It’s not an ulcer is it?
It’s a phrase commonly heard in wound clinics when an elderly patient presents with a slow to heal wound. It’s a phrase that also evokes fear. Why? Well often they know or remember a family member or friend having a wound on their lower leg for a significant amount of time or perhaps even dying with the wound.
Luckily today we have a better understanding of lower leg ulcerations and the first principle of management is in establishing a diagnosis.
1. Venous insufficiency
2. Arterial disease
3. Mixed venous/arterial
4. Skin cancers
5. Autoimmune/inflammatory conditions
Venous ulceration is the most common form accounting for approximately 70% of all leg ulcerations. There are classic signs and symptoms and relatively easy diagnostics available to confirm the underlying pathological problem.
It’s often seen in people who have occupations of prolonged standing or sitting, who may have had a deep vein thrombosis, family history of leg ulceration, and possibly overweight. It is said to be more common in women, especially those who have had many pregnancies or large babies.
The ulcer is classically located in the lower third of the lower leg known in the gaiter region. It’s usually shallow and not too painful, leaking fluid and relatively shallow in appearance. The leg may swell as the day progresses and recede when the leg is elevated or resting.
Arterial ulcers on the other hand are generally seen in people who have a history of smoking, diabetes or high cholesterol. These ulcers may be located almost anywhere on the leg, but especially over bony prominences. They are also painful, deep and easily infected.
Once the correct diagnosis has been made the management of these ulcers is straight forward provided guidelines are followed, as with many other conditions.
Venous ulcers require compression therapy and surgery is also an option if the incompetent valves are within the superficial veins. Whereas arterial ulcers may require interventions that will correct the narrowing or blockage within the artery to improve blood flow.
Leg ulceration should not be a feared diagnosis. With the correct diagnosis help is available. Exercising, leg elevation and potentially wearing support therapy garments are all ways in which the venous return can be assisted.
A slow to heal wound on the lower leg does require a thorough examination, often by a health professional trained in wound management. In these modern times people should not have slow to heal wounds. There is help available - with good diagnostics and correct management all wounds should heal in a timely manner.