Leg ulcers

Around one per cent of the Australian population suffers from leg ulcers (chronic venous leg ulceration). The most common cause is poor blood circulation, particularly the inability of the veins to return deoxygenated blood from the legs back to the heart. Other causes or exacerbating factors include relentless pressure (bed sores), badly managed diabetes, high cholesterol, smoking, dietary problems and poor arterial circulation. Older people are at greater risk. Although chronic venous leg ulceration afflicts both sexes equally, women are slightly over-represented because of their increased life span. Treatment options include compression bandages, medication, surgery and (more recently) hyperbaric oxygen therapy.

Symptoms
The features of a leg ulcer include:

• Commonly found on the lower leg and ankle
• Sunken, asymmetrically shaped wound
• Edges of the ulcer are clearly defined from the surrounding skin
• Surrounding skin is intact, but inflamed
• Surrounding skin may be pigmented, hardened or calloused
• Yellowishwhite exudate (pus)
• Pain, particularly while standing
• Varicose veins in the leg.

• Age - peripheral circulation becomes less efficient with old age.
• Varicose veins - the one-way valves that stop blood from traveling backwards in the vein stop working. The pooling of blood stretches and distorts the vein.
• Cigarette smoking - tobacco is known to constrict the vessels of the circulatory system.
• Arterial disease - vein problems are more likely if the person already has other associated diseases of the arteries.
• Certain disorders - including diabetes and arthritis.
• Pressure sores - bed-bound people are at risk of pressure sores, which are areas of damage to the skin caused by constant pressure or friction.
• Medication - some cardiovascular drugs can contribute to leg oedema and altered circulation.

• Cleaning the wound using wet and dry dressings and ointments, or surgery to remove the dead tissue.
• Specialised dressings - a whole range of products are available to assist with the various stages of wound healing. Dressings are changed less often these days, because frequent dressing changes remove healthy cells as well as debris.
• Occlusive dressings - ulcers heal better when they are covered; dressings should be changed weekly.
• Compression treatment - to boost internal pressure, using either elasticised bandages or stockings. This is particularly effective if multiple layers are used.
• Medications - such as painkillers, and oral antibiotics if infection is present.
• Supplements - there is evidence to suggest that leg ulcers may heal faster with mineral and vitamin supplements, but only if the person suffers from a deficiency. Zinc, iron and vitamin C may be used.
• Skin grafts - a surgical procedure, where healthy skin is grafted onto the prepared wound site.
• Hyperbaric oxygen - this is now an accepted management option for ulcers that resist other methods of healing for example, diabetic ulcers.

• Your doctor.

• Leg ulcers affect around one per cent of the Australian population.
• The most common cause is poor circulation.
• Treatment options include compression bandages, dressings and surgery.

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