Chronic Leg Ulcers

Original Editor - Lucinda hampton

Top Contributors - Lucinda hampton, Kim Jackson and Aminat Abolade  

Introduction

Chronic leg ulcer is defined as a defect in the skin below the level of knee persisting for more than six weeks and shows no tendency to heal after three or more months. Chronic ulceration of the lower legs is a relatively common condition amongst adults, one that causes pain and social distress.

The condition affects 1% of the adult population and 3.6% of people older than 65 years.

• Leg ulcers are debilitating and greatly reduce patients' quality of life. The common causes are venous disease, arterial disease, and neuropathy. Less common causes are metabolic disorders, hematological disorders, and infective diseases.
• As many factors lead to chronic lower leg ulceration, an interdisciplinary approach to the systematic assessment of the patient is required, in order to ascertain the pathogenesis, definitive diagnosis, and optimal treatment.
• The researchers are inventing newer modalities of treatments for patients with chronic leg ulceration, so that they can have better quality life and reduction in personal financial burden.

Aetiopathogenesis

It has been reported that ulcers related to venous insufficiency constitute 70%, arterial disease 10%, and ulcers of mixed etiology 15% of leg ulcer presentations. The remaining 5% of leg ulcers result from less common pathophysiological causes (this latter group comprise considerable challenges in diagnosis, assessment, and management).

Management of Chronic Leg Ulcers

An ideal management plan for patients with chronic leg ulcers should involve an early strategic and coordinated approach to delivering the correct treatment option for each individual patient, based on accurate assessment of the underlying pathophysiology.

The management of leg ulcers should include a detailed history of the onset of the problem, examination of the legs and skin, investigations, and modalities of treatments. Successful management of leg ulcers requires a clear diagnosis, establishment of a treatment plan, accurate monitoring, and adherence to the plan as the ulcer decreases in size. Education and training is vital for all those involved in caring for patients with chronic ulceration.

Wound management products

Passive dressings:

• Use the ‘passive’ or the ‘plug and conceal’ concept, including gauze, lint, non-stick dressings and tulle dressings. These products fulfill very few of the properties of an ideal dressing and have very limited, if any, use as primary dressing, but some are useful as secondary dressings.

Interactive dressings:

• These dressings help to control the micro-environment by combining with the exudate to form either a hydrophilic gel or, by means of semipermeable membranes, controlling the flow of exudate from the wound into the dressing. They may also stimulate activity in the healing cascade and speed up the healing process.

• There are six classes of interactive dressings, classified according to their functionality (The choice of dressing will depend on the wound type and depth, level of exudate and the presence of bacteria):
  1. Film dressings
  2. Hydroactive dressings
  3. Hydrocolloid dressings
  4. Hydrogel dressings
  5. Foam dressings
  6. Alginate absorbent fibre dressings.

Bandages

• Used from ancient times. In the past 15 years there has been an explosion in the types of bandages available. The bandage may be needed for several reasons:
  • Retention: keeping a dressing in place
  • Musculoskeletal support: supporting an injured joint
  • Compression: assisting venous return from the lower leg.

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