older age, and family history of venous insufficiency, as well as other chronic health conditions, can also contribute to the development of the condition.
Symptoms
Identifying the causes of leg ulcers early can help manage them more effectively. Common symptoms of leg ulcers include:
- Pain and Discomfort: Venous leg ulcers often cause an achy or heavy feeling in the legs, while arterial ulcers may be associated with more intense pain.
- Discolouration: The skin around the ulcer may appear red, purple, or brown, especially in venous ulcers due to blood pooling.
- Swelling: Poor circulation in the veins can cause swelling in the lower legs.
- Itching and Rash: Many people experience itching, especially around the affected area.
- Wound Drainage: Leg ulcers often leak fluid, and infected leg ulcers may produce a foul odour, redness, and increased swelling.
Leg Ulcers Treatment
The treatment involves promoting healing, preventing infection, and addressing the underlying cause.
Compression Therapy for Leg Ulcers
Compression therapy is the most recommended treatment for venous leg ulcers. Compression stockings or bandages help improve blood flow by applying pressure to the affected area, reducing swelling and helping the ulcer heal more efficiently. It’s important to have compression bandages fitted by a healthcare professional to avoid causing more harm. Patients with both venous and arterial problems may require the arterial problem fixed as a first step so compression can be safely used.
Medications and Topical Treatment
For infected leg ulcers, antibiotics may be prescribed to fight infection and reduce symptoms. Topical treatments, such as antiseptic creams or ointments, can keep the area clean, reduce bacteria, and promote healing. Pain relievers may also be recommended to manage discomfort.
Wound Dressings
The best dressings for leg ulcers depend on the wound’s characteristics. Common dressings include foam, hydrocolloid, alginate, and hydrogel dressings. These dressings are designed to ensure the correct amount of moisture, which aids in the healing process. If the wound is too dry or too wet, then healing may not occur, or the wound may even deteriorate. Specialised antimicrobial dressings may be used if there’s an infection, helping to manage bacteria while protecting the ulcer.
Surgical Intervention
If conservative treatments are unsuccessful, or if the ulcer is very severe, surgery might be recommended.
- Endovenous Ablation (thermal or “glue”): These minimally invasive procedures use heat or a medical glue to close off damaged veins. By rerouting blood flow to healthier veins, these methods relieve pressure on the ulcerated area expedite healing versus compression alone and reduce the likelihood of future leg ulcer development.
- Sclerotherapy: Sclerotherapy is a technique where a special solution is injected into the vein, causing it to collapse and eventually be reabsorbed by the body. This can be helpful if there is an abnormal vein immediately deep in the ulcer.
- Angioplasty/Stenting: This may be required if there are blockages in arteries preventing healing. In this procedure, narrowings/blockages are reopened with a balloon inserted into the artery via a needle. A stent is often needed to keep the artery open. This improves blood flow and provides the tissues with oxygen and nutrients needed for healing.
- Skin Grafting: This involves taking healthy skin, usually from another part of the body, and placing it over the ulcer. This promotes new skin growth, speeds up healing, and provides a barrier to protect against infection.
- Debridement: This procedure involves removing dead or infected tissue from the ulcer site to promote healing. Although it’s sometimes performed as part of conservative treatment, surgical debridement may be necessary for large or infected leg ulcers.
Prevention
While not all leg ulcers can be prevented, taking certain measures can lower the risk.
- Maintain a Healthy Weight: Excess weight puts added pressure on the veins and can lead to poor circulation.
- Exercise Regularly: Physical activity helps keep the blood flowing, reducing the risk of developing ulcers. Exercises like walking, swimming, and cycling can improve circulation without placing excessive pressure on the legs.
- Wear Compression Stockings: If you are at risk for venous leg ulcers, wearing compression stockings as recommended by Dr Magee can help support blood flow to the legs. Always check with your doctor before using these to ensure it will be safe.
- Stop smoking: Smoking not only causes long-term damage to blood vessels but also severely reduces healing and the body’s ability to fight infection. Stopping smoking is hard, and most people will need help to achieve this. Speak to your health professional or call the Quitline to explore options for help.
Leg ulcers can be challenging to live with, but with proper treatment and prevention strategies, you can manage symptoms and promote healing. Schedule a consultation at Sunshine Coast Vascular and talk to Dr Rebecca Magee about the best leg ulcer treatment.
Specialists in minimally invasive vascular treatments