POSTED BY Dr. Sumit Kapadia | Nov 08, 2023

In India, where access to specialized healthcare is crucial, understanding leg ulcers, their types, symptoms, causes, and treatments is vital. Dr Sumit Kapadia, a leading vascular specialist, offers expert insights into managing these common but often misunderstood conditions.

Leg ulcers, a common and often discomforting condition, manifest in various types and stem from multiple causes. Understanding these ulcers is crucial for effective management and treatment. In this comprehensive guide, Dr. Sumit Kapadia, an esteemed vascular specialist, sheds light on the types, symptoms, causes, and treatments of leg ulcers.

Understanding Leg Ulcers: An In-Depth Look

Leg ulcers, a common yet often challenging health condition, are more than just a surface-level issue. They are deep wounds or open sores that fail to heal normally and can take a prolonged period to recover. To understand them better, let’s delve into the specifics:

The Anatomy of a Leg Ulcer

  • Formation: Leg ulcers typically develop when a minor injury to the leg fails to heal due to poor blood circulation in the veins or arteries. This results in the skin breaking down, leading to an open sore. Sometimes these ulcers can occur spontaneously without any injury. 
  • Appearance: These ulcers usually appear around the ankles or lower legs. They can vary in size, and their appearance depends on the underlying cause. Some are shallow, while others may be deep, exposing underlying tissues.
  • Symptoms: The common signs include pain, itching, swelling, and a feeling of heaviness in the legs. The skin around the ulcer may become hardened and discoloured, often turning brown due to the buildup of waste products from the blood.

Types of Leg Ulcers

  • Venous Ulcers: Caused by damaged valves in the veins, leading to prolonged high pressure in the veins and eventual breakdown of the skin.
  • Arterial Ulcers: Result from poor blood circulation due to narrowed arteries often caused by atherosclerosis. They are typically located on the feet and toes.
  • Neuropathic Ulcers: Common in individuals with diabetes, these occur due to nerve damage which leads to a loss of sensation in the feet, making them prone to injury and subsequent ulceration.
  • Varicose Ulcers: Associated with varicose veins, these occur due to increased pressure and blood pooling in the lower legs.
  • Vasculitic Ulcers: These are small, painful ulcers occurring in Legs or feet due to small blood vessel blockage and often occur due to infection or autoimmune diseases like arthritis. 

Why Do Leg Ulcers Happen?

The root causes of leg ulcers are diverse:

  • Poor Circulation: The most common cause, is where veins or arteries fail to supply or drain blood effectively.
  • Diabetes: This leads to both reduced blood flow and nerve damage, making the skin susceptible to injury and delayed healing.
  • Inflammatory Diseases: Conditions like vasculitis or rheumatoid arthritis can contribute to the development of ulcers.
  • Lifestyle Factors: Smoking, obesity, and lack of mobility are significant risk factors.

Symptoms of Ulcers on the Leg

When it comes to leg ulcers, recognising the symptoms early can significantly impact the effectiveness of treatment and the speed of recovery. Here’s a detailed look at the symptoms typically associated with ulcers on the leg:

 

  1. Pain and Discomfort

Nature of Pain: The pain associated with leg ulcers can vary widely. Some people may experience a dull ache or a burning sensation, while others might endure sharp, intense pain.

Location: Pain is often localized around the site of the ulcer but can also affect the entire leg.

  1. Changes in Skin Appearance

Colour: The skin around the ulcer may become discoloured, often exhibiting a dark red, purple, or brown hue.

Texture: The affected area might feel hard to the touch due to the buildup of tissue or swelling. The hardness is also called lipodermatosclerosis. 

Temperature: The skin around the ulcer may feel warmer or cooler than the surrounding areas.

  1. Swelling

Swelling or oedema often occurs in the vicinity of the ulcer, especially if the ulcer is venous.

  1. Weeping and Discharge

Exudate: Leg ulcers often produce a discharge or exudate, which can vary in colour from clear to yellow or green if infected.

Odour: An unpleasant odour can sometimes emanate from the ulcer, particularly in cases of infection.

  1. Visible Wound

The ulcer itself appears as an open wound. The size and depth can vary, with some ulcers exposing the underlying layers of tissue.

  1. Itching and Irritation

The skin surrounding the ulcer might be itchy or irritated. Scratching can exacerbate the condition and increase the risk of infection.

  1. Leg Cramps and Heaviness

Individuals may experience a sensation of heaviness or cramping in the affected leg, particularly after standing or sitting for prolonged periods.

  1. Flaking or Scaly Skin

The skin around the ulcer may become flaky or scaly, often due to underlying venous insufficiency.

  1. Reduced Hair Growth

Hair growth around the ulcer area may diminish, a sign of poor circulation in the region.

  1. Temperature Sensitivity

Some ulcers, particularly arterial ulcers, can become more painful or exhibit increased symptoms in response to temperature changes.

Understanding these symptoms is crucial for anyone at risk of or currently experiencing a leg ulcer. Early detection and seeking professional medical care, such as from a vascular expert like Dr Sumit Kapadia, can make a significant difference in the healing process and overall health outcomes. Regular check-ups and paying close attention to the health of your legs are key steps in managing and preventing the progression of leg ulcers.

The Complications

Untreated leg ulcers can lead to several complications, including:

Infection: Open sores are vulnerable to bacteria, leading to infections that can spread to the bone or bloodstream.

Cellulitis: A painful skin infection that can cause redness, swelling, and warmth. This indicates spread of infection from the ulcer to normal surrounding skin.

Venous Eczema: The skin around the ulcer becomes itchy and scaly.

Bone involvement: Rarely, ulcers if long standing and deep can spread to the underlying bone, leading to bone infection ( osteomyelitis)

Cancer: Rarely, long standing ulcers can undergo malignant transformation.

Leg ulcers are a serious health concern that requires prompt and effective management. Understanding the types, causes, and risks associated with these ulcers is crucial for effective treatment and prevention. Regular monitoring, proper wound care, and lifestyle modifications play a significant role in managing and preventing leg ulcers.

Treatment of a Leg Ulcer with Dr. Sumit Kapadia

Treating leg ulcers effectively requires a comprehensive approach, combining advanced medical techniques with personalized care. Dr Sumit Kapadia, a renowned vascular specialist in Vadodara, employs a multi-faceted strategy to treat leg ulcers, taking into account their type, severity, and the patient’s overall health. Here’s an in-depth look at his approach:

Understanding the Patient’s Condition

Initial Assessment: Dr. Kapadia begins with a thorough assessment, including reviewing the patient’s medical history and conducting a physical examination of the affected area.

Diagnostic Tests: Depending on the type of ulcer, various diagnostic tests like Doppler ultrasound,, blood flow assessments, and CT scan or angiography imaging may be conducted to determine the underlying cause.

Personalised Treatment Plans

Venous Ulcers:

Compression Therapy: This is often the first line of treatment, using compression stockings or bandages to improve blood flow. See our youtube video for knowing how 4 layer bandages are applied. 

Wound Care: Regular cleaning and dressing of the ulcer to prevent infection and promote healing. There are a large number of newer dressing materials which can often help in the healing process. 

Medication: Topical or oral medications to manage pain and inflammation.

Surgery or Laser with sclerotherapy: For venous ulcers, these procedures are often required to correct venous insufficiency which helps the ulcers to heal faster. 

Iliac vein angioplasty : sometimes, the venous ulcers are due to narrowing or blockage of the iliac veins ( in abdomen). In these patients, we perform Intravascular Ultrasound ( IVUS) & do angioplasty with stenting to improve the venous blood flow.

Arterial Ulcers:

Improving Circulation: Medications to improve blood flow and reduce blood pressure.

Risk Factor Management: Addressing underlying conditions like diabetes or high cholesterol.

Surgery or Interventions: Procedures like angioplasty or bypass surgery are recommended  to restore blood flow and help in healing. 

Diabetic Ulcers:

Blood Sugar Control: Strict management of blood glucose levels.

Debridement: Removal of dead tissue to promote healing. This is often followed by proper offloading measures like Plaster of Paris slabs or specialised offloading footwear. 

Infection Control: Antibiotics and antiseptics to prevent and treat infections.

Varicose Ulcers:

Varicose Vein Treatment: Procedures like sclerotherapy, laser therapy, or surgery to treat underlying varicose veins.

Compression Therapy and Wound Care: Similar to venous ulcers.

Holistic Care Approach

Lifestyle Guidance: Counseling on diet, exercise, and lifestyle modifications to improve overall vascular health.

Regular Monitoring: Scheduled follow-ups to monitor healing progress and adjust treatment as necessary.

Patient Education: Educating patients about self-care techniques and preventive measures to avoid future occurrences.

Newer advanced wound healing techniques 

Usually treating the cause of the ulcer would itself help in healing of these ulcers.

However, for some patients who have slow healing or large ulcers, some additional methods are used at our Wound Care center.

 

  1. Negative Pressure Wound Therapy ( NPWT), also called as Vacuum Assisted Closure ( VAC Therapy)In this, specialised medical grade foam is applied to the wound, sealed by impervious dressings and connected to a vacuum machine, which applies constant low pressure suction. This helps in  removing the discharge exudate and also improves the granulation of these wounds.
  2. Biologic or Synthetic Skin substitutes:  There are few dermal substitutes like Matriderm, Polynova BTM and Integra which are very useful for larger or deeper wounds and make them ready for skin grafting. They are useful even if there are exposed tendons or bone in the wound ( previously these were considered as indications for amputation). However, now with advanced technologies and materials, amputation has been avoided in many of these patients. 
  3. Special infection Control beads ( Stimulan) : Special antibiotics coated calcium sulfate beads are prepared and instilled locally in deeper wounds to provide good local control of infection and help in healing for infective wounds, even if there is minor bone involvement.  
  4. Hyperbaric Oxygen Therapy ( HBOT): We have one of the largest use of HBOT in wound healing
  5.  in Western India. ( Read our blogs on HBOT). 10 to 20 sessions of HBOT have shown good results in non healing wounds and diabetic foot ulcers. ( Also see this YouTube video on HBOT)  

Cutting-edge techniques and Compassionate Care

Dr. Kapadia stays abreast of the latest advancements in vascular medicine, ensuring his patients receive the most effective, modern treatments available. His compassionate approach, coupled with his technical expertise, provides patients with not just medical care but also emotional and psychological support throughout their treatment journey.

The treatment of leg ulcers under Dr Sumit Kapadia’s care is a testament to his commitment to providing holistic, patient-centred care. His tailored approach to each case ensures that patients not only receive the best possible medical treatment but also feel supported and empowered throughout their healing journey.

Why Choose Dr. Sumit Kapadia?

In the intricate field of vascular health, Dr. Sumit Kapadia stands out with his profound knowledge, state-of-the-art treatments, and a patient-first approach. He ensures that each patient receives a tailored treatment plan, aiming for not just healing but also improved quality of life.

Consulting Dr. Sumit Kapadia

Dealing with leg ulcers requires expert care and guidance. For those in India looking for a top-notch vascular specialist, Dr Sumit Kapadia is the answer. You can easily book a consultation with him by contacting his appointment number or by sending a simple “Hi” message to +91 9904114443 on WhatsApp (Dr. Sumit Kapadia’s 24 x 7 Vascular Helpline).

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