Leg ulcer

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What is it about ?

A leg ulcer is an open wound in the leg. It is frequently due to poor local blood circulation, to diabetes, Has varicose veins or calcification of the arteries. Leg ulcers often heal poorly.

Treatment depends on the cause. In the event of poor blood circulation, it will first need to be improved or restored. Compression stockings can reducefluid build-up, and a sterile dressing can prevent contamination. For the wound to heal, local conditions must be optimal. The pressure points in bedridden patients can be relieved by regular changes in position to avoid an ulcer associated with lying down (pressure ulcer).
This is called a protective measure. Despite this, a number of sores will remain open and even become larger. In this case, we will consider the plastic surgery).

What is its frequency?

A little less than 1 in 1,000 people per year see the general practitioner for a leg ulcer. This figure is much higher among people over the age of 75-80.
Leg ulcer due to poor local blood circulation is less and less frequent thanks to better screening and treatment. What we find most frequently are varicose veins with what are called “venous ulcers”. The leg ulcer as a result of diabetes is also seen more and more often, especially because the number of people who are overweight (and therefore the number of people with type 2 diabetes) is increasing.

How to recognize it?

The leg ulcer is a “full-depth wound”. This means that the entire thickness of the skin, including the hair roots, is affected. The sore is often in the ankle and, in most cases, is red or yellow in color. In the presence of dead tissue (necrosis, gangrene), the wound is black.

How is the diagnosis made?

The doctor will examine the ulcer. It starts by looking for the blood vessels, it detects a possible infection and assesses the depth of the wound. He may refer you for a blood vessel test, such as a Doppler examination, which assesses the circulation in the blood vessels of the limbs using a special ultrasound machine.

What can you do ?

Elevate the leg to prevent or reducefluid build-up (edema) because this accumulation slows the healing of the wound.
Live as healthily as possible and eat a balanced diet with enough protein.

Treatment of leg ulcer

First, provisional measures are applied. If they are not enough, we will consider plastic surgery).

Conservative treatment

Avoid thefluid build-up (edema) in the legs using elastic bandages or compression stockings.

  • Wear elastic bandages day and night. Only remove them for your daily grooming and to treat the wound. Change the bandages in the morning, because the leg is then less swollen. Place them first at the level of the foot before moving up along the leg.
  • For compression stockings, class 2 is generally used. The stockings are sized for the user.
  • In special cases, the doctor may suggest pneumatic compression treatment, which consists of pushing back the liquid leg with an inflatable boot. This treatment is repeated regularly and usually takes place in the hospital.

In people with diabetes, blood sugar (blood sugar) levels should be controlled as well as possible.
Other possible problems must be addressed: correction of theanemia, improvement of blood circulation, treatment ofheart failure…
In case of severe infection of the leg ulcer, antibiotics must be prescribed.

Local treatment

Fluid is often produced, and the ulcer is covered with scabs or contains dead tissue. They must be eliminated to promote healing.
If there are scabs, the wound should be cleaned, and after local baths, the wound debris is removed.
If there is dead tissue (black debris on the wound), it is removed after applying a numbing gel.

Plastic surgery

A plastic surgery intervention may be considered if the ulcer:

  • gets bigger;
  • does not heal after a few months;
  • is due to trauma;
  • is probably a malignant lesion.

Plastic surgery involves removing the ulcer to healthy tissue and performing a skin graft. The intervention is successful 8 out of 10 times.
Sometimes the treatment is carried out by a team consisting of a vascular surgeon, a plastic surgeon and an internist, for example in cases of traffic problems or if the person has a diabetes.
Good follow-up is important.

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