What are Leg Ulcers?
A leg ulcer is simply a break in the skin of the leg, which allows air and bacteria to get into the underlying tissue.
What causes Leg Ulcers?
- Vein problems: 85% of leg ulcers are due to varicose veins or deep vein thrombosis.
- Arterial problems 10% of leg ulcers are due to arterial disease.
- Miscellaneous: 5% of leg ulcers may be due to other causes like vasculitis, rheumatoid arthritis and neuropathy.
What are the diagnostic methods for Leg Ulcers?
Usually a proper examination by a vascular specialist gives a clue about the possible cause of the ulcer, and depending on the cause, certain investigations may be performed which include:
- CT Angiography
- Blood Investigations
- Skin Biopsy
How are Venous Ulcers treated?
- Controlling the high pressure in the leg veins by leg elevation, compression bandaging or 4 layer bandages
- Treatment of the ulcer by dressings. Different materials may be recommended depending on the type and healing pattern of ulcer
- Treatment of underlying cause:
- Varicose veins can be treated by laser or foam sclerotherapy
- Deep vein obstruction may need vein angioplasty & stenting
- Non-healing ulcers may require skin grafting or muscle flaps
How are Arterial Ulcers treated?
- Treatment of the underlying cause by angioplasty or bypass surgery to re-establish blood flow in the leg.
- Adjuvant medical treatment by Prostacyclin therapy injections can also help in ulcer healing.
How are Diabetic Ulcers treated?
- Treatment of infection by systemic antibiotics
- Wide spread removal of all infected and bad tissues
- Regular dressings
- NPWT (Negative Pressure Wound Therapy) or VAC (Vacuum Assisted Closure) Dressings
- HBOT (Hyperbaric Oxygen Therapy)
Some patients with extensive diabetic foot infections treated successfully are shown here.
Frequently asked questions
A leg ulcer is a long lasting sore/wound that takes more than 5-7 weeks to heal, depending upon the treatment. A vascular leg ulcer usually develops around the ankle. Majority venuous leg ulcers heal within 3 months if they are treated by a expert using compression therapy for the leg ulcers. Arterial ulcers or ulcers due to Peripheral Arterial Disease ( PAD) may require angioplasty or bypass of the blocked leg arteries. However, some ulcers may take longer time to heal and a very rare number of leg ulcers never heal.
No, you can not apply creams to any areas of active leg ulcer unless prescribed by your doctor. Usually experts suggest to keep the skin of your legs clean and well moisturized. Your doctor suggests lotion or cream that does not contain alcohol as it may cause further drying and cracking of the skin.
Leg ulcers are treatable diseases although leg ulcers can be challenging to eliminate, even with treatment leg ulcer wounds can persist for months. In leg ulcer treatment, as a part of one of the therapy your doctor will suggest compression therapy with putting bandages on leg to stimulate blood flow into the legs.
Leg ulcers are open wounds on the leg that take more than 3-6 weeks to heal depending upon the type and cause of leg ulcer and its treatment by an expert doctor. Some vascular ulcers may not show spontaneous healing and would need additional treatment methods like Hyperbaric Oxygen Therapy (HBOT), Negative Pressure Wound Therapy (NPWT) or even Skin Grafting.
There is no best cream for leg ulcers Appropriate cream or ointment is recommended by your expert doctor on the basis of severity of the leg ulcer. Out of many creams and ointments available, the most useful one would be prescribed depending on cause of ulcer as well as presence of infection, slough or discharge. Usually ulcers need to be kept moist and for this purpose, hydrogels are commonly used. There are numerous other newer dressing materials which can be suggested by expert doctors.
You should not treat leg ulcers at home without expert doctor’s advice and prescribed treatment. But your doctor will advice few tips to practice at home to heal and treat your leg ulcer at home which includes use of Aloe Vera gel application on wound, application of Honey on ulcers, moisturized would with the help of coconut oil, Other home remedies like application of Turmeric powder, apple cider vinegar, tea tree oil. Apart from this your doctor will suggest to keep your affected leg elevated whenever you are sitting or lying down at home alongwith regularly exercising your legs by moving your feet up and down and rotating them at the ankles can help encourage better circulation.
A bandaid is only suitable for stitched wounds, superficial wounds or abrasions. For deeper wounds, it is preferable to consult an expert doctor once to decide the treatment method. Your expert doctor may advise the type of dressing material as well as bandage to be used for appropriate dressing.
Like any other disease, untreated leg ulcers can worsen and can lead to many complications including infection in legs. Infections are the most common complication one can have with untreated venous leg ulcers. You often have a fever, pus, necrotic tissues or cellulitis in the affected area due to spread of infection. This may eventually require higher antibiotics as well as surgical removal of infected tissues ( debridement).
“This is a very common question asked by our patients while they are under treatment at our hospital” says Dr. Sumit Kapadia, an expert and senior most vascular & endovascular surgeon in Gujarat. It’s not a simple question to answer as there can be a multitude of reasons why one’s leg ulcer is not healing. A sore on your leg that doesn’t heal after three months of treatment is considered a chronic condition. Your doctor may suggest skin grafts for leg ulcer wounds larger than 4 inches or leg ulcers that don’t heal with other treatment.
There are very few ulcer clinics or Diabetic foot clinics in our country. Aadicura hospital in Vadodara has a high volume ulcer & Diabetic foot care clinic under Vascular and Endovascular Surgery Department where basic to most modern vascular treatment methods are available. This is the only centre in Central Gujarat where Hyperbaric Oxygen Therapy (HBOT) is available.