LEG ULCERS

Leg ulcers are a common problem and they affect millions of people worldwide. The term leg ulcer can be used to refer to many different types of chronic wounds, including those called pressure ulcers, venous leg ulcers, and diabetic foot ulcers, and those that are caused by atherosclerosis.

Management

Accurate diagnosis is the key in the management of leg ulcers.

One really important thing is to determine that a patient has adequate arterial flow for a lower extremity wound to heal.

In general, the aims of the treatment are to alter any anatomic impediment to healing and to optimise the healing environment.

Aetiology includes wounds due to arterial insufficiency, pressure ulcers, or diabetic neuropathic foot ulcers, although the majority of leg ulcers are usually classified as venous ulcers.

Venous ulcers are caused indirectly by ambulatory venous hypertension, most often due to the failure of the calf muscle pump system. Therefore, management hinges on lower limb compression and good wound care. Good wound care includes debridement and/or cleansing, management of exudate, and the use of a moist dressing. Furthermore, elevation of the legs at night and, when necessary, weight reduction may also reduce the impact of any venous abnormalities. In the setting of lower limb compression, exercise of the lower extremity may be of benefit.

Other approaches to management include the use of topical recombinant growth factors, skin equivalents (or cell-based therapies), and oral pentoxifylline. Most patients will improve with conservative management (compression and dressings), although compliance with compression therapy (e.g., compression stockings, compression bandages, etc.) may be a challenge. Most of these wounds heal in less than 6 months. The likelihood that a wound will heal is often related to how it responds to therapy with in the first 4 weeks of care, and based on the size and age of the wound when first examined.

Patients with diabetes mellitus may develop venous leg ulcers and wounds due to arterial insufficiency. However, diabetics may also develop neuropathic foot ulcers, which stem from the neuropathy associated with diabetes. As a result, at least in part, the unperceived repetitive trauma and pressure from walking leads to the ulcer. Management hinges on optimal control of diabetes, offloading of the affected limb, and good wound care.

Other treatment options include recombinant growth factors such as recombinant human platelet-derived growth factor (rh-PDGF), and skin equivalents, which may be necessary in order to achieve optimal results. Finally, individuals with diabetes may commonly have a wound due to a combination of neuropathy and lower extremity ischemia.

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