Leg Ulcers

What are Leg Ulcers?

Leg Ulcers can be either Venous or Arterial. A Venous Leg Ulcer is a Chronic Non Healing Wound that has been present for at least 6 weeks with Broken Layers of Skin and Exposed Tissue. Venous Leg Ulcers are usually found on the inside of the leg just above the ankle. They can be painful especially when they are infected.

What causes Leg Ulcers?

A Venous Leg Ulcer is caused by Poor Blood Circulation due to damaged veins in your legs.

There are two main types of blood vessel:

• Arteries – oxygen rich blood is pumped from your heart through your arteries to the rest of your body.
• Veins – blood is returned to the heart through the veins once the oxygen has been removed.

Vein problems occur when the valves inside the veins stop working properly.

In a healthy vein, blood flows towards the heart. Blood is prevented from flowing backwards by a series of valves that open and close to let blood through. If the valves weaken or are damaged, for example, following a Deep Vein Thrombosis (DVT) the blood can flow backwards.

This may cause Varicose Veins visible on the surface of the leg or the damage may lie in the deep veins hidden from view. Pressure inside these veins is increased and this can damage the Skin.

The constant high blood pressure in your legs causes fluid to leak from the veins. The fluid causes swelling and damages the skin which becomes hard and inflamed leading to a Leg Ulcer.

Symptoms of a Leg Ulcer

• Swollen Ankles filled with fluid that temporarily hold the imprint of your finger when pressed (Oedema)
• Discolouration and Darkening of your skin around the Ulcer (Haemosiderosis)
• Hardened Skin around the Ulcer (Lipodermatosclerosis)
• Small, Smooth areas of White Skin which may have tiny Red Spots (Atrophie Blanche)

The associated symptoms of a Venous Leg Ulcer are caused by blood not flowing properly through your veins. This is known as Venous Insufficiency and can cause the following:

• Leg Pain
• Heavy feeling in the affected leg
• Aching
• Itching
• Swelling
• Varicose Eczema (Itchy, Irritated Skin associated with Varicose Veins)

Diagnosis of a Leg Ulcer

If you have the above symptoms then you need to see a Medical Professional. You may well have a Doppler and a Duplex Ultrasound Scan. A referral to a Consultant Vascular Surgeon is next to determine the next stage and treatment for the Leg Ulcer.

Treatment for Leg Ulcers

Treatment for Leg Ulcers should start with the UNDERLYING vein problems.

• Assessment by a ConsultantVascular Surgeon
• Duplex Ultrasound Scan
• Surgery (approx 60% of patients)
• Long term Compression (40% of patients)

What should be avoided at all costs?

• Patients with Leg Ulcers being condemned to dressings and compression bandages/stockings without assessment by a Specialist Vascular Surgeon (unless patient is immobile, has poor ankle movement, is very unwell for any other reason or has a very short life expectancy).
• Patients with skin changes at the ankle being given creams (particularly steroid creams) before venous causes have been excluded by a Specialist Vascular Surgeon
• Patients with Varicose Veins being told that it is a cosmetic problem only and to "wait until there is a problem before having anything done".
• Patients with skin changes at the ankle or Varicose Veins being given long term support stockings without a cause being found and the possibility of a cure being offered.

(The College of Phlebology)